[Driving with dementia as a reason for counseling in general practice - An integrative review]

Dementia is associated with progressive impairments that increase the risks to driving safety. General practitioners (GPs) play an important role in initiating conversations about fitness to drive and in supporting people with dementia and their families. This integrative review asked how counseling on driving with dementia can be improved through needs-based interventions in general practice in Germany.

An integrative review was conducted. Using a predefined, highly sensitive search strategy, we searched seven bibliographic databases without time restrictions. Study selection, analysis, and interpretation were performed by a multiprofessional team. Studies in English and German were included.

69 primary studies met the inclusion criteria and were analyzed. 39 quantitative studies, 24 qualitative studies, 3 studies using mixed methods, and 3 consensus and Delphi studies were included. Driving was viewed as important for maintaining autonomy and social participation by both people with dementia and family caregivers. Physician recommendation can be decisive in facilitating voluntary driving cessation. GPs reported concerns about straining the patient-physician relationship as a barrier to addressing driving safety. They also described feelings of uncertainty when assessing driving-relevant impairments and a need for communication and decision-support tools. Existing guidelines were perceived as too general and insufficiently tailored to the general practice setting.

International studies identified several intervention elements that facilitate talks about driving safety and driving cessation in primary care. In Germany, counseling in general practice should focus on early planning and ongoing support to maintain social participation and to address fears experienced by people with dementia.