Implementation of municipal mobility support services for older people who have stopped driving in Japan

Dementia-Friendly Transportation Services: A Scoping Review

BACKGROUND AND OBJECTIVES

Transportation is an important component of dementia-friendly communities. People living with dementia have the right to access transportation services to keep their mobility in their community, which is essential for independence, well-being, and quality of life. This scoping review maps the literature on dementia-friendly transportation services and explores their characteristics to inform future development and research.

RESEARCH DESIGN AND METHODS

Empirical quantitative and qualitative studies in English or French that informed on transportation services for people living with dementia in the community were searched in 15 databases. Two authors independently screened records and charted relevant characteristics from selected publications. Important findings were summarized with a narrative synthesis approach.

RESULTS

Thirty-five studies informed on important dimensions of transportation services in urban and/or rural context: availability, accessibility, acceptability, adaptability, and affordability. Important insights were identified: the importance of staff training and attitude, and the challenges of availability of affordable services in the rural context. Emerging policy and program intervention areas include the need for access to quiet areas in transit hubs, training to use mass public transit and mobility management.

DISCUSSION AND IMPLICATIONS

The literature on dementia-friendly transportation services is important in the expansion and maintenance of mobility for people living with dementia in the community. The scope of the existing scientific literature remains limited. Although several studies indicated a clear need for better access to dementia-friendly transportation services, the best practices still need to be demonstrated in the scientific literature.

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

At the point of diagnosis of dementia many people will be driving and go on to experience the significant life transition from driver to non-driver. Driving plays an important role in society enhancing independence, quality of life and general health and well-being. Hence cessation from driving can be a very difficult life transition to make. The aim of this integrative review was to summarise what is known about the impact and experience for people with dementia and their carers in the 'post-cessation' phase of retiring from driving. Thematic analysis utilised themes identified in previous life transition research focusing on driving cessation and these included processes, influences, emotions, roles and programmes. Analysis revealed a lack of formal processes to follow in surrendering one's licence and that the medical professions and multi-disciplinary teams should take more responsibility for the legal processes of driving cessation and supporting individuals at the point of and following this disclosure. People with dementia and their carers experience a significant impact upon their life roles and considerable emotional and psychological consequences. The review also suggested that there are a variety of influences affecting the life transition period from driver to non-driver such as family support and access to alternative forms of transport and that there is a need for development for interventions/programmes to support individuals with dementia post-driving cessation.

A comparison of seat belt fit and comfort experience between older adults and younger front seat passengers in cars

Objective: The purpose was to study how occupant age affects seat belt fit and comfort by comparing older adults and younger occupants in the front seat of a passenger vehicle.Methods: An exploratory user study was performed for the front seat of a stationary large passenger vehicle in a laboratory environment, including 11 older (aged 72-81) and 11 younger (aged 25-30) participants. Each participant first entered the vehicle and buckled up in a predefined seat position. Next, they adjusted the seat to their preferred seat position and buckled up again. Anthropometric data were collected on height, weight, and waist and hip circumferences. Photographs and measurements were taken of seat/seat belt positions and posture, and structured interviews were conducted regarding comfort perceptions of the 2 tested scenarios, including previous experience and awareness of seat belt usage and discomfort experienced as passengers in cars.Results: Nonoptimal belt fit included shoulder belt on the shoulder edge or close to the neck or lap belt over the abdomen. Five of 11 older adults had nonoptimal belt fit in the predefined position, and in the preferred position 7 older adults had nonoptimal belt fit. Only one showed safety awareness and recognized the nonoptimal belt fit in the preferred position. In the younger group, 4 of 11 had nonoptimal belt fit in the predefined position and 4 in the preferred position. Two acknowledged the nonoptimal belt fit. Older adult participants with a more pronounced kyphotic posture had the upper part of the shoulder belt positioned closer to the suprasternal notch compared to younger participants. Older adults were also more likely to have the lower part of the shoulder belt higher up on the abdomen compared to younger participants. Participants with higher body mass indexes (BMIs) were more likely to have the shoulder belt higher up on the abdomen, independent of age and gender. When the shoulder belt was positioned higher up on the abdomen the upper portion of the shoulder belt was routed closer to the throat. Older adults preferred to sit higher up to achieve a better field of vision compared to younger adults.Conclusions: The change in body posture due to aging influences belt fit. Older adults seemed less aware of safety related to belt fit. Increased BMI influenced shoulder belt fit, independent of age. These findings are important when designing restraint systems to ensure safety for all occupants.

The creation and dissemination of downloadable information on dementia and driving from a social health perspective

BACKGROUND

Driving cessation is a likely consequence of progressive dementia. Patients and families can benefit from support through this transition, both to safeguard the patient and public and to help preserve healthy social activity of the patient.

METHODS

To provide appropriate supportive information, we developed a 35-page manual ('Supporting family caregivers of older drivers with dementia') available as a free download from our department website. We then informed municipal governments of its availability, tracked website access metrics, and followed up 7 months later with a postal survey to the heads of each municipal government's department of welfare for older citizens.

RESULTS

From February to September 2010, the manual was accessed 33 494 times. Of the 1750 municipalities sent surveys, we received 1067 responses (61%). The responses showed that 943 professionals (94.6%) were able to obtain information they needed from the manual, 247 (23%) had used the manual to help residents during the 7 months, and 89% of those who used the manual used it to provide relevant advice to family caregivers. The responses also showed that significantly more use occurred in towns and villages as opposed to cities, consistent with the limited public transportation options in smaller municipalities (P = 0.002).

CONCLUSIONS

We anticipate that use of this manual will raise general awareness of this social health issue and facilitate collaborations to provide more social support for those with dementia and their family members.

Driving and dementia: a clinical decision pathway

OBJECTIVE

This study aimed to develop a pathway to bring together current UK legislation, good clinical practice and appropriate management strategies that could be applied across a range of healthcare settings.

METHODS

The pathway was constructed by a multidisciplinary clinical team based in a busy Memory Assessment Service. A process of successive iteration was used to develop the pathway, with input and refinement provided via survey and small group meetings with individuals from a wide range of regional clinical networks and diverse clinical backgrounds as well as discussion with mobility centres and Forum of Mobility Centres, UK.

RESULTS

We present a succinct clinical pathway for patients with dementia, which provides a decision-making framework for how health professionals across a range of disciplines deal with patients with dementia who drive.

CONCLUSIONS

By integrating the latest guidance from diverse roles within older people's health services and key experts in the field, the resulting pathway reflects up-to-date policy and encompasses differing perspectives and good practice. It is potentially a generalisable pathway that can be easily adaptable for use internationally, by replacing UK legislation for local regulations. A limitation of this pathway is that it does not address the concern of mild cognitive impairment and how this condition relates to driving safety.