Phyllis Liang

A driving cessation program to identify and improve transport and lifestyle issues of older retired and retiring drivers

BACKGROUND This study explored the transport and lifestyle issues of older retired and retiring drivers participating in the University of Queensland Driver Retirement Initiative (UQDRIVE), a group program to promote adjustment to driving cessation for retired and retiring older drivers. METHODS A mixed method research design explored the impact of UQDRIVE on the transport and lifestyle issues of 55 participants who were of mean age 77.9 years and predominantly female (n = 40). The participants included retired (n = 32) and retiring (n = 23) drivers. Transport and lifestyle issues were identified using the Canadian Occupational Performance Measure and rated pre- and post-intervention. RESULTS Paired t-tests demonstrated a statistically significant improvement in performance (t = 10.5, p < 0.001) and satisfaction (t = 9.9, p < 0.001) scores of individual issues. Qualitative content analysis identified three categories of issues including: protecting my lifestyle; a better understanding of transport options; and being prepared and feeling okay. CONCLUSIONS Participation in UQDRIVE had a positive and significant effect on the issues of the participants. The results highlight that although all participants stated issues related predominantly to practical concerns, there were trends in the issues identified by the drivers and retired drivers that were consistent with their current phase of the driving cessation process.

Family members’ needs and experiences of driving disruption due to health conditions or ageing

Abstract Purpose: Family members often assume the caregiving role and provide practical assistance and emotional support when an individual is experiencing driving disruption due to health conditions or ageing. The purpose of this study was to understand the experiences, viewpoints and needs of family members with regards to an individual undergoing driving disruption across various population groups. Method: A scoping review was conducted through searching across six databases and hand searching articles published from 1985 to 2013. Findings from the articles specific to the aims of the review were extracted and summarised into common topics. Results: Twenty-seven articles were included; dementia or cognitive impairment (16 articles), older adults (8 articles) and brain injury (3 articles). The most common topic raised was related to decisions and consequences for the individual. Other concerns were related to family members’ occupational role changes, emotional and communication issues and support needs of family members and their recommendations for services. Conclusions: This review revealed the impact of driving disruption on family members but research is limited, especially in the area of brain injury. The majority of articles did not set out to explore family members’ experiences and needs and this highlights an area that requires critical attention. Implications for Rehabilitation Health professionals should be aware of the potential impact of driving disruption on family members. Family members frequently raise concerns regarding the decisions and consequences for their relative, but also bring up personal concerns such as changes to their own occupational roles and the communication and emotional issues they face during driving disruption. Unique challenges arise between family members of individuals of different health conditions, thus highlighting the importance of family caregiving research in various population groups.

Family members’ needs and experiences of driving disruption over time following an acquired brain injury: an evolving issue

Abstract Purpose: 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. Method: A qualitative prospective longitudinal research design was used with semi-structured interviews at recruitment to study, 3 and 6 months later. Results: 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. Conclusions: 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.

Occupational experience of caregiving during driving disruption following an acquired brain injury

Introduction Caregiving 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 and meaning behind the occupation of a family member providing care during driving disruption. Method A prospective longitudinal design with a phenomenological approach was used as part of a larger study exploring family members’ needs and experiences. Forty-two semi-structured interviews were conducted with 15 family members over a 6-month period. Interviews were analysed using inductive thematic analysis. Results The occupational experiences related to caregiving during driving disruption emerged as a key finding. The meaning and activities comprising the caregiving occupation during driving disruption are captured in three themes: (1) More than just driving; (2) The invisible and undervalued care and (3) Being a therapist at home. Family members highlighted the challenges of managing broader and multiple responsibilities. Conclusion The lived experiences, perceived meaning and activities involved in the caregiver occupation during driving disruption extend beyond just transport provision. Family members require support for occupational engagement and satisfaction at this key time. Rehabilitation and support for the person after an acquired brain injury may also improve the occupational experiences of family members.

Family members’ experiences of driving disruption after acquired brain injury

ABSTRACT Primary objective: 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. Research design: Mixed methods phenomenological research approach. Methods and procedures: 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). Results: 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. Conclusions: 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.

Mixed evidence exists for Internet-based education and support interventions for caregivers of someone with a chronic health condition in enhancing wellbeing and decreasing stress.

Objective of review: To assess the effectiveness of Internet-based interventions aiming to decrease caregiver stress. Design: Systematic review (AMSTAR rating 6/11). Search strategies: A search was conducted in databases (e.g., Ovid MEDLINE, Embase, PsycINFO, CINAHL). Search terms were reported. Selection criteria: Studies that met criteria of involving informal caregivers of someone with a chronic health condition, interventions delivered using Internet-based technology, interventions aiming to improve quality of life or reduce stress or burden. Open-label trials (where both participants and researchers had prior knowledge of allocation) or randomised controlled trials (RCTs) published in English-language peer-reviewed journals were included. Studies that were not Internet-based or did not have an interactive element were excluded. Methods of the review: Two reviewers independently screened abstracts. Disagreements between reviewers were resolved following discussion. Ratings of risk of bias were conducted by two raters using the Cochrane Risk of Bias Tool (only of RCTs). Data were extracted and tabulated about participants, interventions, outcome measurements and results. Results: Of the 1474 abstracts identified, 309 articles were full-text reviewed, which resulted in eight open-label trials and 16 RCTs (published between 2002 and 2014) being included. Studies involved caregivers of people with a range of conditions, including cancer, traumatic injuries, cardiac, neurodegenerative and mental health conditions. Care-recipients ranged in age from paediatric to geriatric populations. Some studies included only caregivers, whereas others also included care-recipients. Overall, more than 2000 caregivers were enrolled across all studies, with wide ranging sample sizes. All interventions contained interactive aspects. Some studies compared Internet-based interventions with standard care, unguided computer use or providing information. Intensity and duration varied and appeared unrelated to efficacy, though some studies did not measure these when interventions were self-directed. Outcomes included formal measures of caregiver outcomes, such as stress, anxiety, mood, wellbeing and quality of life. Mixed results were found (nine studies had positive findings; nine partially positive; six negative). Authors noted that many studies were not designed with the Cochrane Risk of Bias Tool in mind and aspects of reporting were unclear. Using the Internet to provide interventions limits the use of blinding or control groups. Dropout rates were a potential source of bias. Authors’ conclusions: Mixed evidence was found for the benefit of Internet-based education and support programs for caregivers of people with chronic diseases. The effectiveness of programs appears to be increasing as technology improves. The quality of RCTs conducted was acceptable, though further high quality studies are needed; consistency in methodology and outcomes measured would build the evidence. Contact details of original author: kung.simon@mayo.edu