Australian occupational therapists' perspectives about the management of driving safety concerns for older people with dementia and mild cognitive impairment

Introduction

Driving safety may be compromised in people with dementia or mild cognitive impairment (MCI). Occupational therapists assess and screen for driving safety in older people with cognitive impairment. However, little is known about their perspectives relating to these assessments. Aims included to (1) obtain perspectives from driver-trained and non-driver-trained occupational therapists about the management of driving safety concerns for older people with dementia and MCI; (2) understand factors influencing clinician's behaviour relating to driving assessment; and (3) gain perspectives regarding resources to support fitness-to-drive assessment.

Methods

Semi-structured interviews were conducted with occupational therapists recruited from driving assessment services, hospitals, and community settings in Australia. Data were analysed inductively using content analysis, followed by a deductive approach with two authors mapping subcategories to the domains of the Theoretical Domains Framework and Capability, Opportunity and Motivation-Behaviour model.

Consumer and community involvement

No consumers were involved in the design or study analysis.

Findings

Participants (n = 17) reported inconsistencies in how the fitness-to-drive assessment is managed, with driving safety concerns often missed or avoided. Perceived barriers to fitness-to-drive assessment included: (i) clinician's capabilities: limited knowledge about fitness-to-drive assessment, and difficulties having complex discussions with patients with cognitive impairment; (ii) motivational factors: lack of confidence, fear of damaging therapeutic relationship with patients, and desire to maintain a sense of professional identity; and (iii) environmental factors: lack of processes to support health professionals with identifying cognitive concerns, lack of clarity of who takes responsibility for managing driving safety concerns, time constraints for completing in-office assessments and limited access to practical occupational therapy driving assessments. Participants expressed a desire for an evidence-based clinical pathway to improve the knowledge and communication skills of clinicians from non-driving specialist settings.

Conclusion

Findings identify the need for an evidence-based pathway to support health professionals in managing driving safety concerns for people with dementia and MCI.

PLAIN LANGUAGE SUMMARY

Dementia and mild cognitive impairment (MCI) are brain conditions involving difficulty with memory and thinking, with dementia diagnosed when the changes are more severe. These conditions are not a normal part of getting older, but they are much more common in older people. Research has found that some, but not all, people with dementia and MCI show unsafe driving behaviours. As people with dementia and MCI are often unaware that their driving is unsafe, health professionals, such as doctors and occupational therapists, should be involved in deciding if, or when, they should stop driving. In this study, occupational therapists were asked to provide their opinions about how driving safety concerns for older people with dementia and MCI are managed by health professionals. Occupational therapists reported that there is variation in how concerns are managed, with driving problems often getting missed or avoided. They reported that this can happen because health professionals may not feel confident in their decision-making abilities, or they may feel that discussing driving concerns will cause the person to get upset or angry with them. They also reported that health professionals may not always know that a person has dementia or MCI, and if they do know, it is not always clear which health professional should take on the responsibility of considering the person's driving safety. The occupational therapists wanted a resource to support health professionals in providing more consistent care for patients relating to driving safety.