An integrative review: understanding driving retirement decisions for individuals living with a dementia

Abstract

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.

Keywords: assessment; care pathways; decision-making; dementia; ethics; nurses; nursing; patient participation.