Andrew Catherine, Traynor Victoria, Iverson Don
University of Wollongong, New South Wales, Australia.
CPE, HFESA, Sydney, NSW, Australia.
J Adv Nurs. 2015 Dec;71(12):2728-40. doi: 10.1111/jan.12727. Epub 2015 Jul 30.
To synthesise primary research exploring decision making practices used to determine the time to retire from driving for individuals living with a dementia.
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.
Integrative literature review informed by Whittemore & Knafl (2005).
Electronic database search of Medline, CINAHL, Web of Science, Google Scholar 1997-2012; and incremental hand search.
Primary studies published in peer reviewed journals were appraised against quality assessment criteria using CASP methodological assessment tools.
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.
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.
综合探索用于确定痴呆症患者停止驾驶时间的决策实践的初步研究。
驾驶需要复杂的认知和身体技能，而痴呆症的渐进性可能会损害这些技能。虽然临床医生认为道路评估是驾驶能力的可靠指标，但痴呆症患者却不认同。
采用Whittemore & Knafl（2005年）提出的综合文献综述法。
对1997年至2012年期间的Medline、CINAHL、科学引文索引、谷歌学术进行电子数据库搜索；并进行增量手工检索。
使用CASP方法学评估工具，根据质量评估标准对同行评审期刊上发表的初步研究进行评估。
共保留43项研究进行综合分析。提取关键发现并生成主题矩阵以识别意义模式。出现了六个主题：（i）痴呆症可能会影响驾驶这项复杂任务；（ii）界定痴呆症的发病和严重程度存在问题；（iii）症状进展会影响驾驶技能；（iv）对驾驶适宜性的评估仍然主观；（v）一些驾驶员不愿接受负面评估结果；（vi）寻找提高对驾驶员退休接受度的有效策略的工作仍在继续。
这项综合文献综述确定了大量关于痴呆症患者停止驾驶问题的知识。然而，对于从业者、驾驶员及其家庭护理人员来说，如何最好地解决这个高度情绪化的问题仍然是一个挑战。研究结果可为及时处理这个敏感话题的结构化方法提供参考。
