'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid.

BACKGROUND: Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom. METHODS: This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid. RESULTS: Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options. CONCLUSIONS: Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics. PATIENT AND PUBLIC INVOLVEMENT: Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.

"The Challenge is Not to Make Her Feel Old and Bad": Exploring Australian Family Member Experiences of Conversations About Driving With Older Adults Using an Online Survey.

This study explored the experiences of Australian family members having conversations about driving with older adults. An exploratory cross-sectional design using an online survey was carried out with Australian family members of current or retired (former) older drivers. One hundred and fifty-six intergenerational family members across Australia completed the survey. Qualitative content analysis of free-text responses identified that the outcomes of conversations were impacted by a range of environmental and individual factors. The essence of conversations centered around two opposing (positive and negative) discourses. The findings highlighted that an individualized approach to the content of conversations is required due to; driver attributes and actions, variations in the level of support experienced by family members, differences in physical and cognitive declines with age, negative perceptions on the impact of driving retirement, and absence of acceptable alternatives to driving. We recommend using positive discourse and reappraisal techniques when initiating driving conversations with older adults.

"I don't trust it, so I don't read it": How do older Australians navigate and search for information about their health and driving?

OBJECTIVES: Driving is pivotal to successful aging, yet older people may need to adapt their driving to changes associated with aging or transition to driving retirement at some stage. However, most older people are reluctant to discuss or plan for changes to their future mobility. This study describes formative research to inform a social marketing campaign to promote the "DRIVING AND STAYING INDEPENDENT" resource assisting older drivers to make informed decisions about timely changes to their driving. METHODS: Semi-structured interviews were conducted with 16 drivers aged between 67 and 84 years living in the state of NSW, Australia. A discussion guide based on social marketing principles was used to explore the perspectives and experiences of older drivers seeking health and driving information. Thematic analysis was conducted on the interview data. RESULTS: Succinct, clear messages with a clear call to action were identified as essential features of social marketing campaigns targeting older drivers. Realistic portrayals of older people in marketing material are important in engaging the audience. Older drivers preferred positive messages that emphasize the relevance of the product to them. Trusted and reputable sources were of utmost importance when seeking health and driving information. Traditional channels such as TV and radio remain the dominant media consumed by the older participants, however, digital resources are being used increasingly. CONCLUSIONS: This study provides important insights for an evidence-based social marketing campaign promoting the "DRIVING AND STAYING INDEPENDENT" resource to older drivers. The findings add to the limited literature on campaigns targeting older adults and may prove valuable for promoting other issues relevant to older adults. Campaigns targeting older drivers should consider selecting clear messages, demonstrating relevance to the audience, using trustworthy sources and selecting channels used by older adults.

Having the conversation about vision for safe driving with older adults: an exploratory study of eyecare professional experiences in England and Australia.

CLINICAL RELEVANCE: Eyecare professionals assess older adults against the vision requirements for driving and discuss this with them on a regular basis. Improved access to resources/training would be beneficial and help eyecare professionals navigate more difficult conversations about driving, e.g., following acute vision changes. BACKGROUND: The numbers of drivers aged >65 years is increasing in many countries, in line with ageing populations. In most countries the onus is on the driver to self-monitor their vision for driving, by engaging in regular eye tests. Eyecare professionals therefore could play an important role in older driver decision-making about their fitness to drive. There is limited guidance for eyecare professionals regarding how to approach conversations with older drivers about their vision, and when these conversations should be had. METHODS: Semi-structured interviews were undertaken with eyecare professionals involved in vision assessments and decision-making about medical fitness to drive for older adults (optometrists, orthoptists, ophthalmologists). Framework analysis identified challenges and facilitators to conversations with older drivers about vision. RESULTS: Twenty-six eyecare professionals from Australia (n = 17) and England (n = 9) participated from urban and regional/rural areas. Themes were divided into facilitators (clear standards and comprehensive testing; positive approach; preparation and patient self-awareness; relationships and trust; importance of multiple options in guiding a transition to driving retirement) and challenges (acute loss of visual function; limited self-awareness of the impact of visual problems on driving; and perceived lack of resources and need for training). CONCLUSIONS: Eyecare professionals prefer to have early and regular conversations with older adults about their vision for driving. Acute visual field/acuity loss or onset of double vision, necessitating rapid changes to driving behaviour, were both identified as major challenges for eyecare professionals. Improved access to resources and training would be beneficial, to help eyecare professionals navigate these especially difficult conversations and signpost older drivers to appropriate support.

Evaluation of an education intervention for Australian health practitioners to support people with dementia with driving decisions: A pretest-posttest survey.

OBJECTIVE: Drivers with dementia will at some stage need to stop driving. The timing of driving retirement is informed by the advice of health practitioners, however many find this task complex and challenging as they feel unprepared or lack confidence, having limited training and education on dementia and driving. Few opportunities exist for Australian health practitioners to advance learning about dementia and driving. This study evaluated the impact of a Dementia and Driving Education Module on practitioner self-perceived knowledge, confidence, and competence in supporting people living with dementia with decisions about driving. METHODS: A single group, pretest-posttest survey was conducted for this study. Health practitioners were recruited over 19 months via email and invited to attend a face-to-face dementia and driving workshop. The workshop comprised of a two-hour Dementia and Driving Education Module including seven learning activities incorporating six vignettes, five self-reflections, one case study and a paper copy of a dementia and driving decision aid. Participants completed a survey prior to, immediately after and six weeks post completion of the education module. RESULTS: A total of 240 health practitioners, from over six disciplines, took part in one of eleven workshops delivered via face-to-face and online across five states of Australia. Significant increases occurred in all outcome measures of perceived knowledge, confidence and competence between baseline and immediately post-education module survey responses and between baseline and six weeks post-survey responses. CONCLUSIONS: The Dementia and Driving Education Module and accompanying decision aid demonstrate an efficacious solution for a diverse range of health practitioners to enhance their knowledge, confidence, and competence in supporting people living with dementia with driving retirement decisions.

Driving assessments for older adult patients: Interviews with general practitioners to gauge current strategies and future directions.

BACKGROUND AND OBJECTIVES: General practitioners (GPs) in New South Wales are required to perform annual medical assessments of driving fitness in patients aged 75 years or older. The objective of this study was to understand GPs' attitudes towards driving assessments and to highlight guideline limitations and possible solutions. METHOD: Semi-structured interviews with a sample of 10 GPs were audio-recorded, transcribed and thematically analysed. RESULTS: The key themes that emerged were challenges GPs face with the current driving fitness assessment, techniques used to overcome these challenges, and the process of negotiating with patients. DISCUSSION: The findings highlighted the need for further support of GPs and for more statistical evidence of driving risks. Key areas of uncertainty were applying licence restrictions, calculating the sum of effects of comorbidities and assessment of new patients. This study might prompt consideration of a range of supports to assist GP decision making, as well as contribute to a decision aid for older drivers.

Evaluating the effects of a physical activity on agitation and wandering (PAAW) experienced by individuals living with a dementia in care homes.

AIM AND METHODS: The aim was to evaluate the implementation of a structured physical activity (PA) programme for individuals living with a dementia in care homes. More specifically, the study aimed to test the effects on the behavioural and psychological symptoms of dementia (BPSD) using the Cohen-Mansfield Agitation Inventory and Algase Wandering Scale. The study was undertaken over 16 weeks using a quasi-experimental design. Registered nurses, physiotherapists, assistants in nursing and physiotherapy aids from one aged care organisation in NSW, Australia, undertook the study with academics. RESULTS: A total of 72 individuals living with a dementia from four care homes participated. Implementation of the structured PA programme generated statistically significant findings with reductions in agitation (p < 0.001) and eloping (p = 0.001) achieved for individuals living with a dementia in care homes. CONCLUSIONS: Physiotherapists and exercise physiologists can complement nursing-focused care teams and contribute to a holistic model of care for individuals living with dementia in care homes. The study demonstrated how a structured PA programme positively affected the levels of agitation and wandering experienced by individuals living with a dementia. Individuals living with a dementia in care homes who participated in a structured PA experienced positive outcomes from the programme. The findings demonstrated that they benefited from the programme and PA should be promoted for this group just as it is for other population groups, including general populations of older people.