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Ferguson MA, Nakano K, Jayakody DMP. Clinical Assessment Tools for the Detection of Cognitive Impairment and Hearing Loss in the Ageing Population: A Scoping Review. Clin Interv Aging 2023; 18:2041-2051. [PMID: 38088948 PMCID: PMC10713803 DOI: 10.2147/cia.s409114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/07/2023] [Indexed: 12/18/2023] Open
Abstract
Objective There is a strong association between cognitive impairment and hearing loss, both highly prevalent in the ageing population. Early detection of both hearing loss and cognitive impairment is essential in the management of these conditions to ensure effective and informed decisions on healthcare. The main objective was to identify existing and emerging cognitive and auditory assessment tools used in clinical settings (eg, memory clinics, audiology clinics), which manage the ageing population. Methods A scoping review of peer-reviewed publications and results were reported according to the PRISMA-ScR guidelines. Results A total of 289 articles were selected for data extraction. The majority of studies (76.1%) were conducted in 2017 or later. Tests of global cognitive function (ie, Mini-Mental State Exam, Montreal Cognitive Assessment) were the most commonly used method to detect cognitive impairment in hearing healthcare settings. Behavioral hearing testing (ie, pure-tone audiometry) was the most commonly used method to detect hearing loss in cognitive healthcare settings. Objective, physiological measures were seldom used across disciplines. Conclusion Preferences among clinicians for short, accessible tests likely explain the use of tests of global cognitive function and behavioral hearing tests. Rapidly evolving literature has identified inherent limitations of administering global cognitive function tests and pure-tone testing in an ageing population. Using electrophysiological measures as an adjunct to standard methods of assessment may provide more reliable information for clinical recommendations in those with cognitive and hearing impairment, and subsequently achieve better healthcare outcomes.
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Affiliation(s)
- Melanie A Ferguson
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Ear Sciences, Medical School, University of Western Australia, Perth, Australia
| | - Kento Nakano
- Ear Science Institute Australia, Perth, Australia
| | - Dona M P Jayakody
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Centre for Ear Sciences, Medical School, University of Western Australia, Perth, Australia
- Ear Science Institute Australia, Perth, Australia
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Abstract
Hearing impairment commonly co-occurs with dementia. Audiologists, therefore, need to be prepared to address the specific needs of people living with dementia (PwD). PwD have needs in terms of dementia-friendly clinical settings, assessments, and rehabilitation strategies tailored to support individual requirements that depend on social context, personality, background, and health-related factors, as well as audiometric HL and experience with hearing assistance. Audiologists typically receive limited specialist training in assisting PwD and professional guidance for audiologists is scarce. The aim of this review was to outline best practice recommendations for the assessment and rehabilitation of hearing impairment for PwD with reference to the current evidence base. These recommendations, written by audiology, psychology, speech-language, and dementia nursing professionals, also highlight areas of research need. The review is aimed at hearing care professionals and includes practical recommendations for adapting audiological procedures and processes for the needs of PwD.
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McDonough A, Dookhy J, McHale C, Sharkey J, Fox S, Kennelly SP. Embedding audiological screening within memory clinic care pathway for individuals at risk of cognitive decline-patient perspectives. BMC Geriatr 2021; 21:691. [PMID: 34906082 PMCID: PMC8672578 DOI: 10.1186/s12877-021-02701-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 11/18/2021] [Indexed: 11/15/2022] Open
Abstract
Background With the evolving knowledge on hearing as a potentially modifiable mid-life risk factor for dementia, identification of people at risk becomes increasingly important. People with mild cognitive impairment (MCI) presenting to specialist memory services represent a key “at-risk” target population for audiological evaluation, but few services have established this pathway. This study sought to examine the patient experience and understanding of this process. Methods All patients with MCI attending a tertiary referral memory service referred for audiology review were contacted. A patient survey was delivered over the phone. Outpatient letters and the memory clinic database were reviewed. Results Twenty patients with MCI were included in the survey. Eight (8/20, 40%) had self-reported hearing loss. Upon formal audiological assessment seventeen (17/20, 85%) had objective evidence of hearing loss; nine (9/17, 52.9%) with mild-moderate and eight (8/17, 47%) with moderate-severe hearing loss. Only six patients (6/20, 30%) recalled having the rationale behind having a hearing test as part of their memory work-up explained to them. However, the majority (15/20, 75%) felt a hearing test was an important part of their memory assessment. Just seven patients overall (7/20, 35%) identified a link between hearing-loss and cognition. All patients who provided feedback on the service itself made positive comments, although (4/20, 20%) felt they did not get adequate information about the results. Conclusions A significant proportion of people with MCI had de-novo evidence of hearing impairment upon assessment. Patients are satisfied with incorporating audiological evaluation into a memory clinic assessment, however clear communication around indication, recommendations, and follow-up ensuring compliance is required. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02701-0.
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Affiliation(s)
- Anna McDonough
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland. .,Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
| | - Joshi Dookhy
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland
| | - Cathy McHale
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland
| | - Jennifer Sharkey
- Department of Audiology, Tallaght University Hospital, Dublin, Ireland
| | - Siobhan Fox
- Centre for Gerontology and Rehabilitation, University College Cork, Dublin, Ireland
| | - Sean P Kennelly
- Department of Age-Related Health Care, Tallaght University Hospital, Dublin, Ireland.,Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland
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Paramasivam A, Jaiswal A, Minhas R, Wittich W, Spruyt-Rocks R. Informed Consent or Assent Strategies for Research With Individuals With Deafblindness or Dual Sensory Impairment: A Scoping Review. Arch Rehabil Res Clin Transl 2021; 3:100115. [PMID: 34179751 PMCID: PMC8212005 DOI: 10.1016/j.arrct.2021.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To synthesize evidence on existing informed consent/assent strategies and processes that enable the participation of individuazls with deafblindness or dual sensory impairment in research. DATA SOURCES Five scientific databases (PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and PsycINFO) and other sources such as Google Scholar, Journal of Visual Impairment and Blindness, and British Journal of Visual Impairment were hand-searched from January 2015 until July 2020. STUDY SELECTION Studies were selected using a priori inclusion criteria of sensory and cognitive disabilities and focused on consent/assent strategies and processes in research within this population. Articles related to the medical or sexual consent processes were excluded. DATA EXTRACTION An Excel spreadsheet was used to extract data from the eligible sources. Discrepancies were resolved in discussion with team members. DATA SYNTHESIS A total of 2163 sources were screened, and 16 articles were included in the review. Seven sources only examined consent strategies, whereas the remaining 8 included a combination of consent/assent and dissent strategies. Using thematic analysis, 3 key themes emerged: consent/assent strategies, researcher capacity, and capacity to consent tools. Key identified strategies included the accessibility of the consent/assent process, building relationships with participants and caregivers, identifying behavioral cues, and communication training for researchers. CONCLUSIONS Despite the absence of literature on consent/assent strategies within the population with deafblindness, the review found promising strategies applied to individuals with other cognitive or sensory disabilities that researchers can adopt. Researchers are encouraged to use best practices in creating an inclusive research environment to include individuals with deafblindness.
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Affiliation(s)
| | - Atul Jaiswal
- School of Optometry, Université de Montréal, Montreal, Quebec, Canada
| | - Renu Minhas
- DeafBlind Ontario Services, Newmarket, Ontario, Canada
| | - Walter Wittich
- School of Optometry, Université de Montréal, Montreal, Quebec, Canada
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Leroi I, Wolski L, Charalambous AP, Constantinidou F, Renaud D, Dawes P, Hann M, Himmelsbach I, Miah J, Payne M, Simkin Z, Thodi C, Yeung WK, Yohannes AM. Support care needs of people with hearing and vision impairment in dementia: a European cross-national perspective. Disabil Rehabil 2021; 44:5069-5081. [PMID: 34027751 DOI: 10.1080/09638288.2021.1923071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE Aging-related sensory impairments are among the most common and disabling comorbidities in people with dementia (PwD). This study explored the unmet support care needs (SCNs) from the perspectives of people with hearing and/or vision impairment in dementia (PwD), and their care partners in Europe. METHODS This was a two-phase mixed methods study. We administered standardized questionnaires of SCNs and quality of life (QoL) to PwD with hearing and/or vision impairment (n = 97), and their care partners (n = 97) in the UK, France, and Cyprus. Next, a purposive sub-sample of 34 participants (PwD and care partners) participated as focus groups (FGs) or semi-structured interviews to explore their SCNs in depth. RESULTS Over 94% of the participants reported unmet SCNs (median, 13 (range 5-23)). Nearly three-quarters reported SCNs in the moderate to high range, with the most prevalent unmet SCNs for PwD being in the psychological (>60%) and physical domains (>56%), followed by the need for health information (>46%). Emergent qualitative themes were: (1) the need for tailored support care interventions; (2) care burden, social isolation, and loneliness arising from the combined problems; (3) the need for adequate support from professionals from the different fields, including education around the use of sensory aids. Both study phases revealed that SCNs were highly individualized. CONCLUSIONS This cross-national study revealed that PwD with sensory impairment and their care partners experience a wide range of unmet SCNs, the interactions between sensory impairments, SCNs and QoL are also complex. A tailored intervention could address these unmet SCNs, including additional support with sensory aids, psychological support, more information about concurrent impairments, and joined up health systems providing care.Implications for rehabilitationA majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs.The needs of care partners including the risk of loneliness and social isolation, need to be considered.Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education.
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Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Lucas Wolski
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | | | - Fofi Constantinidou
- Centre for Applied Neurosciences & Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - David Renaud
- CMRR Memory Center, Claude Pompidou Institute, University of Nice Sophia Antipolis, Nice, France
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
| | - Mark Hann
- Centre for Biostatistics, University of Manchester, Manchester, UK
| | - Ines Himmelsbach
- Catholic University of Applied Sciences Freiburg, Freiburg, Germany
| | - Jahanarah Miah
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Magali Payne
- CMRR Memory Center, Claude Pompidou Institute, University of Nice Sophia Antipolis, Nice, France
| | - Zoe Simkin
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
| | - Chryssoula Thodi
- Department of Health Sciences, European University Cyprus, Engomi, Cyprus
| | - Wai Kent Yeung
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
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Leroi I, Chauhan N, Hann M, Jones L, Prew S, Russell G, Sturrock RA, Taylor J, Worthington M, Dawes P. Sensory Health for Residents with Dementia in Care Homes in England: A Knowledge, Attitudes, and Practice Survey. J Am Med Dir Assoc 2021; 22:1518-1524.e12. [PMID: 33932354 DOI: 10.1016/j.jamda.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/12/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Most residents with dementia (RwD) in long-term care (LTC) facilities experience hearing and vision problems, yet these sensory deficits, which are associated with poor outcomes, are frequently under-recognized or incompletely managed. OBJECTIVE We investigated the knowledge, attitudes, and practice (KAP) of LTC facility staff in England regarding sensory-cognitive health of RwD. DESIGN A cross-sectional survey using self-administered online or mail-in questionnaires. SETTING AND PARTICIPANTS The study included 117 LTC facilities throughout England, involving 887 staff of different grades (managers, n=79; nurses/allied health professionals, n=160; care workers, n=648). METHODS Using a sampling frame of all LTC facilities nationwide, we included a stratified random selection of facilities, surveying staff regarding KAP of sensory-cognitive health. Analysis was descriptive, followed by a regression model for predictors of overall KAP capacity of staff, based on a Rasch analysis of survey items. RESULTS Staff of all grades reported high knowledge and awareness of sensory-health concerns amongst RwD, but training opportunities were infrequent and most front-line staff felt they lacked the skills necessary to support the use of hearing and vision aids. The most reported reason for poor use of hearing aids/glasses related to lack of maintenance and care procedures (ie, broken and lost devices), and poor adherence support (ie, not tolerating the devices). Staff willingness to receive training was high. Most managers reported that training in communication skills and "sensory-friendly" environments was not provided. Finally, higher overall KAP capacity of staff was predicted by smaller facility size and public, rather than private, facility type. CONCLUSIONS AND IMPLICATIONS Training and practice of sensory health care in RwD in LTC in England is lacking. To improve sensory-cognitive care for LTC RwD, there is a clear need for (1) practice recommendations and (2) multifaceted interventions that include staff training, tailored sensory support, and environmental modification.
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Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, Department of Psychiatry, School of Medicine, Trinity College Dublin, Ireland.
| | - Nisha Chauhan
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Mark Hann
- University of Manchester, Manchester, United Kingdom
| | - Louise Jones
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - Sandra Prew
- ENRICH Lead West Midlands NIHR Clinical Research Network (CRN), Birmingham, United Kingdom
| | - Gregor Russell
- Bradford District Care NHS Foundation Trust, Bradford, United Kingdom
| | | | | | - Mark Worthington
- Lancashire & South Cumbria NHS Foundation Trust, Preston, United Kingdom
| | - Piers Dawes
- Department of Linguistics, Macquarie University, Sydney, Australia; Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, United Kingdom
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