Barriers to assessing fitness to drive in dementia in Nova Scotia: Informing strategies for knowledge translation

Background and Purpose: Over half a million Canadians have a diagnosis of dementia, approximately 25-30% of whom continue to drive. Individuals with dementia have a risk of motor vehicle collision up to eight times that of drivers without dementia. In Nova Scotia, the responsibility of reporting unsafe drivers is discretionary, but national survey data indicate that many physicians do not feel comfortable assessing driving safety. We report on barriers to addressing driving safety as identified by Nova Scotian primary care physicians (PCPs). Methods: We conducted a cross-sectional study of surveys completed by 134 English-speaking, Nova Scotian PCPs (mean years of practice 17.9±11; 53% female; 58% urban). Statistical analysis included descriptive statistics and multivariate linear and logistic regression (controlling for sex, urban/rural, and years of practice). Results: Most PCPs (96%) routinely address driving safety in dementia, but physicians at all levels of experience find these discussions uncomfortable and sometimes avoid them. PCPs experience multiple barriers to assessing driving in dementia and desire further education and resources. Conclusions: In Nova Scotia, driving assessment is considered part of routine care in dementia, but general lack of comfort in administering these assessments is a risk. To improve physician comfort further education and resources are required.