In this section of the review you will find papers relating to mobility for people with dementia, including types of transport. You will also find papers that address specific safety issues or debates.
In this study, Doherty et al. (2015) focus on GPs and their experience of assessing patients with cognitive impairment for driving fitness and their attitudes to this role using a postal survey of 200 GPs across three counties in the ROI. A total of 125 GPs responded to the survey.
Most (96.8%) GPs agreed that assessing fitness to drive in the context of cognitive impairment was an important issue, with the majority (84%) assessing fitness to drive on a daily or weekly basis. While over two-thirds regularly use guidelines, less than one-third agreed that the guidelines were adequate. The majority of GPs commonly referred patients for further assessment, most often to geriatrics (74.4%), but also to psychiatry of old age 32.6%), external driving assessors (30.6%) and Occupational Therapy (8%). Nearly all GPs stated that they would refuse to certify someone fit to drive if they had concerns about cognitive impairment. Isolation and lack of alternative transport was factors influencing GP decision-making. The study discusses these findings, highlighting the paucity of guidance available to GPs, the well-developed and established role of OTs in other countries in assessing fitness to drive, the differences between GPs in rural and urban areas, GPs’ concerns over their legal liability, doctor-patient relationships. The study concludes by outlining some measures that could assist with the task of assessing fitness to drive among people with cognitive impairment.
This paper by Bantry et al. (2016) documents the process and early development of a structured method for assessing safety in people with dementia walking outdoors.
The authors discuss the complexity of assessing the risk in this population and the need for flexible use of any schedule based on individual circumstances. They acknowledge that the study is limited by its lack of consultation with people who have dementia, as it was designed as a carer informant tool. They point to the need for further research that consults people with dementia and that considers the potential benefits as well as the risks associated with an issue such as walking outdoors.
Carr & O’Neill (2015) summarise the literature on dementia and driving, focusing on the two major outcomes of mobility and safety. The literature suggest that approximately 4% of those drivers over 75 years have a dementia and a 2-5 fold increase in crash rate is documented.
While driver simulation studies suggest poorer performance among those with Alzheimer’s, other studies show that 69% of those with mild dementia passed a formal driving test. Currently there is no accepted “gold standard” for assessing driver safety. The authors argue that enquiry among people being assessed for memory problems is essential but that a diagnosis alone is not justification for revoking someone’s license. Driving cessation is associated with decreased social integration, increased depression and higher risk of nursing home placement. The need for interventions to extend driving expectancy and for alternative transport options is highlighted.