Reactions to driving cessation: a qualitative study of people with dementia and their families

Chacko, Emme; Wright, Wendy; Worrall, Richard Charles; Adamson, Carole; Cheung, Gary

doi:10.1177/1039856215591326

Cited by 19 publications

(39 citation statements)

References 8 publications

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“…[21][22][23][24][25] Healthcare providers have been identified as key stakeholders who can increase the understanding of patients and caregivers about the link between dementia and deterioration of driving skills, 21,25,26 address the attendant emotional losses, and engage in practical planning. 23,24,27,28 There have been a limited number of intervention approaches aimed at facilitating the process of driving cessation among older adults with dementia 26,[29][30][31][32] with various designs, target audiences, results, and limitations.…”

Section: Introductionmentioning

confidence: 99%

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

Rapoport¹,

Sarracini

Mulsant

et al. 2019

Health Informatics J

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Clinicians face challenges in deciding which older patients with dementia to report to transportation administrators. This study used a qualitative thematic analysis to understand the utility and limitations of implementing a computer-based Driving in Dementia Decision Tool in clinical practice. Thirteen physicians and eight nurse practitioners participated in an interview to discuss their experience using the tool. While many participants felt the tool provided a useful ‘virtual second opinion’, specialist physicians felt that the tool did not add value to their clinical practice. Barriers to using the Driving in Dementia Decision Tool included lack of integration with electronic medical records and inability to capture certain contextual nuances. Opinions varied about the impact of the tool on the relationship of clinicians with patients and their families. The Driving in Dementia Decision Tool was judged most useful by nurse practitioners and least useful by specialist physicians. This work highlights the importance of tailoring knowledge translation interventions to particular practices.

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Section: Introductionmentioning

confidence: 99%

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

Rapoport¹,

Sarracini

Mulsant

et al. 2019

Health Informatics J

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show abstract

“…However, a proportion of patients with dementia continues to drive despite evidence of a decreased fitness to drive [ 20 ]. Some of these patients did not recall their fitness-to-drive assessment, others were not aware of their own cognitive impairment (due to decreased insight associated with dementia) or believed that their cognitive impairment did not affect driving safety [ 13 , 16 , 21 – 25 ]. According to the last group, the assessment process was ‘not fair’ and did not accurately reflect their fitness to drive [ 13 , 16 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

“…According to the last group, the assessment process was ‘not fair’ and did not accurately reflect their fitness to drive [ 13 , 16 , 21 ]. These findings suggest that fitness-to-drive assessments should be comprehensive, comprising several types of tasks and sources of information, and that guidance for patients with dementia in interpreting a recommendation about driving is essential [ 25 – 28 ].…”

Section: Introductionmentioning

confidence: 99%

Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

et al. 2018

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BackgroundDriving is related to social participation; therefore older drivers may be reluctant to cease driving. Continuation of driving has also been reported in a large proportion of patients with cognitive impairment. The aim of this study is to investigate whether patients with cognitive impairment adhere to driving cessation advice after a fitness-to-drive assessment and what the consequences are with regard to mobility.MethodsPatients with cognitive impairment (n = 172) participated in a fitness-to-drive assessment study, including an on-road driving assessment. Afterwards, patients were advised to either continue driving, to follow driving lessons, or to cease driving. Approximately seven months thereafter, patients were asked in a follow-up interview about their adherence to the driving recommendation. Factors influencing driving cessation were identified using a binary logistic regression analysis. Use of alternative transportation was also evaluated.ResultsRespectively 92 and 79% of the patients adhered to the recommendation to continue or cease driving. Female gender, a higher Clinical Dementia Rating-score, perceived health decline, and driving cessation advice facilitated driving cessation. Patients who ceased driving made use of less alternative modes of transportation than patients who still drove. Nonetheless, around 40% of the patients who ceased driving increased their frequency of cycling and/or public transport use.ConclusionsAdherence to the recommendations given after the fitness-to-drive assessments was high. Female patients were in general more likely to cease driving. However, a minority of patients did not adhere to driving cessation advice. These drivers with dementia should be made aware of the progression of their cognitive impairment and general health decline to facilitate driving cessation. There are large differences in mobility between patients with cognitive impairment. Physicians should discuss options for alternative transportation in order to promote sustained safe mobility of patients with cognitive impairment.

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“…People with dementia would like to be the ones deciding when to stop driving,25 but in many cases the person loses insight into their deficits before stopping driving. The burden of enforcing a decision to stop driving frequently lies with the spouse of the person with dementia, and they tend to welcome support from family and healthcare professionals25 and definitive guidance from driving authorities 35Key Points

Clinicians are generally unable to predict driving ability accurately.

Clinical assessment alone should not be used to determine driving ability.

Individual cognitive tests and screening tools (e.g.

…”

Section: Introductionmentioning

confidence: 99%

Driving and dementia: a clinical update for mental health professionals: Table 1

Allan

Behrman

Baruch

et al. 2016

Evid Based Mental Health

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Most people with mild dementia can continue to drive, but dementia is progressive and many patients and clinicians will be faced with questions about driving safety in the course of their illness. Determining when this happens is a complex decision, with risks of personal and public safety needing to be weighed against individual patient benefits of driving in terms of autonomy, independence and well-being. Decisions need to make reference to cognitive abilities, as well as other factors including physical comorbidity, vision, mobility, insight and history of driving errors and accidents. Deciding to stop driving, or being required to stop driving is often difficult for patients to accept and can be a particularly problematic consequence of a dementia diagnosis. Legal frameworks help in decision-making but may not provide sufficient detail to advise individual patients. We review the current guidelines and evidence relating to driving and dementia to help clinicians answer questions about driving safety and to consider the full range of assessment tools available. INTRODUCTIONWe are becoming ever more dependent on driving; in 2014 81% of people aged 60-69 years and 62% of those over 70 years old in the UK held a full driving licence.

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Reactions to driving cessation: a qualitative study of people with dementia and their families

Abstract: The preliminary findings highlight the need for a more comprehensive process for driving cessation in those with dementia, with closer links to regulatory bodies, and increased support for their families/carers.

Cited by 19 publications

References 8 publications

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia

Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility

Driving and dementia: a clinical update for mental health professionals: Table 1

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