Occupational therapy interventions to improve driving performance in older people with mild cognitive impairment or early-stage dementia: A systematic review

Claire Spargo, Kate Laver, Angela Berndt, Zoe Adey-Wakeling, Stacey George

Research output: Contribution to journalReview articlepeer-review

Abstract

Importance: For a person with mild cognitive impairment (MCI) or early-stage dementia, driving is important for independence. However, driving presents safety concerns for both the person and family members. It is important to determine whether occupational therapy interventions can prolong safe driving for this population. Objective: To determine the effectiveness of occupational therapy interventions to improve driving performance in older people with MCI or early-stage dementia. Data Sources: We conducted a search of MEDLINE, PsycINFO, CINAHL, and gray literature using Google Scholar. Study Selection and Data Collection: Studies were included if they evaluated interventions that (1) aimed to improve the driving performance of older people (M age ≥60 yr) with MCI or early-stage dementia and (2) could be designed or delivered by an occupational therapy practitioner who specializes in driving. Citations were reviewed independently by two authors, and quality appraisal was conducted using the Cochrane risk-of-bias guidelines. Findings: One Level I randomized controlled trial (RCT) and 4 Level III quasi-experimental studies were included; these studies had 231 participants in total with reported M ages of 65.6–72.5 yr. One study evaluated a compensatory approach, whereas th others evaluated a remedial approach. The studies used different measures to assess outcomes and reported mixed effects. Conclusions and Relevance: Low strength of evidence suggests that occupational therapy interventions may improve the driving performance of older people with MCI or early-stage dementia. More RCTs are needed that include long-term follow-up measure and address clinically important outcomes. What This Article Adds: In the absence of conclusive evidence from research studies and best practice guidelines, occupational therapy practitioners must rely on their clinical experience and their clients’ abilities. Development of evidence and guidelines in thi area is critical. It is also important for practitioners to work closely with clients, families, and interdisciplinary team members to carefully monitor fitness to drive.

Original languageEnglish
Pages (from-to)1-14
Number of pages14
JournalAmerican Journal of Occupational Therapy
Volume75
Issue number5
DOIs
Publication statusPublished - Sep 2021

Bibliographical note

Funding Information:
This systematic review was registered on PROSPERO on February 20, 2019 (CRD42019111294). This work was supported by a Dementia Australia Research Foundation PhD scholarship.

Publisher Copyright:
© 2021 American Occupational Therapy Association, Inc. All rights reserved.

Keywords

  • dementia
  • driving simulators
  • minimal cognitive impairment
  • older adult

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