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Tappen R, Newman D, Rosselli M, Conniff J, Sepe CP, Newman M. Fit2Drive: Screening Older Drivers with Cognitive Concerns. J Am Med Dir Assoc 2024; 25:105054. [PMID: 38843871 DOI: 10.1016/j.jamda.2024.105054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVES The purpose of this study was to identify the most parsimonious combination of cognitive tests that accurately predicts the likelihood of passing an on-road driving evaluation in order to develop a screening measure that can be administered as an in-office test. DESIGN This was a psychometric study of the new test's diagnostic accuracy. SETTINGS AND PARTICIPANTS The study was conducted at the Florida Atlantic University's Memory Center and Clinical Research Unit, both easily accessible to older drivers. Participants were older drivers who received a driving evaluation at the Memory Center and agreed to have their results included in the Driving Repository and community-based older drivers who volunteered to participate. METHODS Mini-Mental State Exam (MMSE), Trail Making Tests A and B, Clock Test, Hopkins Verbal Learning Test, and Driving Health Inventory results were compared with an on-road driving evaluation to identify those tests that best predict the ability to pass the on-road evaluation. RESULTS Altogether, 412 older drivers, 179 men and 233 women, were included in the analysis. Fifty-four percent of Driving Repository participants failed the on-road evaluation compared with 8% of the community sample. The highest correlation to the on-road evaluation was Trails B time in seconds r = -0.713 (P < .001). Variables with high multicollinearity and/or low correlation with the on-road evaluation were eliminated and sets of receiver operating characteristics curves were generated to assess the predictive accuracy of the remaining tests. A linear combination of Trails B in seconds and MMSE using the highest of the Serial 7s or WORLD spelled backward scores accounted for the highest area under the curve of 0.915. Finally, an algorithm was created to rapidly generate the prediction for an individual patient. CONCLUSIONS AND IMPLICATIONS The Fit2Drive algorithm demonstrated a strong 91.5% predictive accuracy. Usefulness in office-based patient consultations is promising but remains to be rigorously tested.
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Affiliation(s)
- Ruth Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA.
| | - David Newman
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Monica Rosselli
- Department of Psychology, Florida Atlantic University, Davie, FL, USA
| | - Joshua Conniff
- Neuropsychology Lab, Florida Atlantic University, Boca Raton, FL, USA
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Liddle J, Gustafsson L, Scott T, Byrnes J, Salmon A, Pachana NA. Still in first gear: Exploration of barriers for implementing driving cessation support. Australas J Ageing 2023; 42:796-800. [PMID: 37236918 DOI: 10.1111/ajag.13218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/14/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Driving cessation is a major life transition; lack of support in this process may lead to deleterious outcomes in terms of physical, mental and social well-being. Despite approaches to driving cessation being developed, their integration into ongoing geriatric clinical practice has been slow. METHODS Health-care providers were surveyed about their impressions of the barriers and facilitators to implementing a driving cessation intervention as part of regular clinical services. Methods of funding the intervention were queried. Surveys were sent via professional listserves and a snowballing strategy employed. Twenty-nine completed surveys were analysed by content analysis. RESULTS Participants identified that an understanding of driving cessation and optimal driving cessation supports was required. They identified four key approaches to support the implementation of driving cessation support: the need to consider complexity and emotional support needs in clinical contexts; knowing and showing the outcomes by clearly communicating the benefits and values to different stakeholders; managing systemic barriers included workforce issues, funding models and efforts required for initiating and sustaining an intervention; and not doing it alone, but instead developing processes supports to collaboratively provide access to programs. CONCLUSIONS The current study reveals a recognition of unmet needs of older persons and families regarding driving cessation as well as signalling service delivery, costing and workforce needs which act as barriers.
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Affiliation(s)
- Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Brisbane, Queensland, Australia
| | - Theresa Scott
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Joshua Byrnes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Salmon
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Malvitz M, Zahuranec DB, Chang W, Heeringa SG, Briceño EM, Mehdipanah R, Gonzales XF, Levine DA, Langa KM, Garcia N, Morgenstern LB. Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals. J Am Geriatr Soc 2023; 71:3520-3529. [PMID: 37382492 PMCID: PMC10755064 DOI: 10.1111/jgs.18493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Individuals with Alzheimer's disease and Alzheimer's disease-related dementias may lose the ability to drive safely as their disease progresses. Little is known about driving prevalence in older Latinx and non-Hispanic White (NHW) individuals. We investigated the prevalence of driving status among individuals with cognitive impairment in a population-based cohort. METHODS This was a cross-sectional analysis of the cohort BASIC-Cognitive study in a community of Mexican American (MA) and NHW individuals in South Texas. Participants scored ≤25 on the Montreal Cognitive Assessment (MoCA), indicating a likelihood of cognitive impairment. Current driving status was assessed by the Harmonized Cognitive Assessment Protocol informant interview. Logistic regression was used to assess driving versus non-driving adjusted for pre-specified covariates. Chi-square and Mann-Whitney U tests were used to compare NHW and MA differences in driving outcomes from the American Academy of Neurology (AAN) questions for evaluating driving risk in dementia. RESULTS There were 635 participants, 77.0 mean age, 62.4% women, and 17.3 mean MoCA. Of these, 360 (61.4%) were current drivers with 250 of 411 (60.8%) MA participants driving, and 121 of 190 (63.70%) NHW participants driving (p = 0.50). In fully adjusted models age, sex, cognitive impairment, language preference, and Activities of Daily Living scores were significant predictors for the likelihood of driving (p < 0.0001). Severity of cognitive impairment was inversely associated with odds of driving, but this relationship was not found in those preferring Spanish language for interviews. Around one-third of all caregivers had concerns about their care-recipient driving. There were no significant differences in MA and NHW driving habits and outcomes from the AAN questionnaire. CONCLUSIONS The majority of participants with cognitive impairment were currently driving. This is a cause for concern for many caregivers. There were no significant ethnic driving differences. Associations with current driving in cognitively impaired persons require further research.
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Affiliation(s)
- Madelyn Malvitz
- University of Michigan Medical School Department of Neurology
| | | | - Wen Chang
- University of Michigan Institute of Social Research
| | | | - Emily M. Briceño
- University of Michigan Medical School Department of Neurology
- University of Michigan Medical School Department of Physical Medicine and Rehabilitation
| | - Roshanak Mehdipanah
- University of Michigan School of Public Health Department of Health Behavior and Health Education
| | | | - Deborah A. Levine
- University of Michigan Medical School Department of Neurology
- University of Michigan Medical School Department of Internal Medicine
| | - Kenneth M. Langa
- University of Michigan Institute of Social Research
- University of Michigan Medical School Department of Internal Medicine
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor
| | - Nelda Garcia
- University of Michigan Medical School Department of Neurology
| | - Lewis B. Morgenstern
- University of Michigan Medical School Department of Neurology
- University of Michigan School of Public Health Center for Social Epidemiology and Population Health
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Danesh V, McDonald AD, McPeake J, Eaton TL, Potter K, Su H, Jackson JC, Boehm LM. Driving decisions after critical illness: Qualitative analysis of patient-provider reviews during ICU recovery clinic assessments. Int J Nurs Stud 2023; 146:104560. [PMID: 37531701 PMCID: PMC10528726 DOI: 10.1016/j.ijnurstu.2023.104560] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/18/2023] [Accepted: 06/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Driving a vehicle is a functional task requiring a threshold of physical, behavioral and cognitive skills. OBJECTIVE To report patient-provider evaluations of driving status and driving safety assessments after critical illness. DESIGN Qualitative secondary analysis of driving-related dialog drawn from a two-arm pilot study evaluating telemedicine delivery of Intensive Care Unit Recovery Clinic assessments. Multidisciplinary providers assessed physical, psychological, and cognitive recovery during one-hour telemedicine ICU-RC assessments. Qualitative secondary analysis of patient-provider dialog specific to driving practices after critical illness. SETTING AND PATIENTS Multidisciplinary Intensive Care Unit Recovery clinic assessment dialog between 17 patients and their providers during 3-week and/or 12-week follow-up assessments at a tertiary academic medical center in the Southeastern United States. MAIN MEASURES AND KEY RESULTS Thematic content analysis was performed to describe and classify driving safety discussion, driving status and driving practices after critical illness. Driving-related discussions occurred with 15 of 17 participants and were clinician-initiated. When assessed, driving status varied with participants reporting independent decisions to resume driving, delay driving and cease driving after critical illness. Patient-reported driving practices after critical illness included modifications to limit driving to medical appointments, self-assessments of trip durations, and inclusion of care partners as a safety measure for new onset fatigue while driving. CONCLUSION We found that patients are largely self-navigating this stage of recovery, making subjective decisions on driving resumption and overall driving status. These results highlight that driving status changes are an often underrecognized yet salient social cost of critical illness. TRIAL REGISTRATION Clinicaltrials.gov: NCT03926533.
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Affiliation(s)
- Valerie Danesh
- Center for Applied Health Research, Baylor Scott & White Research Institute, Dallas, TX, USA; School of Nursing, University of Texas at Austin, Austin, TX, USA.
| | - Anthony D McDonald
- College of Engineering, University of Wisconsin at Madison, Madison, WI, USA. https://twitter.com/hfml_lab
| | - Joanne McPeake
- Intensive Care Unit, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom; The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK. https://twitter.com/Jomcpeake22
| | - Tammy L Eaton
- National Clinician Scholars Program (NCSP), VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, University of Michigan, Ann Arbor, MI, USA; Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, USA. https://twitter.com/tammyeaton17
| | - Kelly Potter
- Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA. https://twitter.com/KP_ICURN
| | - Han Su
- School of Nursing, Vanderbilt University, Nashville, TN, USA. https://twitter.com/HanSu_hs
| | - James C Jackson
- Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA; VA Tennessee Valley Geriatric Research Education and Clinical Center (GRECC), Nashville, TN, USA; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. https://twitter.com/jcjackson68
| | - Leanne M Boehm
- School of Nursing, Vanderbilt University, Nashville, TN, USA; Critical Illness, Brain dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA. https://twitter.com/boehmleanne
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Cations M. A devastating loss: driving cessation due to young onset dementia. Age Ageing 2023; 52:afad174. [PMID: 37725970 DOI: 10.1093/ageing/afad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/21/2023] Open
Affiliation(s)
- Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Sturt Road Bedford Park, Adelaide 5042, Australia
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Scott TL, Rooney D, Liddle J, Mitchell G, Gustafsson L, Pachana NA. A qualitative study exploring the experiences and needs of people living with young onset dementia related to driving cessation: 'It's like you get your legs cut off'. Age Ageing 2023; 52:afad109. [PMID: 37481262 PMCID: PMC10362976 DOI: 10.1093/ageing/afad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND driving disruptions have significant impact on individuals living with dementia, their care partners and family members. Previous studies show that for older people with dementia, stopping driving is one of the hardest things that they cope with. To date, no studies exist that address the expressed needs and experiences of people living with young onset dementia (YOD) who are adjusting to life without driving, whose needs are not well understood and whose needs might be expected to differ from those of older people with dementia. METHODS a multi-perspective, qualitative descriptive phenomenological approach was undertaken. A topic guide was developed in consultation with lived experience experts. In-depth interviews (n = 18) with 10 people with YOD and eight family caregivers were conducted, to elicit lived experiences in relation to changing and cessation of driving. Interviews were recorded and transcribed verbatim. Data were analysed using a hybrid approach, employing deductive and inductive coding. RESULTS core findings reflected the impact and coping strategies employed by people with YOD and their care partners across four themes: (i) losses and burdens, (ii) the unique challenges of YOD, (iii) coping and adjustment and (iv) how to meet needs. CONCLUSIONS driving disruptions often come at a time when people living with YOD are likely to have significant financial and family commitments, or they/their partners may be employed or raising a family, negatively impacting individual's roles and self-identities. Intervention to support emotional and practical adjustment and reduce social isolation is essential for coping.
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Affiliation(s)
- Theresa L Scott
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Donna Rooney
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD 4072 Australia
| | - Geoffrey Mitchell
- General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, St Lucia, QLD, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Nathan, QLD 4111, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, QLD 4072, Australia
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Peterson CM, Birkeland RW, Louwagie KW, Ingvalson SN, Mitchell LL, Scott TL, Liddle J, Pachana NA, Gustafsson L, Gaugler JE. Refining a Driving Retirement Program for Persons With Dementia and Their Care Partners: A Mixed Methods Evaluation of CarFreeMe™-Dementia. J Gerontol B Psychol Sci Soc Sci 2023; 78:506-519. [PMID: 36149829 PMCID: PMC9985324 DOI: 10.1093/geronb/gbac151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES We adapted the CarFreeMe™-Dementia program created by The University of Queensland for drivers in the United States. CarFreeMe™-Dementia aims to assist drivers living with dementia and their care partners as they plan for or adjust to driving retirement. This semistructured program focuses on driving retirement education and support. Topics include how dementia affects driving, lifestyle planning, stress management, and alternative transportation options. This study evaluated the feasibility, acceptability, and utility of the CarFreeMe™-Dementia intervention. METHODS This pilot phase of the study included 16 care partners and 11 drivers with memory loss who were preparing for or adjusting to driving retirement. Participants completed 4-8 CarFreeMe™-Dementia intervention telehealth sessions. Online surveys (baseline, 1- and 3-month) and postintervention semistructured interviews informed evaluation of the intervention program using a mixed methods approach. RESULTS This study established initial support for CarFreeMe™-Dementia in the United States. Participants indicated the program facilitated dialogue around driving retirement and provided guidance on community engagement without driving. Respondents appreciated the program's emphasis on overall well-being, promoted through lifestyle planning and stress management. They also reported the program offered practical preparation for transitioning to driving retirement. DISCUSSION The CarFreeMe™-Dementia intervention, tailored to an American audience, appears to be a feasible, acceptable, and useful support program for drivers with memory loss (and/or their care partners) who are preparing for or adjusting to driving retirement. Further investigations of the efficacy of the CarFreeMe™-Dementia intervention in the United States, as well as in other countries and cultural contexts, are warranted.
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Affiliation(s)
- Colleen M Peterson
- Transportation Research Institute, University of Michigan, Ann Arbor, Michigan, USA
| | - Robyn W Birkeland
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Katie W Louwagie
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Lauren L Mitchell
- Department of Psychology and Neuroscience, Emmanuel College, Boston, Massachusetts, USA
| | - Theresa L Scott
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Jacki Liddle
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland, Australia and the Princess Alexandra Hospital in Woolloongabba, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, Brisbane, Queensland, Australia
| | - Louise Gustafsson
- School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
| | - Joseph E Gaugler
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Stasiulis E, Naglie G, Sanford S, Belchior P, Crizzle A, Gélinas I, Mazer B, Moorhouse P, Myers A, Porter MM, Vrkljan B, Rapoport MJ. Developing the Driving and Dementia Roadmap: a knowledge-to-action process. Int Psychogeriatr 2023:1-14. [PMID: 36710624 DOI: 10.1017/s1041610222001235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.
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Affiliation(s)
- Elaine Stasiulis
- Rotman Research Institute, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- Department of Medicine, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
| | - Gary Naglie
- Rotman Research Institute, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- Department of Medicine, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- KITE Research Institute, University Health Network, Toronto, OntarioM5G 2A2, Canada
- Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
| | - Sarah Sanford
- Rotman Research Institute, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
- Department of Medicine, Baycrest Health Sciences, Toronto, OntarioM6A 2E1, Canada
| | - Patricia Belchior
- Faculty of Medicine and Health Sciences, McGill University and Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QuebecH3G 2M1, Canada
| | - Alexander Crizzle
- School of Public Health, University of Saskatchewan, Saskatoon, SaskatchewanS7N 2Z4, Canada
| | - Isabelle Gélinas
- Faculty of Medicine and Health Sciences, McGill University and Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QuebecH3G 2M1, Canada
| | - Barbara Mazer
- Faculty of Medicine and Health Sciences, McGill University and Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montréal, QuebecH3G 2M1, Canada
| | - Paige Moorhouse
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova ScotiaB3H 2E1, Canada
| | - Anita Myers
- School of Public Health Sciences, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
| | - Michelle M Porter
- Faculty of Kinesiology and Recreation, University of Manitoba, Winnipeg, ManitobaR3T 2N2, Canada
| | - Brenda Vrkljan
- Faculty of Health Sciences, McMaster University, Hamilton, OntarioL8N 3Z5, Canada
| | - Mark J Rapoport
- Geriatric Psychiatry, Sunnybrook Health Sciences, Toronto, OntarioM4N 3M5, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, M5T 1R8, Canada
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Knoefel F, Mayamuud S, Tfaily R. Driving Cessation: What Are Family Members' Experiences and What Do They Think about Driving Simulators? Geriatrics (Basel) 2022; 7:geriatrics7060126. [PMID: 36412615 PMCID: PMC9680467 DOI: 10.3390/geriatrics7060126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/01/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Driving cessation is difficult for persons living with cognitive decline (PLWCD) and their caregivers (CG). Physicians are often required to notify authorities of driving risks, and typically base decisions on paper-based cognitive assessments and on-road tests. This study examines experiences surrounding cessation and CG's views regarding simulators in the process. METHODS Semi-structured virtual interviews were conducted with CGs of PLWCD from an academic memory clinic. Experiences around cessation were explored first, followed by discussions regarding the simulator. Framework analysis was applied to transcribed interviews. RESULTS Six females and two males, three children and five spouses participated. PLWCD viewed driving cessation negatively, often had difficulty understanding why, and believed cessation was temporary. CGs experienced relief and/or shock. Cessation negatively impacted the relationships between the PLWCD and both the physician and CG. Isolation, coping challenges and loss of independence were experienced by the PLWCD. The lives of caregivers were adversely affected, especially regarding driving burden and worsening mental health. CGs were generally supportive of simulators. Positives included: measurement of driving skills, method of testing, and providing an understanding regarding the driving suspension. Potential drawbacks included difficulty using the machine, testing anxiety and stress induced by a crash. Caregivers were concerned about: PLWCD's disappointment of failure, requesting to retest, and reluctance to accept the decision. CONCLUSION PLWCD and caregivers had negative experiences related to the driving cessation. Generally, caregivers viewed implementing driving simulators positively, in a context of a practice session and support for PLWCD's potential reactions to the decision.
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Affiliation(s)
- Frank Knoefel
- Memory and Cognition Group, Bruyère Research Institute, Ottawa, ON K1N 5C8, Canada
- Bruyère Memory Program, Bruyère Continuing Care, Ottawa, ON K1N 5C8, Canada
- Faculty of Medicine, University of Ottawa, Ottawa ON K1H 8L6, Canada
- Faculty of Engineering and Design, Carleton University, Ottawa, ON K1S 5B6, Canada
- AGE-WELL National Innovation Hub—Sensors and Analytics for Monitoring Mobility and Memory (SAM3), Ottawa, ON K1N 5C8, Canada
- Correspondence: ; Tel.: +1-(613)-562-6322
| | - Salma Mayamuud
- Faculty of Science, University of Ottawa, Ottawa, ON K1N 9B4, Canada
| | - Rania Tfaily
- Department of Sociology and Anthropology, Faculty of Arts and Social Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
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Stasiulis E, Rapoport MJ, Sivajohan B, Naglie G. The Paradox of Dementia and Driving Cessation: "It's a Hot Topic," "Always on the Back Burner". THE GERONTOLOGIST 2021; 60:1261-1272. [PMID: 32301497 DOI: 10.1093/geront/gnaa034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the well-recognized difficulty that persons with dementia and family carers experience in the decision making and transition to nondriving, there are few interventions and resources to support them. As part of our ongoing research to develop a driving cessation toolkit that addresses this gap, we sought to examine the context-specific factors relevant to its effective implementation in settings that support older adults with dementia. RESEARCH DESIGN AND METHODS A qualitative descriptive approach was used to explore the perspectives of Alzheimer Society (AS) staff in their work of supporting people with dementia and family carers within the context of driving cessation. Individual in-depth interviews were conducted with 15 AS staff members in 4 Canadian provinces. Data were examined using interpretative thematic analysis. RESULTS The study results revealed an overarching paradox that despite the importance of driving cessation in people with dementia, it continues to be largely avoided at the individual and system levels. This is explored via the themes of (a) paradox of importance and avoidance identified in AS settings; (b) lack of awareness and understanding about dementia and driving among people with dementia and family carers; (c) distress and avoidance rooted in ongoing system issues; and (d) moving driving cessation to the "front burner." DISCUSSION AND IMPLICATIONS Viewed through the emerging social health paradigm, which focuses on the social and emotional consequences of dementia, our results highlight the urgent need to mobilize our communities, medical education systems, and transportation authorities to finally resolve the dementia and driving cessation paradox.
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Affiliation(s)
- Elaine Stasiulis
- Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Ontario, Canada
| | - Brintha Sivajohan
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Gary Naglie
- Department of Medicine and Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,Departments of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
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Chang HCR, Ho MH, Traynor V, Tang LY, Liu MF, Chien HW, Chan SY, Montayre J. Mandarin version of dementia and driving decision aid (DDDA): Development and stakeholder evaluation in Taiwan. Int J Older People Nurs 2021; 16:e12370. [PMID: 33595919 DOI: 10.1111/opn.12370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/10/2021] [Accepted: 01/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dementia causes cognitive and memory difficulties which can reduce the driving safety of the individuals. The decision-making process for driving retirement is challenging, and yet limited guidance is available. OBJECTIVES This article reports the development of the Taiwanese version of dementia and driving decision aid (DDDA) and the evaluation from stakeholders through a dementia and driving education programme. METHODS A multi-method approach was adopted using a pre-test, post-test survey and focus group interviews. A total of 154 healthcare professionals, family caregivers and people with dementia participated education programme, and 12 experts attended the focus group discussion. The survey included demographics, knowledge, confidence, competence and awareness of using DDDA. Participants completed a survey prior and immediately after the education programme. We translated a 32-page interactive DDDA booklet from the original English version to Mandarin. The education programme consisted of three-hour dementia and driving education module delivered both face-to-face and online. RESULTS The majority of participants described the booklet as balanced (91.7%) with the information presented in a 'good' or 'excellent' manner (93.4%). Most participants (85.3%) felt that DDDA helps them in making decisions about driving. Five themes were extracted from the focus group interview: (1) approach targeted to people with dementia, (2) specific content and additional information, (3) culturally appropriate modification, (4) having the right to drive and (5) booklet dissemination. The knowledge, confidence, competence and awareness of using the DDDA increased significantly (p < 0.001) after the education programmes. CONCLUSION We anticipate that use of the DDDA booklet will raise awareness of this social and health issue among the general public and facilitate collaborations with clinicians, municipalities and related organisations in providing a decision-making resource material for those with people living with dementia and their families. This study was not a clinical trial and the focus of this study was development and evaluation of the DDDA booklet. As mentioned in the methods section, participants were invited to attend the education program and provided their thoughts on the DDDA booklet based on their satisfaction level. Moreover, the education program was a one-day, workshop type program. This study was neither "prospectively assigns human participants or groups of humans to one or more health-related interventions" nor "to evaluate the effects on health outcomes", according to the definition of clinical trial by WHO. Therefore, we did not consider this study was a clinical trial. IMPLICATIONS FOR PRACTICE There is an urgent need for supporting people with dementia and their families to negotiate the complex decision-making involved in deciding to change their approach to driving. The DDDA booklet can fill an important gap in service delivery to people with dementia who are adjusting to life without driving.
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Affiliation(s)
- Hui Chen Rita Chang
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Mu-Hsing Ho
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Department of Nursing, Taipei Medical University Hospital, Taipei, Taiwan
| | - Victoria Traynor
- Faculty of Science, Medicine and Health, School of Nursing, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Li-Yu Tang
- Taiwan Alzheimer's Disease Association, Taipei City, Taiwan
| | - Megan F Liu
- School of Gerontology Health Management, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Chien
- Department of Nursing, College of Medicine & Health Science, Asia University, Taichung, Taiwan
| | - Su-Yuan Chan
- Taiwan Alzheimer's Disease Association, Taipei City, Taiwan
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW, Australia
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12
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'We're not doing it to be nasty': Caregivers' ethical dilemmas in negotiating driving safety with older adults. Can J Aging 2021; 41:7-14. [PMID: 33397532 DOI: 10.1017/s0714980820000409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this research was to investigate how informal caregivers of older adults cope with and negotiate driving safety when their loved one is no longer safe to drive. Fifteen informal caregivers of an older adult living at home took part in the present study. Participants cared for individuals with a range of health conditions that significantly impaired driving safety, including dementia, Parkinson's disease, macular degeneration, and stroke. A thematic analysis of participants' accounts identified the complex interpersonal, social, and organisational context they encountered when their loved one did not recognise or acknowledge limitations in their ability to drive. This analysis highlights the ethical dilemma at the heart of caregivers' experiences and identifies stake and blame as key considerations in the development of sensitive and effective policies and practices.
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13
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Managing the transition to non-driving in patients with dementia in primary care settings: facilitators and barriers reported by primary care physicians. Int Psychogeriatr 2020; 32:1419-1428. [PMID: 30782226 DOI: 10.1017/s1041610218002326] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This research addresses dementia and driving cessation, a major life event for affected individuals, and an immense challenge in primary care. In Australia, as with many other countries, it is primarily general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients with dementia. Qualitative evidence from studies with family members and other health professionals shows it is a complicated area of practice. However we still know little from GPs about how they manage the challenges with their patients and the strategies that they use to facilitate driving cessation. METHODS Data were collected through five focus groups with 29 GPs at their primary care practices in metropolitan and regional Queensland, Australia. A semi-structured topic guide was used to direct questions addressing decision factors and management strategies. Discussions were audio recorded, transcribed verbatim and thematically analyzed. RESULTS Regarding the challenges of raising driving cessation, four key themes emerged. These included: (i) Considering the individual; (ii) GP-patient relationships may hinder or help; (iii) Resources to support raising driver retirement; and (iv) Ethical dilemmas and ethical considerations. The impact of discussing driving cessation on GPs is discussed. CONCLUSIONS The findings of this study contribute to further understanding the experiences and needs of primary care physicians related to managing driving retirement with their patients with dementia. Results support a need for programs regarding identification and assessment of fitness to drive, to upskill health professionals and particularly GPs to manage the complex issues around dementia and driving cessation, and explore cost-effective and timely delivery of such support to patients.
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14
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Adaptation of the CarFreeMe driver retirement intervention to provide driving cessation support to older people living with dementia. BRAIN IMPAIR 2020. [DOI: 10.1017/brimp.2020.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AbstractObjective:Driving and stopping driving present challenging issues for older people living with memory problems and the family members supporting them. Changes to driving status impact the individual stopping driving and their family members. CarFreeMe is an existing, effective driving cessation program for older people that may be applicable to older people living with dementia. The purpose of this study was to adapt the program and explore feasibility and key stakeholder perspectives.Methods:The Medical Research Council guidelines for conducting research into complex interventions guided the development, acceptability and feasibility piloting. A multidisciplinary approach was taken, and key stakeholders were involved throughout the process. This included an adaptation process, followed by expert reference group feedback and case series pilot study.Results:The background research indicated that some key changes were required to meet the needs of people living with dementia. Aspects of the content, language, format and activities were adapted and an additional module was created for family members – whose involvement was identified as important. A more personalized, flexible approach was recommended. The expert reference group [psychologists (n = 2), occupational therapists (n = 3) and dementia behavior consultants (n = 2)] indicated the program was appropriate and needed, and made recommendations for feasibility. Pilot testing with three families indicated acceptability.Conclusion:A driving cessation program adapted for use with people living with dementia and their families required some changes to meet the needs and situations based on feedback from key stakeholders. Future studies will evaluate implementation outcomes across a range of settings.
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15
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Yang L, Ye H, Sun Q. Family caregivers' experiences of interaction with people with mild-to-moderate dementia in China: A qualitative study. Int J Nurs Pract 2020; 27:e12892. [PMID: 32967060 PMCID: PMC8459268 DOI: 10.1111/ijn.12892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022]
Abstract
Aim This study aimed to explore the experiences of family caregivers interacting with people with dementia. Background A majority of people with mild‐to‐moderate dementia live at home with family caregivers. This interaction creates positive experiences and challenges for these caregivers. Design Descriptive phenomenological qualitative inquiry guided this study. Methods This qualitative study involved semi‐structured interviews with the caregivers of people with mild‐to‐moderate dementia (n = 10). Data were collected from June to September 2018, and then data were thematically analysed. Results Six categories of themes were identified from the interviews: (1) unexpected things often happen; (2) positive coping strategies; (3) sense of accomplishment because people with dementia actively participate in activities; (4) sense of frustration because of the reluctance of people with dementia to participate in activities; (5) hope for the happiness of people with dementia; and (6) want to have their own life. Conclusions This study reveals that caregivers could positively interact with people with dementia through creating opportunities and arranging meaningful activities. Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia. What is already known about this topic?
A majority of people with mild‐to‐moderate dementia live at home with family caregivers. Many caregivers suffer from depression, anxiety, fatigue, insomnia, family conflicts and low levels of life satisfaction. How caregivers interact with people with dementia at home remains unclear.
What this paper adds?
Caregivers experience various feelings, such as a sense of accomplishment and occasionally frustration, when interacting with people with dementia. Caregivers stated that they wanted people with dementia to be happy and live their life. Thus, the caregivers changed their attitude, accepted the situation and organized meaningful activities for people with dementia. Caregivers employed various strategies for handling situations involving people with dementia and shared how they interacted with such individuals.
The implications of this paper:
Care organizations that can offer certain services for people with dementia should be developed to lessen caregivers' burden. Community nurses should develop caregivers' strengths and enhance their abilities to improve interaction with people with dementia. Future research should focus on family management and training on how to help caregivers interact effectively with people with dementia.
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Affiliation(s)
- Lili Yang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
| | - Huiling Ye
- Department of Nursing, Zhejiang University of Traditional Chinese Medicine First Affiliated Hospital, Hangzhou, China
| | - Qiuhua Sun
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, China
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16
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Ferreira DH, Boland JW, Kochovska S, Honson A, Phillips JL, Currow DC. Patients' and caregivers' experiences of driving with chronic breathlessness before and after regular low-dose sustained-release morphine: A qualitative study. Palliat Med 2020; 34:1078-1087. [PMID: 32519599 DOI: 10.1177/0269216320929549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Chronic breathlessness is a disabling syndrome that profoundly impacts patients' and caregivers' lives. Driving is important for most people, including those with advanced disease. Regular, low-dose, sustained-release morphine safely reduces breathlessness, but little is known about its impact on driving. AIM To understand patients' and caregivers' (1) perspectives and experiences of driving with chronic breathlessness; and (2) perceived impact of regular, low-dose, sustained-release morphine on driving. DESIGN A qualitative study embedded in a pragmatic, phase III, randomised, placebo-controlled trial of low-dose, sustained-release morphine (⩽32 mg/24 h) for chronic breathlessness. Semi-structured interviews were conducted immediately after participants withdrew or completed the randomised, placebo-controlled trial. Informed by grounded theory, a constant comparative approach to analysis was adopted. SETTING/PARTICIPANTS Participants were recruited from an outpatients palliative care service in Adelaide, Australia. Participants included patients (n = 13) with severe breathlessness associated with chronic obstructive pulmonary disease and their caregivers (n = 9). RESULTS Participants were interviewed at home. Eleven received morphine 8-32 mg. Three themes emerged: (1) independence; (2) breathlessness' impact on driving; and (3) driving while taking regular, low-dose, sustained-release morphine. CONCLUSION Driving contributed to a sense of identity and independence. Being able to drive increased the physical and social space available to patients and caregivers, their social engagement and well-being. Patients reported breathlessness at rest may impair driving skills, while the introduction of sustained-release morphine seemed to have no self-reported impact on driving. Investigating this last perception objectively, especially in terms of safety, is the subject of ongoing work.
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Affiliation(s)
- Diana H Ferreira
- Palliative and Supportive Services, Flinders University, Bedford Park, SA, Australia
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Aaron Honson
- Palliative and Supportive Services, Flinders University, Bedford Park, SA, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David C Currow
- Palliative and Supportive Services, Flinders University, Bedford Park, SA, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
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17
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Holt Clemmensen T, Hein Lauridsen H, Andersen-Ranberg K, Kaae Kristensen H. Informal carers' support needs when caring for a person with dementia - A scoping literature review. Scand J Caring Sci 2020; 35:685-700. [PMID: 32781496 DOI: 10.1111/scs.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/14/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Informal carers of people with dementia report having unmet needs for support and few supportive interventions have been shown to be effective. There is a need to develop needs assessment instruments and supportive interventions with a holistic and person-centred approach to meet the various and complex needs of carers. The aim of this study was to provide an overview of carers' support needs when caring for people with dementia with the objectives to map and synthesise knowledge on key concepts of carers' support needs. METHODS A scoping review methodology was used. A literature search was conducted in PsycINFO, CINAHL, PubMed and EMBASE between January 2007 and October 2019. Three authors independently selected articles meeting the inclusion criteria, and data were extracted using a matrix developed for that purpose. Inductive content analysis was used to synthesise key concepts of carers' support needs. RESULTS The search identified 2748 articles after removing duplicates, and 122 articles were included in the mapping of carers' support needs. Synthesising carers' support needs indicated that the full extent of support needs emerges in the interaction between the carer and the person cared for and that it is possible to categorise support needs into four key concepts related to: 1) the carer as a person, 2) managing being a carer, 3) providing care, and 4) knowledge of dementia. CONCLUSION The findings of this study help to map a framework describing carers' support needs that may guide the development of future needs assessment instruments and supportive interventions.
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Affiliation(s)
- Trine Holt Clemmensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Henrik Hein Lauridsen
- Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Department of Public Health, University of Southern Denmark, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Hanne Kaae Kristensen
- Health Sciences Research Centre, UCL University College, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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18
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Pellichero A, Lafont S, Paire-Ficout L, Fabrigoule C, Chavoix C. Barriers and facilitators to social participation after driving cessation among older adults: A cohort study. Ann Phys Rehabil Med 2020; 64:101373. [PMID: 32272286 DOI: 10.1016/j.rehab.2020.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/27/2020] [Accepted: 03/04/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Driving cessation is a challenging transition for older drivers. It is indeed often associated with reduced mobility, loss of autonomy and poor quality of life, as in individuals with acquired disabilities. We examined factors that inhibit or facilitate out-of-home occupations after driving cessation (shopping, visiting/helping friends/family, leisure, and associative activities) in older adults, with particular focus on the role of anticipation. METHODS This longitudinal study was conducted with the SAFE MOVE cohort (n=1014 drivers aged≥70 years). Socio-demographic, health, cognitive, mobility and out-of-home occupations data were collected at home at baseline and by a postal questionnaire at 2-year follow-up. RESULTS In total, 48 (5%) participants stopped driving between baseline and follow-up, at a mean age of 81.8 years; 71% of drivers who stopped reported that driving cessation affected their out-of-home occupations. Participation in social occupations started to decline before driving cessation. Retired drivers were older, had poorer health, poorer cognitive abilities, drove less at baseline but used more public transportation than active drivers. As compared with participants who did not consider driving cessation at baseline, those who did were more likely to expect a better quality of life in the event of driving cessation and to use public transportation at baseline and follow-up despite their older age and poorer health. CONCLUSION Some factors associated with reduced social participation and driving cessation are inevitable, such as health status. However, other factors may facilitate maintenance of social participation, including anticipation of driving cessation and mobility habits. Our findings highlight the need for appropriate interventions that are widely available to older drivers before driving cessation occurs and for public policy actions facilitating alternative transport systems.
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Affiliation(s)
- Alice Pellichero
- UMR U1075, Inserm, COMETE, Unicaen, PFRS, Normandie university, 2, rue des Rochambelles, 14000 Caen, France; Department of rehabilitation, université Laval, Quebec City, QC, Canada; Centre for interdisciplinary research in rehabilitation and social integration, Québec City, QC, Canada
| | - Sylviane Lafont
- UMR_T9405, UMRESTTE, IFSTTAR, university Lyon, university Lyon 1, 69500 Lyon, France
| | | | - Colette Fabrigoule
- USR 3413 CNRS, CHU de Pellegrin, université Bordeaux Segalen, 33076 Bordeaux, France
| | - Chantal Chavoix
- UMR U1075, Inserm, COMETE, Unicaen, PFRS, Normandie university, 2, rue des Rochambelles, 14000 Caen, France.
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19
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Sanford S, Naglie G, Cameron DH, Rapoport MJ. Subjective Experiences of Driving Cessation and Dementia: A Meta-Synthesis of Qualitative Literature. Clin Gerontol 2020; 43:135-154. [PMID: 29863962 DOI: 10.1080/07317115.2018.1483992] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives: To review qualitative research on the specific challenges and strategies that relate to driving cessation for older adults with dementia, from the perspectives of key informant groups.Method: A meta-synthesis of qualitative studies was conducted. Structured inclusion criteria were applied to screen 616 titles and abstracts, and 9 qualitative studies were included, published from 2002 to 2016. Descriptive themes were identified using content analysis and synthesized to generate analytic themes.Results: The study samples and methodologies represented a diverse range. Cross-cutting themes on experiences of driving cessation for people with dementia are the: importance of open communication and autonomy in decision-making, and advanced planning to connect people with resources; significance of relationships; importance of providing support for the impact of cessation on identity and emotional wellbeing; and benefit of individualizing supportive approaches.Conclusion: This review identifies some important areas for consideration when designing supportive programs to address driving.Clinical Implications: Interventions to support driving cessation for people with dementia should prioritize support for communication, advanced planning, and emotional effects of stopping driving.
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Affiliation(s)
| | - Gary Naglie
- Rotman Research Institute, Toronto, Canada.,Department of Medicine, Baycrest Health Sciences, Toronto, Canada.,Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Research Department, Toronto Rehabilitation Institute-University Health Network, Toronto, Canada
| | - Duncan H Cameron
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
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20
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Rapoport MJ, Sarracini CZ, Mulsant BM, Seitz DP, Molnar F, Naglie G, Herrmann N, Rozmovits L. A virtual second opinion: Acceptability of a computer-based decision tool to assess older drivers with dementia. Health Informatics J 2019; 26:911-924. [PMID: 31210555 DOI: 10.1177/1460458219852870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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21
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Scott T, Liddle J, Mitchell G, Beattie E, Pachana N. Implementation and evaluation of a driving cessation intervention to improve community mobility and wellbeing outcomes for people living with dementia: study protocol of the 'CarFreeMe' for people with dementia program. BMC Geriatr 2019; 19:66. [PMID: 30832581 PMCID: PMC6399961 DOI: 10.1186/s12877-019-1074-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Giving up driving is a pivotal life event and universal challenge for people living with dementia and their families, and a complex area of clinical practice for health professionals who monitor driving cessation. The best outcomes are for individuals to plan for and eventually cease driving, however with insufficient support programs in place, many avoid the issue until it is reaches a crisis point. This program of research investigates a comprehensive support- and education-based intervention targeted at people living with dementia and their care partners who are managing driving cessation. The primary aim of this research is to determine the effectiveness of the program through a cluster randomized controlled trial. Methods/design The intervention (CarFreeMe) is an intensive program delivered by a trained health professional that addresses practical and emotional needs relevant to driving cessation. The seven module program is person-centred, covering awareness raising, adjustment, and practical support that is individualized according to geographic location and the particular goals and preferences of participants. A cluster randomized controlled trial will evaluate the effectiveness of the program. Evaluation will take place pre-intervention, immediately following, and three months post-intervention. Clusters are randomized to either intervention or usual treatment. Participants within clusters will be recruited via primary and secondary care clinics, community agencies, service providers, local media, social media, support groups, and word of mouth. The primary outcome measure for persons with dementia and their care partners is lifespace, collected via (i) smartphone GPS technology and (ii) self-reported number of episodes away from home (during the past week). Secondary outcomes include safe alternative transport status, wellbeing, depression, anxiety, and self-efficacy, which will be collected from dyads. Caregiving strain will be collected from care partner/family member only. A process evaluation of the intervention will also be undertaken. Discussion There is an urgent need for therapeutic approaches to supporting people living with dementia and their families to negotiate the complex decision making involved in deciding to change their approach to driving. The driving cessation intervention may fill an important gap in service delivery to people living with dementia who are adjusting to life without driving. Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12618000388213, 15 March 2018.
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Affiliation(s)
- Theresa Scott
- School of Psychology, The University of Queensland, St Lucia, Queensland, 4072, Australia.
| | - Jacki Liddle
- School of Information Technology and Electrical Engineering, The University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, RB&W Hospital, Herston, Queensland, 4006, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Kelvin Grove, Queensland, 4059, Australia
| | - Nancy Pachana
- School of Psychology, The University of Queensland, St Lucia, Queensland, 4072, Australia
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22
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Jacobs M, Hart EP, Miranda YM, Groeneveld GJ, van Gerven JMA, Roos RAC. Altered driving performance of symptomatic Huntington's disease gene carriers in simulated road conditions. TRAFFIC INJURY PREVENTION 2018; 19:708-714. [PMID: 30273496 DOI: 10.1080/15389588.2018.1497796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/13/2018] [Accepted: 07/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments. METHODS This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups. RESULTS Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway. CONCLUSIONS Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD.
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Affiliation(s)
- Milou Jacobs
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands
| | - Ellen P Hart
- b Centre for Human Drug Research , Leiden , The Netherlands
| | - Yuri Mejia Miranda
- c Department of Statistics , Centre for Human Drug Research , Leiden , The Netherlands
| | | | | | - Raymund A C Roos
- a Department of Neurology , Leiden University Medical Center , Leiden , The Netherlands
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23
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Piersma D, Fuermaier ABM, De Waard D, Davidse RJ, De Groot J, Doumen MJA, Ponds RWHM, De Deyn PP, Brouwer WH, Tucha O. Adherence to driving cessation advice given to patients with cognitive impairment and consequences for mobility. BMC Geriatr 2018; 18:216. [PMID: 30223796 PMCID: PMC6142418 DOI: 10.1186/s12877-018-0910-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/10/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Driving 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. METHODS Patients 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. RESULTS Respectively 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. CONCLUSIONS Adherence 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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Affiliation(s)
- Dafne Piersma
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Anselm B. M. Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Dick De Waard
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | | | - Jolieke De Groot
- SWOV Institute for Road Safety Research, The Hague, The Netherlands
| | - Michelle J. A. Doumen
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
| | - Rudolf W. H. M. Ponds
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neurosciences (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Peter P. De Deyn
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Wiebo H. Brouwer
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
- Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, The Netherlands
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Stepney M, Kirkpatrick S, Locock L, Prinjha S, Ryan S. A licence to drive? Neurological illness, loss and disruption. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1186-1199. [PMID: 29790195 DOI: 10.1111/1467-9566.12754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The sense of freedom and independence that being able to drive generates may be taken for granted by many until it is threatened by illness. Drawing on the 'mobility turn' in social sciences that emphasises the social and emotional significance of the car (Sheller and Urry , ), this article presents secondary analysis of narratives of driving and its significance across four neurological conditions (epilepsy, Parkinson's disease, transient ischaemic attack and motor neurone disease). Taking an interactionist approach we explore how the withdrawal of a driving licence can represent not just a practical and emotional loss of independence, but also loss of enjoyment; of a sense and feeling of 'normal' adulthood and social participation; and of an identity (in some cases gendered) of strength and power. Conversely the ability to keep driving can maintain an unbroken thread of narrative, for example enabling people with speech difficulties to feel and look normal behind the wheel. Moments of pleasure and normality illuminate the importance of examining the micro-strands of disruption illness can cause.
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Affiliation(s)
- Melissa Stepney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Susan Kirkpatrick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Suman Prinjha
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sara Ryan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Sanford S, Rapoport MJ, Tuokko H, Crizzle A, Hatzifilalithis S, Laberge S, Naglie G. Independence, loss, and social identity: Perspectives on driving cessation and dementia. DEMENTIA 2018. [DOI: 10.1177/1471301218762838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study on driving cessation was to explore the process of coping, decision-making and adaptation through this major life transition. We sought to examine understandings of the emotional responses of drivers and ex-drivers with dementia from the perspective of healthcare providers and family caregivers of persons with dementia. Interviews and focus groups were conducted with several key informant groups: healthcare providers who work with patients with dementia and their families ( N = 10), representatives from organizations that provide services and support for persons with dementia ( N = 6), and family caregivers of drivers and former drivers with dementia ( N = 13). Data analysis involved inductive analytic techniques to generate descriptive and analytic themes from the data. The main themes from the analysis involve the: (1) Loss of independence and disruption to identity connected to emotional responses to driving cessation; (2) Experience of driving cessation as one loss within a series of losses related to dementia; (3) Importance of addressing emotional and identity-related effects in supportive responses to driving cessation; and (4) Support for maintained and adapted roles as a strategy to provide meaning and purpose in the context of driving cessation. Driving cessation can represent a significant disruption to identity, and is closely linked to losses, such as independence, within people’s broader experiences of grief and loss associated with dementia. The findings suggest the need for supportive responses that address unique emotion and identity-related aspects of driving cessation for people with dementia and their family caregivers.
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Affiliation(s)
- Sarah Sanford
- Rotman Research Institute, Baycrest Health Sciences, Canada
| | - Mark J Rapoport
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Holly Tuokko
- Centre on Aging and Department of Psychology, University of Victoria, Canada
| | | | | | - Sarah Laberge
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - Gary Naglie
- Rotman Research Institute, Baycrest Health Sciences, Canada; Department of Medicine, Baycrest Health Sciences, Baycrest Health Sciences, Canada; Department of Medicine and Institute of Health Policy, Management & Evaluation, University of Toronto, Canada; Research Department, Toronto Rehabilitation Institute, University Health Network, Canada
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26
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Jacobs M, Hart EP, Roos RAC. Driving with a neurodegenerative disorder: an overview of the current literature. J Neurol 2017; 264:1678-1696. [PMID: 28424901 PMCID: PMC5533843 DOI: 10.1007/s00415-017-8489-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/06/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Abstract
Driving is important for employment, social activities, and for the feeling of independence. The decision to cease driving affects the quality of life and has been associated with reduced mobility, social isolation, and sadness. Patients with neurodegenerative disorders can experience difficulties while driving due to their cognitive, motor, and behavioral impairments. The aim of this review is to summarize the available literature on changes in driving competence and behavior in patients with neurodegenerative disorders, with a particular focus on Huntington's (HD), Parkinson's (PD), and Alzheimer's disease (AD). A systematic literature search was conducted in the PubMed/Medline database. Studies using on-road or simulated driving assessments were examined in this review. In addition, studies investigating the association between cognitive functioning and driving were included. The review identified 70 studies. Only a few publications were available on HD (n = 7) compared to PD (n = 32) and AD (n = 31). This review revealed that driving is impaired in patients with neurodegenerative disorders on all levels of driving competence. The errors most commonly committed were on the tactical level including lane maintenance and lane changing. Deficits in executive functioning, attention, and visuospatial abilities can partially predict driving competence, and the performance on neuropsychological tests might be useful when discussing potential driving cessation. Currently, there is no gold standard to assess driving ability using clinical measures such as neuropsychological assessments, so more studies are necessary to detect valid screening tools and develop useful and reliable evidence-based guidelines.
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Affiliation(s)
- Milou Jacobs
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
| | - Ellen P Hart
- Center for Human Drug Research, Leiden, The Netherlands
| | - Raymund A C Roos
- Department of Neurology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Liddle J, Gustafsson L, Mitchell G, Pachana NA. A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers. THE GERONTOLOGIST 2016; 57:82-88. [PMID: 27102058 DOI: 10.1093/geront/gnw079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/15/2016] [Indexed: 11/14/2022] Open
Abstract
Recognizing the clinical importance and safety and well-being implications for the population, a multidisciplinary team has been researching older drivers and driving cessation issues for more than 15 years. Using empirical approaches, the team has explored quality of life and participation outcomes related to driving and nondriving for older people and has developed interventions to improve outcomes after driving cessation. The team members represent occupational therapists, medical practitioners, and clinical and neuropsychologists. While building the evidence base for driving- and driving cessation-related clinical practice, the researchers have also had first-hand experiences of interruptions to their own or parents' driving; involvement of older family members in road crashes; and provision of support during family members' driving assessment and cessation. This has led to reflection on their understandings and re-evaluation and refocusing of their perspectives in driving cessation research. This work will share the narratives of the authors and note their developing perspectives and foci within research as well as their clinical practice. Personal reflections have indicated the far-reaching implications for older drivers and family members of involvement in road crashes: the potential for interruptions to driving as a time for support and future planning and the conflicting and difficult roles of family members within the driving cessation process. Overall the lived, personal experience of the authors has reinforced the complex nature of driving and changes to driving status for the driver and their support team and the need for further research and support.
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Affiliation(s)
- Jacki Liddle
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute,
| | | | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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