Catherine Andrew Occupational Therapist, University of Wollongong Associate Professor Victoria Traynor School of Nursing, Midwifery and Indigenous Health Pro-Vice-Chancellor (Health) Professor Don Iverson Vice 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 identified 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 Literature 1 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 preparing drivers 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 Objectives Aim: 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 collection Thematic analysis (using n-vivo to manage data) Data analysis

Findings: Five Themes Mapping a road to driving retirement 1Whose opinion will I accept as trustworthy? 2Real on road experiences are most convincing. 3Let's discuss this before my judgement is compromised. 4Would knowing my alternatives influence my decision? 5Informative 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 ? No yes Yes Perceived 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… 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 practice Risks identified Early discussion Objective evidence Choose to be assessed or retire Accept Cancellation or Challenge decision Retirement 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

Conclusion Retirement 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 O'Conner AM & Jacobsen MJ 2007, ‘Decisional conflict: supporting people experiencing uncertainty about options affecting their health’, Ottawa Health Research Institute, Ottawa (available at 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

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