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Driving and Dementia

Decision Aid:

is this a useful resource for

health professionals?

Cathie Andrew (Occupational Therapist) Jan Ervan (Occupational Therapist)

Dr Victoria Traynor (Registered Nurse)

Dr John Carmody (Neurologist)

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Context of this Study

Driving and prevalence of dementia

Health

professionals’ role in decisions about fitness to drive

Translating use of DDDA into Clinical Practice (UOW & ISLHD)

2015

Developing DDDA USA Version (Global Challenges)

2014

RCT: Effect of DDDA on Decisional Conflict

(PhD**)

2013

Development and pilot testing of DDDA (UOW & RMS )

2010

Focus groups with drivers (Master of Science by Research*)

2008

Occupational Therapy Driving assessments

1989

* Andrew, 2012 ** Carmody, 2015

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Aim

To explore opinions about the Driving and Dementia Decision Aid (DDDA) as an appropriate resource for use by health professionals.

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Objectives 1. Obtain opinion from health

practitioners regarding how they support the decisional journey of drivers with dementia and their family carers in clinical practice

2. Obtain opinion from health practitioners regarding use of the tool for facilitating discussion with drivers who have a recognised dementia, about potential driving retirement

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Literature Review Driving - an important ADL (Austroads 2012)

The difficult discussion (Adler et al 2006, Liddle et al

2008, Freund et al., 2005)

A diagnosis of dementia- insufficient evidence (Perkinson et al 2005, Brown et al 2005)

Fitness to drive - case by case (Australian and New

Zealand Society for Geriatric Medicine, 2009, Molnar et al., 2006)

Myths and misinformation (Austroads 2012 , Carmody

et al 2012)

Consumer informed research (Alzheimer’s Australia

research paper 2008)

A paradigm shift (Adler 2010, O'conner & Jacobson 2007)

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Method Setting community practitioners & Sample: (n=33) Ethics: UOW & NSW Health Recruitment: via known networks Mixed method: Data Collection

i. attitude scale

ii. face to face group interviews

Data Analysis i. descriptive statistics

ii. thematic Analysis

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Findings

i. Demographic profile of participants

ii. Descriptive statistics

iii. Emergent themes

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Findings: Demographic Profile

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Findings: Descriptive Statistics Those with specialist qualifications (n=5) reported greater confidence in supporting a person with dementia regarding decisions about driving retirement 45% reported awareness of the DDDA (n=15) and 25% had used it as a clinical practice resource (n=8) 40% reported awareness of other resources (n=13) and 65% had used one or more as a clinical practice resource (n=22)

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Findings: Themes Person centred focus “I like the way it takes people through the decision making progress – it guides then through with some questions that are not threatening, it is very objective, it is easy to read and hopefully it is not threatening to someone it is about having that conversation and also I think it is a nice tool. A good stepping stone and good starting point.” (Occupational therapist)

Facilitation of purposeful discussion “It is a very useful tool for us in the community setting because we are often seeing people and they might have had a diagnosis of dementia and as a result of that Geriatrician visit they have been referred to us and we are sort of the first port of call” (Registered Nurse)

Presentation of information “It is nice it does not have any of the stereotypical comic pictures of people. It is very respectful and very professional which is good rather than being a photocopy of extra paperwork for them. They might take it more seriously to read it if it actually is a proper book.” (Occupational Therapist)

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Future Directions

• Dissemination and distribution

• Language translation (CALD)

• New York, USA project

• University of Newcastle, UK

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References Adler, G 2010, ‘Driving decision making in older adults with dementia’, Dementia: The International Journal of Social Research and Practice, vol. 9, no.1, pp. 45-60.

Adler, G, Rottunda, S, Christensen, K, Kuskowski, M A & Thuras, P 2006, ‘Driving safe: Development of a knowledge test for drivers with dementia’, Dementia, vol. 5, no.2, pp. 213-222.

Alzheimer's Australia 2008, Consumer involvement in dementia research: Paper 22, (available at http://www.alzheimers.org.au/upload/ResearchPaper, accessed October 2009)

Andrew, C, 2012, ‘Mapping a road to driving retirement with the driver who has a diagnosis of dementia: Enhancing acceptance of the difficult decisions’, Thesis collection, University of Wollongong, NSW Austroads National Road Transport Commission 2012, ‘Assessing fitness to drive for commercial and private vehicles: Medical standards for licensing and clinical management guidelines’, Sydney, NRTC. Brown, LB, Ott, BR, Papandonatos, GD, Sui, YMS, Ready, RE & Morris, JC 2005, ‘Prediction of on-road driving performance in patients with early Alzheimer's disease’, Journal of the American Geriatrics Society, vol. 53, no.1, pp. 94-98. 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. Freund, B, Colgrove, LA, Burke, BL & Mcleod, R 2005, ‘Self-rated driving performance among elderly drivers referred for driving evaluation’, Accident Analysis & Prevention, vol. 37, no.4, pp. 613-618. Jacobsen, MJ & O'Conner, AM 2006, ‘Population needs assessment workbook: Patient decisions Liddle, J, Turpin, M, Carlson, G & McKenna, K 2008, ‘The needs and experiences related to driving cessation for older people’, The British Journal of Occupational Therapy, vol. 71, no.9, pp. 379-388.

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)

Perkinson, MA, Berg-Weger, ML, Carr, DB, Meuser, TM, Palmer, JL, Buckles, VD, Powlishta, KK, Foley, DJ & Morris, JC 2005, ‘Driving and dementia of the Alzheimer type: Beliefs and cessation strategies among stakeholders’, Gerontologist, vol. 45, no.5, pp. 676-685.

Images http://smah.uow.edu.au/nursing/adhere/drivingdementia/index.html