CarFreeMe™-Dementia: Potential Benefits of a Driving Retirement Intervention Supporting Persons With Dementia and Their Families.

Background and Objectives: Driving retirement can be a necessary but challenging and emotionally complex transition, especially for people living with dementia. This pilot study evaluated the utility of CarFreeMe™-Dementia (CFM™-D), a telehealth intervention providing tailored education and social support to those living with dementia and their care partners, as they prepare for or adjust to driving retirement. Delivered by empathetic health professionals, CFM™-D is a person-centric, flexible program tailored to address challenges specific to the participants' driving retirement stage and individualized contexts. Research Design and Methods: A single-arm, mixed-methods design was used to follow participants over a 6-month period. Participants received CFM™-D, a 7-8-module semistructured intervention, including education and planning support for driving retirement (impact of dementia, transportation options) and emotional adjustment (grief and loss, stress management). Surveys evaluated the perceived utility of intervention components as well as changes in well-being and readiness for driving retirement over time. An open-ended survey item and semistructured interviews provided additional feedback and a contextual understanding of the empirical data. Results: A total of 50 families enrolled (17 care partners, 16 retiring/retired drivers with memory loss, and 17 care partner-retiring/retired driver dyads). Nearly all participants would recommend the intervention. Care partners reported significantly reduced (p < .05) isolation and relationship strain, and retiring drivers reported significant reductions in depressive symptoms. Driving retirement preparedness scores improved. Driving retirement phase, enrolling as a dyad, and retiring driver cognitive/functional impairment were associated with these outcomes. Participants also engaged in more driving retirement activities outside of the intervention (e.g., talking with health professionals). Discussion and Implications: CFM™-D is a useful intervention for retiring drivers with dementia and their family members, with preliminary data suggesting it supports improved well-being and driving retirement preparedness. A randomized controlled trial is needed to determine the efficacy of the CFM™-D intervention and future translation needs.

A qualitative study exploring the experiences and needs of people living with young onset dementia related to driving cessation: 'It's like you get your legs cut off'.

BACKGROUND: driving disruptions have significant impact on individuals living with dementia, their care partners and family members. Previous studies show that for older people with dementia, stopping driving is one of the hardest things that they cope with. To date, no studies exist that address the expressed needs and experiences of people living with young onset dementia (YOD) who are adjusting to life without driving, whose needs are not well understood and whose needs might be expected to differ from those of older people with dementia. METHODS: a multi-perspective, qualitative descriptive phenomenological approach was undertaken. A topic guide was developed in consultation with lived experience experts. In-depth interviews (n = 18) with 10 people with YOD and eight family caregivers were conducted, to elicit lived experiences in relation to changing and cessation of driving. Interviews were recorded and transcribed verbatim. Data were analysed using a hybrid approach, employing deductive and inductive coding. RESULTS: core findings reflected the impact and coping strategies employed by people with YOD and their care partners across four themes: (i) losses and burdens, (ii) the unique challenges of YOD, (iii) coping and adjustment and (iv) how to meet needs. CONCLUSIONS: driving disruptions often come at a time when people living with YOD are likely to have significant financial and family commitments, or they/their partners may be employed or raising a family, negatively impacting individual's roles and self-identities. Intervention to support emotional and practical adjustment and reduce social isolation is essential for coping.

3-Domains screening toolkit for medical assessment of older drivers: Feasibility study in Australian general practice.

BACKGROUND AND OBJECTIVES: Some general practitioners (GPs) find the older driver medical assessment challenging, citing clinical uncertainty and concerns about communicating the need for further testing or driving cessation while maintaining a trusting therapeutic relationship. A screening toolkit could help support GP decision making and communication about fitness to drive. The aim of this study was to investigate the feasibility, acceptability and utility of the 3-Domains screening toolkit for the medical assessment of older drivers in Australian general practice. METHOD: A prospective mixed-methods study was conducted in nine general practices in south-east Queensland. Participants were older drivers (age ≥75 years) attending annual driving licence medical assessment, GPs and practice nurses. The 3-Domains toolkit comprises three screening tests (Snellen chart visual acuity, functional reach, road signs recognition). We evaluated the feasibility, acceptability and utility of the toolkit. RESULTS: Practices used the toolkit in 43 older driver medical assessments (age 75-93 years; combined predictive score 13-96%). Twenty-two semistructured interviews were conducted. Older drivers felt reassured by the thorough assessment. GPs said the toolkit fitted into practice workflows, informed clinical judgement and supported conversations about fitness to drive while preserving therapeutic relationships. DISCUSSION: The 3-Domains screening toolkit is feasible, acceptable and useful for the medical assessment of older drivers in Australian general practice.

Does Context Count? The Association Between Quality of Care and Job Characteristics in Residential Aged Care and Hospital Settings: A Systematic Review and Meta-Analysis.

BACKGROUND AND OBJECTIVES: Within residential aged care settings, reduced quality of care (QoC), abuse, and neglect have been global phenomena which require urgent intervention. As the reported rate of these problems is much higher in aged care compared to hospital settings, we investigated whether differing job design characteristics between the 2 settings might explain the difference. RESEARCH DESIGN AND METHODS: We used a meta-analysis to compare differences in the relationships between high job demands, low job resources, and job strain with QoC and counterproductive work behaviors (CWBs) across aged care and hospital settings. RESULTS: Data were extracted from 42 studies (n = 55 effects). QoC was negatively correlated with high job demands (ρ¯ = -0.22, 95% confidence interval [CI]: -0.29, -0.15, k = 7), low job resources (ρ¯ = -0.40, 95% CI: -0.47, -0.32, k = 15), and job strain (ρ¯ = -0.32, 95% CI: -0.38, -0.25, k = 22), CWBs had a positive relationship with job demands (ρ¯ = 0.35, 95% CI: 0.10, 0.59, k = 3) and job strain (ρ¯ = 0.34, 95% CI: 0.13, 0.56, k = 6). The association between poor QoC and low job resources was stronger in aged care (r = -0.46, 95% CI: -0.55, -0.36, k = 8) than in hospital settings (r = -0.30, 95% CI: -0.41, -0.18, k = 7). DISCUSSION AND IMPLICATIONS: Our findings suggest that relationships between low job resources and poor QoC are exacerbated in residential aged care contexts. To improve care outcomes, stakeholders should improve job resources such as skill discretion, supervisory supports, and increased training and staffing levels in residential aged care.

Refining a Driving Retirement Program for Persons With Dementia and Their Care Partners: A Mixed Methods Evaluation of CarFreeMe™-Dementia.

OBJECTIVES: We adapted the CarFreeMe™-Dementia program created by The University of Queensland for drivers in the United States. CarFreeMe™-Dementia aims to assist drivers living with dementia and their care partners as they plan for or adjust to driving retirement. This semistructured program focuses on driving retirement education and support. Topics include how dementia affects driving, lifestyle planning, stress management, and alternative transportation options. This study evaluated the feasibility, acceptability, and utility of the CarFreeMe™-Dementia intervention. METHODS: This pilot phase of the study included 16 care partners and 11 drivers with memory loss who were preparing for or adjusting to driving retirement. Participants completed 4-8 CarFreeMe™-Dementia intervention telehealth sessions. Online surveys (baseline, 1- and 3-month) and postintervention semistructured interviews informed evaluation of the intervention program using a mixed methods approach. RESULTS: This study established initial support for CarFreeMe™-Dementia in the United States. Participants indicated the program facilitated dialogue around driving retirement and provided guidance on community engagement without driving. Respondents appreciated the program's emphasis on overall well-being, promoted through lifestyle planning and stress management. They also reported the program offered practical preparation for transitioning to driving retirement. DISCUSSION: The CarFreeMe™-Dementia intervention, tailored to an American audience, appears to be a feasible, acceptable, and useful support program for drivers with memory loss (and/or their care partners) who are preparing for or adjusting to driving retirement. Further investigations of the efficacy of the CarFreeMe™-Dementia intervention in the United States, as well as in other countries and cultural contexts, are warranted.

Exploring Psychosocial Dynamics Underpinning Driver Identity in an Older Adult Sample.

Many older adults consider driving a crucial aspect of their daily routine and the prospect of driving cessation to be disruptive to their current lifestyle. Driving cessation is associated with multiple adverse consequences, including poorer health trajectories, and increased depressive symptoms. Research suggests that driving cessation may be disruptive to identity. This study aimed to explore the characteristics that are associated with driver identity and whether identity impacted people's readiness for mobility changes. Of interest was whether stopping driving was perceived as either a positive or negative event. Participants, (N = 410) older adults recruited via Prolific survey panel between July and November 2021, responded to questions about transport and travel behaviors, driver identity, and perceptions of mobility changes. Driving cessation was generally perceived as a negative change. However, individuals with self-reported low readiness for mobility change also had higher overall scores for Identity, and for the subscales, Centrality and Ingroup Affect. These findings suggest that people with more concerns for mobility transition may think about and have more of an emotional investment regarding driving. The findings provide novel insight into the psychosocial dynamics of driving and the factors that influence driver identity, however further research, co-designed with older drivers and retired drivers is required.

Well-Being Benefits of Horticulture-Based Activities for Community Dwelling People with Dementia: A Systematic Review.

Most people living with dementia in the early-to-middle stages live in the community or in their own homes and engagement in enjoyable activities is fundamental to maintaining quality of life and autonomy. Horticulture-based activities are beneficial for the health and well-being for people living with dementia ("PLWD") in residential care settings, yet evidence within community settings, where the majority live, has not been comprehensively synthesized. A mixed studies systematic review protocol was registered and a systematic search conducted to June 2022 across MEDLINE, COCHRANE, Web of Science, Embase, Psycnet, CINAHL, PsycINFO databases, using terms relating to dementia and horticulture. Original studies examining group or individual horticulture-based programs for community-dwelling PLWD were included. Forty-five articles were selected for full review, eight met inclusion criteria and were retained for data extraction. Evidence from three mixed methods, two quantitative, two qualitative, and one case study design, involving a total of 178 community dwelling PLWD, was narratively summarized. Findings revealed that involvement in horticulture-based activities led to positive impacts on engagement, social interactions, and mental and physical well-being in PLWD. No conclusive evidence was found from included studies for improvement in cognitive function. As most studies to date have concentrated on PLWD in long-term care settings, future research should evaluate the effect of these types of activities in a more rigorous intervention design in community settings.

Making Meaning of Integrated Care during a Pandemic: Learning from Older Adults.

OBJECTIVES: The aim of the current study was to investigate meaning-making in 57 older predominantly female adults (M = 72.68) required to temporarily cease attending a university-affiliated integrated care clinic in Australia with a focus on exercise and well-being due to COVID-19 restrictions, specifically regarding consequential grief, loss, hopelessness, and loss of purpose. METHODS: Quantitative and qualitative data were collected by telephone interviews and an online survey. RESULTS: Results indicated that most participants valued attending the Clinic, and experienced a number of physical, social and emotional benefits from attending, including a sense of meaning. Specifically, some participants developed social connections, learned to cope more effectively with mental health conditions, and regained strength following stressful or traumatic events through their attendance at the clinic. CONCLUSIONS: Throughout the pandemic, most participants retained their resilience and continued to derive meaning from various sources, including their families, careers, interests, and attitude toward life. CLINICAL IMPLICATIONS: Older adults may experience enhanced physical, emotional and social health from engaging in community-based programs focused on exercise and overall wellness. Furthermore, meaning-making has the potential to buffer the harmful effects of stress and traumatic events on the physical, emotional and social health of older adults.

Positive Aspects of Dementia Caregiving During the COVID-19 Pandemic.

OBJECTIVES: This project investigated experiences of caregivers of people living with dementia during COVID-19. We recorded caregivers' perceptions of care before, during, and moving forward from COVID-19, emphasizing positive experiences, coping strategies, creative care adaptation, strengths demonstrated, and benefits of providing care. METHODS: Allied health professionals conducted semi-structured interviews with 26 informal caregivers of people living with dementia. We categorized and thematically analyzed responses as before, during or moving forward from COVID-19. RESULTS: A range of themes were derived from the data. Pre-pandemic care: (1) focusing on the person living with dementia and (2) working together. During-pandemic care: (1) respecting personhood; (2) connecting with virtues and values; (3) improving relationships; (4) seeking and receiving support; (5) prioritizing self-care; (6) being protective and proactive; (7) making practical changes. Moving forward from COVID-19: (1) strengthening commitment to the person living with dementia, (2) looking after my own needs, and (3) considering practical requirements. CONCLUSIONS: Participants reported positive caregiving experiences in all timeframes, focusing more on their own needs and experiences during and moving forward from COVID-19. This research may highlight informal caregivers' challenges and needs. CLINICAL IMPLICATIONS: Enforced isolation produced deeper connections for some caregivers. Caregivers benefit from resources facilitating adaptive care.

Positive aging benefits of home and community gardening activities: Older adults report enhanced self-esteem, productive endeavours, social engagement and exercise.

OBJECTIVES: This study examined relationships between home and community gardening and older adults' self-reported psychosocial and physical well-being, attitudes to aging relative to gardening activities and benefits of membership to a gardening group. METHODS: A survey addressing (a) demographic characteristics, (b) gardening interests and sentiments, (c) activities, (d) benefits, (e) self-rated health and quality of life and (f) attitudes to aging was administered online and via mail-out. RESULTS: Participants, 331 gardeners aged 60-95 years from Australia, reported numerous benefits from leisure gardening. According to multiple regression analysis, Restoration and Physical benefits were the strongest explanatory variables of participants' positive aging self-perceptions. Members of gardening groups reported significantly more social and physical benefits than non-members. CONCLUSION: The current study provides support for promoting positive aging through gardening. Regardless of 'doing' gardening or simply 'being' in the garden, having contact with nature was key to attaining positive therapeutic benefits for this sample.

How medical professional students view older people with dementia: Implications for education and practice.

BACKGROUND: Healthcare professionals' attitudes to older people, and especially those living with dementia, may contribute to unsatisfactory healthcare. Despite repeated calls to address increasing need, training an adequate geriatric workforce remains an international concern. Of particular concern are the attitudes and knowledge healthcare workers may hold about people living with dementia. Students' knowledge of dementia has been found to be low at the beginning of their university education and has shown limited improvement throughout their coursework; greater understanding of students' attitudes to ageing and dementia, upon entry and throughout their degrees, may help inform targeted educational interventions to improve the healthcare delivered to older people. METHODS: This study measured knowledge of and attitudes toward dementia and ageing in an Australian university student sample (n = 183), comparing students from medical professional versus non-medical professional related fields at both undergraduate and postgraduate levels. We examined diagnostic and prognostic biases through age manipulation of a vignette describing a hypothetical patient (aged 42 or 72 years), who was experiencing symptoms that were consistent with DSM-5 criteria for both dementia and depression. Based on information provided in the vignette, student participants were asked to select a primary disorder that they would assign to the patient. RESULTS: Showed that while medical professional students held significantly more positive attitudes toward ageing than 'other' students, average attitudinal scores indicated neutrality. Medical professional students indicated a diagnostic bias toward the older vignette patient, who was more likely to be diagnosed with dementia than depression. A history of geriatric-specific training did not predict dementia knowledge; however, having prior contact with people with dementia predicted both dementia knowledge and more positive prognoses. CONCLUSIONS: Overall, findings indicated medical professional students held neutral attitudes towards older people and showed deficits in knowledge of dementia. Educational interventions that introduce students to people living with dementia may improve knowledge, skills, and attitudes. All university students would benefit from education about dementia and inclusivity to reduce stereotyping and stigma.

Nonpharmacological Interventions for Anxiety and Dementia in Nursing Homes: A Systematic Review.

Anxiety is a major mental disorder in later life that impacts on activities of daily living and quality of life for adults living with dementia in nursing homes. The aim of this article was to systematically review nonpharmacological interventions for older adults living in nursing homes who experience comorbid anxiety and dementia. METHOD: A systematic literature search was conducted across key databases (Cinahl, ASSIA, Cochrane reviews and trials, psycARTICLES, psycINFO, and PubMed) to identify studies measuring anxiety as an outcome for an intervention for older adults living with dementia in nursing homes, up to December 31, 2017. RESULTS: The search yielded a total of 1,925 articles with 45 articles accessed for full article review. A total of 13 articles were included in this review following quality appraisal based on Cochrane methodology with six different anxiety measures used. The studies included were moderate to high-quality randomized control trials although heterogeneity precluded a combined meta-analysis. CLINICAL IMPLICATIONS: The most common interventions used to address anxiety in this population were music therapy and activity-based interventions although there was limited evidence for the efficacy of either intervention. Little is known about effective nonpharmacological treatment for anxiety for people living with dementia in nursing homes. Further research using consistent measurement tools and time points is required to identify effective interventions to improve the quality of life for people living with both dementia and anxiety in nursing homes.

Multisensory installations in residential aged-care facilities: increasing novelty and encouraging social engagement through modest environmental changes.

The current study examined the effect of an indoor simulated garden installation that included visual, auditory, and olfactory stimuli on resident well-being, compared to the effect elicited by a reminiscence installation and a control no-installation condition. A quasi-experimental ABA design was used (i.e., two intervention conditions plus a wait-list control condition). A survey instrument was administered to nursing home residents (N = 33) at three time points (pre-, during, and post intervention) over an 8-week period, which measured mood, behavior, health, and social interaction. Additionally, staff reports (N = 24) were collected. Both the nature-based and non-nature-based installations led to enhanced well-being and significantly more social benefits for residents because of their novel and aesthetic appeal, compared with the control condition. Residents in the nature-based installation condition reported more satisfaction with their living environment during the intervention phase than those in the comparison conditions. The results show that an indoor garden simulation is a relatively inexpensive way to transform a disused indoor area of an aged-care facility for the benefit of residents and staff.