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

Transport digitalisation: Navigating futures of hypercognitive disablement

People living with cognitive impairments face new forms of disablement in the context of transport digitalisation, an issue recently catalysed by controversies regarding rail ticket office closures. Transport can dramatically impact the lives of people diagnosed with dementia, who often find their mobility suddenly and dramatically impaired. Unfortunately, sociological analysis of cognitive disability has traditionally been undermined by under-theorisation. One solution can be found in classic bioethical work on hypercognitivism-the veneration of cognitive acuity-and its disabling consequences. A hypercognitive approach can nurture an attentiveness to the specificities of digital disablement. Here, disability does not emerge from digitalisation inherently, but is instead intensified by the implementation of digitalisation in line with value commitments. A more robust sociology of cognitive disability could better represent the interests of people with cognitive impairments and resist the new forms of disability that current digitalisation risks spreading.

Still in first gear: Exploration of barriers for implementing driving cessation support

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.

Nurse practitioners' preferences for online learning regarding driving and dementia

ABSTRACT

With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application.

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

INTRODUCTION

Individuals living in rural communities are at heightened risk for Alzheimer's disease and related dementias (ADRD), which parallels other persistent place-based health disparities. Identifying multiple potentially modifiable risk factors specific to rural areas that contribute to ADRD is an essential first step in understanding the complex interplay between various barriers and facilitators.

METHODS

An interdisciplinary, international group of ADRD researchers convened to address the overarching question of: "What can be done to begin minimizing the rural health disparities that contribute uniquely to ADRD?" In this state of the science appraisal, we explore what is known about the biological, behavioral, sociocultural, and environmental influences on ADRD disparities in rural settings.

RESULTS

A range of individual, interpersonal, and community factors were identified, including strengths of rural residents in facilitating healthy aging lifestyle interventions.

DISCUSSION

A location dynamics model and ADRD-focused future directions are offered for guiding rural practitioners, researchers, and policymakers in mitigating rural disparities.

HIGHLIGHTS

Rural residents face heightened Alzheimer's disease and related dementia (ADRD) risks and burdens due to health disparities. Defining the unique rural barriers and facilitators to cognitive health yields insight. The strengths and resilience of rural residents can mitigate ADRD-related challenges. A novel "location dynamics" model guides assessment of rural-specific ADRD issues.

Driving following a diagnosis of dementia: Exploring the views and experiences of people with dementia-A UK survey

BACKGROUND

Driving cessation can be one of the adjustments made following a diagnosis of dementia. Little is known about the views and opinions of people living with dementia about this. The study aimed to gather a broad idea of the expectations, impacts and the process of driving cessation from the perspective of those living with dementia.

METHODS

138 people with dementia and 91 relatives/friends (on behalf of an individual with dementia) took part in an online questionnaire.

RESULTS

People living with dementia reported stopping driving following diagnosis can have negative psychological impacts particularly in relation to; feelings of isolation, depression, loss of freedom and feeling life isn't worth living. Age, gender and choice in the driving cessation process were related to the degree of negative experiences.

CONCLUSIONS

The difficulties reported by people with dementia suggest a need to provide more structured post diagnostic support to aid decision making of driving continuation or cessation; with the view to reducing associated distress and enabling people with dementia to continue to live a meaningful life.

Developing the Driving and Dementia Roadmap: a knowledge-to-action process

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.

Can Automated Vehicles Be Useful to Persons Living With Dementia? The Perspectives of Care Partners of People Living With Dementia

Background and Objectives

Driving cessation is a complex challenge with significant emotional and health implications for people with dementia, which also affects their family care partners. Automated vehicles (AVs) could potentially be used to delay driving cessation and its adverse consequences for people with dementia and their care partners. Yet, no study to date has investigated whether care partners consider AVs to be potentially useful for people with dementia.

Research Design and Methods

This mixed-methods study assessed the views of 20 former or current family care partners of people with dementia on AV use by people with dementia. Specifically, questionnaires and semistructured interviews were used to examine care partners’ acceptance of AV use by people with dementia and their views about the potential usefulness of AVs for people with dementia.

Results

The results demonstrated that care partners identified possible benefits of AV use by people with dementia such as their anticipated higher social participation. However, care partners also voiced major concerns around AV use by people with dementia and reported significantly lower levels of trust in and perceived safety of AVs if used by the person with dementia in their care compared to themselves. Care partners’ concerns about AV use by people with dementia included concerns around the driving of people with dementia that AVs are not designed to address; concerns that are specific to AVs but are not relevant to the nonautomated driving of people with dementia; and concerns that arise from existing challenges around the nonautomated driving of people with dementia but may be exacerbated by AV use.

Discussion and Implications

Findings from this study can inform future designs of AVs that are more accessible and useful for people with dementia.