“The biggest problem we’ve ever had to face”: how families manage driving cessation with people with dementia

Abstract

The continuum of family dynamics experienced during driving cessation may help clinicians better understand and respond to complex family needs. Interventions should be tailored to families' distinctive needs with consideration of their unique contextual factors influencing dynamics, to provide sensitive and responsive support for families managing driving cessation.

A Difficult Journey: Reflections on Driving and Driving Cessation From a Team of Clinical Researchers

“…Older people may be defensive and feel misjudged and scrutinized if family members or friends comment on their driving skills (Betz et al, 2015;Liddle et al, 2016). We have found this to be the case, particularly when family members know of our research focus on older drivers.…”

“…The assumption was that people would be either safe or unsafe to drive, and if unsafe, would be told so, and would then permanently stop. She had not anticipated how many people voluntarily stopped with no testing or intervention, even if they were safe to continue driving, nor fully appreciated the vast difficulties associated with driving cessation, including unlicensed driving and family conflict (Choi, Mezuk, & Rebok, 2012;Liddle, Hayes, Gustafsson, & Fleming, 2014;Liddle et al, 2016). Another team member experienced frustration and deep sadness when repeated advice to a client's GP that poor testing results on cognitive assessments (particularly impaired frontal functioning which called his driving ability into question) was ignored.…”

“…Another key role for family members is providing alternative transport during interruptions or permanent cessation of driving (Johnson, 1998;Liddle et al, 2016). This is the most common alternative to driving and is generally regarded as accessible and acceptable to retired drivers particularly for important travel (Coughlin, 2001;Logan, Dyas, & Gladman, 2004), especially if the family member is living with them.…”

“…This is the most common alternative to driving and is generally regarded as accessible and acceptable to retired drivers particularly for important travel (Coughlin, 2001;Logan, Dyas, & Gladman, 2004), especially if the family member is living with them. Some research notes that there can be considerable conflict related to driving someone who has unwillingly transitioned to being a passenger (Liddle et al, 2016). There can also be substantial burden related to the provision of transport for a nondriver, especially if travel patterns and destinations are not shared (Liang, Gustafsson, Liddle, & Fleming, 2015).…”

“…The issue of driving and driving cessation is an extremely challenging aspect of aging for many older people, their families, and their health teams (Betz, Scott, Jones, & DiGuiseppi, 2015;Liddle et al, 2016;Organisation for Economic Cooperation and Development, 2001). Road crash statistics indicate a complex situation where changing driving abilities, combined with increasing physical frailty, and vehicles and a built environment which are not optimized for older people, lead to an increasing road toll (Cicchino, 2015;Koppel, Bohensky, Langford, & Taranto, 2011).…”