Not If But When – A Dementia and Driving Cessation Project
As a practicing geriatrician, Dr. Moorhouse became interested in the topic of dementia and driving cessation. Because of the progressive nature of dementia, she knew it was always a case of when, not if, driving would have to cease. The legislation in Nova Scotia indicates that it is at the physician’s discretion to report patients who may pose a risk on the roads.
Dr. Moorhouse and her group reviewed the literature on this topic. An issue highlighted by this review was that mandatory reporting/testing does not appear to have a great effect on accident rates, but positive family involvement can facilitate cessation. Additionally, carers were often acting as “co-pilots” for the person with dementia, which was a key element in allowing them to continue to drive past the point that may be safe for themselves and others. Dr. Moorhouse decided to explore ways to address this. This group set about gathering stakeholders from a variety of backgrounds to assist them.
Involving their audience
Stakeholder meetings and interviews were held with a variety of groups, including persons with dementia, their carers/family members, physicians, nurses, and representatives from community care and the voluntary sector, as well as from the provincial department of motor vehicles.
One of the main aims of the meetings was to discuss the idea of a Public Service Announcement (PSA) video that would be aimed at carers of people with dementia. This PSA would help people recognize the dangers of driving with dementia, and encourage people to talk to their physicians, and to the person with dementia about when driving would need to stop.
Public Service Announcement (PSA)
Stakeholders welcomed the idea of the PSA and participated with the research team in further meetings to develop the content of the PSA, where they reviewed and offered feedback on the various drafts. The PSA aired in Atlantic Canada on television and is now available online.
An unexpected finding
While the stakeholder meetings confirmed that people wanted to encourage dialogue about driving and dementia, and would welcome a PSA, they also revealed another issue. It was overwhelmingly reported that physicians were reluctant to speak to patients about driving for fear of alienating them, and that they felt that they were not adequately equipped with the tools and knowledge to address this.
As a result of this issue, Dr. Moorhouse’s group initiated a physician survey to learn about what physicians would need in order to feel more comfortable addressing this topic. The responses led to the development of the “Not If But When” website, which offers information and resources aimed at physicians and other healthcare professionals, as well as families and caregivers of persons with dementia.
The final products
This collaborative project into dementia and driving cessation resulted in a website where information resources and the PSA are housed, and the PSA was released on regional television, along with an on-the-road promotional campaign including bumper stickers and bus advertising visible to drivers.
Evaluation of this project to examine attitude and behaviour changes in caregivers of persons with dementia, as well as physician confidence and practice change around the topic of dementia and driving cessation in Nova Scotia, Canada as a result of the campaign is ongoing.
Moorhouse, P., Hamilton, L., Fisher, T., Rockwood, K. (2011). Barriers to assessing fitness to drive in dementia in Nova Scotia: Informing strategies for knowledge translation. Canadian Geriatrics Journal, 14(3): 61-65.