title: An integrative review: understanding driving retirement decisions for individuals living with a dementia.
abstract: OBJECTIVE
  To synthesise primary research exploring decision making practices used to determine the time to retire from driving for individuals living with a dementia.
  
  
  BACKGROUND
  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.
  
  
  METHODS
  Integrative literature review informed by Whittemore & Knafl (2005).
  
  
  METHODS
  Electronic database search of Medline, CINAHL, Web of Science, Google Scholar 1997-2012; and incremental hand search.
  
  
  METHODS
  Primary studies published in peer reviewed journals were appraised against quality assessment criteria using CASP methodological assessment tools.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Wollongong, New South Wales, Australia.|CPE, HFESA, Sydney, NSW, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Andrew
authors.affiliation: University of Wollongong, New South Wales, Australia.
authors.forename: Victoria
authors.initials: V
authors.lastname: Traynor
authors.affiliation: Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia.
authors.forename: Don
authors.initials: D
authors.lastname: Iverson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001334:Automobile Driving / Q000523:psychology*; D003657:Decision Making; D003704:Dementia / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
keywords: assessment; care pathways; decision-making; dementia; ethics; nurses; nursing; patient participation