title: "The biggest problem we've ever had to face": how families manage driving cessation with people with dementia.
abstract: BACKGROUND
  It is recognized that people with dementia are likely to need to stop driving at some point following diagnosis. Driving cessation can lead to negative outcomes for people with dementia and their family caregivers (FC), who often experience family conflict and tension throughout the process. Family experiences surrounding driving cessation have begun to be explored but warrant further examination.
  
  
  METHODS
  Using a descriptive phenomenological approach, semi-structured interviews were undertaken with key stakeholders, including 5 retired drivers with dementia, 12 FC, and 15 health professionals (HP). Data were analyzed inductively to explore the needs and experiences of people with dementia and FC.
  
  
  RESULTS
  The data revealed a range of possible interactions between people with dementia and FC. These were organized into a continuum of family dynamics according to levels of collaboration and conflict: in it together, behind the scenes, active negotiations, and at odds. At the in it together end of the continuum, people with dementia and FC demonstrated collaborative approaches and minimal conflict in managing driving cessation. At the at odds end, they experienced open conflict and significant tension in their interactions. Contextual factors influencing family dynamics were identified, along with the need for individualized approaches to support.
  
  
  CONCLUSIONS
  The continuum of family dynamics experienced during driving cessation may help clinicians better understand and respond to complex family needs. Interventions should be tailored to families' distinctive needs with consideration of their unique contextual factors influencing dynamics, to provide sensitive and responsive support for families managing driving cessation.
authors.affiliation: UQ Centre for Clinical Research,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Jacki
authors.initials: J
authors.lastname: Liddle
authors.affiliation: School of Health and Rehabilitation Sciences,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Amelia
authors.initials: A
authors.lastname: Tan
authors.affiliation: School of Health and Rehabilitation Sciences,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Liang
authors.affiliation: School of Health and Rehabilitation Sciences,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Bennett
authors.affiliation: School of Health and Rehabilitation Sciences,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Shelley
authors.initials: S
authors.lastname: Allen
authors.affiliation: Metro South Older Persons Mental Health Services,Brisbane,Queensland,Australia, andCentre for Research in Geriatric Medicine,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: David C
authors.initials: DC
authors.lastname: Lie
authors.affiliation: School of Psychology,The University of Queensland,Brisbane,Queensland,Australia.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Pachana
mesh_terms: D000368:Aged; D001334:Automobile Driving / Q000523:psychology*; D017028:Caregivers; D003220:Conflict, Psychological; D003299:Cooperative Behavior; D003704:Dementia / Q000523:psychology*; D019468:Disease Management; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male
keywords: adjustment; carers; community mobility; family dynamics; qualitative