The Subjective Experiences of Driving Cessation and Life Satisfaction

Compared to the driving group, the driving cessation group in this study was found to be a high-risk population in terms of their life satisfaction. This study evaluated data from 315 older adults, aged 55 or older, using the 2018 Korean Older Adults Driving and Mobility Service Trend Survey. These data were collected from 17 representative cities and provinces in South Korea. To minimize the potential for selection bias and the confounding factors inherent in observational studies, this study employed the propensity score matching (PSM) method. Following the matching, multivariate regression analyses were conducted to compare the driving cessation group (n = 65) with the driving group (n = 50) in terms of their life satisfaction. After adjusting for demographic and health-related variables, the older adults who had ceased driving were found to have lower life satisfaction (Coef. = -1.39, p-value = 0.018). Our results highlight the importance of establishing preliminary evidence to guide the development of tailored programs for older adults-especially for those likely to experience diminished life satisfaction and heightened risk-to address the mobility challenges stemming from driving cessation.

Neighbourhood transportation, elapsed years, and well-being after surrendering the driver's licence in older Japanese adults: The JAGES longitudinal study

This study aimed to examine how the associations between surrendering driving licence and changes in self-rated health and social interactions among older adults differ by the years elapsed since surrendering and the number of public transportation systems (PTS) in the neighbourhood. We used the 2013 and 2016 survey data from the Japan Gerontological Evaluation Study targeting residents aged ≥65 years in 30 municipalities in Japan. Two-waves longitudinal data from 4894 older adults were evaluated. Based on the difference-in-differences method, the interaction terms of respondents' driving status, which was the categorical exposure variable representing respondents' driving status for three years during the study period, and a dummy variable of year (2016) were used as explanatory variables in logistic regression analyses to examine changes in outcomes (poor self-rated health and infrequent meeting with friends) between 2013 and 2016 by driving status during this period. Analyses were stratified based on neighbourhood PTS ('more PTS' and 'fewer PTS' groups). We found that, while surrendering licence within three years was associated with increased probability of poor self-rated health in more PTS group, the confidence interval was large. Although surrendering licence within three years was associated with decreased social interactions, this association weakened if licence was surrendered more than three years ago. These associations were not markedly affected by neighbourhood PTS. Our findings suggested that, regardless of neighbourhood PTS, support and care to promote social interactions at or shortly after surrendering licence may be beneficial to the well-being of older adults who lost their driving licence.

Psychological Resources and Driving Status: A Study of Current and Former Drivers 55 Years of Age and Older

Psychological resources can help individuals adjust to changes associated with aging. In this study, we examined the effect of demographic, health, and psychological resource variables in explaining driving status among adults 55 years and older. A convenience sample of 222 adults between the ages of 55 and 91 years (mean = 72.20 years) completed questionnaires that included measures of driving status, self-rated health, and psychological resources (e.g., life control, life purpose, and locus of control). Multiple logistic regression models that controlled for confounders were constructed with driver status (i.e., current driver or former driver) as the outcome. Former drivers were older, reported being in poorer health, and reported more depression symptoms. After controlling for age and health, current drivers reported higher levels of life control and life purpose and a more internal locus of control. Results highlight the importance of considering psychological resources when examining driving cessation.

Driving and cognitive function in people with stroke and healthy age-matched controls

The decision to return to driving is both complex and difficult. It is often made with clinician support, perhaps on the basis of results from standardized paper and pencil tests, and less frequently an assessment of on-road driving. However, the resources required and inherent reliability and validity challenges suggest that greater use of computerization and driving simulation may play a useful role in the assessment process. In this study, thirty-six age-matched healthy and post-stroke drivers completed standard psychometric assessments (including NART, MMSE, BADS, IADL), computer delivered cognitive assessments (including SART, N-Back, Simple Reaction Time), as well as simulated and on-road assessments of driving. While significantly different in terms of psychometric and computer-based assessments, the healthy and post-stroke drivers who completed the on-road test did not differ. In contrast, driving in the portable simulator showed impaired driving, on some but not all driving manoeuvres, for those who failed the on-road test or had voluntarily ceased to drive. These results are discussed in terms of the implications they have for the multi-faceted nature of driving as a skill, and the need to involve simulation when assessing fitness to drive.

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.

The Association between Public Transportation and Social Isolation in Older Adults: A Scoping Review of the Literature

Inadequate public transportation was recognized as a barrier to social participation, especially for older adults in rural communities and with mobility issues. Older adults will not benefit from opportunities to engage with their community and maintain social networks if they are unable to access them. The purpose of this scoping review was to make recommendations for further research and to summarize areas for improvement identified in the literature that will aid in the development of public transportation initiatives that can better address social isolation for older adults (≥ 55 years of age). Nineteen articles met the inclusion criteria, identifying themes of access to rural public transportation, issues with public transportation, and mobility. In practice, older adults need to prepare for driving cessation and mobility transitions; sound policy requires input to tailor transportation initiatives to an aging population, and future research should explore older adults' transportation needs and potential solutions in urban and rural communities.

Comparing executive functioning and clinical and sociodemographic characteristics of people with schizophrenia who hold a driver's license to those who do not

BACKGROUND.

Community engagement requires driving. However, there is paucity of research focusing on the potential to drive for people with schizophrenia.

PURPOSE.

This study aimed to characterize people with schizophrenia by comparing clinical signs, executive functions (EF), and sociodemographic aspects of those holding a driver's license to those without one.

METHOD.

This cross-sectional study used convenience sampling to select 60 ambulatory individuals to participate: 31 with a driver's license and 29 without one. They completed the Wisconsin Card Sorting Test (WCST) for evaluation of EF and the Positive and Negative Syndrome Scale (PANSS) for symptoms severity evaluation. Data were analyzed using multivariate analyses of covariance and logistic regression models.

FINDINGS.

Participants with a license had less severe negative symptoms and general psychopathology and better EF and sociodemographic aspects compared to those without a license. Logistic regression revealed significant odds ratios (OR) in general psychopathology (PANSS; OR = 0.963, p = .011) and in the WCST (OR = 0.504, p = .027).

IMPLICATIONS.

This study offers occupational therapists a data-driven perspective on evaluating potential fitness to drive to enable participation in daily life and well-being of people with schizophrenia.

Analysis of the Relationship between Turning Signal Detection and Motorcycle Driver's Characteristics on Urban Roads; A Case Study

The investigations on the effectiveness of the turn signal in motorcyclists understanding of motorists’ potential intentions in potentially dangerous car–motorcycle interactions and on the relationships among some variables that could influence the perception of rear and front turn signal status are examined in this paper. The investigations have been based on data pooled from the answers of a survey of 136 motorcycle riders, with special regards to the correct detection of turning indicators. Experimental videos have been realized during in-situ simulations, both in urban and suburban areas, recording vehicular interactions in three-leg road intersections, able to potentially generate crash risks, through a 360-camera mounted on a motorcyclist’s helmet. The blinkers detection rate has been combined with other factors related to motorcyclist’s characteristics and test context (e.g., age, gender, location of the test site, presence of a car behind tester vehicles and if the motorcyclist are also habitual car or bicycle drivers) in a stepwise logistic regression that modelled the odds of detecting the turn signal turned on as a function of significant factors. Within the limits of the proposed methodology, the results highlight the low percentage of correct sighting of the turn indicators and confirm the existence of a relation between the detection of the turn indicators aspect and some of the variables considered (e.g., age, being habitual cyclist or car driver and the presence of a car occluding the views), suggesting the opportunity to further investigate the phenomenon through the use of ad-hoc simulations, in order to highlight connections among the factors that can influence the perception of turning indicators in potentially dangerous contexts for cars and motorcycles.

Driving with Parkinson’s Disease: Exploring Lived Experience

A growing body of literature has explored the impact of Parkinson's disease (PD) on fitness to drive. As such, evidence now supports the use of specific clinical tests for screening purposes, the predictive validity of risk impressions, and the critical driving errors that predict on-road pass/fail outcomes in this population. However, little is known about the lived experiences of persons with PD as they navigate driving-related concerns such as driving impairments, cessation, potential threats to independence, and community mobility. This qualitative secondary data analysis aimed to explore the driving-related lived experiences of persons with PD. We utilized summative content analysis to identify themes related to driving from transcribed interviews with nineteen community-dwelling individuals with PD who participated in the primary study. Five themes emerged within the analysis: (1) the meaning and significance of driving; (2) driving cessation; (3) modified driving behaviors; (4) factors affecting driving; and (5) accessibility. Participants identified driving as an activity that holds significant importance—both directly (i.e., as a primary activity) and as a means for enabling other activities. This study lays the foundation for the development of client-centred and evidence-informed driving interventions for individuals with PD, as well as the development of driving retirement programs.

The Social Context of Driving Cessation: Understanding the Effects of Cessation on the Life Satisfaction of Older Drivers and Their Social Partners

Older adults with vision loss and a friend or family member were interviewed over a 2-year period. We examined the effects of driving cessation on life satisfaction among older adults and a social contact. Drivers' use of public transportation was examined as a moderator. Driving cessation was associated with a decline in life satisfaction among social partners but not for the drivers. Drivers' use of public transportation at baseline moderated the effects of cessation on changes in well-being among social partners, but had little effect on the life satisfaction of the drivers. Life satisfaction was greater among the social partners of ex-drivers who used public transportation more frequently. The association between driving cessation and well-being should be studied in the context of older drivers' social networks. Infrastructure (e.g., subways and buses) that supports transportation needs plays an important role in mitigating the effects of cessation on older adults' social networks.

Outil de sensibilisation des proches à la conduite automobile des aînés

This study aimed to explore the impact of an awareness tool for relatives of older drivers (OSCARPA) on i) their interest, openness and knowledge, ii) changes of abilities required for safe driving, and iii) utilization of compensatory strategies. A pre-experimental design with pretest (T0) and post-test (T1) eight to ten weeks after the intervention was realized with 45 relatives in contact with an older driver of 65 years old or older and who was driving at least once a week. Overall, the results demonstrated that OSCARPA increased i) interest, openness and knowledge of relatives (p<0.001), as well as their perceptions of ii) changes of abilities of older drivers (p=0.02), and iii) their utilization of compensatory strategies (p=0.001). Future studies would be relevant to further evaluate and increase the effectiveness of OSCARPA.

Family members' experiences of driving disruption after acquired brain injury

PRIMARY OBJECTIVE

1) To explore family members' lived experiences of driving disruption at early and later stages of the recovery continuum following acquired brain injury (ABI). 2) To describe health-related quality of life of family members of individuals with ABI who are experiencing driving disruption.

RESEARCH DESIGN

Mixed methods phenomenological research approach.

METHODS AND PROCEDURES

Semi-structured interviews and health-related quality of life questionnaires were conducted with 15 family members of individuals with ABI (early group: 1-12 months post-injury, n = 6; later group: >1 year post-injury, n = 9).

RESULTS

Two main themes were identified: Different for everyone: how driving disruption affects families, and Making it harder: context of driving disruption. The challenges of driving disruption were reported more frequently and with a more intense focus by family members who were caring for their relative for more than 1 year post-injury. This group also reported higher caregiver strain and poorer health-related quality of life. Reduced satisfaction with life, poor mental health and affected family functioning were reported by both groups.

CONCLUSIONS

Driving disruption impacts on family members and has long-lasting consequences. It is important for clinicians to work with family members to manage these challenges even years after ABI and consider individual contextual factors.

Driver rehabilitation: a systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive

OBJECTIVE

Driver rehabilitation has the potential to improve on-road safety and is commonly recommended to clients. The aim of this systematic review was to identify what intervention approaches are used by occupational therapists as part of driver rehabilitation programmes, and to determine the effectiveness of these interventions.

METHOD

Six electronic databases (MEDLINE, CINAHL, PsycInfo, Embase, The Cochrane Library, and OTDBase) were searched. Two authors independently reviewed studies reporting all types of research designs and for all patient populations, provided the interventions could be administered by occupational therapists. The methodological quality of studies was assessed using the 'Downs and Black Instrument', and the level of evidence for each intervention approach was established using 'Centre for Evidence Based Medicine' criteria.

RESULTS

Sixteen studies were included in the review. The most common type of intervention approach used was computer-based driving simulator training (n=8), followed by off-road skill-specific training (n=4), and off-road education programmes (n=3). Car adaptations/modifications were used in one of the included studies. There was significant variability between studies with regards to frequency, duration, and total number of intervention sessions, and the diagnoses of the participants. Of the four intervention approaches, there is evidence to support the effectiveness of off-road skill-specific training (with older clients), and computer-based driving simulator training (with both older clients and participants with acquired brain injury).

CONCLUSION

Three types of intervention approaches are commonly reported, however, there is limited evidence to determine to effectiveness of these in improving fitness-to-drive. Further research is required, with clients from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving these clients' on-road fitness-to-drive.

Is planning for driving cessation critical for the well-being and lifestyle of older drivers?

BACKGROUND

Driving cessation has demonstrated impacts on well-being and lifestyle. Despite the recognized reluctance of older people to plan for driving cessation, this study has identified a new group who has a stated plan to stop driving within 12 months. Although gradual reduction of driving has been documented as part of the usual driving cessation, this study explored the differences between retired drivers and those with a stated plan to retire within 12 months in sociodemographic, well-being and lifestyle outcomes.

METHODS

This study extracted all baseline data from a clinical trial exploring the effectiveness of a group program for older retiring and retired drivers. Sociodemographic data included age, gender, health status, educational level, and living situation. All participants completed measures related to episodes away from home, well-being, and lifestyle. These were compared using parametric and nonparametric statistical analysis.

RESULTS

Participants (n = 131) included 68 retired drivers (mean age 79.8 years) and 63 retiring drivers (mean age 77.8 years). Retiring drivers engaged in more episodes away from home (p = 0.03), and more social activities (p = 0.02), used less alternative transport (p < 0.001), displayed fewer anxiety (p = 0.05), and depressive (p = 0.01) symptoms, but demonstrated lower transport and lifestyle self-efficacy (p = 0.04).

CONCLUSION

Both retired and retiring drivers require support for driving cessation and community engagement. Retiring drivers may be in a critical position to engage in driving cessation interventions to improve self-efficacy and begin adapting community mobility.

Older people's attitudes towards resuming driving in the first four months post-stroke

AIM

Little is known about how older people recovering from stroke perceive their return to driving, particularly in the early stages of recovery when they may receive driving information.

METHODS

Semistructured interviews were conducted with 21 participants (52% female, mean age 74.5 years) within the first 16 weeks post-stroke, while inpatients in either acute or rehabilitation stroke wards. Interview data were analysed using content analysis.

RESULTS

Three main themes emerged: 'driving as independence', 'emphasis on physical recovery', and 'limits on driving pre-stroke'.

CONCLUSIONS

For the most part, driving was not a key consideration for participants during this phase of their recovery. Physical restrictions and confidence were seen as the main deterrent to driving post-stroke; however, this varied according to gender. Driving information is generally not retained in the first four weeks of recovery post-stroke. This has implications for the content and timing of driving information given post-stroke.

A Survey Examining the Impact of Driving Cessation on People with Epilepsy in Ireland

Introduction:

Driving is a job, a hobby and a form of transport that enables occupation. This research investigated the impact of the inability to drive due to epilepsy on community mobility and occupational participation, and compared both men and women's perceptions of the impact of driving cessation on romantic relationships and family involvement.

Method:

By means of an internet-based survey, data were collected concerning community mobility, personal impact of driving cessation, previous driving practices, epilepsy and demographics. Statistical analysis was performed on quantitative data and content analysis was used with responses to open questions. The survey received 95 eligible participants.

Findings:

Participants used public transport more than the general population; however, when unable to drive, being driving by friends or relatives was the main mode of transport. As a result, people experienced restricted access to the community, had to give up activities, had a reduced quality of life and a lowered self-esteem. Significantly more men than women felt that driving cessation had a negative impact on romantic relationships (p = 0.024) yet men and women did not differ significantly in their feelings about the impact of driving cessation on family involvement (p = 0.58).

Conclusion:

Independent access to the community is often dependent on the ability to drive.

A driving cessation program to identify and improve transport and lifestyle issues of older retired and retiring drivers

BACKGROUND

This study explored the transport and lifestyle issues of older retired and retiring drivers participating in the University of Queensland Driver Retirement Initiative (UQDRIVE), a group program to promote adjustment to driving cessation for retired and retiring older drivers.

METHODS

A mixed method research design explored the impact of UQDRIVE on the transport and lifestyle issues of 55 participants who were of mean age 77.9 years and predominantly female (n = 40). The participants included retired (n = 32) and retiring (n = 23) drivers. Transport and lifestyle issues were identified using the Canadian Occupational Performance Measure and rated pre- and post-intervention.

RESULTS

Paired t-tests demonstrated a statistically significant improvement in performance (t = 10.5, p < 0.001) and satisfaction (t = 9.9, p < 0.001) scores of individual issues. Qualitative content analysis identified three categories of issues including: protecting my lifestyle; a better understanding of transport options; and being prepared and feeling okay.

CONCLUSIONS

Participation in UQDRIVE had a positive and significant effect on the issues of the participants. The results highlight that although all participants stated issues related predominantly to practical concerns, there were trends in the issues identified by the drivers and retired drivers that were consistent with their current phase of the driving cessation process.

The Experiences and Needs of People Who Cease Driving After Stroke

Driving cessation can result in a range of negative consequences, including impacts on identity, mood, and life satisfaction. The aims of this study were to explore the needs and experiences of people who cease driving following a stroke, with the aim of informing clinical practice. Method: Using a qualitative phenomenological approach, semi-structured, audiotaped interviews were conducted to gain an understanding of the needs and experiences of 24 participants (17 male, 7 female, mean of 5.5 years post driving cessation) who had ceased driving following a stroke. Results: After constant comparative analysis, four themes emerged from the data. These were labelled ‘life without driving’, ‘key times of need’, ‘alternatives and other ways’, and ‘carer support and assistance’. Most participants found stopping driving after their stroke to be a sudden, unexpected and intense experience and raised issues, including the loss of numerous life-roles, challenges associated with arranging alternative transport, and reliance on carers and the need for more information throughout the process. Conclusion: Individuals who cease driving following a stroke have unmet needs and difficult experiences throughout the process. Key times of particular need have been identified in this study. These findings have important implications for health professionals that include providing more information and support with driving cessation and alternatives to driving.

Time use, role participation and life satisfaction of older people: impact of driving status

BACKGROUND/AIM

Driving cessation has been recognised as affecting the health and wellbeing of older people. Further exploration of the impact of driving status on time use, role participation and life satisfaction was required.

METHODS

A cross-sectional survey of 234 older people (current drivers, retired drivers and people who have never driven) was employed. Time use in the previous week, role participation and life satisfaction were measured and compared between the groups, while controlling for sociodemographic variables (health status, activities of daily living and instrumental activities of daily living status, gender, age and living situation).

RESULTS

When compared to current drivers, retired drivers had significantly lower life satisfaction (P = 0.01), fewer present roles (P < 0.0001) and were less likely to participate in volunteer (P = 0.005) and family member roles (P = 0.009). Retired drivers spent less time on social leisure (P = 0.002) and away from home (P = 0.0001), and more time in solitary leisure (P= 0.0001). Comparing the participation of retired drivers with those who had never driven indicated that retired drivers spent significantly less time in volunteer work (P = 0.009).

CONCLUSIONS

The findings indicate that older non-drivers may require support for participation and wellbeing.

Occupational therapy practice in predriving assessment post stroke in the Irish context: findings from a nominal group technique meeting

PURPOSE

Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke.

METHOD

A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended.

RESULTS

Thirteen occupational therapists speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT).

CONCLUSION

Tests were recommended that gave an indication of the patient's underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.

Validation of the modified assessment of living skills and resources, an IADL measure for older people

PURPOSE

The aim of this study was to examine the validity of the assessment of living skills and resources (ALSAR) and the extent it contributes to and reflects the risk and accomplishment in instrumental activities of daily life for older people.

METHOD

The assessment was examined for evidence of construct validity, internal, consistency and effectiveness of the categorical rating schema. Rasch modelling was used to examine the hierarchy of items, item performance and scale quality.

RESULTS

A revised 5-level rating schema is proposed whereby skill rating levels are incrementally more at risk when a resource issue is identified. The sample comprised 290 ratings from 160 people 56-101 years (mean 79+/-9). Item mean infit statistics were 0.98 (Z = -0.2, SD = 0.63) and mean outfit statistics 1.02 (Z = -1.0, SD = 0.74). Reliability was 0.89 with a separation index of 2.81. People with long standing severe vision loss display an atypical response pattern denoting the vision item was of low relevance to their total IADL functioning.

CONCLUSIONS

This study has further verified the validity of the ALSAR as an IADL outcome measure for use with older people and has offered a more effective refinement of the rating scale. We note the importance of assessing vision prior to IADL testing.

The Needs and Experiences Related to Driving Cessation for Older People

Older people may cease driving owing to health concerns, discomfort while driving, cancellation of their licence or financial reasons. Because driving is fundamental to the freedom and independence of older people, driving cessation can lead to depression, loss of roles and unsafe use of alternative transport. Little consideration has been given to the development of approaches to improve outcomes for retiring drivers. This study aimed to understand the experiences of driving cessation for older people to inform the design of interventions for retiring drivers.

Qualitative methodology was used to explore the experiences of driving cessation from the perspective of nine retired drivers, three family members and six service providers. The retired drivers experienced challenges during three phases of driving cessation, in addition to discussing their driving history. The challenges were (1) a predecision phase – a balancing act and achieving awareness; (2) a decision phase – making the decision and owning the decision; and (3) a post-cessation phase – finding new ways and coming to terms.

Interventions to facilitate the process of driving cessation may need to be designed according to the phase of driving cessation and the challenges that the person is experiencing and to be underpinned by behaviour change and life transition theories.

Using a matrix in life transition research

Life transitions can be planned or can occur unexpectedly. They can cause a major change to a person's life patterns and well-being. Older adulthood is a time for many life transitions as a result of changes in life roles and health status. In this exploratory study, the authors investigate the transition involved in driving cessation for older people. In analyzing and organizing the data, they develop a matrix that incorporated descriptive and temporal factors associated with the transition. This matrix is useful in organizing and communicating the findings as a whole and could be used in describing individual experiences. It might be of use for the organization of qualitative data about other life transitions such as illness, retirement, and the development and adoption of new behaviors.