2.1. Literature Search Strategy

We employed the PICO (Population, Intervention, Comparison, Outcome,) framework to determine the overall structure of this systematic review. Our population/participants of interest included older adult drivers, which was defined here as those of 60 years of age or older. Use of interventions/treatment was not a focus of this review; however, if an intervention was used, it was examined in the context of driving. We were also interested in studies that compared persons with symptomatic, vascular conditions to controls. The outcome of interest (driving) could vary but was required to be contextually relevant to driving as an activity and could encapsulate driving performance, crashes, cessation, natural driving, fitness to drive and use of an automobile.

The published literature was searched using strategies designed in consultation with a clinical librarian in our medical school for the concepts of vascular conditions, including stroke and vascular dementia, driving and elderly or older aged adults. The search strategies were created using a combination of database specific and controlled vocabulary terms and keywords and were executed in Embase 1947-, Ovid-Medline 1946- and Scopus 1823-. Each database only examined the title, abstract and indexing fields of a specific citation record. Results were limited to English language using database-supplied filters.

All searches were completed in March 2020. A complete search strategy is provided for Embase.com as an example—(‘cerebrovascular accident’/exp OR ‘white matter hyperintensities’/exp OR ‘white matter’/de OR ‘hypertension’/exp OR ‘hypercholesterolemia’/exp OR ‘heart infarction’/exp OR ‘congestive heart failure’/exp OR ‘multiinfarct dementia’/exp OR stroke *:ti,ab OR ‘cerebrovascular accident’:ti,ab OR ‘cerebrovascular apoplexy’:ti,ab OR ‘cerebrovascular lesion’:ti,ab OR ‘brain accident’:ti,ab OR ‘brain attack’:ti,ab OR ‘brain insultus’:ti,ab OR ‘brain vascular accident’:ti,ab OR ‘cerebrovascular failure’:ti,ab OR ‘cerebrovascular injury’:ti,ab OR ‘white matter hyperintensities’:ti,ab OR leukoaraiosis:ti,ab OR ‘white matter’:ti,ab OR hypertension:ti,ab OR hypertensive:ti,ab OR ‘high blood pressure’:ti,ab OR hypercholesterolemia:ti,ab OR ‘high cholesterol’:ti,ab OR ‘elevated cholesterol’:ti,ab OR hypercholesterinaemia:ti,ab OR hypercholesterinemia:ti,ab OR hypercholesterolaemia:ti,ab OR ‘heart attack’:ti,ab OR ‘myocardial infarct *’:ti,ab OR ‘heart infarct *’:ti,ab OR ‘cardiac infarct *’:ti,ab OR ‘myocardium infarct *’:ti,ab OR ‘subendocardial infarct *’:ti,ab OR ‘cardiovascular stroke’:ti,ab OR ‘congestive heart failure’:ti,ab OR ‘congestive cardiac failure’:ti,ab OR ‘congestive heart insufficiency’:ti,ab OR ‘CHF’:ti,ab OR ‘vascular dementia’:ti,ab OR ‘arteriosclerotic dementia’:ti,ab OR ‘Binswanger disease’:ti,ab OR ‘Binswanger encephalopathy’:ti,ab OR ‘subcortical leukoencephalopathy *’:ti,ab OR ‘multi-infarct dementia’:ti,ab OR ‘multiinfarct dementia’:ti,ab) AND (‘car driving’/exp OR ‘driving cessation’ OR ‘natural * driving’ OR ‘natural * drive’ OR ((drive OR driving OR use) NEAR/6 (car OR auto OR automobile * OR truck * OR van OR vans OR vehicle *))) AND (‘aged’/exp OR elderly:ti,ab OR aged:ti,ab OR older:ti,ab OR “senior citizen”:ti,ab OR geriatric:ti,ab OR senescent:ti,ab) AND [english]/lim.