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Mapping a road to driving retirement with the driver who has a diagnosis of dementia: Enhancing acceptance of the difficult decisions . Catherine Andrew Occupational Therapist, University of Wollongong Associate Professor Victoria Traynor School of Nursing, Midwifery and Indigenous Health - PowerPoint PPT Presentation
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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