An International Approach to Enhancing a National Guideline on Driving and Dementia
Purpose of Review
The purpose of this study was to update a national guideline on assessing drivers with dementia, addressing limitations of previous versions which included a lack of developmental rigor and stakeholder involvement.
An international multidisciplinary team reviewed 104 different recommendations from 12 previous guidelines on assessing drivers with dementia in light of a recent review of the literature. Revised guideline recommendations were drafted by consensus. A preliminary draft was sent to specialist physician and occupational therapy groups for feedback, using an a priori definition of 90% agreement as consensus.
The research team drafted 23 guideline recommendations, and responses were received from 145 stakeholders. No recommendation was endorsed by less than 80% of respondents, and 14 (61%) of the recommendations were endorsed by more than 90%.The recommendations are presented in the manuscript.
The revised guideline incorporates the perspectives of consensus of an expert group as well as front-line clinicians who regularly assess drivers with dementia. The majority of the recommendations were based on evidence at the level of expert opinion, revealing gaps in the evidence and future directions for research.
KeywordsDementia Driving Clinical practice guidelines Knowledge translation
The authors acknowledge the encouragement and support of Yoassry Elzohairy, Paul Boase, Kirsty Olsen, and Regina McFadden in earlier stages of this work.
The editors would like to thank Dr. William McDonald and Dr. Alice Pomidor for reviewing this manuscript.
This knowledge synthesis was funded by the Canadian Institutes of Health Research (CIHR) (KRS Grant #339665). The funders played no role in the study methodology, interpretation of results, preparation of the report, or the process of disseminating this work. They accept no responsibility for the contents.
Compliance with Ethical Standards
Conflict of Interest
Several of the authors have publications on the topic that were included as part of the review. To mitigate the associated risk, the authors were not involved in the screening or data extraction of their own publications (MJR, DBC, SC, NH, JD, JC, SM, JPT). Several co-authors disclosed research grants/funding for their work (MJR, DBC, SC, NH, JD, JC, KL, SM, FM). Potential COIs were declared by MJR (Canadian Academy of Geriatric Psychiatry (CAGP) board president; consultancy at the Canadian Medical Association(CMA)), DBC (board membership for Memory Care Home Solutions, Dementia Organization, and the Advocacy Committee for the Alzheimer’s Association; consultancies at ADEPT, MEDSCAPE, Traffic Injury Research Foundation, and AAA Foundation for Traffic Safety; legal cases on medical conditions and driving), SC (honoraria from National Institutes of Health (NIH) and Canadian Association of Occupational Therapy (CAOT)), NH (research support from Lundbeck and Roche; consultancies at AbbVie, Astellas, and Merck; honouraria from Pfizer, Lundbeck, and Novartis), JC (board membership for BrainLink; consultancies at the Royal College of Physicians of Ireland, and National Transportation Commission), SM (consultancies at the CMA, the Ministry of Transportation of Ontario (MTO), and from physicians; expert testimony on TBI; honouraria for peer-reviewed speaking activities), FM (consultancy at the CMA).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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