Catherine AndrewOccupational Therapist, University of Wollongong

Associate Professor Victoria TraynorSchool of Nursing, Midwifery and Indigenous Health

Pro-Vice-Chancellor (Health) Professor Don IversonVice Chancellor’s Unit University of Wollongong

Mapping a road to driving retirement with the driver who has a diagnosis of dementia:

Enhancing acceptance of the difficult decisions.

Background

Risks identifie

d•Concerns regarding driver safety

initiate need to seek medical advice

Assessment •Medical practitioner initiates referral

for assessment of fitness to drive

Licence review

•Assessment is conducted to (i) determine fitness to drive; (ii) quantify any restrictions; or (iii) recommend licence cancellation

Review of the Literature1 Driving is a complex task that can be compromised by dementia

2 Onset and severity of dementia are difficult to define

3 Dementia is progressive and impacts on driving skills

4 Assessment of fitness to drive remains subjective

5 Some drivers with dementia are reluctant to accept negative assessment outcomes

6 The search continues for most effective means of preparingdrivers with dementia for accepting driver retirement

Theoretical Framework: Ottawa Decision Support Framework

O'Conner and Jacobsen, 2007

Stage 1• Assessment and identification of decisional

support needs

Stage 2• Provision of decisional support tailored to patient

needs

Stage 3• Evaluation of the decision-making process and

outcomes

Research Aims and ObjectivesAim: This study sought to identify decisional

support needs to inform strategies for enhancing acceptance of driving retirement for drivers with dementia.

Objectives:(i) Review existing educational literature(ii) Identify the type of evidence drivers

consider objective

Method: A qualitative study

•Cross-state community study of current drivers (n=15) over 55 years who identified as : (i) having a dementia (n=2) ; or (ii) having no known cognitive impairment (n=13).

Setting and

sample•Unstructured interviews (one to one and

group)Data collecti

on

•Thematic analysis (using n-vivo to manage data)Data analysi

s

Findings: Five Themes

Mapping a road to driving retirement

1 Whose opinion will I accept as trustworthy?

2 Real on road experiences are most convincing .

3 Let's discuss this before my judgement is compromised.

4 Would knowing my alternatives influence my decision?

5 Informative resources that include checklists are useful.

1. Whose opinion will I accept as trustworthy?

(Int2, P13, p. 12)

The relationship

is a very important

factor

2. Real on road experiences are most convincing.I think the

clues might be when

you’re driving

(Int1, P004, p. 5)

3. Let's discuss this before my judgement is compromised

(Int1, P005, p. 4)

If you see the signs …say to

me, ‘You’re not safe to drive’.…

4. Would knowing my alternatives influence my decision ?

….it would be more of a psychological

loss than a real loss of ability to go

places…

(Int1, P001, p. 2)

Would knowing my alternatives

increase acceptance ?

Noyes

YesPerceived barriers are explicit and can be resolved with practical solutions

Explore self efficacy theory

(Bandura 1986)

I have always been a good driver….I love to drive….I don’t like buses….I need to be independent…

No

Perceived barriers are less tangible and potential solutions are not considered. acceptable

Maybe

Implications for practiceRisks identifiedEarly discussionObjective evidenceChoose to be assessed or retireAccept Cancellation or Challenge decisionRetirement or cancellation

• These Findings have implications for those health practitioners providing support to people with dementia making decisions about driving retirement.

Risks identified

Early discussion

Objective evidence

Choose to be assessed or retire

Accept Cancellation or Challenge decision

Retirement or cancellation

Implications for OT practice

These findings have implications for health practitioners

This study contributes important empirical knowledge informed by consumers and potential consumers.

Further quantitative research is underway (Carmody et al., 2012)

Where to from here? Stage 1 assess

Stage 2 develop

Stage 3 evaluate

ConclusionRetirement from driving can be enhanced for people with dementia by including:

views of trusted sources feedback from real on road

experiences early discussion identification of suitable alternatives relevant, concise and informative

resources

References Bandura, A 1986, Social foundations of thought and action : A

social cognitive theory Englewood Cliffs, New Jersey, Prentice-Hall.

Carmody, J, Traynor, V & Iverson, D 2012, ‘Dementia and driving: An approach for general practice’, Australian Family Physician, vol. 41, no.4, pp. 230-3.

O'Conner AM & Jacobsen MJ 2007, ‘Decisional conflict: supporting people experiencing uncertainty about options affecting their health’, Ottawa Health Research Institute, Ottawa (available at http://decisionaid.ohri.ca/odsf.htm, accessed August 2008)

O'Conner, A, Jacobsen, M & Stacey, D 2002, ‘An evidence-based approach to managing women's decisional conflict’, Journal of Obstetric, Gyneologic & Neonatal Nursing, vol. 31, no.5, pp. 570-581.

Acknowledgement of visual imageshttp://images.smh.com.au/2012/06/26/3407005/ipa

d-art-wide-cbd2-420x0.jpghttp://rac.com.au/Travel/~/media/Travel/TravelVario

us/Jan11_IDPLandingPage.ashxhttp://resources0.news.com.au/images/2012/08/03/

1226442/458136-old-man-driving-a-car.jpghttp://www.alphacarhire.com.au/images/articles/driv

er-liscence.jpghttp://rac.com.au/Motoring/Driving-centre/Driving-c

ourses/Defensive-driving/~/media/Motoring/driving_centre/Banner_Driving_Enhancement.ashx

http://www.umtri.umich.edu/content/FP_Winter_driver.jpg