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Objectives:The Tailored Activity Program (TAP) is an evidence-based occupational therapist-led intervention for people living with dementia and their care partners at home, developed in the USA. This study sought to understand its acceptability to people living with dementia, their care partners, and health professionals, and factors that might influence willingness to participate prior to its implementation in Australia.Methods:This study used qualitative descriptive methods. Semi-structured interviews were conducted with people living with dementia in the community (n = 4), their care partners (n = 13), and health professionals (n = 12). People living with dementia were asked about health professionals coming to their home to help them engage in activities they enjoy, whereas care partners’ and health professionals’ perspectives of TAP were sought, after it was described to them. Interviews were conducted face-to-face or via telephone. All interviews were recorded and transcribed. Framework analysis was used to identify key themes.Results:Analysis identified four key themes labelled: (i) TAP sounds like a good idea; (ii) the importance of enjoyable activities; (iii) benefits for care partners; and (iv) weighing things up. Findings suggest the broad, conditional acceptability of TAP from care partners and health professionals, who also recognised challenges to its use. People living with dementia expressed willingness to receive help to continue engaging in enjoyable activities, if offered.Discussion:While TAP appeared generally acceptable, a number of barriers were identified that must be considered prior to, and during its implementation. This study may inform implementation of non-pharmacological interventions more broadly.

To explore older inpatients' experiences and perceptions of delirium and non-pharmacological delirium prevention strategies (NDPS). Delirium is a distressing and serious complication in hospitalised older adults. NDPS (supporting nutrition, mobility and cognitive participation) have strong supporting evidence. Few studies have explored older inpatients' perspectives of these strategies. This information may assist staff to better support patient participation in NDPS. Qualitative study using an interpretive descriptive (ID) methodological approach to explore older patient's experience of delirium and NDPS. Structured interviews of inpatients aged over 65 years across 6 medical and surgical wards explored patients' experiences and perceptions of delirium and prevention activities related to nutrition, mobility and cognition; and barriers and enablers to participation. Reporting used COREQ. Twenty-three participants were included (12 male, 11 reported delirium experience). Participants reported a range of physiological, emotional and psychological responses to delirium, hearing about delirium was different to experiencing it. Most participants were aware of the benefits of maintaining nutrition and hydration, physical activity and cognitive engagement in hospital. Barriers included poor symptom control, inflexible routines and inconsistent communication, while enablers included access to equipment, family involvement, staff encouragement and individual goals. These were organised into themes: outlook, feeling well enough, hospital environment, feeling informed and listened to, and support networks. A more patient centred approach to delirium prevention requires consideration of older people's values, needs, preferences and fit within the hospital environment and routines. Feeling informed, listened to and receiving support from staff and family carers can improve older inpatients' engagement in NPDS to prevent delirium in hospital. Nurses are ideally placed to improve patient participation in NDPS through holistic assessment and care, addressing symptoms, providing clear information about delirium and delirium prevention, and facilitating family carer support and patient interactions.

Objective Research involving people with dementia is vital to appropriately inform policy and practice decisions affecting this population. As dementia-care researchers, we frequently advocate to Human Research Ethics Committees for the right of people with dementia to choose whether to participate in research. This brief report provides some considerations for researchers and ethics committees. Method Descriptive summary of principles that argue for inclusion of people with dementia in research studies. Results Specifically excluding people living with dementia from research because of perceived cognitive impairment is inappropriate in light of human rights principles and the right to contribute to evidence-based care. Conclusion There is a difference between capacity to provide informed consent and ability to provide perspectives that are valid for each individual. Providing the opportunity for a person with dementia to participate in research and offering support to do this is a matter of human rights.

OBJECTIVE Lifespace, the physical area in which someone conducts life activities, indicates lived community mobility. This study explored the feasibility of technology-based lifespace measurement for older people with dementia and mild cognitive impairment (MCI), including the generation of a range of lifespace metrics, and investigation of relationships with health and mobility status. METHODS An exploratory study was conducted within a longitudinal observational study. Eighteen older adults (mean age 86.7 years (SD: 3.2); 8 men; 15 MCI), participated. Lifespace metrics were generated from geolocation data (GPS and Bluetooth beacon) collected through a smartphone application for one week (2015-2016). Cognitive and mobility-related outcomes were compared from study data sets at baseline (2005-2007) and 6-year follow-up (2011-2014). RESULTS Lifespace data could be collected from all participants, and metrics were generated including percentage of time at home, maximum distance from home, episodes of travel in a week, days in a week participants left home, lifespace area (daily, weekly and total), indoor lifespace (regions in the home/hour), and a developed lifespace score that combined time, frequency of travel, distance and area. Results indicated a large range of lifespace areas (0.1 - 97.88 km2 ; median 6.77 km2 ) with similar patterns across lifespace metrics. Significant relationships were found between lifespace metrics and concurrent driving status and anteceding scores on the sit-to-stand test (at baseline and follow-up). CONCLUSIONS Further longitudinal exploration of lifespace is required to develop an understanding of the nature of lifespace of older community-dwelling people, and its relationship with health, mobility and well-being outcomes.

Background Deep brain stimulation is a surgical treatment for Parkinson’s disease. Its impacts on motor symptoms are widely reported; however, little is known about the broader impact of deep brain stimulation on the community lives of people with Parkinson’s disease. Lifespace is a measure of lived community mobility, providing an indication of community access and participation. Aims This pilot study explored the feasibility of remotely monitoring the qualitative and quantitative community outcomes related to deep brain stimulation. Methods A longitudinal mixed methods study with a convergent design was undertaken exploring the lifespace, quality of life, life satisfaction and lived experiences of people with Parkinson’s disease before and after deep brain stimulation. Data were collected through questionnaires, semi-structured interviews and a smartphone-based application which collected geolocation data. Results Quantitative and qualitative data from eight participants living with Parkinson’s disease were analysed and integrated. At baseline, participants had a median age of 68 years and a median Hoehn and Yahr score of 2. Measuring a range of community-based outcomes indicated different change trajectories for individuals across outcomes. Key content areas were developed from the qualitative data: participation in occupations and travel and home. This study indicates the potential value of including geolocation data-based lifespace collection in metropolitan and regional areas. Conclusions Monitoring lifespace in conjunction with subjective measures provides insights into the complex and individually varied experiences. Further research could explore the impacts of deep brain stimulation on occupations and community participation to gain a deeper understanding of the related needs and support clinical approaches.

BackgroundDeep brain stimulation (DBS) is an effective treatment for the motor symptoms of Parkinson’s disease (PD). The lived experience of people with PD suggests a process of adjustment follows. This study aimed to explore the adjustment and associated education and support needs of people with PD undergoing DBS and their family members across the continuum of the DBS experience.MethodA structured qualitative description study including semi-structured interviews with people with PD (n = 14), family members (n = 10) and clinicians (n = 11) was conducted to explore lived experiences, needs, perspectives and clinical considerations. Inductive analysis indicated common temporal stages related to undergoing DBS, and the related experiences and needs were mapped.FindingsFour stages, each with unique needs, emerged: Considering DBS involved needs for peer-based education and realistic, meaningful goal setting; Surgery and Support shifted to clinical support related to the surgery and support for the person and their family around immediate changes experienced; Seeking Stability focused on timely clinical and practical support for the person and family around new changes and challenges to symptoms, behaviours and roles; and Next Steps involved direction and support for reengagement in the self-management of the condition, and current and future changes related to PD.All participants with PD and their family members in this study indicated that overall their experiences with DBS had led to positive changes in their symptoms and lives. Consideration of different needs at different times in the process may be applied within clinical practice to support adjustment.

Objectives:This research addresses dementia and driving cessation, a major life event for affected individuals, and an immense challenge in primary care. In Australia, as with many other countries, it is primarily general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients with dementia. Qualitative evidence from studies with family members and other health professionals shows it is a complicated area of practice. However we still know little from GPs about how they manage the challenges with their patients and the strategies that they use to facilitate driving cessation.Methods:Data were collected through five focus groups with 29 GPs at their primary care practices in metropolitan and regional Queensland, Australia. A semi-structured topic guide was used to direct questions addressing decision factors and management strategies. Discussions were audio recorded, transcribed verbatim and thematically analyzed.Results:Regarding the challenges of raising driving cessation, four key themes emerged. These included: (i) Considering the individual; (ii) GP-patient relationships may hinder or help; (iii) Resources to support raising driver retirement; and (iv) Ethical dilemmas and ethical considerations. The impact of discussing driving cessation on GPs is discussed.Conclusions:The findings of this study contribute to further understanding the experiences and needs of primary care physicians related to managing driving retirement with their patients with dementia. Results support a need for programs regarding identification and assessment of fitness to drive, to upskill health professionals and particularly GPs to manage the complex issues around dementia and driving cessation, and explore cost-effective and timely delivery of such support to patients.

Background: Following traumatic brain and spinal cord injuries, maximising community participation leads to better physical and mental health outcomes.Objectives: To determine the effectiveness and health system resource use of a group intervention (CarFreeMe TI) on community participation in people with complex trauma injuries.Method: Randomised crossover trial of 54 participants, recruited from rehabilitation services in Adelaide, Australia. Inclusion criteria is a trauma injury, unable to return to full driving, aged over 18 years of age, adequate cognition/behavioural/communication abilities to participate in sessions and mobile. Exclusion criterion is living in setting where alternative transport is provided. Participants will be randomly assigned on a 1:1 allocation basis, to receiving Phase 1 CarFreeMe TI-group-based intervention or Phase 2 information related to transport options. Then, crossover to Phase 1 or 2 will occur. Primary outcome measure is community participation using a Global Positioning System. Secondary outcome measures include Community Mobility Self-efficacy Scale; CarFreeMe TI Transport Questionnaire, AQOL, EQ-5D-5L; Carer's Community Mobility Self-efficacy Scale and Modified Carer Strain Index for carers of participants. Outcome assessors will be blinded to group allocation. All analyses will be on an intention to treat basis with difference in community participation between the groups determined via a GLM ANOVA and the significance between groups on other measures using independent samplet-tests. It is hypothesised that the community mobility intervention (CarFreeMeTI) will result in increased community participation.Discussion: The results will provide proof of concept information on the feasibility and inform allocation of resources for people with complex trauma injuries.Trial registration: Australian and New Zealand Clinical Trials Register (ANZCTR): ACTRN12616001254482.

The COVID-19 pandemic is worsening loneliness for many older people through the\ud challenges it poses in engaging with their social worlds. Digital technology has been offered\ud as a potential aid, however, many popular digital tools have not been designed to address the\ud needs of older adults during times of limited contact. We propose that the Social Identity\ud Model of Identity Change (SIMIC) could be a foundation for digital loneliness interventions.\ud While SIMIC is a well-established approach for maintaining wellbeing during life transitions,\ud it has not been rigorously applied to digital interventions. There are known challenges to\ud integrating psychological theory in the design of digital technology to enable efficacy,\ud technology acceptance, and continued use. The interdisciplinary field of Human Computer\ud Interaction has a history of drawing on models originating from psychology to improve the\ud design of digital technology and to design technologies in an appropriate manner. Drawing on\ud key lessons from this literature, we consolidate research and design guidelines for\ud multidisciplinary research applying psychological theory such as SIMIC to digital social\ud interventions for loneliness.

This chapter addresses dementia and driving. The ability to get out and about is an important element in living well with dementia. Driving is the main form of transport for most adults and giving up driving is a major life event. For people living with dementia, it comes at significant personal cost to their social and occupational well-being, limiting access to activities outside of the home, loneliness, isolation, and loss of a pleasurable activity in itself. Providing person-centered lifestyle adjustment counseling, alternative transport options and services, and emotional support for grief and loss can help lessen the negative effects for people living with dementia. Family members need support and education about how to have informed discussions around driving with dementia. People living with dementia and their family members need accessible built environments and equitable alternative transportations.

Objectives: The social connectedness of older people is of increasing concern. Technology has been suggested for enhancing social inclusion. This study aimed to explore the nature and quality of connections via technology. Methods: Qualitative exploration of experiences, stories, and needs was undertaken through semi-structured interviews with older (7) and middle-aged (3) adults with rich experience of connections via technology in Australia and England. Core aspects of connections through technology were constructed through interpretive description analysis. Results: Four key aspects were: 1. The caliber of connections: descriptions of a range of subjective quality of connections and characteristics of good connections; 2. Experiences of poor connection (mis- and dis-connection) including descriptions of experiences creating isolation; 3. Reasons to connect described the purposes of technology-based connections including connecting with others, themselves and places important to them; 4. Making connections work described active strategies to enhance connection. Conclusions: Using technology is part of the social engagement of many people. Considering the related feelings of connection and support strategies and needs could enhance future research and practice with older people. Clinical implications: The different characteristics and potential positive and negative experiences of connection via technology need consideration in measuring social isolation and supporting older adults.

Introduction Measuring activity engagement using the Activity Card Sort Australia (18–64) supports occupational therapists and clients to identify goals for therapeutic interventions. The aim of this study was to investigate activity engagement for people aged 18 to 64 years with and without Parkinson’s disease. Method Thirty-two participants, 16 people with Parkinson’s disease (mean age 57.8) and 16 healthy adults (mean age 53.1), were required to sort 85 visual activity cards into one of five categories: ‘never done’, ‘do not do now’, ‘do now’, ‘do less now’ and ‘given up’. The retained activity values were calculated and compared using the Mann–Whitney U Test. Results The overall retained activity scores were not significantly different ( p = .81); however, the group with Parkinson’s disease had higher retained scores in the physical activities domain ( p = .04) Conclusion The preventative exercise regimes of people with Parkinson’s disease seems to influence activity engagement patterns. A more detailed understanding of activity engagement may further help form the basis of meaningful interventions.

Background Understanding quality of life and participation is a key aspect of occupational therapy research. The use of smartphones to deliver experience-sampling surveys may provide an accessible way to monitor these outcomes. This study used smartphone-based experience sampling methods (ESM) to investigate factors influencing momentary quality of life (mQOL) of university students. Methods A convenience sample of students at an Australian university participated. Using a custom smartphone application, ESM surveys were sent six to eight times, every second day, over a week. Participants indicated their mQOL, occupational participation, occupational enjoyment, social context and location via surveys and provided demographic and health information in a single self-report questionnaire. The relationship between mQOL and variables was analysed at the survey level using logistic regression. Results Forty students completed 391 surveys. Higher mQOL was significantly related to participation in productive occupations (z = 3.48; P = 0.001), moderate (z = 4.00; P

1) To explore family members' lived experiences of driving disruption at early and later stages of the recovery continuum following acquired brain injury (ABI). 2) To describe health-related quality of life of family members of individuals with ABI who are experiencing driving disruption.Mixed methods phenomenological research approach.Semi-structured interviews and health-related quality of life questionnaires were conducted with 15 family members of individuals with ABI (early group: 1-12 months post-injury, n = 6; later group:1 year post-injury, n = 9).Two main themes were identified: Different for everyone: how driving disruption affects families, and Making it harder: context of driving disruption. The challenges of driving disruption were reported more frequently and with a more intense focus by family members who were caring for their relative for more than 1 year post-injury. This group also reported higher caregiver strain and poorer health-related quality of life. Reduced satisfaction with life, poor mental health and affected family functioning were reported by both groups.Driving disruption impacts on family members and has long-lasting consequences. It is important for clinicians to work with family members to manage these challenges even years after ABI and consider individual contextual factors.

The Activity Card Sort (ACS) measures activity engagement levels. The Activity Card Sort–Australian version for adults aged 18 to 64 (ACS-Aus (18-64)) was recently developed, and psychometric properties have not yet been determined. This study was established to determine the test–retest reliability and internal consistency of the ACS-Aus (18-64) and describe activity engagement trends for healthy adults. Fifty-four adults aged 18 to 64 participated in this descriptive study. The ACS-Aus (18-64) demonstrated excellent test–retest reliability ( r = .92, p < .001) and acceptable internal consistency (α = .83). Adults aged 18 to 40 retained a lower percentage of activities than adults aged 41 to 64 for personal care, daily life, home maintenance activities ( t = −2.22, p = .03), and recreation and relaxation activities ( t = −2.38, p = .02). The ACS-Aus (18-64) may be used to explore the activity engagement patterns of community-dwelling Australian adults aged 18 to 64. Further research will determine validity for clinical populations.

OBJECTIVES Education affects the attitudes and abilities of health professionals regarding older people. This study examines the nature and amount of ageing-related content in programs at universities and in continuing education in Queensland for disciplines involved in the direct care of older people. METHODS Surveys developed for the different settings were sent to universities and health professional representative bodies. RESULTS Representatives from thirty (of 71) programs and 12 (of 22) professional bodies responded. Many program representatives (62%) reported ageing content was at an appropriate level. The remainder indicated it was too low. Representatives from professional bodies identified ageing was a priority (81%) and offered ageing-related education (72%). Time spent on ageing in university programs varied widely (median of 67 hours [interquartile range: 222.5]). Qualitative feedback indicated tensions existed about accreditation standards and perceptions of ageing as a specialty versus a core practice area. CONCLUSION Ageing-related education for health professionals requires attention to address shortcomings.

Deep-brain stimulation (DBS) can be effective in controlling medically intractable symptoms of Tourette’s syndrome (TS). There is no evidence to date, though, of the potential cost-effectiveness of DBS for this indication. To provide the first estimates of the likely cost-effectiveness of DBS in the treatment of severe TS. We conducted a cost-utility analysis using clinical data from 17 Australian patients receiving DBS. Direct medical costs for DBS using non-rechargeable and rechargeable batteries and for the alternative best medical treatment (BMT), and health utilities for BMT were sourced from the literature. Incremental cost-effectiveness ratios (ICERs) were estimated using a Markov models with a 10-year time horizon and 5% discount rate. DBS increased quality-adjusted life year (QALY) gained from 2.76 to 4.60 over a 10-year time horizon. The ICER for DBS with non-rechargeable (rechargeable) batteries, compared to BMT, was A$33,838 (A$15,859) per QALY. The ICER estimates are sensitive to DBS costs and selected time horizon. Our study indicates that DBS may be a cost-effective treatment for severe TS, based on the very limited clinical data available and under particular assumptions. While the limited availability of data presents a challenge, we also conduct sensitivity analyses to test the robustness of the results to the assumptions used in the analysis. We nevertheless recommend the implementation of randomised controlled trials that collect a comprehensive range of costs and the use of a widely accepted health-related quality of life instrument to enable more definitive statements about the cost-effectiveness of DBS for TS.

Community mobility is an important social determinant of health. For people living with dementia, the forfeiture of a driving licence can signal a loss of independence, limiting access to activities outside of the home. Loss of community connectivity and social participation has a substantial impact on quality of life and may lead to depression and more rapid cognitive decline. This study is focused on a driving cessation intervention that helps people with dementia identify personal goals that are framed around community mobility and adjusting to life without driving. Health professionals work with participants to translate these into specific, practical and achievable outcomes by program end. Participants may nominate more than one goal. This study reports on goal setting and achievement. Using a modified version of the Canadian Occupational Performance Measure it examines pre- to post-intervention achievement of, and satisfaction with, identified goals for 17 participants living with dementia aged 63-93 (M=75.24, 76% male) from regional and metropolitan Australia. Thematic analysis of clinical interviews and field notes highlighted the range of desired goals, and the challenges posed and problem-solving strategies used in setting realistic, non-driving goals. Significant positive improvements were found across a total of 29 goals for (i) performance t(28) = -10.01, p < .000, and (ii) satisfaction, t(28) = -10.32, p < .000. The implications for practice are that supportive goal-setting of personally relevant objectives and valued activities following driving cessation may be effective in lessening some of the negative effects of giving up driving for people with dementia.

IntroductionCaregiving associated with driving disruption following an acquired brain injury is challenging and impacts on family members’ daily lives. However, little is known about the activities...

Dementia is a common neurodegenerative condition involving the deterioration of cognitive and communication skills. Pausing in the speech of people with dementia is a dysfluency that may be used to signal conversational trouble in social interaction. This study aimed to examine the speech-pausing profile within picture description samples from people with dementia and healthy controls (HCs) within the DementiaBank database using the Calpy computational speech processing toolkit. Sixty English-speaking participants between the ages of 53 and 88 years (Mage= 67.43, SD = 8.33; 42 females) were included in the study: 20 participants with mild cognitive impairment, 20 participants with moderate cognitive impairment, and 20 HCs. Quantitative analysis shows a progressive increase in the duration of pausing between HCs, the mild dementia group, and the moderate dementia group, respectively.

Background:It is recognized that people with dementia are likely to need to stop driving at some point following diagnosis. Driving cessation can lead to negative outcomes for people with dementia and their family caregivers (FC), who often experience family conflict and tension throughout the process. Family experiences surrounding driving cessation have begun to be explored but warrant further examination.Methods:Using a descriptive phenomenological approach, semi-structured interviews were undertaken with key stakeholders, including 5 retired drivers with dementia, 12 FC, and 15 health professionals (HP). Data were analyzed inductively to explore the needs and experiences of people with dementia and FC.Results:The data revealed a range of possible interactions between people with dementia and FC. These were organized into a continuum of family dynamics according to levels of collaboration and conflict: in it together, behind the scenes, active negotiations, and at odds. At the in it together end of the continuum, people with dementia and FC demonstrated collaborative approaches and minimal conflict in managing driving cessation. At the at odds end, they experienced open conflict and significant tension in their interactions. Contextual factors influencing family dynamics were identified, along with the need for individualized approaches to support.Conclusions:The continuum of family dynamics experienced during driving cessation may help clinicians better understand and respond to complex family needs. Interventions should be tailored to families’ distinctive needs with consideration of their unique contextual factors influencing dynamics, to provide sensitive and responsive support for families managing driving cessation.

Introduction Peer leaders are increasingly involved in health-related programmes due to the perceived benefits that they bring to the group process. This exploratory study examined the experiences of peer leaders in the University of Queensland Driver Retirement Initiative, an educational support group for older people undergoing driving cessation. Method Semi-structured interviews were conducted with five peer leaders (two men, three women, age range: 67–81 years) regarding their role and involvement as a peer leader in the University of Queensland Driver Retirement Initiative programme as well as their positive and negative experiences. Results Inductive thematic analysis revealed three themes: diversity of peer leaders, drawing on personal strengths and experiences, and taking the middle ground. Conclusion This study revealed that peer leaders drew from their diverse range of personal resources and experiences to perform the role of peer leader, using varying approaches to perform the role successfully. The provision of broad guidelines in training allowed individual approaches to be developed and this contributed to a positive experience for peer leaders in the University of Queensland Driver Retirement Initiative. These findings have implications for the development of future peer-led driving cessation programmes and the selection of their peer leaders.

Deep brain stimulation (DBS), a surgically based treatment for people living with Parkinson's disease (PD), can result in a significant improvement of motor symptoms. However, the broader impact of DBS and the changes it creates are not well understood. Greater understanding of the experiences and needs related to DBS would enable development of relevant outcome measures and supports. To explore the lived experiences of people undergoing DBS for Parkinson's disease. A descriptive phenomenological study was undertaken exploring experiences, perspectives and outcomes with key stakeholders. Semi-structured, audiotaped interviews were undertaken with people with PD who have had DBS, their family members and health professionals across four states and territories in Australia. Perspectives and experiences of 14 people with PD undergoing DBS, 10 family members and 11 health professionals were analysed. Occupations emerged as a key aspect throughout the DBS experience. Two major themes captured the role of occupation in relation to DBS: Occupations as a barometer, where occupational experiences and performances shaped people's understanding of their condition, the impact of treatments and their overall adjustment; and Shifting occupational identity where the life transition of DBS altered the occupational experiences of relationships, volition, roles and responsibilities of people with PD and their family members. Occupational experiences and changes served as an important way for people with PD and their families to understand and communicate their experiences of PD and related treatments. There is an identified need for outcome measures and clinical education and interventions to reflect this.

This research addresses dementia and driving cessation, a major life event, and an immense challenge in primary care. In Australia it is general practitioners (GPs) who identify changes in cognitive functioning and monitor driving issues with their patients. Doctors are advised not to base their fitness to drive decisions solely on disease duration, and without clear guidelines or tests, it is a complicated area of practice. We aimed to gain an understanding of the barriers and facilitators that primary care practitioners experience in managing driving cessation with their patients with dementia, and the strategies implemented to address these. A qualitative study was undertaken to understand how GPs transition a patient with dementia to non-driving status. Data were collected through five focus groups with GPs in practices across S.E. Queensland, Australia. Discussions were audio recorded, transcribed verbatim and thematically analyzed taking a phenomenological approach. Preparation and education were identified as key. Because loss of insight into declining driving abilities exacerbated the challenges of stopping, timing of the discussion was regarded as critically important. However, it was complicated with the difficulty of identifying early dementia; and concern for the negative impact that raising the driving issue had on the doctor-patient relationship. A number of in-room tests were reported as somewhat useful, however no single test satisfactorily predicted fitness to drive, and these lacked face validity with patients. GPs noted that involving supportive family members and providing strategies for accessing alternative transportation were helpful. The findings clarify a need for programs to support GPs and their patients to manage the complex issues around dementia and driving cessation.

In addition to the motor and cognitive symptoms that people with Parkinson's disease (PD) typically experience, psychiatric symptoms such as anxiety are also commonly experienced by people with PD. The overall purpose of the current study was to explore driving and driving cessation for people with PD and their families.A descriptive phenomenological approach was employed using semi-structured interviews and 34 interviews were conducted overall (22 participants with PD and 12 family members).Experiences of anxiety and worry that had an impact on driving and driving cessation arose from the data, and this article specifically captured the lived experience of anxiety with driving and driving cessation for people with PD and their families.Findings reveal that the experience of anxiety while driving, as well as anticipatory anxiety and/or worry related to driving cessation, affect the driving experiences and wellbeing of people with PD.Implications of the study findings are outlined and aim to provide information about the needs to enable future clinical directions to be developed.

Background:Driving cessation has demonstrated impacts on well-being and lifestyle. Despite the recognized reluctance of older people to plan for driving cessation, this study has identified a new group who has a stated plan to stop driving within 12 months. Although gradual reduction of driving has been documented as part of the usual driving cessation, this study explored the differences between retired drivers and those with a stated plan to retire within 12 months in sociodemographic, well-being and lifestyle outcomes.Methods:This study extracted all baseline data from a clinical trial exploring the effectiveness of a group program for older retiring and retired drivers. Sociodemographic data included age, gender, health status, educational level, and living situation. All participants completed measures related to episodes away from home, well-being, and lifestyle. These were compared using parametric and nonparametric statistical analysis.Results:Participants (n = 131) included 68 retired drivers (mean age 79.8 years) and 63 retiring drivers (mean age 77.8 years). Retiring drivers engaged in more episodes away from home (p = 0.03), and more social activities (p = 0.02), used less alternative transport (p < 0.001), displayed fewer anxiety (p = 0.05), and depressive (p = 0.01) symptoms, but demonstrated lower transport and lifestyle self-efficacy (p = 0.04).Conclusion:Both retired and retiring drivers require support for driving cessation and community engagement. Retiring drivers may be in a critical position to engage in driving cessation interventions to improve self-efficacy and begin adapting community mobility.

Background/aim: The ability to drive safely can be affected by an acquired brain injury. Following acquired brain injury, clients may experience driving disruptions, formal assessment, return to driving or permanent cessation. Health professionals may be involved in formal driving or component skills' assessment and rehabilitation, or interventions for continued community participation. Meeting the needs of clients related to driving remains a challenging area of clinical practice. The aim of this study was to investigate how driving issues are currently managed by acquired brain injury rehabilitation teams. Method: This study utilised a qualitative phenomenological approach to gain insight into the approaches undertaken by four rehabilitation teams working with clients post-acquired brain injury. Semi-structured, audiotaped interviews were conducted with 25 participants who had identified driving as part of their role. Results: Health professional participants described three major areas of clinical focus, describing strategies and challenges associated with each. These were as follows: 'Integrating driving goals into rehabilitation' which involved optimising timing and acknowledging the clients' focus on driving while enhancing driving and rehabilitation outcomes; 'Managing emotional responses' which required protecting therapeutic relationships and providing information, as well as responding to more extreme responses; and finally 'Managing unlicensed driving and meeting long-term needs', which participants identified as the most challenging aspect. Strategies involved using set procedures, building on knowledge of the client, supporting the family and exploring alternatives. Conclusion: The teams described a range of strategies used to address the challenges related to driving and driving cessation which can be applied to successfully manage this issue in acquired brain injury rehabilitation.

Objectives: The UQDRIVE program, a group education and support program, was developed to meet the needs associated with driving cessation for older adults. The current study investigated the effect of the program on community mobility. Design and Methods: A prospective, parallel, stratified randomized controlled trial was undertaken with a waitlist control group receiving current clinical practice (no intervention). Data were collected pre, post, and 3 months following the intervention. Participants were adults aged 60 years or older who had ceased driving or planned to cease driving within 12 months. Results: A total of 131 participants were included in analyses (67 intervention, 64 control). Participating in the intervention was significantly associated with a higher number of episodes away from home per week at immediately postintervention (z = 2.56, p = .01). This was not significantly maintained at 3-month follow-up. Participation in the intervention also significantly predicted higher use of public transport at immediately postintervention (z = 2.12, p = .034), higher use of walking at immediately postintervention (z = 2.69, p = .007), increased aspects of community mobility self-efficacy (z = 3.81, p = .0001), and higher satisfaction with transport at 3-month follow-up (z = 2.07, p = .038). Implications: The program increased community mobility immediately postintervention and transport satisfaction at 3 months postintervention. Due to a high attrition rate, further research is required to clarify the long-term impact of the intervention.

Family members often assume the role of driver for individuals who are not driving post-acquired brain injury (ABI). Given that return to driving can be unpredictable and uncertain, the impact of driving disruption on family members may vary at different stages post-injury. This study aims to understand the needs and experiences of family members over time during driving disruption following an ABI.A qualitative prospective longitudinal research design was used with semi-structured interviews at recruitment to study, 3 and 6 months later.Fourteen family members completed 41 interviews. The longitudinal data revealed four phases of driving disruption: (1) Wait and see, (2) Holding onto a quick fix, (3) No way out, and (4) Resolution and adjustment. The phases described a process of building tension and a need for support and resolution over time.Holding onto a quick fix is a pivotal phase whereby supports, such as engagement in realistic goal setting, are essential to facilitate family members' resolution of driving disruption issues. Family members who see no way out might not actively seek help and these points to a need for long-term and regular follow-ups. Future research can explore ways to support family members at these key times. Implications for rehabilitation Health professionals need to facilitate the process of fostering hope in family members to set realistic expectations of return to driving and the duration of driving disruption. It is necessary to follow-up with family members even years after ABI as the issue of driving disruption could escalate to be a crisis and family members might not actively seek help. Health professionals can consider both practical support for facilitating transport and emotional support when addressing the issue of driving disruption with family members.

Background: The distances and distribution of people, and pressures on the health system in Australia mean that access to services for people living with a neurodegenerative condition may be inadequate. Telehealth may offer ways to provide timely and efficient monitoring and support. People with Parkinson's disease require regular screening of their symptoms and needs, but may have limited access to health professionals. Cognitive changes can impact on occupational performance, thus timely monitoring of cognition is important for informing occupational therapy interventions. Aim: To evaluate the feasibility of screening cognition in people with Parkinson's disease using available technology in their homes. Method: Eleven participants with Parkinson's disease completed the Montreal Cognitive Assessment face-to-face and then via videoconferencing one week later using the technology available at their home. Participants and assessors provided feedback on their experience. Results: All Montreal Cognitive Assessment items could be completed over videoconference (e.g. Skype), with a median difference of 2 (IQR: 1–2.5) between face-to-face and videoconference scores. Higher scores were not favoured by either mode of assessment. Three participants received inconsistent cognitive classifications between the two assessment methods. Participant and assessor feedback indicated reported benefits including convenience as well as technological limitations. Conclusions: Given the pressures on the health system and the apparent acceptability to consumers, occupational therapists may explore the utility of readily accessible technology to enable timely monitoring of cognition for people with Parkinson's disease. Further research is needed to develop and demonstrate the reliability and validity of this approach.

This author accepted manuscript (post print) is made available following a 12 month embargo from date of publication (16 December 2015) in accordance with the publisher copyright policy.

Purpose.To evaluate the feasibility of assessing a person’s symptoms of Parkinson’s disease (PD) in their home using the videoconferencing technology they already possess, without a home visit.Method.Eleven participants with PD completed the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) face-to-face and then via videoconferencing within a two-week period. Participants used free software and the computers and webcams available at their home to complete the videoconference assessment with a clinical rater scoring remotely. Clinical raters and participants provided feedback on the experience.Results.Excluding rigidity and postural stability, between zero and seven items could not be completed in the assessment of each participant (median 2.0, IQR 1.0–4.0). Between face-to-face and videoconference assessments, the median difference in scores was 3.0 (IQR 1.5–9.0). Content analysis of feedback identified the clinical raters’ reasons why some scoring could not be completed and the participants’ hope for future clinical application.Conclusions. In using free everyday technology available in participants’ homes, MDS-UPDRS ratings could be obtained without an initial home visit; however some items were unable to be scored for some participants. Use of a protocol or technological advances are likely to reduce missing items.

Background: People with dementia have a range of needs that are met by informal caregivers. A DVD-based training program was developed using research-based strategies for memory and communication in dementia. The effectiveness of the training on the caregiver experience and the well-being of the person with dementia was evaluated.Methods: A pre-test/post-test controlled trial was undertaken with caregiver–care-recipient dyads living in the community. Measures of the carers’ knowledge of memory and communication strategies, burden, positive perceptions of caregiving, and perceptions of problem behaviors were taken pre- and three months post-intervention. The depression and well-being of the person with dementia were also evaluated. Satisfaction with the training and feedback were measured.Results: Twenty-nine dyads (13 training group, 16 control group) participated. Bonferroni's correction was made to adjust for multiple comparisons, setting α at 0.00385. A significant improvement was found in caregivers’ knowledge for the training group compared to the control group (p = 0.0011). The training group caregivers reported a reduction in the frequency of care recipient disruptive behaviors (p = 0.028) and increased perceptions of positive aspects of caregiving (p = 0.039), both at a level approaching significance. The training group care recipients had increased frequency of verbally communicated depressive behaviors at a level approaching significance (p = 0.0126). The frequency of observed depressive behaviors was not significantly different between groups.Conclusions: This approach to training for caregivers of people with dementia appears promising for its impact on knowledge and the caregiving experience. Further research could monitor the impact of the training on broader measures of depression and well-being, with a larger sample.

Background/aims: Community mobility is affected by an interruption to or cessation of driving following traumatic brain injury (TBI). This study aimed to examine loss of the driving role and to explore the outcomes associated with driving cessation from the perspectives of key people involved within the process: people with TBI, their family members and involved health professionals.

Background/aim: Dementia significantly impacts on the individual’s and caregiver’s quality of life. The aim of this study was to describe Australian occupational therapy practice with people with dementia. Methods: A questionnaire was piloted and sent to occupational therapists in Australia working with people with dementia. Participants were recruited in one of three ways: (i) identified by OT AUSTRALIA as working in aged care; (ii) through dementia-specific facilities in Australia; or (iii) through occupational therapy aged care list serves. The questionnaire asked occupational therapists about referrals received, assessments and interventions used, perceived barriers to the delivery of interventions and perceived educational needs. Data were analysed descriptively and presented as frequencies and percentages. Results: One hundred and thirty-four occupational therapists responded to this survey. Referrals were predominantly for environmental modification, home assessment or falls prevention and for assessment of activities of daily living. Therapists spent most of their time on assessment, with brief cognitive and functional assessments used most frequently. The most common interventions were environmental modification advice and prescription of assistive equipment. Lack of time was the most commonly reported barrier to the delivery of interventions with therapists also identifying concerns about staffing and role restrictions imposed by organisations. Therapists also identified that further training in this area would be useful. Conclusions: Therapists working in dementia care indicated that they are constrained in terms of time, staffing and organisational restrictions. Recommendations include enhanced training, further research into the most viable occupational therapy interventions, and advocating for improved funding, staffing and resources.

Background. Driving cessation can lead to negative consequences, such as depression and reduced social activities. Purpose. The University of Queensland Driver Retirement Initiative (UQDRIVE) intensive support program is a six-week program to assist older people with driving cessation. Methods. Fifty-five participants completed a survey of satisfaction with the program, including identification of the aspects of the program that were useful and they had applied in real life. Findings. There was overall satisfaction with the program, and content analysis identified three areas that were highlighted as particularly useful: “Finding alternative means: transport and service options,” “Planning with more wisdom: thinking about driving cessation,” and “Being with people: sharing experiences with peers.” Implications. These findings indicate that program participants were satisfied with the current UQDRIVE intensive support group program and found both the psychosocial supports and practical strategies to be useful in managing driving cessation.

The ability to drive safely is commonly affected by traumatic brain injury (TBI). Driving is a role and activity that is highly valued and also associated with successful community reintegration after TBI. Relatively little is understood about the processes of interruption to driving and potential return to driving that can be experienced by people with TBI and their family members (FMs). Exploring the way in which driving interruption, return to driving and permanent cessation of driving happen for people with TBI, their FMs and health professionals (HPs) who work with them can enable a fuller understanding of the experiences and needs and enhance the rehabilitation approaches in this situation.A descriptive phenomenological approach was used to explore the experience with the aim of improving services for people with TBI. Semi-structured interviews about driving and driving cessation were conducted with 15 people with TBI, 10 FMs and 10 HPs who had experience in driving and driving cessation issues.The findings reveal experiences of the process of driving and driving cessation contextualised within experiences of the accident and treatment process. Participants identified key times of need in relation to driving: being told about driving restrictions, understanding driving restrictions, the 'on hold' period, and returning to driving.The processes surrounding driving and driving cessation after TBI are complex. Informational, support and practical needs differ at the different times. There are key times where people may need further support to improve rehabilitation outcomes. Rehabilitation approaches may particularly need to provide clear, consistent information about driving restrictions, and the process required for returning to driving. While recovery time appears necessary for allowing a safe return to driving, active support for continued involvement in the community using alternative transport may reduce the frustration and disengagement experienced by people in the 'on hold' period.

Aims Licensing authorities in different countries differ in their approaches to the use of age based licensing, medical fitness and driving assessments. This article describes a new licensing policy introduced in Singapore in 2006 whereby driving assessment by occupational therapists became a critical stage in the licensing process for older taxi drivers. Preliminary data on the older taxi drivers are presented. Implications for future studies and clinical intervention are discussed. Methods Information was gained from the Land Transport Authority of Singapore on current taxi drivers, the projected number of taxi drivers aged 70 years who were eligible to renew their licences in 2008, 2009, 2010, and any data on accidents, demerit points and complaints against taxi drivers. Information about the 70 year old taxi drivers that had undergone the functional driving assessment program in 2006 and 2007 was gained from the Department of Occupational Therapy. This information was analysed. Findings There was a very high pass rate - 98% of those aged 70 or over who took the test, passed. Conclusions The high pass rate needs further exploration. Future research can explore the cost effectiveness of the licensing and driving assessment systems in terms of accident rates, the validity of on road tests and useful predictive off road tests.

Driving cessation can result in a range of negative consequences, including impacts on identity, mood, and life satisfaction. The aims of this study were to explore the needs and experiences of people who cease driving following a stroke, with the aim of informing clinical practice. Method: Using a qualitative phenomenological approach, semi-structured, audiotaped interviews were conducted to gain an understanding of the needs and experiences of 24 participants (17 male, 7 female, mean of 5.5 years post driving cessation) who had ceased driving following a stroke. Results: After constant comparative analysis, four themes emerged from the data. These were labelled ‘life without driving’, ‘key times of need’, ‘alternatives and other ways’, and ‘carer support and assistance’. Most participants found stopping driving after their stroke to be a sudden, unexpected and intense experience and raised issues, including the loss of numerous life-roles, challenges associated with arranging alternative transport, and reliance on carers and the need for more information throughout the process. Conclusion: Individuals who cease driving following a stroke have unmet needs and difficult experiences throughout the process. Key times of particular need have been identified in this study. These findings have important implications for health professionals that include providing more information and support with driving cessation and alternatives to driving.

This study investigated the time use, role participation and life satisfaction of older Australians (aged 65 years and older) who were 1-3 years post-stroke and living in the community. The results of this study were compared with a published study on the time use, role participation and life satisfaction of older Australians who had not experienced stroke. Twenty-three participants with stroke (mean age 74.2 years, 69.6% men) were interviewed using measures of time use, role participation and life satisfaction. Participants with stroke spent most of their time in sleep (7.2 h/day), solitary leisure (7.0 h/day), social leisure (3.0 h/day), and basic activities of daily living (2.9 h/day). Compared to the sample without stroke, participants with stroke spent significantly less time in sleep, instrumental activities of daily living, and volunteer work, and significantly more time at home, with others, and engaged in solitary leisure. Similar to the sample without stroke, the most common roles for participants with stroke were family member, friend, and home maintainer. Participants with stroke engaged in fewer roles than participants without stroke. Unlike the sample without stroke, role loss was not correlated with life satisfaction for participants with stroke; however, having more roles was correlated with greater life satisfaction.Experiencing a stroke can affect the configuration of older people's time use and reduce their role participation. Facilitation of older people's role participation after stroke may enhance their life satisfaction.

The continuation of older people in the paid workforce is regarded as beneficial for both the economy and older workers. While there have been attempts to encourage older people to continue working, little is understood about older workers' perspectives. This qualitative study explored the lived experiences and perceptions of paid workers aged 60 years and older with the aim of understanding why older people continue to work and the barriers and facilitators they encounter. Sixteen older Australians (eight males and eight females, mean age 67 years) who participated in paid employment for at least 12 hours per month were interviewed. Thematic analysis elicited themes of benefits of work, problems encountered at work and the ways in which older people respond to these challenges. Financial considerations, the desire to contribute and the absence of competing interests were reasons given for continuing involvement in work. Older workers identified stress, lack of support, physical demands and overemphasis on qualifications as barriers to their participation. Maintaining a healthy lifestyle, having a passion for work, and education were factors that participants identified as supporting continued work. These findings enhance the understanding of the experiences of older workers and may have implications for encouraging workforce participation of older people.

Family members of a person with an acquired brain injury often provide transport assistance during driving disruption with potential impacts on their own travel and participation within the community. The geographic area in which people travel and conduct their activities is known as lifespace. This study aimed to describe the quantitative changes in family members' lifespace after brain injury and understand their subjective experiences through interacting with maps during narratives.Mapping was embedded within in-depth semi-structured interviews with 15 family members. Two sets of maps were generated per participant showing the number of travel locations before and after brain injury. In the interviews, participants reflected on the perceived meaning of lifespace change. Qualitative data were analysed using a narrative approach.Quantitative data from the mapping revealed an increase in travel locations for nine participants, a decrease for five, and no change for one participant. Data analysis revealed four typologies which complemented and enriched the quantitative data: (i) I will do everything for him or her; (ii) Trying to fit all in; (iii) We spend all our time together now; (iv) I need to also care for myself.The findings describe the change in family members' lifespace after taking on the driver role following acquired brain injury. This study highlights the importance of understanding both quantitative and qualitative aspects of lifespace. The subjective experiences and consequences of lifespace changes are different from the impact on individuals with health conditions. Mapping in an interview as a tool has potential clinical utility.

Mobile phones and other remote monitoring devices, collectively referred to as "mHealth," promise to transform the treatment of a range of conditions, including movement disorders, such as Parkinson’s disease. In this viewpoint paper, we use Parkinson’s disease as an example, although most considerations discussed below are valid for a wide variety of conditions. The ability to easily collect vast arrays of personal data over long periods will give clinicians and researchers unique insights into disease treatment and progression. These capabilities also pose new ethical challenges that health care professionals will need to manage if this promise is to be realized with minimal risk of harm. These challenges include privacy protection when anonymity is not always possible, minimization of third-party uses of mHealth data, informing patients of complex risks when obtaining consent, managing data in ways that maximize benefit while minimizing the potential for disclosure to third parties, careful communication of clinically relevant information gleaned via mHealth technologies, and rigorous evaluation and regulation of mHealth products before widespread use. Given the complex array of symptoms and differences in comfort and literacy with technology, it is likely that these solutions will need to be individualized. It is therefore critical that developers of mHealth apps engage with patients throughout the development process to ensure that the technology meets their needs. These challenges will be best met through early and ongoing engagement with patients and other relevant stakeholders.

Driving is a complex and valued instrumental activity of daily living, which is associated with a person's freedom, independence and autonomy. With an ageing population and various cohort effects, the number of older drivers is increasing at a nearly exponential rate. While drivers over the age of 65 years have attracted media and research attention because of accident statistics, research has also begun to focus on the outcomes for older people giving up driving. The outcomes of older people driving or giving up driving need to be considered by occupational therapists because of the potential impact on quality of life, life roles, independence and safety. Occupational therapists must be aware of legislation pertaining to older drivers and health professionals, although this is complicated by the fact that it differs between and within countries. This literature review aims to investigate the issues associated with older drivers and with driving cessation and the implications for occupational therapists.