Driving in Early-Stage Alzheimer's Disease: An Integrative Review of the Literature

Abstract

One of the most difficult decisions for individuals with Alzheimer's disease (AD) is when to stop driving. Because driving is a fundamental activity linked to socialization, independent functioning, and well-being, making the decision to stop driving is not easy. Cognitive decline in older adults can lead to getting lost while driving, difficulty detecting and avoiding hazards, as well as increased errors while driving due to compromised judgment and difficulty in making decisions. The purpose of the current literature review was to synthesize evidence regarding how individuals with early-stage AD, their families, and providers make determinations about driving safety, interventions to increase driving safety, and methods to assist cessation and coping for individuals with early-stage AD. The evidence shows that changes in driving ability start early and progress throughout the trajectory of AD. Some individuals with mild cognitive impairment or early-stage AD may be safe to drive for a period of time. Support groups aimed at helping with the transition have been shown to be helpful for individuals who stop driving. Research and practice must support interventions to help individuals maintain safety while driving, as well as cope with driving cessation. [Res Gerontol Nurs. 2017; 10(2):86-100.].

A Naturalistic Study of Driving Behavior in Older Adults and Preclinical Alzheimer Disease: A Pilot Study

“…However, some for the DRIVES variables (e.g., hard braking, aggression, and trips driven at night) may be more sensitive in predicting driving problems in a preclinical cohort. Persons with AD who still drive tend to self-regulate their driving by avoiding inclement weather, speeding, high traffic, congested roads, night driving, and single, short trips (Davis & Ohman, 2016; Eby et al, 2012). These self-regulatory practices may start in preclinical AD and be identifiable during naturalistic driving.…”

“…Standardized road tests and driving simulators are currently the mainstays of driving evaluation. Yet, limitations with these assessment methods include high equipment cost, difficulty replicating test conditions, observer bias, the confound of anxiety, and questionable generalizability to real-world driving behavior (Davis & Ohman, 2017; De Winter, Van Leuween, & Happee, 2012). Therefore, trends in driving research are shifting to examine naturalistic driving behaviors using GPS (Eby, Silverstein, Molnar, LeBlanc, & Adler, 2012; Molnar et al, 2014; Molnar & Eby, 2008).…”

The impact of driving cessation for people with dementia – An integrative review

“…(2018) have also conducted a recent systematic review investigating the subjective experiences of driving cessation however this was a meta-synthesis of qualitative literature which included all key informant groups. Integrative reviews related to dementia and driving have previously been conducted, but these have similarly focused upon on driving retirement decisions (Andrew et al., 2015) and strategies to remain safe driving in the early stages of dementia (Davis & Ohman, 2016). An integrative review, combining both quantitative and qualitative data and focusing on the post-cessation phase has not been conducted.…”

Using Naturalistic Driving Data to Predict Mild Cognitive Impairment and Dementia: Preliminary Findings from the Longitudinal Research on Aging Drivers (LongROAD) Study

“…Several studies have demonstrated that atypical changes in driving performance and driving behaviors could be detected in older drivers with preclinical AD [ 4 , 5 , 6 ] and early-stage dementia [ 11 ], and that these changes may progress throughout the trajectory of AD [ 4 , 5 , 6 , 7 , 12 ]. In recent years, naturalistic driving study designs have been used for understanding driving behaviors in older adults with preclinical AD [ 7 ] and early-stage dementia [ 11 ].…”