Barriers to Assessing Fitness to Drive in Dementia in Nova Scotia: Informing Strategies for Knowledge Translation

Moorhouse, Paige; Hamilton, Laura; Fisher, Tracey L.; Rockwood, Kenneth

doi:10.5770/cgj.v14i3.7

Cited by 10 publications

(22 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…(2) At baseline (Table 2), years of practice showed a positive correlation with the probability of discussing driving as a part of routine assessment for patients with dementia ( r = .19; p = .03). This association was not demonstrated in the follow-up survey results.…”

Section: Resultsmentioning

confidence: 99%

Not If, But When: Impact of a Driving and Dementia Awareness and Education Campaign for Primary Care Physicians

Moorhouse

Hamilton

2014

Can Geri J

Self Cite

View full text Add to dashboard Cite

BackgroundCanadian physicians are responsible for assessing medical fitness to drive; however, national data indicate that physicians lack confidence in performing such assessments and face numerous barriers to addressing driving in patients with dementia. We report on the impact of a provincial Web-based resource (www.notifbutwhen.ca) regarding driving cessation in dementia aimed towards primary care physicians (PCPs).MethodsA pre/post cross-sectional survey (n = 134 baseline and n = 113 follow-up) of English-speaking, Nova Scotian PCPs. Descriptive statistics, chi-square, Pearson correlation, and multivariable logistic regression (controlling for sex, years of practice, and practice type) are reported.ResultsMost PCPs consider discussions regarding driving cessation to be routine part of dementia care; however, report multiple barriers to such discussions. Although the Web-based resource and awareness campaign were not associated with improvement in physician comfort in assessing driving risk in dementia, after completion of the campaign, fewer PCPs reported avoiding the topic of driving. Additionally, family resistance and lack of resources were less often reported as barriers.ConclusionsDespite a lack of confidence, Nova Scotian PCPs routinely discuss driving cessation, and perform driving assessments for individuals with dementia. The Web-based resource and awareness campaign have shown moderate effectiveness in addressing specific barriers to assessment (e.g., caregiver resistance, lack of resources). Future efforts will address additional barriers, such as lack of comfort in decision-making.

show abstract

Section: Resultsmentioning

confidence: 99%

Not If, But When: Impact of a Driving and Dementia Awareness and Education Campaign for Primary Care Physicians

Moorhouse

Hamilton

2014

Can Geri J

Self Cite

View full text Add to dashboard Cite

show abstract

“…Seven studies were cross-sectional surveys [ 9 , 21 , 28 , 32 – 35 ], six studies were pre/post evaluations of improvement or education programmes [ 22 , 23 , 25 , 26 , 29 , 30 ], and five were primary qualitative studies [ 10 , 11 , 24 , 27 , 31 ]. Eleven studies focused on FtD in the specific setting of cognitive impairment [ 9 , 11 , 21 , 23 , 24 , 26 , 28 – 30 , 33 , 35 ], five studies on the general assessment of FtD in older people (but included data on cognitive impairment) [ 10 , 22 , 31 , 32 , 34 ], and two studies on the broader management of dementia but included data on FtD [ 25 , 27 ]. Four studies provided patient or care-giver views [ 11 , 21 , 24 , 30 ], while fifteen examined PCPs’ views.…”

Section: Resultsmentioning

confidence: 99%

“…PCPs were generally content to discuss driving with their cognitively-impaired patients and act as a first-point of contact for patients with concerns, but they disliked the “ emotionally-charged task ” of actually assessing or determining patients’ FtD [ 9 , 10 , 27 , 28 , 31 , 33 , 34 ]. In North American and Australian studies, PCPs voiced a preference for an overall shift in responsibility for assessment to third parties such as physicians within Ministries of Transportation, hospital-based geriatric programs or occupational therapists [ 10 , 27 , 28 , 31 , 33 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Less than a third of sampled Canadian PCPs were comfortable with their ability to assess FtD [ 26 , 28 , 33 , 34 ], and almost 70% at least sometimes avoided discussions about driving [ 28 ]. Similar findings were observed in the US where PCPs self-rated their confidence in FtD assessments in cognitive impairment as 4.3/7 [ 23 ] and almost half (48%) of Californian PCPs reported an absence of confidence in their skills [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence

et al. 2018

View full text Add to dashboard Cite

ObjectivesTo review the empirical evidence on approaches used by Primary Care Physicians (PCPs) in fitness to drive (FtD) consultations with people living with cognitive impairment.DesignScoping review of empirical literature focused on primary studies of any design.SettingPrimary care practice.ParticipantsPCPs or their equivalent and/ or individuals with cognitive impairment across the spectrum of mild cognitive impairment to dementia.MeasurementsSystematic search of Medline, Cinahl, PsychINFO, Academic Search Complete, Psychological and Behavioural Sciences Collection, SocIndex and Social Sciences FT were conducted. Records screened by two reviewers against agreed inclusion criteria. Mixed studies (qualitative and quantitative) were synthesized within overarching themes.ResultsEighteen studies met our inclusion criteria. Synthesized data showed PCPs have mixed feelings on the appropriateness of their role in FtD assessments, with many feeling particularly uncomfortable and lacking confidence in the context of possible cognitive impairment. Reasons include lack of familiarity with legal requirements and local resources; fear of damaging the doctor-patient relationship; and impact on the patient’s quality of life. Patients voiced their desire to maintain agency in planning their driving cessation. Studies evaluating pragmatic educational programmes suggest these can improve physician confidence in FtD consultations.ConclusionThe increasing number of older people affected by cognitive impairment, for whom driving may be a concern, has implications for primary care practice. Addressing the reasons for PCPs lack of comfort in dealing with this issue is essential in order for them to better engage in, collaborative discussion with patients on plans and preferences for driving cessation.

show abstract

“…Most concur that simply having a diagnosis of dementia should not preclude an individual from driving (Carr & O'Neill, 2015). In a number of countries such as the UK, USA and Canada, medical fitness to drive reviews for people with dementia are routine (Lincoln & Radford, 2014;Meuser, Carr, Unger & Ulfarsson, 2015;Moorhouse, Hamilton, Fisher & Rockwood, 2011;Rapoport et al, 2014). The benefit of in-office reviews is that they are widely accessible and cost effective compared to on road assessment (Wilson & Pinner, 2013).…”

Section: Introductionmentioning

confidence: 99%

Determining Fitness to Drive for Drivers with Dementia: A Medical Practitioner Perspective

Bennett

Chekaluk

Batchelor

2019

JACRS

View full text Add to dashboard Cite

Currently in Australia medical fitness to drive decisions for people with dementia are largely conducted by front line medical practitioners. Little is known about the processes that these practitioners use to make these decisions, and how current guidelines assist in making determinations about driving capacity. A short survey was completed by 42 practitioners. The results of the survey supported previous findings that practitioners do not feel comfortable with making the decision regarding fitness to drive for people with dementia. Practitioners relied largely on self-report or informant information regarding current driving practices. Although practitioners reported that the level of cognitive functioning was the most important factor in determining safe driving, only 25% of practitioners employed cognitive assessments. Whilst the vast majority of practitioners were aware of the fitness to drive guidelines, over half did not find them to be sufficient in enabling determinations of driving capacity. Due to this, almost all practitioners reported that they believe they have missed cases of unsafe driving in this population with over 85% endorsing the need for a more objective tool. Significantly, over three quarters of practitioners reported that they have never received training on how to make fitness to drive decisions. Given that the current driver licensing system for people with dementia depends on medical fitness to drive reviews, the lack of confidence by practitioners regarding making fitness to drive decisions can have a detrimental impact on both the safety of the individual drivers, but also the community as a whole.

show abstract

Barriers to Assessing Fitness to Drive in Dementia in Nova Scotia: Informing Strategies for Knowledge Translation

Cited by 10 publications

References 29 publications

Not If, But When: Impact of a Driving and Dementia Awareness and Education Campaign for Primary Care Physicians

Not If, But When: Impact of a Driving and Dementia Awareness and Education Campaign for Primary Care Physicians

Consultations on driving in people with cognitive impairment in primary care: A scoping review of the evidence

Determining Fitness to Drive for Drivers with Dementia: A Medical Practitioner Perspective

Contact Info

Product

Resources

About