Home' Community Care Review : CCR Aug-Spt 2015 Contents Ibrahim. It also places a significant burden
on informal carers, he says.
Dr Jacqueline Liddle, occupational
therapist and postdoctoral research fellow
with the School of Health and Rehabilitation
Sciences at the University of Queensland,
says driving can form a significant part of an
older person's identity and that attachment
to driving can make losing the ability to
drive particularly distressing.
As part of her research into the
experiences of older people going through
this transition, she asked them what
driving meant to them. "For some it's a very
convenient and familiar way of getting from
A to B, but for other people it is part of
them. It was their entry into adulthood. It
was part of their job or family holidays.
"Some people showed me pictures of the
cars they have had or their empty garage or
an old licence. Driving was a symbol of their
independence," Liddle says.
Ibrahim says complicating the decision-
making process further is the lack of a simple
objective test that medical professionals
can use to reliably distinguish between safe
and unsafe drivers. Relying on the subjective
judgments of medical professionals leads
to variable outcomes, with some people
stopping driving too soon and others too late.
On-road driving assessments can also be
very expensive, especially for rural drivers,
and there is a shortage of specialised
occupational therapists to conduct them.
In an article published in Injury Prevention
in June, Ibrahim and colleagues from
Monash University and Ballarat Health
Services argue that rural drivers in the
early stages of dementia should be allowed
to drive with a greater level of cognitive
impairment than those in urban centres.
The controversial proposal seeks to
recognise the likely lower crash risk in rural
areas due to reduced vehicle and pedestrian
traffic, and the higher health and social
costs of stopping driving.
"What is being proposed is a risk
management approach that accepts a degree
of risk in exchange for enhanced benefits for
the individual and their family," they write.
All the dimensions of the individual
must be taken into account and decisions
should be evidence-based and not
discriminate simply because of the
presence of old age or disease, it says.
ACCEPTING SOME RISK
Ibrahim points to the issue of alcohol and
driving as an example of society's tolerance
for some level of risk on the road and says
the same principles should apply for drivers
with early stage dementia.
"People drink alcohol and drive, and
as a society we have drawn the line at a
blood alcohol limit of 0.05. ... We have in a
sense accepted that risk but we have never
actually said it out loud."
Ibrahim says no one is arguing that
people with severe dementia should be
on the road. However, for those with mild
dementia who are still functioning well,
removing their right to drive can have
significant impacts on the person that are
not proportional to the level of risk posed
to themselves and the community.
SUPPORTING EACH STEP
Liddle, who has studied the needs of
people with dementia and their carers
as they stop driving, says the transition
to giving up driving is often gradual
and requires different support at
At the early stages people value
information about their circumstances
and, as they modify or reduce their level of
driving, practical support to broaden their
use of other modes of transport, she says.
Many people often experience a 'crisis
stage' as their condition progresses
and require help with problem solving,
resolving family conflict and preventing
social isolation, she says. Grief support
also helps individuals cope with the loss
of driving and the emotional toll on the
person and their family.
There is also the need for caregiver
support as the process can go on for
many years and some carers said they felt
exhausted by the end, she says.
Ibrahim says it's important to begin
a discussion early and forward plan the
transition to becoming a passenger.
In addition to providing valuable
community transport options, Liddle
says community aged care providers
have an important role to play role in
noticing when older people need support
during the process of adjustment
and connecting people with peers in
In our UQDrive program for older drivers
we use peer leaders, so older people who
have successfully stopped driving and still
stay involved in their communities, and it's
quite powerful to show that a person can
have a good life without driving." n
Tool to support drivers
A team of researchers from the University of Wollongong has
developed a decision aid tailored for drivers with dementia.
Associate Professor Victoria Traynor from the university's
faculty of science, medicine and health, says early planning
and support is critical to avoid the need to stop driving
abruptly in the future.
"Giving up driving later on in the process can be very
damaging for an individual's self-esteem when they are
forced to give up driving rather than make a decision slowly,"
she says. "It can lead to depression and cause terrible family disharmony."
The resource was piloted with individuals living with dementia and was found to
reduce the psychological distress associated with driving cessation.
"We used the format of a decision aid because we recognised that giving up driving
is actually a decision. It doesn't just happen and shouldn't be forced on a person. It
should be something that an individual makes a decision about because that can be
more empowering and less traumatic for the person and their family members, and
also the health practitioner who finds it distressing being the one who has to force
someone to give up driving."
The booklet is divided into four stages, with guided prompts and questions around
knowledge, values and support, and is designed to help both older people with
dementia and their families with the transition process.
Traynor says a good time to use the resource is when an individual, family member
or carer first recognises a person is having difficulty with driving capacity. A pre-
planned strategy, which addresses the transition to driving retirement gradually, will
remove the need for clinicians to insist upon licence removal later, she says.
Download the aid free from University of Wollongong's Aged Dementia Health
Education and Research website.
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