Effectiveness of Hearing Rehabilitation for Care Home Residents With Dementia: A Systematic Review

"I don't really know how to help her." Family caregivers' capabilities, opportunities and motivations to provide hearing support to long-term care home residents with dementia

PURPOSE

Hearing loss is highly prevalent in long-term care home (LTCH) residents with dementia ("residents") and exacerbates confusion and communication difficulties. Residents rely on caregivers, including family, for hearing-related care. This study aims to understand the drivers of family caregivers' provision of hearing support to LTCH residents using the Behaviour Change Wheel.

MATERIALS AND METHODS

This exploratory two-stage study was guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). A self-report survey (N = 87) and interviews (N = 6) explored drivers behind the provision of hearing support. Quantitative data were analysed using descriptive statistics and a within-participants ANOVA. Deductive coding of TDF domains alongside thematic analysis was used for qualitative data.

RESULTS

Provision of hearing support was variable. Gaps in family caregivers' psychological capability, reflective motivation and physical opportunity were identified. Barriers included lacking knowledge, unclear caregiver responsibilities, deprioritising hearing support, COVID-19 restrictions and fragmented collaborations with audiology services.

CONCLUSIONS

Future behaviour-change interventions to facilitate family caregivers' provision of hearing support to LTCH residents should include: Improving knowledge of how to provide effective hearing support, establishing caregiver responsibilities and increasing the resources for hearing support within LTCHs.

A meta-review and synthesis of the effectiveness of psychosocial interventions for people living with dementia nearing the end of life and their family carers

BACKGROUND

Dementia, is a leading cause of death internationally, affecting 55 million people. A palliative approach, emphasizing holistic and psychosocial care, is increasingly recognised as essential for addressing the complex needs of people with dementia and their carers. However, little research has explored the interface between psychosocial interventions for people with dementia near the end of life and palliative care, necessitating a synthesis to guide integrated, person-centred care.

AIM

To establish a framework of evidence-based psychosocial interventions in dementia palliative care.

METHODS

We conducted a systematic review using narrative synthesis. Three electronic databases (Epistemonikos, MEDLINE and ASSIA) were searched (January 1980-May 2024), for systematic reviews, guided by the methods of Cochrane overview of reviews. This is part of a series of reviews with the focus for this manuscript on psychosocial interventions for people with dementia.

RESULTS

Thirty-four reviews were included, published between 2009 and 2023. No reviews of interventions covered all domains of dementia palliative care. The majority focussed on neuropsychiatric symptom management and promoting wellbeing. There were no reviews which covered managing care transitions, continuity of care and care co-ordination, or information for people with dementia.

CONCLUSIONS

There is significant progress in the development and evaluation of interventions targeting behavioural and psychological symptoms of dementia (BPSD). However, a critical gap persists in addressing other essential aspects of quality of life and dementia care, with a notable gap in addressing many crucial aspects of palliative dementia care, such as care co-ordination, transitions, and carer support.

SENSE-Cog Residential Care: hearing and vision support for residents with dementia in long-term care in Ireland-protocol for a pilot cluster-randomised controlled trial

BACKGROUND

Hearing and vision loss is highly prevalent in residents with dementia (RwD) living in long-term care (LTC) facilities. Sensory loss often has a negative impact on quality of life and other dementia-related outcomes. Optimising sensory function may improve dementia-related outcomes in LTC facilities. The SENSE-Cog Residential Care pilot trial will evaluate whether a multi-faceted hearing and vision intervention for RwD and concurrent sensory loss is suitable for definitive testing in a large-scale cluster-randomised control trial (RCT) in Ireland and how this can best be achieved.

METHODS

This is a 6-month feasibility-pilot, multicentre, cluster RCT. Between eight and 15 LTC facilities (with an average of 5 RwD recruited per home) will be randomly assigned to receive either 'care as usual' (CAU) or a multi-component sensory intervention comprising (1) personalised resident hearing and vision support, (2) staff training in sensory health, (3) fostering a 'sensory friendly' environment, and (4) mapping sensory care provision with community-based audiologists and opticians. The intervention's feasibility, acceptability, and tolerability for residents and staff will be examined. In addition, a battery of exploratory outcome measures will be evaluated for suitability for the definitive trial and to inform the choice of primary and secondary outcome measures.

DISCUSSION

If the SENSE-Cog Residential Care pilot trial demonstrates that the sensory support intervention for residential care is feasible and tolerated in LTC facilities in Ireland, a larger definitive trial to evaluate its effectiveness in improving dementia-related outcomes will be conducted. Training materials, resources, and information will be made available to health and social care providers to enable the implementation of sensory support for RwD in routine LTC, potentially improving the quality of such care in Ireland.

TRIAL REGISTRATION

ISRCTN, ISRCTN14462472. Registered 24 February 2022, https://doi.org/10.1186/ISRCTN14462472.

Protocol for a Field Trial of a Hearing and Vision Support Intervention for People Living in Long-Term Care in Australia

INTRODUCTION

Hearing and vision impairments are prevalent among residents in long-term care settings. Hearing and vision impairments frequently go unsupported, affecting residents' quality of life and healthcare costs. This paper describes the protocol for a pre-post evaluation and process evaluation of a pragmatic sensory support intervention (SSI) that was developed with residents, informal caregivers and long-term care workers.

METHODS AND ANALYSIS

A prospective pre-post-intervention trial within long-term care will be conducted, including three groups: residents (n = 87), informal caregivers (n = 87) and long-term care workers (n = 40). Outcome measures include health-related quality of life and well-being measures relevant to each group measured at baseline, 3- and 6-months post-intervention. Health resource and sensory device utilisation will be captured from routine data and by direct observation. Qualitative interviews, including a representative sample of residents and informal caregivers, will be conducted as part of a simultaneous process evaluation. Generalised linear models and paired t-tests will be used to evaluate the effects on residents' and caregivers' quality of life and sensory device use. The cost-effectiveness of the intervention will be examined using within-trial analysis, economic modelling and budget impact assessment. A process evaluation will use descriptive statistics and thematic analysis to assess the intervention's reach, adoption, implementation, acceptability, mechanisms of change and contextual influences.

CONCLUSION

Hearing and vision impairments are common but under-supported in older adults in long-term care. This protocol involves a systematic evaluation of the effectiveness and implementation challenges of a pragmatic SSI to optimise hearing and vision function and improve the quality of life for long-term care residents and their caregivers.

Rehabilitation, reablement, and restorative care approaches in the aged care sector: a scoping review of systematic reviews

BACKGROUND

Ageing populations are set to drive up demand for aged care services, placing strain on economies funding social care systems. Rehabilitation, reablement, and restorative care approaches are essential to this demographic shift as they aim to support independent function and quality of life of older people. Understanding the impact of these approaches requires nuanced insights into their definitions, funding, and delivery within the aged care context. This scoping review mapped and compared systematic review-level research on rehabilitation, reablement, and restorative care approaches within aged care with the aim of determining definitional clarity, key themes, and the professional groups delivering each approach.

METHODS

Nine databases were searched (2012 to September 2023) to identify English-language systematic reviews on aged care-based rehabilitation, reablement and/or restorative care. Two reviewers independently screened studies following predetermined eligibility criteria. Only reviews reporting quality appraisal findings were eligible. Data charting and synthesis followed the Arksey and O'Malley approach and are reported according to PRISMA-ScR guidelines.

RESULTS

Forty-one reviews met inclusion criteria. Most (68%) reported on rehabilitation in aged care, and eight (20%) combined the approaches. Only 14 reviews (34%) defined the approach they described. Reviews centred on services for older people in the home or community (n = 15), across a mix of settings including community, hospital, and residential care (n = 10). Ten distinct themes highlight the importance of multidisciplinary teams, allied health, risk of falls, hip fracture, reduced functional independence, and specific types of interventions including physical activity, technology, cognitive rehabilitation, goal setting, and transition care. Most reviews described the role of occupational therapists (n = 22), physiotherapists (n = 20) and nurses (n = 14) with wider support from the multidisciplinary team. The quality of primary studies within the reviews varied widely.

CONCLUSIONS

This scoping review summarises the evidence landscape for rehabilitation, reablement, and restorative care approaches in the context of aged care. Despite their role in enhancing independence and quality of life for older people, policy, funding, and terminology variation means the evidence lacks clarity. This fragmented evidence makes it challenging to argue the effectiveness of one approach over another for older people in receipt of aged care services.

CLINICAL TRIAL NUMBER

Not applicable.

Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia

OBJECTIVES

Skilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

We included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019.

METHODS

Follow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days' survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding.

RESULTS

Our final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1-12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2-6 compared with sextile 1 were, respectively, 2.20 (1.85-2.62), 2.48 (2.09-2.94), 2.52 (2.12-2.99), 2.62 (2.21-3.11), and 2.69 (2.27-3.19).

DISCUSSION

During SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours.

CONCLUSIONS AND IMPLICATIONS

Higher ST hours are associated with successful discharge from SNF after HF hospitalization.

Clinical and Market Analysis of NanoBEO: A Public-Worth, Innovative Therapy for Behavioral and Psychological Symptoms of Dementia (BPSD)-Emerging Evidence and Its Implications for a Health Technology Assessment (HTA) and Decision-Making in National Health Systems

BACKGROUND

According to scientific literature, some 99% of patients affected by Alzheimer's disease (AD) suffer from behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms (NPSs). In particular, agitation is one of the most difficult disorders to treat. States of agitation represent a very serious problem as they make these subjects dangerous for themselves and others and worsen as the disease advances. To date, there are no specific solutions for treating agitation. The only authorized drug is risperidone (as well as brexpiprazole, approved by the FDA on 11 May 2023), which can be used for no longer than 6-12 weeks because it increases the risk of death-owing to cardiocerebrovascular accidents-by 1.6-1.7 times.

METHODS

In order to address the latter noteworthy unmet medical need, NanoBEO was produced. The aim of the present work is to generate the health technology assessment (HTA) of this nanotechnological device. The latter consists of a controlled release system, based on solid lipid nanoparticles loaded with bergamot essential oil (BEO).

RESULTS

The results of the present research assessed the current evidence in the field of non-pharmacological treatments for this condition, including relevant primary preclinical and clinical data studies supporting the use of this device and the production of the operative plan for its launch on the market. The findings offer recommendations for decision-making on its implementation in dementia.

CONCLUSIONS

NanoBEO represents a public-worth innovation in this neglected area, marking a significant advancement in the history of dementia, moving from academic research to product development.

Do people with cognitive impairment benefit from cochlear implants? A scoping review

PURPOSE

To identify and evaluate the evidence for the benefits of cochlear implants for people with cognitive impairment or dementia in terms of speech recognition, quality of life, behavioural and psychological symptoms of dementia, cognition, function in daily life, mental well-being, and caregiver burden.

METHODS

Ten electronic databases were searched systematically from inception to December 2023 for studies reporting on outcomes for cochlear implants that included adults identified with cognitive impairment, mild cognitive impairment, or dementia.

RESULTS

Thirteen studies were included in this review with a combined total of 222 cochlear implant patients with cognitive impairment, mild cognitive impairment. Two studies were non-randomised controlled design, the remainder were single group studies, case series or single case studies. Evidence suggested that people with cognitive impairment benefit in terms of improved speech recognition from cochlear implants, although they may benefit less than those with healthy cognition and the degree of benefit depends on the level of cognitive impairment. There was no evidence for increased adverse events among those with cognitive impairment. There was limited or no evidence for any other outcome.

CONCLUSION

People with cognitive impairment or dementia do benefit from cochlear implants. To inform policy and clinical practice, further data are needed about the broader benefits of cochlear implants for people with cognitive impairment or dementia, and referral, eligibility, and cochlear implant support needs for people with cognitive impairment and their caregivers.

"We're just winging it". Identifying targets for intervention to improve the provision of hearing support for residents living with dementia in long-term care: an interview study with care staff

PURPOSE

Hearing loss and dementia are common in long-term care home (LTCH) residents, causing communication difficulties and worsened behavioural symptoms. Hearing support provided to residents with dementia requires improvement. This study is the first to use the Behaviour Change Wheel (BCW) to identify barriers and propose interventions to improve the provision of hearing support by LTCH staff.

METHODS

Semi-structured interviews with 10 staff members were conducted. Transcripts were analysed according to the BCW's Theoretical Domains Framework alongside reflective thematic analysis. Relevant intervention functions and exemplar interventions were proposed.

RESULTS

Staff believed hearing support to be beneficial to residents (Beliefs about Consequences) but lacked knowledge of hearing loss management (Knowledge). Poor collaborations between LTCHs and audiology (Environmental Context and Resources), led to despondency, and apprehension about traditional hearing aids for residents (Optimism). Despite feeling responsible for hearing support, staff lacked personal accountability (Social/Professional Role and Identity).

CONCLUSIONS

Future interventions should include staff Training (on hearing support), Education (on the consequences of unsupported hearing loss), Enablement (dementia-friendly hearing devices), Incentivisation and Modelling (of Hearing Champions) and Environmental Restructuring (flexible audiology appointments to take place within the LTCH). Interventions should be multi-faceted to boost the capabilities, opportunities and motivations of LTCH staff.

The clinical use of personal hearing amplifiers in facilitating accessible patient-provider communication: A scoping review

BACKGROUND

Older adults with hearing loss struggle to communicate with care providers and experience higher mortality rates when hospitalized (Genther et al., 2015), even after controlling for age and comorbidities. Personal hearing amplifiers (PHAs), (e.g., Pocketalkers™), can improve communication with older patients.

METHODS

We conducted a scoping review to identify research gaps and summarize findings on the clinical use of PHAs with patients with hearing loss. After refining search terms relating to hearing loss and PHAs, we searched MEDLINE, Embase, PsycINFO, Cochrane Library, CINAHL Complete, Web of Science Core Collection, ERIC (Proquest), PubMed, ClinicalTrials.gov, International Clinical Trials Registry Platform, and the International Standard Randomised Controlled Trial Number Registry. We identified articles published in English between 1980 and 2022 that reported empirical outcomes relating to PHA use in clinical settings. Two reviewers independently extracted data from articles. We then organized data into an evidence map, and a narrative review summarizing outcomes.

RESULTS

From 4234 initially identified titles and abstracts, 12 met our criteria as full texts. These included three surveys on clinicians' awareness and use of PHAs, one evaluation of the acoustic output of a PHA, and eight interventions wherein PHAs were provided to patients with hearing loss. These papers used 10 different terms for PHAs and largely did not cite one another. Results showed high levels of satisfaction with PHAs, and consistently improved speech understanding. Despite this, care providers used devices inconsistently, with challenges around provider awareness, and device maintenance and location tracking.

CONCLUSIONS

PHAs have a consistent positive effect on patients' ability to understand their care providers despite hearing loss. Barriers and facilitators to their use in clinical settings should be further explored.

Capabilities, opportunities and motivations of staff to provide hearing support to long-term care home residents with dementia

OBJECTIVE

Many long-term care home (LTCH) residents have dementia and hearing loss, causing communication difficulties and agitation. Residents rely on staff for hearing support, but provision is often inconsistent. This study used the Behaviour Change Wheel's Capability, Opportunity and Motivation model to understand why LTCH staff do or do not, provide hearing support to residents with dementia who they believe could benefit from it.

DESIGN

An online survey exploring hearing support provision, capabilities, opportunities, motivations and demographics. Data were analysed using descriptive statistics, within-participants ANOVA and multiple linear regression.

STUDY SAMPLE

165 LTCH staff.

RESULTS

Staff provided hearing support to 50% of residents with dementia who they thought would benefit. Self-reported physical and psychological capabilities (skills/knowledge) were significantly higher than physical opportunity (having time/resources). The physical capability was significantly higher than social opportunity (collaborative working) and reflective motivation (feeling motivated). Lower levels of hearing support provision were predicted by LTCH funding (private vs. local authority), job role (care assistant vs. nurse) and fewer physical opportunities.

CONCLUSIONS

Boosting capabilities through training alone may not be as effective as increasing opportunities via environmental restructuring. Opportunities may include strengthening working relationships with audiologists and ensuring hearing and communication aids are available within LTCHs.

Hearing Loss and Dementia: Where to From Here?

Victorian era psychologists were the first to comment on associations between sensory and cognitive function. More recently, hearing loss has been shown as a marker of risk for dementia. However, it is not known whether this association represents a causal impact of hearing loss, nor whether treating hearing loss may help prevent dementia. Most studies on relationships between hearing loss and cognitive outcomes are observational, are at risk of confounding, and cannot reach conclusions about causation. A recent high quality randomized controlled trial, relatively uncommon in audiology, reported no impact of a comprehensive hearing intervention in mitigating cognitive decline in older adults. Although secondary analysis revealed potential benefits in a sub-sample of adults, this finding may be spurious. Encouraging policymakers, patients, and other health care practitioners to address hearing loss in terms of dementia prevention may be inappropriate on the grounds of both relevance at individual level and lack of clear evidence of benefit. In addition, advocating need to address hearing loss in terms of mitigating dementia risk may reduce the importance of addressing hearing loss in its own right. Linking hearing loss to dementia risk may also exacerbate the stigma of hearing loss, inadvertently discouraging people from seeking help for hearing. We suggest that treating hearing loss may have important benefits in preventing or delaying diagnosis of dementia via improving orientation and functioning in daily life, without changing the underlying pathology. Rather than linking hearing loss to dementia risk, we suggest a positive message focusing on the known benefits of addressing hearing loss in terms of improved communication, quality of life, and healthy aging.

Prevalence of Hearing Impairment by Age: 2nd to 10th Decades of Life

Background: Accurate data on the prevalence of hearing impairment and severity across age and gender are paramount to formulate hearing health policies. Here, we sought to analyze audiometric data from a large group of age-diverse people in Japan, which has not been previously described in detail. Methods: We analyzed retrospective hearing threshold data of 23,860 participants (10−99 years; left-right hearing threshold difference <15 dB; air-bone gap ≤10 dB) at 500, 1000, 2000, and 4000 Hz, and then classified them for hearing impairment severity according to the WHO Classification. Findings: There was a significant gender difference in median hearing thresholds, starting in 20-year-olds up to early 80-year-olds. Twenty-five percent of men in their late 50s had some level of HI, ~50% in their late 60s, and ~75% in their late 70s. For women, 25% had some level of HI in their early 60s, ~50% in their early 70s, and ~75% in their late 70s. For participants in their early 80s, 50% of either gender had moderate or more severe HI. Interpretation: Our results, derived from a large number of participants, provide basic information about the prevalence of hearing loss by age decade. Since people can expect to live longer than those in previous generations, our detailed data can inform national social systems responsible for hearing screening in making decisions about hearing-aid qualification, which may reduce barriers to older people’s independence, productivity, and quality of life.