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Spargo C, Laver K, Berndt A, Adey-Wakeling Z, George S. Australian medical practitioners' perspectives about current practice relating to fitness to drive assessment for older people with dementia and mild cognitive impairment: A qualitative study. Australas J Ageing 2024; 43:323-332. [PMID: 38343276 DOI: 10.1111/ajag.13281] [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: 09/11/2023] [Revised: 12/01/2023] [Accepted: 12/18/2023] [Indexed: 06/28/2024]
Abstract
OBJECTIVES To describe the perspectives of Australian medical practitioners about current practice, and the potential benefit of tools and resources to support fitness to drive assessment for older people with dementia and mild cognitive impairment (MCI). METHODS Semi-structured interviews with 22 medical practitioners from cognitive/memory clinics, hospitals, general practice and driving fitness assessment services in Australia. Reflexive thematic analysis was conducted. RESULTS Two overarching themes were generated: (1) Uncomfortable decisions, describing feelings of discomfort expressed by practitioners about making fitness to drive recommendations, with two subthemes: (a) 'Feeling uncertain' and (b) 'Sticking your neck on the line'; and (2) Easing the discomfort, describing participants' desire for tools/resources to support practitioners to increase comfort with fitness to drive recommendations, with two subthemes: (a) 'Seeking certainty' and (b) 'Focusing on the process' conveying two different perspectives about how this may be achieved. There was a desire for a new in-office assessment tool capable of accurately predicting fitness to drive outcomes and views that an evidence-based clinical pathway could improve practitioners' confidence in decision-making. CONCLUSIONS Perceptions of discomfort relating to fitness to drive assessment of older people with dementia and MCI exist amongst medical practitioners from health-care settings across Australia. In the absence of a well-validated in-office assessment tool, practitioners may benefit from an evidence-based clinical pathway to guide driving recommendations.
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Affiliation(s)
- Claire Spargo
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
- Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Angela Berndt
- University of South Australia, Allied Health and Human Performance, Adelaide, South Australia, Australia
| | - Zoe Adey-Wakeling
- Rehabilitation Aged and Palliative Care, Flinders Medical Centre, Adelaide, South Australia, Australia
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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Veerhuis N, Merizzi A, Papoulias S, Bradbury C, Sheret K, Traynor V. 'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid. Health Expect 2024; 27:e14006. [PMID: 38497286 PMCID: PMC10945392 DOI: 10.1111/hex.14006] [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: 05/31/2023] [Revised: 02/06/2024] [Accepted: 02/11/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom. METHODS This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid. RESULTS Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options. CONCLUSIONS Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics. PATIENT AND PUBLIC INVOLVEMENT Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.
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Affiliation(s)
- Nadine Veerhuis
- Aged, Dementia, Health Education and Research Centre, Faculty of Science Medicine and Health, School of NursingUniversity of WollongongWollongongNew South WalesAustralia
| | - Alessandra Merizzi
- Memory Assessment and Treatment ServicePennine Care National Health Service Foundation TrustOldhamUK
- Present address:
Research Department, Centre for Socio‐Economic Research on AgingNational Institute of Health and Science on Aging (INRCA)Via Santa Margherita, 5Ancona60124Italy
| | - Stephanie Papoulias
- Memory Assessment and Treatment ServicePennine Care National Health Service Foundation TrustOldhamUK
- Present address:
Sheffield Health and Social Care NHS Foundation Trust, Fulwood HouseOld Fulwood RoadSheffieldS10 3THUK
| | - Claire Bradbury
- Memory Assessment ServiceDorset Healthcare University Foundation Trust, Alderney HospitalPooleUK
| | - Kathy Sheret
- Memory Assessment ServiceDorset Healthcare University Foundation Trust, Alderney HospitalPooleUK
| | - Victoria Traynor
- Aged, Dementia, Health Education and Research Centre, Faculty of Science Medicine and Health, School of NursingUniversity of WollongongWollongongNew South WalesAustralia
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Stasiulis E, Tymianski D, Byszewski A, Gélinas I, Naglie G, Rapoport MJ, Vrkljan B. Nurse practitioners' preferences for online learning regarding driving and dementia. J Am Assoc Nurse Pract 2023; 35:669-675. [PMID: 37159432 DOI: 10.1097/jxx.0000000000000877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023]
Abstract
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.
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Affiliation(s)
- Elaine Stasiulis
- Baycrest Health Sciences, Toronto, Ontario, Canada
- Rotman Research Institute, Toronto, Ontario, Canada
| | | | - Anna Byszewski
- University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Gary Naglie
- Baycrest Health Sciences, Toronto, Ontario, Canada
- Rotman Research Institute, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Mark J Rapoport
- University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences, Toronto, Ontario, Canada
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Camilleri L, Whitehead D. Driving Assessment for Persons with Dementia: How and when? Aging Dis 2023; 14:621-651. [PMID: 37191415 DOI: 10.14336/ad.2022.1126] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/26/2022] [Indexed: 05/17/2023] Open
Abstract
Dementia is a progressive neurodegenerative disease leading to deterioration in cognitive and physical skills. Driving is an important instrumental activity of daily living, essential for independence. However, this is a complex skill. A moving vehicle can be a dangerous tool in the hand of someone who cannot maneuver it properly. As a result, the assessment of driving capacity should be part of the management of dementia. Moreover, dementia comprises of different etiologies and stages consisting of different presentations. As a result, this study aims to identify driving behaviors common in dementia and compare different assessment methods. A literature search was conducted using the PRISMA checklist as a framework. A total of forty-four observational studies and four meta-analyses were identified. Study characteristics varied greatly with regards to methodology, population, assessments, and outcome measures used. Drivers with dementia performed generally worse than cognitively normal drivers. Poor speed maintenance, lane maintenance, difficulty managing intersections and poor response to traffic stimuli were the most common behaviors in drivers with dementia. Naturalistic driving, standardized road assessments, neuropsychological tests, participant self-rating and caregiver rating were the most common driving assessment methods used. Naturalistic driving and on-road assessments had the highest predictive accuracy. Results on other forms of assessments varied greatly. Both driving behaviors and assessments were influenced by different stages and etiologies of dementia at varying degrees. Methodology and results in available research are varied and inconsistent. As a result, better quality research is required in this field.
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Affiliation(s)
- Lara Camilleri
- Saint Vincent De Paul Long Term Care Facility, L-Ingiered Road, Luqa, Malta
| | - David Whitehead
- Department of Gerontology, University Hospital of Wales, Heath Park, Cardiff, CF14 4XW, United Kingdom
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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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Veerhuis N, Traynor V. Evaluation of an education intervention for Australian health practitioners to support people with dementia with driving decisions: A pretest-posttest survey. TRAFFIC INJURY PREVENTION 2022; 23:327-332. [PMID: 35708996 DOI: 10.1080/15389588.2022.2079121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Drivers with dementia will at some stage need to stop driving. The timing of driving retirement is informed by the advice of health practitioners, however many find this task complex and challenging as they feel unprepared or lack confidence, having limited training and education on dementia and driving. Few opportunities exist for Australian health practitioners to advance learning about dementia and driving. This study evaluated the impact of a Dementia and Driving Education Module on practitioner self-perceived knowledge, confidence, and competence in supporting people living with dementia with decisions about driving. METHODS A single group, pretest-posttest survey was conducted for this study. Health practitioners were recruited over 19 months via email and invited to attend a face-to-face dementia and driving workshop. The workshop comprised of a two-hour Dementia and Driving Education Module including seven learning activities incorporating six vignettes, five self-reflections, one case study and a paper copy of a dementia and driving decision aid. Participants completed a survey prior to, immediately after and six weeks post completion of the education module. RESULTS A total of 240 health practitioners, from over six disciplines, took part in one of eleven workshops delivered via face-to-face and online across five states of Australia. Significant increases occurred in all outcome measures of perceived knowledge, confidence and competence between baseline and immediately post-education module survey responses and between baseline and six weeks post-survey responses. CONCLUSIONS The Dementia and Driving Education Module and accompanying decision aid demonstrate an efficacious solution for a diverse range of health practitioners to enhance their knowledge, confidence, and competence in supporting people living with dementia with driving retirement decisions.
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Affiliation(s)
- Nadine Veerhuis
- Aged Dementia Health Education and Research (ADHERe), School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Victoria Traynor
- Aged Dementia Health Education and Research (ADHERe), School of Nursing, University of Wollongong, Wollongong, NSW, Australia
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Eramudugolla R, Laird M, Black AA, Cameron ID, Wood JM, Anstey KJ. Inability of the Mini-Mental State Exam (MMSE) and high-contrast visual acuity to identify unsafe drivers. ACCIDENT; ANALYSIS AND PREVENTION 2022; 168:106595. [PMID: 35247852 DOI: 10.1016/j.aap.2022.106595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 12/14/2021] [Accepted: 02/04/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND/OBJECTIVES To examine the validity of high-contrast visual acuity and the Mini-Mental State Exam (MMSE) as tools for identifying at-risk older drivers. DESIGN Prospective multi-site observational cohort study. SETTING Community sample drawn from cities of Brisbane and Canberra, Australia. PARTICIPANTS 560 licensed drivers aged 65-96 years recruited between 2013 and 2016, from the community, an optometry clinic and driver referral service. MEASUREMENTS 50-minute standardized on-road driving test conducted on a standard urban route in a dual-brake vehicle with a driver trained Occupational Therapist assessor masked to participants' cognitive, visual and medical status. RESULTS Of 560 participants who completed the on-road test, 68 (12%) were classified as unsafe. Binary logistic regression models adjusted for age, gender, site, comorbidity and driving exposure indicated that a 1-point decrease in MMSE score was associated with a 1.35 (95%CI: 1.12-1.63) increase in odds of unsafe driving, and for each line reduction in binocular visual acuity (increase of 0.1 logMAR) was associated with 1.39 (95%CI: 1.07-1.81) increased odds of unsafe driving. However, Receiver Operating Characteristic (ROC) analysis showed low discriminative power for both measures (MMSE: AUC = 0.65 (95%CI: 0.58-0.73), visual acuity: AUC = 0.65 (95%CI: 0.59-0.72)) and typical cut-offs were associated with very low sensitivity for identifying unsafe drivers (MMSE <24/30: 2%; visual acuity worse than 6/12 Snellen (logMAR >0.30): 3%). CONCLUSION The MMSE and high-contrast visual acuity tests do not reliably identify at-risk older drivers. They have extremely low sensitivity for detecting unsafe drivers, even when used together, and poor prognostic properties relative to validated screening instruments that measure cognitive, vision and sensorimotor functions relevant to driving. Clinicians should select alternate validated driver screening tools where possible.
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Affiliation(s)
- Ranmalee Eramudugolla
- School of Psychology, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Morgan Laird
- School of Psychology, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia
| | - Alex A Black
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, Australia
| | - Joanne M Wood
- Centre for Vision and Eye Research, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Kaarin J Anstey
- School of Psychology, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; UNSW Ageing Futures Institute, University of New South Wales, Sydney, Australia.
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Spargo C, Laver K, Adey-Wakeling Z, Berndt A, George S. Mild cognitive impairment and fitness to drive: An audit of practice in a driving specialist clinic in Australia. Australas J Ageing 2021; 41:282-292. [PMID: 34939739 DOI: 10.1111/ajag.13024] [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: 03/26/2021] [Revised: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe current practice and outcomes relating to fitness to drive for people with mild cognitive impairment (MCI) attending a specialist driving clinic. METHODS Retrospective medical record audit from a driving fitness assessment clinic at a tertiary medical centre, South Australia, from 2015 to 2019. RESULTS Of 100 notes audited, n = 40 had a documented diagnosis of MCI and n = 60 had subjective cognitive concerns characteristic of MCI. Participants mean age was 80.0 years (SD 6.7), and mean Mini-Mental State Examination score was 26.1 (SD 2.1). Medical practitioners completed a comprehensive initial assessment relating to medical fitness to drive, considering scores from a cognitive assessment battery and non-cognitive factors (driving history, current driving needs, vision, physical abilities and collateral from family). After the initial assessment, most participants (84%) were referred for a practical on-road assessment, before receiving a final driving recommendation. Over half of participants continued driving (51%), most with conditions, while 35% ceased driving. Outcomes for the remaining 14% are unknown as we were unable to determine whether the practical assessment (11%) or lessons (3%) were completed. CONCLUSIONS Driving outcomes for people with MCI with questionable driving capabilities are variable, with both cognitive and non-cognitive factors important in guiding medical fitness to drive recommendations. There is a need for more driving clinics to provide in-depth assessment for people with MCI who demonstrate uncertain driving capabilities and improved support for decision-making in other non-driving specialist settings.
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Affiliation(s)
- Claire Spargo
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Kate Laver
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Zoe Adey-Wakeling
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Flinders Medical Centre, Rehabilitation Aged and Palliative Care, Adelaide, South Australia, Australia
| | - Angela Berndt
- Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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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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Han Y, Jia J, Li X, Lv Y, Sun X, Wang S, Wang Y, Wang Z, Zhang J, Zhou J, Zhou Y. Expert Consensus on the Care and Management of Patients with Cognitive Impairment in China. Neurosci Bull 2019; 36:307-320. [PMID: 31792911 DOI: 10.1007/s12264-019-00444-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/25/2019] [Indexed: 12/14/2022] Open
Abstract
The cognitive disease consensus was prepared by panels of health and public representatives based on actual clinical practice in Geriatric Departments in Chinese hospitals and a systematic literature review. This consensus reflects the medical knowledge accumulated by those experts and provides information about professional medical care and advice. A multidisciplinary panel of specialists (neurologists, psychiatrists, and nursing specialists) reports an expert consensus on the medical knowledge accumulated from those experts and provides information about professional medical care and advice. The recommendations focus on the care and management of older adults with mild cognitive impairment, the objectives and methods of maintaining cognition and training, the assessments and measures of daily care for patients at different stages of dementia, the assessments and coping strategies for the behavioral and psychological symptoms of dementia, principles and suggestions for an appropriate living environment, arrangements for recreational activities, the care and management of patients with end-stage dementia, and suggestions for addressing stress in caregivers.
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Affiliation(s)
| | - Yuliang Han
- The 305 Hospital of People's Liberation Army, Beijing, 100017, China
| | - Jianjun Jia
- The Second Medical Center, People's Liberation Army (PLA) General Hospital, Beijing, 100853, China.
| | - Xia Li
- Shanghai Mental Health Center, Shanghai JiaoTong University School of Medicine, Shanghai, 200030, China
| | - Yang Lv
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, 630014, China
| | - Xuan Sun
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Shanshan Wang
- The Second Medical Center, PLA General Hospital, Beijing, 100853, China
| | - Yongjun Wang
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Zhiwen Wang
- Peking University School of Nursing, Beijing, 100191, China
| | - Jintao Zhang
- The 960th Hospital of People's Liberation Army, Taian, 271000, China
| | - Jiong Zhou
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuying Zhou
- HuanHu Hospital of Nankai University, Tianjin, 300350, China
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