Dr Jacki LiddleAssoc Prof Kryss McKennaMelody Webbm.webb3@uq.edu.au p 3346 7487

CONTENT

• Research techniques

• UQDrive background

• Driving cessation process

• Improving outcomes for your clients

• UQDrive program

• Future directions

RESEARCH

• Qualitative: Involves an in-depth understanding of human behaviour and the reasons behind human behaviour. It generates non- numerical data, e.g. a patient's description of their pain rather than a measure of pain. OR

• Quantitative: Generates numerical data or data that can be converted into numbers, for example the National Census, which counts people and households.

• Qualitative data investigates the why and how of decision making, as compared to what, where, and when of quantitative data

RESEARCH

• RANDOMISED CONTROL TRIALS• Common method for evaluating treatment efficacy • Must have a comparison between a treatment

and placebo/control group• Subjects must be allocated to either group using a

randomisation procedure• Must have at least a single blind procedure used

to collect the data (to prevent experimenter bias)• If controls are rigorous, can conclude that the

observed outcome, has been caused by the intervention i.e. there is a high probability that the treatment works

UQ Research

• Research began 2001 – qualitative data involving approximately 250 older people, health professionals and family members

• Developed an understanding of the process and outcomes of driving cessation

• UQDrive program part of a 3 year RCT Brisbane and Sunshine Coast funded by NHMRC

Driving as a behaviour OR an Identity

Behaviour• Means to an end; A to B• “It is convenience…never an essential thing”• Driving cessation is a behaviour change, forming

new habits, accepting change

Identity• More than an activity, an identifier of disability or

age• “It made me a prisoner of the house” “I mourn the

car”

Driving cessation as a process

• Not usually a single event• Common phases and challenges related

to behaviour change and life transition in each phase• Predecision (a balancing act, gaining

awareness)• Decision (making the decision, owning the

decision)• Postcessation (finding new ways, coming to

terms)

Outcomes of driving cessation

Retirement from driving is an independent predictor of depression, reduced community engagement and a lower quality of life.

Outcomes of driving cessation

Compared to current drivers (controlling for age, health, functional status, living situation) retired drivers had significantly

• Lower life satisfaction

• Fewer roles (volunteer, family member)

• Less time on social leisure away from home ; more time solitary leisure

What people want

• Planning and preparation

• Respect and control

• Peers and experts involved

• Flexibility due to diversity of needs

• Safe Transport options

• Locally relevant information

Improving outcomes for your clients

Always include assessment of transport needs Start talking about driving cessation early (particularly for

people with degenerative conditions)Encourage clients to have a broad repertoire of transport

options while they are still drivingAssess and teach the skills required for pedestrian and

public transport options (DDA ‘Standards for Accessible Public Transport 2002’ mobility aids and restrictions when using public transport eg weight capacity and anchorage on trains)

Inform clients of advocacy avenues (OPSO, QR Forum)Be aware of your client’s legal responsibilities

Legal Responsibilities

For clients:In QLD need a medical certificate if > 75 Medical certificate will expire at a time

decided by Dr and will need reviewingIf conditions are recommended (time of day,

distance of driving) must be recorded on licence

Legal Responsibilities

Since March 2006 – licence holder needs to report “any long term or permanent medical condition…that may affect their ability to drive” to Queensland Transport (eg epilepsy, stroke, heart disease, vision impairment)

License will show an M – need to carry a current medical certificate while driving. If not, driver is uninsured and can be fined (or condition…)

Austroads “Assessing Medical Fitness to Drive” is recommended as a resource.

Paperwork

• Driver takes “Private and Commercial Vehicle Driver’s Health Assessment Form” to medical practitioner – obtained from QLD Transport

• Driver fills in Part 1 (identifying information and declaration)

• Treating doctor fills in Part 2 (medical history, visual acuity, neurological assessment etc) Refers to specialist or occupational therapist if unsure (OT driving assessment – pre-driving screen and on-road assessment)

Who is responsible?

• “The responsibility for issuing, renewing, suspending or cancelling a person’s licence (including a conditional licence) lies ultimately with the Driver Licensing Authority.”

• “Your Dr does not make the rules but provides advice about how your particular health condition might affect your ability to drive safely”(Austroads ‘Driving and Your health’ Austroads.com.au)

• QLD Transport considers advice of your Dr, accident history and the type of vehicle you drive before making a decision (people who drive commercial vehicles must meet higher medical standards)

Who is responsible?

• If as a community worker, you believe your advice to not drive will not be adhered to, you are:

• Under no obligations to report• Able to voluntarily report if feel patient is

posing risk to public.• If reporting, provide enough information to

identify person in writing (letter, email, fax) and identify self

Some suggestions…

• Document clearly your reasons for concern about someone’s driving. (something they said, something you saw etc)

• Discuss with client and family your concerns, document this and give them a copy.

• Document also when you have told people of consequences of driving without valid licence.

• Explain consequences (include up to $3000 in fines, imprisonment of a year, insurance void)

Where to go for help

• Contact client’s GP or QLD Transport (13 23 80)

• RACQ• Free 90 minute workshops for staying safe

(commentary driving, planning and judgement, medicine labelling)

• Contact RACQ Road Safety Education p. 3872 8925

Where to go for help

UQDRIVE program• 6 week program consisting of 1/2 day group per

week » Flexibly delivered» Health professional delivery» Local content » Peer leaders» Assistance with adjustment to change in

lifestyle» Opportunities to trial local public transport

options

UQDRIVE Program

Participants:65 years and olderLiving in Brisbane / Sunshine Coast regionAble to participate in group (MSQ)Living independentlyNot planning to return to drivingEthics approval pending (60 years and over, 1:1 intervention, non-retired drivers)

How to refer

• Provide clients with our information brochures

• With permission, contact UQ with client details

Group 1 Feedback

• Groups commenced Wed 27th Feb• Method of recruitment• 69 queries to date• Approximately 1/3 not retired, but wanting

help preparing • 9 from ‘rural’ areas (Mt Mee, Milbong,

Bellbowrie)• 7 from concerned family / friends• 5 with dementia related difficulties

Future directions

• UQDRIVE: • RCT to continue for 3 years• New populations: younger people, ABI;

dementia, Professional drivers• AUSTRALIA• Melbourne Tram Group, Wide Bay Bus Group,

Caboolture central referral• OVERSEAS:• ‘Partners in Care’ www.partnersincare.org• ‘STP Exchange’ www.stpexchange.org

Some helpful links for community workers

• Hartford resources: Family conversations with older drivers

• http://www.thehartford.com/talkwitholderdrivers/• How to Establish and Maintain Door-

Through-Door Transport Services for Seniors www.stpexchange.org

• Wheelchair transportation safety www.rercwts.org (crash tested w/cs, crash test videos, safe anchor points and safety belt design)

Any questions?

• Melody Webb• m.webb3@uq.edu.au• 3346 7487 OR• Jacki Liddle • jmliddle@optusnet.com.au• 0422 223 527