Aim. To synthesise primary research exploring decision making practices used to determine the time to retire from driving for individuals living with a dementia. Background. Driving requires complex cognitive and physical skills potentially compromised due to the progressive nature of dementia. Whilst on-road assessments are considered reliable indicators of driving capacity by clinicians, drivers with dementia disagree. Design. Integrative literature review informed by Whittemore & Knafl (2005). Data sources. Electronic database search of Medline, CINAHL, Web of Science, Google Scholar 1997-2012; and incremental hand search. Review methods. Primary studies published in peer reviewed journals were appraised against quality assessment criteria using CASP methodological assessment tools. Results. A total of 43 studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. Six themes emerged: (i) dementia may compromise the complex task of driving; (ii) defining onset and severity of dementia is problematic; (iii) symptom progression impacts on driving skills; (iv) assessment of fitness to drive remains subjective; (v) some drivers are reluctant to accept negative assessment outcomes; and (vi) the search for effective strategies to enhance acceptance of driver retirement continues. Conclusion. This integrative literature review identified a large body of knowledge exploring the issues of driving cessation for drivers with dementia. However a challenge remains for practitioners, drivers and their family carers regarding how best to address this highly emotive issue. Findings could inform a structured approach to address this sensitive topic in a timely manner.

Background/aim Engagement in meaningful occupation, including paid work is considered an important determinant of health, impacted by injury or illness. Dementia is one neurodegenerative syndrome with potential to compromise capacity for remaining engaged in paid employment. In response to ‘ageing’ populations globally, policy shifts within developed economies are increasing workforce participation for those over 45 years and eligibility ages for retirement pensions. Dementia onset is not limited to ‘older age’, consequently an increased impact of dementia is likely for both older workers and those experiencing younger onset dementia. Therefore, identifying and addressing workforce participation issues confronting people with dementia is becoming increasingly important for occupational therapy practice. Method This scoping review draws on peer reviewed literature to explore the impact of dementia on workers across the three domains of occupational engagement: occupational competence; occupational participation; and occupational identity using the Model of Human Occupation (MOHO). International studies published in English including full‐text translations between 2000 and 2017 were identified from an incremental search of electronic databases (Web of Science; Scopus; Proquest; MEDLINE; CINAHL; and Health Business Elite) and hand searched reference lists. Results Six relevant papers were identified and retained for analysis, all reporting qualitative studies. Data were collated under the three domains of occupational engagement and further organised into emergent subcategories. While evidence was limited, person‐centred approaches addressing dementia‐related changes in occupational competence; workforce participation choices; and redefinition of occupational identity may mitigate negative experiences associated with transitioning from paid worker roles. Conclusion There is a significant need for further research exploring the impact of dementia on engagement in paid work. Occupational therapists have an important part to play in enabling access to person‐centred interventions that promote continued engagement in meaningful occupational roles, including opportunities to extend workforce participation and engage in supported transitions to retirement.

No abstract

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.