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Objectives: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. Design: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. Results: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. Conclusion: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation. [ABSTRACT FROM AUTHOR]

Objectives Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. Methods We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g. listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. Results Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95–0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94–0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03–1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04–1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08–1.19). Discussion Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation. [ABSTRACT FROM AUTHOR]

With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application. [ABSTRACT FROM AUTHOR]

Limited studies have investigated the effects of cannabis use on driving among older adults, who represent the fastest growing segment of drivers globally. We conducted a systematic review and meta-analysis to evaluate the effects of delta-9-tetrahydrocannabinol (THC) exposure on risks of (1) motor vehicle collisions (MVC) and (2) culpability for MVCs among adults 50 years and older. Three reviewers screened 7022 studies identified through MEDLINE, EMBASE, CENTRAL, and PsycINFO. Odds Ratios (OR) were calculated using the Mantel-Haenszel method in Review Manager 5.4.1. Heterogeneity was assessed using I2. The National Heart, Lung, and Blood Institute tool was used to assess the quality of each study. Seven cross-sectional studies were included. Three studies evaluated culpability while four evaluated MVC. The pooled risk of MVC was not significantly different between THC-positive and THC-negative older drivers (OR, 95% CI 1.15 [0.40, 3.31]; I2 = 72%). In culpability studies, THC exposure was not significantly associated with an increased risk of being culpable for MVC among adults over the age of 50 (OR, 95% CI 1.24 [0.95, 1.61]; I2 = 0%). Inspection of funnel plots did not indicate publication bias. Our review found that THC exposure was not associated with MVC involvement nor with culpability for MVCs. [ABSTRACT FROM AUTHOR]

Background and Objectives The prospect of automated vehicles (AVs) has generated excitement among the public and the research community about their potential to sustain the safe driving of people with dementia. However, no study to date has assessed the views of people with dementia on whether AVs may address their driving challenges. Research Design and Methods This mixed-methods study included two phases, completed by nine people with dementia. Phase I included questionnaires and individual semistructured interviews on attitudes toward using different types of AVs (i.e. partially or fully automated). Interpretative phenomenological analysis was used to assess participants' underlying reasons for and against AV use. The participants' identified reasons against AV use informed the focus group discussions in Phase II, where participants were asked to reflect on potential means of overcoming their hesitancies regarding AV use. Results The results showed that people with dementia might place higher levels of trust in fully automated compared to partially automated AVs. In addition, while people with dementia expressed multiple incentives to use AVs (e.g. regaining personal freedom), they also had hesitations about AV use. These hesitancies were based on their perceptions about AVs (e.g. cost), their own abilities (i.e. potential challenges operating an AV), and driving conditions (i.e. risk of driving in adverse weather conditions). Discussion and Implications The findings of this study can help promote the research community's appreciation and understanding of the significant potential of AVs for people with dementia while elucidating the potential barriers of AV use by people with dementia. [ABSTRACT FROM AUTHOR]

Background and Objectives Driving cessation is a complex challenge with significant emotional and health implications for people with dementia, which also affects their family care partners. Automated vehicles (AVs) could potentially be used to delay driving cessation and its adverse consequences for people with dementia and their care partners. Yet, no study to date has investigated whether care partners consider AVs to be potentially useful for people with dementia. Research Design and Methods This mixed-methods study assessed the views of 20 former or current family care partners of people with dementia on AV use by people with dementia. Specifically, questionnaires and semistructured interviews were used to examine care partners' acceptance of AV use by people with dementia and their views about the potential usefulness of AVs for people with dementia. Results The results demonstrated that care partners identified possible benefits of AV use by people with dementia such as their anticipated higher social participation. However, care partners also voiced major concerns around AV use by people with dementia and reported significantly lower levels of trust in and perceived safety of AVs if used by the person with dementia in their care compared to themselves. Care partners' concerns about AV use by people with dementia included concerns around the driving of people with dementia that AVs are not designed to address; concerns that are specific to AVs but are not relevant to the nonautomated driving of people with dementia; and concerns that arise from existing challenges around the nonautomated driving of people with dementia but may be exacerbated by AV use. Discussion and Implications Findings from this study can inform future designs of AVs that are more accessible and useful for people with dementia. [ABSTRACT FROM AUTHOR]

Objectives The number of drivers with dementia is expected to increase over the coming decades. Because dementia is associated with a higher risk of crashes, driving cessation becomes inevitable as the disease progresses, but many people with dementia resist stopping to drive. This meta-analysis examines whether there are sex differences in the prevalence and incidence of driving cessation among drivers with dementia and compares the pattern of sex differences in drivers with dementia to those without dementia. Method MEDLINE, PsycINFO, Scopus, and CINAHL were searched in July 2015 for observational studies of sex differences in driving cessation. Meta-analyses were performed using a random-effects model. Results Twenty studies provided data on sex differences in driving cessation in older adults with or without dementia. Driving cessation was significantly more prevalent in women with dementia than men (odds ratio [OR] = 2.11, 95% confidence interval [CI] = 1.50–2.98), and the same pattern was found in women without dementia (OR = 2.74, 95% CI = 1.85–4.06). Discussion Our findings suggest that the patterns of driving cessation differ between men and women with dementia, and this may have implications for sex-specific approaches designed to support drivers with dementia both before and after driving cessation. [ABSTRACT FROM AUTHOR]

Purpose of the study: The Decisional Balance Scale (DBS) was developed to assess older adults' attitudes related to driving and includes both intrapersonal and interpersonal motivations for driving. This study examined the psychometric properties of the DBS ratings across 3 time points in a sample of 928 older drivers who participated in the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive). Design and Methods: Measurement invariance of the DBS was assessed longitudinally and across gender. Results: Confirmatory factor analyses revealed that a two-factor model (positive and negative attitudes) for both driving beliefs related to the self and other provided a good fit to the data at each time point. Measurement invariance was supported across time and gender. Significant associations between the DBS factor scores and other driving measures (e.g., perceived driving ability and self-regulatory driving practices) provided evidence of convergent validity. Implications: The DBS appears to be a robust instrument for measuring attitudes toward driving and is recommended for continued use in future research on driving behaviors with older adults. [ABSTRACT FROM AUTHOR]

• We explored whether older adults were less likely to have road injuries and fatalities in the first month of shelter-in-place lockdown of the COVID pandemic. • We found a 64.7 % reduction in the proportion of injuries and fatalities. • The excess COVID-19- associated mortality in oldest adults may be indirectly partially mitigated by a reduction in mortality from motor vehicle collisions. Older adults constitute the group most vulnerable to COVID-19 mortality. As a result, in North America and elsewhere, older adults have been strongly advised to shelter in place. Older adults also represent the fastest growing segment of licensed drivers. We examined the change in injuries and fatalities sustained by younger and older drivers and pedestrians during the first month of the COVID-19 pandemic. We hypothesized that adults ages 80 years and over would have a proportionally larger reduction than the other drivers and pedestrians. Using a cohort design, we compared the proportion of drivers and pedestrians involved in injuries and fatalities attributable to individuals aged 80 years and over, as recorded in the Ministry of Transportation of Ontario (Canada) database, between the 30 days prior to shelter-in-place related to the COVID-19 pandemic and the subsequent 30 days. By way of comparison, we conducted a similar comparison for younger age cohorts (16−24 years, 25−34 years, 35−54 years, 55−64 years, and 65−79 years). Drivers aged 80 years and over represented 21 per 1000 injuries and fatalities in the 30 days prior to March 17, 2020 (95 % CI: 15−29), and 8 per 1000 injuries and fatalities in the 30 days beginning on that date (95 % CI: 2−20), a 64.7 % reduction (exp (β) post 0.353, 95 % CI 0.105−0.892). Drivers in the 35−54 year age range underwent a significant but smaller reduction of 22.9 %; no significant changes were seen for drivers in other age groups, or for pedestrians of any age. The physical distancing measures that aimed to reduce the spread of COVID-19 resulted in a marked reduction in driver injuries and fatalities in the oldest old, illustrating the impact of physical distancing recommendations in this population. The excess mortality burden faced by the oldest adults during the COVID-19 pandemic, by direct exposure to the virus, may be indirectly mitigated by the reduction in road-related deaths in this cohort. [ABSTRACT FROM AUTHOR]

• Readiness for change in mobility may be an important element in promoting smooth transitions to non-driving for older people. • Participants who reported positive attitudes towards driving relative to themselves and others were less ready for mobility transition. • Participants who reported lower agreeableness were less ready for mobility transition. For many older adults, driving is an important means of community mobility. With changes in health, aging increases the likelihood of ceasing to drive. Driving cessation is associated with a host of negative physical and mental health outcomes. Increased readiness to transition to non-driving status may mitigate some of the adverse consequences of driving cessation, making the transition to non-driving a pivotal period for intervention. We examined the relationship between attitudes towards driving (positive and negative) and readiness for mobility transition. Participants (n = 253, mean age = 79.13) completed measures of health, cognition, personality, attitudes towards driving, and readiness for mobility change. The results from the multiple hierarchical regression analysis showed that individuals who reported more positive attitudes towards driving relative to themselves (i.e., pro-self scale) and others (i.e., pro-other scale), as well as scored lower on the personality trait agreeableness, were less ready for mobility transition. The results emphasize the importance of taking into account driver attitudes, in addition to health considerations, when supporting the transition to non-driving. [ABSTRACT FROM AUTHOR]

Examining environmental factors that influence older adults’ driving patterns has important implications for understanding factors that can lead to self-regulation and cessation. The current study explored the effect of fuel prices on older adults’ driving patterns using objective data from the nationwide Candrive longitudinal study ( N  = 807). Fuel prices were negatively associated with driving distance and positively associated with speeding and acceleration pattern. Specifically, on occasions when fuel prices were high, older adults drove less often but were speeding and accelerating more. However, the magnitudes of the effects were small, suggesting that older adults continue to rely on their vehicles for community mobility, despite variations in fuel prices. [ABSTRACT FROM AUTHOR]