An integrative review: Understanding driving retirement decisions for individuals living with a dementia

Aim To synthesise primary research exploring decision making practices used to determine the time to retire from driving for individuals living with a dementia. Background Driving requires complex cognitive and physical skills potentially compromised due to the progressive nature of dementia. Whilst on‐road assessments are considered reliable indicators of driving capacity by clinicians, drivers with dementia disagree. Design Integrative literature review informed by Whittemore & Knafl (2005). Data sources Electronic database search of Medline, CINAHL, Web of Science, Google Scholar 1997–2012; and incremental hand search. Review methods Primary studies published in peer reviewed journals were appraised against quality assessment criteria using CASP methodological assessment tools. Results A total of 43 studies were retained for synthesis. Key findings were abstracted and a themes matrix was generated to identify patterns of meaning. Six themes emerged: (i) dementia may compromise the complex task of driving; (ii) defining onset and severity of dementia is problematic; (iii) symptom progression impacts on driving skills; (iv) assessment of fitness to drive remains subjective; (v) some drivers are reluctant to accept negative assessment outcomes; and (vi) the search for effective strategies to enhance acceptance of driver retirement continues. Conclusion This integrative literature review identified a large body of knowledge exploring the issues of driving cessation for drivers with dementia. However a challenge remains for practitioners, drivers and their family carers regarding how best to address this highly emotive issue. Findings could inform a structured approach to address this sensitive topic in a timely manner.