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Still in first gear: Exploration of barriers for implementing driving cessation support

Still in first gear: Exploration of barriers for implementing driving cessation support Practice ImpactImplementation of driving cessation supports requires multifaceted approaches that consider contextual barriers as well as creative, cooperative approaches stretching across settings and systems. Such supports can mitigate the negative impact of unsupported driving cessation.INTRODUCTIONA range of health conditions may trigger driving cessation in later life. People who cease driving without support are at greater risk of premature admission to aged care, declines in both physical and mental health, negative changes to their sense of identity and their autonomy, fractured relationships with spouses and family and increased social isolation.1,2 Systematic reviews and qualitative work on the impact of driving cessation point to: the increase in risk for depression following driving cessation3; difficulties enacting driving cessation support for people living with dementia4,5; and the perceived high value of implementing individualised supportive approaches with respect to identity and emotional well‐being.6Driving cessation often follows a process guided by law and local policy in relation to driving safety and ‘medical fitness to drive’ guidelines (e.g. Austroads7). This may involve formal on‐ and off‐road assessments, medical or performance assessments, and discussion with the health‐care team, family and driver. Most people cease driving without any attempt at a supported transition to alternative forms of transport. This lack of formal support may foster avoidance of approaching the issues, be it from a family or health professional perspective.Globally, raising the issue of driving cessation is widely recognised as a difficult aspect of clinician practice with clients, families and health‐care professionals characterising this task as challenging.8 Thus, planning, support and timely cessation may be delayed or avoided because of lack of health professional confidence, or to avoid conflict. However, intervention in the lead‐up to driving cessation may change the person's trajectory towards reaffirmed autonomy and confidence in maintaining their activities and engagement.9While there are now evidenced resources to assist with driving cessation (e.g. Liddle et al.10), there is recognition that there are still considerable barriers to routine consideration of driving cessation in practice.11 In promoting consideration and use of evidenced approaches to managing driving cessation, understanding key stakeholder views is vital. In the current study, a range of health‐care implementation stakeholders' views were sought on barriers to the adoption of driving cessation intervention programs in public, private and community practice.METHODSA qualitative descriptive exploration of Australian practices and considerations with people experiencing driving cessation was undertaken. Open‐ended questions (see Appendix S1) were framed to capture workforce, clinical practice and reimbursement variables within public, private and community health‐care settings. Responses were sought through online survey forms, emails and interviews, and circulated via professional networks. Ethics approval was obtained from the Human Ethics Committee at the University of Queensland (2022/HE000495); all participants gave informed consent prior to inclusion in the study.Analysis was by inductive content analysis.12 Familiarisation with responses, consideration of responses across questions, constructing key areas reflecting practice, needs for practice and recommendations was undertaken. Initially, 12 content areas across practice approaches, across complexity of driving cessation experiences and unmet needs, barriers and enablers to changing practice were identified. Initial coding was conducted by JL and checked by NAP and AS. Key areas were synthesised through reflexive discussion of the team into six key areas—two being key understandings of driving cessation and four reflecting proposed actions to support practice.RESULTSSurveys (N > 100) were sent to members of peak allied health bodies, primary health‐care networks and public and private community outreach health services in Australia. Twenty‐nine completed surveys were analysed from participants in four states (Queensland [24], New South Wales [2], Victoria [2] and South Australia [1]), who ranged in age from 30 to 65; 86% identified as female. They reported providing clinical services to a range of areas (72% major cities, 72% regional and 21% remote; with multiple options possible) and settings (public health settings 31%; private health including private practices 38%, aged care 7%; and other, including government/not for profits 24%). Most self‐identified cross‐disciplinary roles rather than specific disciplines.Participants described how they had engaged with driving cessation‐related concerns including directly seeing clients with driving cessation needs (including unmet needs); referring clients for driving assessment; delivery of driving cessation supports; formal driving assessments, research and personal experiences. In describing their experiences and perceptions of driving cessation supports, participants identified that an understanding of driving cessation and optimal driving cessation supports was required. Key points are highlighted below.Understanding driving cessationResponses indicated that driving cessation and adjustment to it reflected a process, rather than a single event. Supports and interventions needed to consider this process, with careful timing of interventions and potential ongoing availability. Responses indicated the need to build general awareness of the issue, discuss current and future implications at key clinical times (diagnosis, assessment of performance facets or driving), obtain support when people are ready for it or as challenges arrive and iteratively improve what is currently available.Any approach will require multiple facets and playersIn highlighting the range of ways people may improve outcomes of driving cessation (from raising awareness of issues, referring for supports or directly providing support and interventions), respondents indicated a wide range of people who should be involved in driving cessation, including people who initiate driving‐related discussions or assess relevant performance components. More broadly, the entire medical, nursing and allied health team could engage with driving cessation. In some settings, this reflected current practice. Others indicated that while it was not consistently happening in current practice, health professionals engaging in discussing driving cessation should be discussing supports and initiating referrals to them accordingly.Importantly, respondents indicated the need for the driver, family, friends and the wider community to be engaged with the issue of, and supports for, driving cessation. They also indicated that within health settings the whole team, including, for example, reception staff, should be informed and engaged. Others who could be involved included licensing bodies, police, care providers, support and peer workers and case managers. Transitions in health care, cross‐organisation and funding body contexts were also raised as important considerations.Informing people about a driving cessation intervention was also perceived as necessary—from general population awareness to delivery in contexts that were accessible and acceptable to particular clients. All respondents in clinical settings indicated awareness of driving cessation interventions and willingness to refer or implement programs if they were available. However, some identified that within current funding models or parameters of service delivery, driving cessation support was not their core business, even when they could see the unmet needs.Recommended approaches for supporting implementationParticipants identified four key approaches (practices, navigation of barriers and potential solutions) to support the implementation of driving cessation support. These are summarised, along with components and example quotes, in Table 1. These included the need to consider complexity in terms of managing timing, different clinical contexts and supporting relationships and emotional responses. Participants indicated a need for knowing and showing the outcomes in terms of clearly communicating the benefits and values to different stakeholders in different formats that might resonate (e.g. statistics and stories). Importantly, where supporting adjustment to driving cessation aligned with personal, disciplinary or organisational values, this was seen as supporting implementation. The recognition of known barriers was identified with advice to address each individual issue in managing systemic barriers. These included addressing workforce issues, funding models, the effort required for initiating a new program, and supporting its continuation in practice. Finally, participants indicated the importance of not doing it alone, and instead developing processes, expertise‐based telehealth hubs, industry and community supports to work collaboratively on providing access to programs and addressing driving cessation across settings.1TABLEApproaches for supporting implementation.Core area (and description)SubcomponentsExample quotesConsidering complexityDriving cessation is personally, and contextually complex. Interventions require consideration of emotional and practical considerations. Implementation requires consideration of cross‐organisational, cross‐disciplinary, funding body and local contexts, or support will be unavailable or inconsistentRaising awareness, support planning and ongoing engagement.Finding the right context, right time in the process.Managing and support relationships—including overcoming avoidance.Often our doctors don't raise driving cessation till just before discharge as they don't want this issue to impact on their rehab journey, so timing would be an issue for many inpatients. [19]I have found that the earlier the better to allow the person time to grieve as well as practice alternatives. [31]I think the tricky issues are mostly around people choosing to participate, [there] are complex emotions around ceasing driving (grief, sense of failure, loss, shame, change in identity), during this time people are in a vulnerable place and as such the idea of meeting new people, interacting with others and on the topic that is causing them pain is very challenging. [10]Knowing and showing the outcomesOvercoming the reluctance to initiate and continue driving cessation support requires clearly arguing the benefits in ways that resonate with individuals, teams and systems. This needs evidence of effectiveness, stories of acceptance and impact and processes that ease access. Communicating about driving cessation intervention needs to consider values and core business of settingsDemonstrate the value to different stakeholders (consumers, funders, communities).Statistics (health, financial), processes and narratives help convince.Identify that this is our core business, meets an important need and aligns with values.Arranging a meeting [with referrers] and completing a presentation with known benefits and outcome stories. [25]This would depend upon the amount of time it takes and whether provided individually or in a group setting Maybe the Director of Allied Health [would decide if service is offered] – especially if funding was needed to be allocated or staff time. [20]The private practice model of DTOTs [driving assessors] just assessing an older person, cancelling a licence and then walking away doesn't sit well with me. I want to support clients through this process and promote awareness of early intervention re driving cessation. [16]Time/caseload would make it tricky but motivation is high for therapists to be involved.I think there would a steady flow of referrals once GPs and carers knew the service/program was available. [4]Managing systemic barriersKnown barriers to the implementation of programs and consideration of driving cessation need direct attention in each setting. Supports and process to enable access, start‐up of new practice and ongoing usage in regular practice will need co‐development with key stakeholdersWorkforce (time, people, turnover).Funding.Spanning between systems.Getting things started.Making it part of regular practice.Provide awareness training to team (eligibility, content, costs etc). A key contact person/champion could be established within the service, to remind staff of program, and assist with/follow up referrals. [24]Currently we do not have capacity to take staff offline to run a program such as this. We have the skill set within the service, and likely the interest too, but without additional funding/backfill, it would not be possible to run it ourselves.However, we readily refer to other services and projects and have a wide network across the state that we could tap into to generate referrals to a program if it could be offered. [24]Procedures to enable consistency. [25]Not doing it aloneGiven the complexity of driving cessation and the required supports, respondents identified that practice could be supported by the collaboration and support across locations and setting types. Making driving cessation everyone's concern, and setting up ways to identify, refer, access funding and support, as well as alternatives would support health and well‐being. In addition, engaging as a network, with support for providers would help to reduce health professional avoidance and community disengagementClinical processes and supports (assessments, training, mentoring, advice).Telehealth/expertise hubs.Engage industries, communities, advocacy.Add in initial assessment sheet a tick box to refer yes/no in IADL section. [32]Because the patients who would be suitable come sporadically, might be hard … whoever delivers the program to remember what is involved. Maybe start with one facilitated telehealth session with local social worker and central [driving cessation support] provider (who does this work regularly) and the patient. [22]A person with a public profile willing to share their having faced the same problem and given up driving.Strong engagement from RACQ and other motoring organisations, insurers and others with a vested interest in safe driving or driving alternatives e.g., taxis/uber. [11]DISCUSSIONThis study provided initial insights into considerations for implementing driving cessation supports for older people into practice. There was broad awareness of driving cessation, the benefits of interventions and the challenges across settings. The characterisation of driving cessation as complex and process‐based suggests that simple, brief, one‐off resources are unlikely to support driving cessation well. Responses indicated that implementation would require navigating multiple settings and contexts, as well as involving multiple stakeholders including retired drivers, families and communities. The identified complexity means that co‐adaptation of interventions, resources and programs for local relevance (including content, transportation and funding) will be needed for implementation.Limitations and future directionsThis study involved a small group of participants who, while representing a range of regions and settings, volunteered to participate, potentially due to interest. The findings add to the current literature in terms interrogating systemic barriers and facilitators from the view of those residing within the extant system. Future research should expand the exploration of implementation issues by including a more diverse population, employing longer‐term engagement in co‐adapting approaches and measuring the identified barriers and outcomes of interest.CONCLUSIONSA key identified issue was a need to demonstrate value and impact to the multiple stakeholders involved in the decision‐making, practice and process of transitioning to driving cessation. Moreover, the costs and benefits of the provision of supports across contexts need to be clearly articulated to establish and ensure a sustainable funding model. At the same time, delivery models need to be adaptive and responsive to funding limitations and funding bodies' expectations.ACKNOWLEDGMENTSWe would like to thank the health‐care participants who generously gave their time for this study. Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.CONFLICT OF INTEREST STATEMENTNo conflicts of interest declared.DATA AVAILABILITY STATEMENTThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.REFERENCESLiddle J, Tan A, Liang P, et al. “The biggest problem we've ever had to face”: how families manage driving cessation with people with dementia. Int Psychogeriatr. 2016;28:109‐122. doi:10.1017/S1041610215001441Pachana NA, Jetten J, Gustafsson L, et al. To be or not to be (an older driver): social identity theory and driving cessation in later life. Ageing Soc. 2017;37:1597‐1608. doi:10.1017/S0144686X16000507Chihuri S, Mielenz TJ, DiMaggio CJ, et al. Driving cessation and health outcomes in older adults. J Am Geriatr Soc. 2016;64(2):332‐341. doi:10.1111/jgs.13931Holden A, Pusey H. The impact of driving cessation for people with dementia–an integrative review. Dementia. 2021;20(3):1105‐1123. doi:10.1177/1471301220919862Betz ME, Jones J, Petroff E, Schwartz R. “I wish we could normalize driving health:” a qualitative study of clinician discussions with older drivers. J Gen Intern Med. 2013;28:1573‐1580.Sanford S, Naglie G, Cameron DH, et al. Canadian consortium on neurodegeneration in aging driving and dementia team. Subjective experiences of driving cessation and dementia: a meta‐synthesis of qualitative literature. Clin Gerontol. 2020;43(2):135‐154. doi:10.1080/07317115.2018.1483992Austroads. Assessing Fitness to Drive: for Commercial and Private Vehicle Drivers 2022. Austroads; 2017. Accessed November 5, 2022. https://austroads.com.au/drivers‐and‐vehicles/assessing‐fitness‐to‐driveLiddle J, Bennett S, Allen S, Lie DC, Standen B, Pachana NA. The stages of driving cessation for people with dementia: needs and challenges. Int Psychogeriatr. 2013;25:2033‐2046. doi:10.1017/S1041610213001464Scott TL, Liddle J, Pachana NA, Beattie E, Mitchell GK. Managing the transition to non‐driving in patients with dementia in primary care settings: facilitators and barriers reported by primary care physicians. Int Psychogeriatr. 2020;32(12):1419‐1428. doi:10.1017/S1041610218002326Liddle J, Haynes M, Pachana NA, Mitchell G, McKenna K, Gustafsson L. Effect of a group intervention to promote older adults' adjustment to driving cessation on community mobility: a randomized controlled trial. Gerontologist. 2014;54(3):409‐422. doi:10.1093/geront/gnt019Stasiulis E, Rapoport MJ, Sivajohan B, Naglie G. The paradox of dementia and driving cessation: “It's a hot topic,” “always on the back burner”. Gerontologist. 2020;60(7):1261‐1272. doi:10.1093/geront/gnaa034Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107‐115. doi:10.1111/j.1365-2648.2007.04569.x http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australasian Journal on Ageing Wiley

Still in first gear: Exploration of barriers for implementing driving cessation support

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Publisher
Wiley
Copyright
Copyright © 2023 AJA Inc.
ISSN
1440-6381
eISSN
1741-6612
DOI
10.1111/ajag.13218
Publisher site
See Article on Publisher Site

Abstract

Practice ImpactImplementation of driving cessation supports requires multifaceted approaches that consider contextual barriers as well as creative, cooperative approaches stretching across settings and systems. Such supports can mitigate the negative impact of unsupported driving cessation.INTRODUCTIONA range of health conditions may trigger driving cessation in later life. People who cease driving without support are at greater risk of premature admission to aged care, declines in both physical and mental health, negative changes to their sense of identity and their autonomy, fractured relationships with spouses and family and increased social isolation.1,2 Systematic reviews and qualitative work on the impact of driving cessation point to: the increase in risk for depression following driving cessation3; difficulties enacting driving cessation support for people living with dementia4,5; and the perceived high value of implementing individualised supportive approaches with respect to identity and emotional well‐being.6Driving cessation often follows a process guided by law and local policy in relation to driving safety and ‘medical fitness to drive’ guidelines (e.g. Austroads7). This may involve formal on‐ and off‐road assessments, medical or performance assessments, and discussion with the health‐care team, family and driver. Most people cease driving without any attempt at a supported transition to alternative forms of transport. This lack of formal support may foster avoidance of approaching the issues, be it from a family or health professional perspective.Globally, raising the issue of driving cessation is widely recognised as a difficult aspect of clinician practice with clients, families and health‐care professionals characterising this task as challenging.8 Thus, planning, support and timely cessation may be delayed or avoided because of lack of health professional confidence, or to avoid conflict. However, intervention in the lead‐up to driving cessation may change the person's trajectory towards reaffirmed autonomy and confidence in maintaining their activities and engagement.9While there are now evidenced resources to assist with driving cessation (e.g. Liddle et al.10), there is recognition that there are still considerable barriers to routine consideration of driving cessation in practice.11 In promoting consideration and use of evidenced approaches to managing driving cessation, understanding key stakeholder views is vital. In the current study, a range of health‐care implementation stakeholders' views were sought on barriers to the adoption of driving cessation intervention programs in public, private and community practice.METHODSA qualitative descriptive exploration of Australian practices and considerations with people experiencing driving cessation was undertaken. Open‐ended questions (see Appendix S1) were framed to capture workforce, clinical practice and reimbursement variables within public, private and community health‐care settings. Responses were sought through online survey forms, emails and interviews, and circulated via professional networks. Ethics approval was obtained from the Human Ethics Committee at the University of Queensland (2022/HE000495); all participants gave informed consent prior to inclusion in the study.Analysis was by inductive content analysis.12 Familiarisation with responses, consideration of responses across questions, constructing key areas reflecting practice, needs for practice and recommendations was undertaken. Initially, 12 content areas across practice approaches, across complexity of driving cessation experiences and unmet needs, barriers and enablers to changing practice were identified. Initial coding was conducted by JL and checked by NAP and AS. Key areas were synthesised through reflexive discussion of the team into six key areas—two being key understandings of driving cessation and four reflecting proposed actions to support practice.RESULTSSurveys (N > 100) were sent to members of peak allied health bodies, primary health‐care networks and public and private community outreach health services in Australia. Twenty‐nine completed surveys were analysed from participants in four states (Queensland [24], New South Wales [2], Victoria [2] and South Australia [1]), who ranged in age from 30 to 65; 86% identified as female. They reported providing clinical services to a range of areas (72% major cities, 72% regional and 21% remote; with multiple options possible) and settings (public health settings 31%; private health including private practices 38%, aged care 7%; and other, including government/not for profits 24%). Most self‐identified cross‐disciplinary roles rather than specific disciplines.Participants described how they had engaged with driving cessation‐related concerns including directly seeing clients with driving cessation needs (including unmet needs); referring clients for driving assessment; delivery of driving cessation supports; formal driving assessments, research and personal experiences. In describing their experiences and perceptions of driving cessation supports, participants identified that an understanding of driving cessation and optimal driving cessation supports was required. Key points are highlighted below.Understanding driving cessationResponses indicated that driving cessation and adjustment to it reflected a process, rather than a single event. Supports and interventions needed to consider this process, with careful timing of interventions and potential ongoing availability. Responses indicated the need to build general awareness of the issue, discuss current and future implications at key clinical times (diagnosis, assessment of performance facets or driving), obtain support when people are ready for it or as challenges arrive and iteratively improve what is currently available.Any approach will require multiple facets and playersIn highlighting the range of ways people may improve outcomes of driving cessation (from raising awareness of issues, referring for supports or directly providing support and interventions), respondents indicated a wide range of people who should be involved in driving cessation, including people who initiate driving‐related discussions or assess relevant performance components. More broadly, the entire medical, nursing and allied health team could engage with driving cessation. In some settings, this reflected current practice. Others indicated that while it was not consistently happening in current practice, health professionals engaging in discussing driving cessation should be discussing supports and initiating referrals to them accordingly.Importantly, respondents indicated the need for the driver, family, friends and the wider community to be engaged with the issue of, and supports for, driving cessation. They also indicated that within health settings the whole team, including, for example, reception staff, should be informed and engaged. Others who could be involved included licensing bodies, police, care providers, support and peer workers and case managers. Transitions in health care, cross‐organisation and funding body contexts were also raised as important considerations.Informing people about a driving cessation intervention was also perceived as necessary—from general population awareness to delivery in contexts that were accessible and acceptable to particular clients. All respondents in clinical settings indicated awareness of driving cessation interventions and willingness to refer or implement programs if they were available. However, some identified that within current funding models or parameters of service delivery, driving cessation support was not their core business, even when they could see the unmet needs.Recommended approaches for supporting implementationParticipants identified four key approaches (practices, navigation of barriers and potential solutions) to support the implementation of driving cessation support. These are summarised, along with components and example quotes, in Table 1. These included the need to consider complexity in terms of managing timing, different clinical contexts and supporting relationships and emotional responses. Participants indicated a need for knowing and showing the outcomes in terms of clearly communicating the benefits and values to different stakeholders in different formats that might resonate (e.g. statistics and stories). Importantly, where supporting adjustment to driving cessation aligned with personal, disciplinary or organisational values, this was seen as supporting implementation. The recognition of known barriers was identified with advice to address each individual issue in managing systemic barriers. These included addressing workforce issues, funding models, the effort required for initiating a new program, and supporting its continuation in practice. Finally, participants indicated the importance of not doing it alone, and instead developing processes, expertise‐based telehealth hubs, industry and community supports to work collaboratively on providing access to programs and addressing driving cessation across settings.1TABLEApproaches for supporting implementation.Core area (and description)SubcomponentsExample quotesConsidering complexityDriving cessation is personally, and contextually complex. Interventions require consideration of emotional and practical considerations. Implementation requires consideration of cross‐organisational, cross‐disciplinary, funding body and local contexts, or support will be unavailable or inconsistentRaising awareness, support planning and ongoing engagement.Finding the right context, right time in the process.Managing and support relationships—including overcoming avoidance.Often our doctors don't raise driving cessation till just before discharge as they don't want this issue to impact on their rehab journey, so timing would be an issue for many inpatients. [19]I have found that the earlier the better to allow the person time to grieve as well as practice alternatives. [31]I think the tricky issues are mostly around people choosing to participate, [there] are complex emotions around ceasing driving (grief, sense of failure, loss, shame, change in identity), during this time people are in a vulnerable place and as such the idea of meeting new people, interacting with others and on the topic that is causing them pain is very challenging. [10]Knowing and showing the outcomesOvercoming the reluctance to initiate and continue driving cessation support requires clearly arguing the benefits in ways that resonate with individuals, teams and systems. This needs evidence of effectiveness, stories of acceptance and impact and processes that ease access. Communicating about driving cessation intervention needs to consider values and core business of settingsDemonstrate the value to different stakeholders (consumers, funders, communities).Statistics (health, financial), processes and narratives help convince.Identify that this is our core business, meets an important need and aligns with values.Arranging a meeting [with referrers] and completing a presentation with known benefits and outcome stories. [25]This would depend upon the amount of time it takes and whether provided individually or in a group setting Maybe the Director of Allied Health [would decide if service is offered] – especially if funding was needed to be allocated or staff time. [20]The private practice model of DTOTs [driving assessors] just assessing an older person, cancelling a licence and then walking away doesn't sit well with me. I want to support clients through this process and promote awareness of early intervention re driving cessation. [16]Time/caseload would make it tricky but motivation is high for therapists to be involved.I think there would a steady flow of referrals once GPs and carers knew the service/program was available. [4]Managing systemic barriersKnown barriers to the implementation of programs and consideration of driving cessation need direct attention in each setting. Supports and process to enable access, start‐up of new practice and ongoing usage in regular practice will need co‐development with key stakeholdersWorkforce (time, people, turnover).Funding.Spanning between systems.Getting things started.Making it part of regular practice.Provide awareness training to team (eligibility, content, costs etc). A key contact person/champion could be established within the service, to remind staff of program, and assist with/follow up referrals. [24]Currently we do not have capacity to take staff offline to run a program such as this. We have the skill set within the service, and likely the interest too, but without additional funding/backfill, it would not be possible to run it ourselves.However, we readily refer to other services and projects and have a wide network across the state that we could tap into to generate referrals to a program if it could be offered. [24]Procedures to enable consistency. [25]Not doing it aloneGiven the complexity of driving cessation and the required supports, respondents identified that practice could be supported by the collaboration and support across locations and setting types. Making driving cessation everyone's concern, and setting up ways to identify, refer, access funding and support, as well as alternatives would support health and well‐being. In addition, engaging as a network, with support for providers would help to reduce health professional avoidance and community disengagementClinical processes and supports (assessments, training, mentoring, advice).Telehealth/expertise hubs.Engage industries, communities, advocacy.Add in initial assessment sheet a tick box to refer yes/no in IADL section. [32]Because the patients who would be suitable come sporadically, might be hard … whoever delivers the program to remember what is involved. Maybe start with one facilitated telehealth session with local social worker and central [driving cessation support] provider (who does this work regularly) and the patient. [22]A person with a public profile willing to share their having faced the same problem and given up driving.Strong engagement from RACQ and other motoring organisations, insurers and others with a vested interest in safe driving or driving alternatives e.g., taxis/uber. [11]DISCUSSIONThis study provided initial insights into considerations for implementing driving cessation supports for older people into practice. There was broad awareness of driving cessation, the benefits of interventions and the challenges across settings. The characterisation of driving cessation as complex and process‐based suggests that simple, brief, one‐off resources are unlikely to support driving cessation well. Responses indicated that implementation would require navigating multiple settings and contexts, as well as involving multiple stakeholders including retired drivers, families and communities. The identified complexity means that co‐adaptation of interventions, resources and programs for local relevance (including content, transportation and funding) will be needed for implementation.Limitations and future directionsThis study involved a small group of participants who, while representing a range of regions and settings, volunteered to participate, potentially due to interest. The findings add to the current literature in terms interrogating systemic barriers and facilitators from the view of those residing within the extant system. Future research should expand the exploration of implementation issues by including a more diverse population, employing longer‐term engagement in co‐adapting approaches and measuring the identified barriers and outcomes of interest.CONCLUSIONSA key identified issue was a need to demonstrate value and impact to the multiple stakeholders involved in the decision‐making, practice and process of transitioning to driving cessation. Moreover, the costs and benefits of the provision of supports across contexts need to be clearly articulated to establish and ensure a sustainable funding model. At the same time, delivery models need to be adaptive and responsive to funding limitations and funding bodies' expectations.ACKNOWLEDGMENTSWe would like to thank the health‐care participants who generously gave their time for this study. Open access publishing facilitated by The University of Queensland, as part of the Wiley ‐ The University of Queensland agreement via the Council of Australian University Librarians.CONFLICT OF INTEREST STATEMENTNo conflicts of interest declared.DATA AVAILABILITY STATEMENTThe data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.REFERENCESLiddle J, Tan A, Liang P, et al. “The biggest problem we've ever had to face”: how families manage driving cessation with people with dementia. Int Psychogeriatr. 2016;28:109‐122. doi:10.1017/S1041610215001441Pachana NA, Jetten J, Gustafsson L, et al. To be or not to be (an older driver): social identity theory and driving cessation in later life. Ageing Soc. 2017;37:1597‐1608. doi:10.1017/S0144686X16000507Chihuri S, Mielenz TJ, DiMaggio CJ, et al. Driving cessation and health outcomes in older adults. J Am Geriatr Soc. 2016;64(2):332‐341. doi:10.1111/jgs.13931Holden A, Pusey H. The impact of driving cessation for people with dementia–an integrative review. Dementia. 2021;20(3):1105‐1123. doi:10.1177/1471301220919862Betz ME, Jones J, Petroff E, Schwartz R. “I wish we could normalize driving health:” a qualitative study of clinician discussions with older drivers. J Gen Intern Med. 2013;28:1573‐1580.Sanford S, Naglie G, Cameron DH, et al. Canadian consortium on neurodegeneration in aging driving and dementia team. Subjective experiences of driving cessation and dementia: a meta‐synthesis of qualitative literature. Clin Gerontol. 2020;43(2):135‐154. doi:10.1080/07317115.2018.1483992Austroads. Assessing Fitness to Drive: for Commercial and Private Vehicle Drivers 2022. Austroads; 2017. Accessed November 5, 2022. https://austroads.com.au/drivers‐and‐vehicles/assessing‐fitness‐to‐driveLiddle J, Bennett S, Allen S, Lie DC, Standen B, Pachana NA. The stages of driving cessation for people with dementia: needs and challenges. Int Psychogeriatr. 2013;25:2033‐2046. doi:10.1017/S1041610213001464Scott TL, Liddle J, Pachana NA, Beattie E, Mitchell GK. Managing the transition to non‐driving in patients with dementia in primary care settings: facilitators and barriers reported by primary care physicians. Int Psychogeriatr. 2020;32(12):1419‐1428. doi:10.1017/S1041610218002326Liddle J, Haynes M, Pachana NA, Mitchell G, McKenna K, Gustafsson L. Effect of a group intervention to promote older adults' adjustment to driving cessation on community mobility: a randomized controlled trial. Gerontologist. 2014;54(3):409‐422. doi:10.1093/geront/gnt019Stasiulis E, Rapoport MJ, Sivajohan B, Naglie G. The paradox of dementia and driving cessation: “It's a hot topic,” “always on the back burner”. Gerontologist. 2020;60(7):1261‐1272. doi:10.1093/geront/gnaa034Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. 2008;62(1):107‐115. doi:10.1111/j.1365-2648.2007.04569.x

Journal

Australasian Journal on AgeingWiley

Published: Dec 1, 2023

Keywords: ageing; automobile driving; dementia; health services accessibility; health services availability

There are no references for this article.