Dr Jacki Liddle Assoc Prof Kryss McKenna Melody Webb m.webb3@uq.au p 3346 7487

1. Dr Jacki Liddle Assoc Prof Kryss McKenna Melody Webb m.webb3@uq.edu.au p 3346 7487

2. CONTENT • Research techniques • UQDrive background • Driving cessation process • Improving outcomes for your clients • UQDrive program • Future directions

3. 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

4. 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

5. 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

6. 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”

7. 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)

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

9. 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

10. 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

11. 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 driving • Assess 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

12. 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 reviewing • If conditions are recommended (time of day, distance of driving) must be recorded on licence

13. 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.

14. 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)

15. 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)

16. 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

17. 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)

18. 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

19. 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

20. UQDRIVE Program Participants: • 65 years and older • Living in Brisbane / Sunshine Coast region • Able to participate in group (MSQ) • Living independently • Not planning to return to driving • Ethics approval pending (60 years and over, 1:1 intervention, non-retired drivers)

21. How to refer • Provide clients with our information brochures • With permission, contact UQ with client details

22. 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

23. 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

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

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