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Xu S, Jesdale WM, Dubé CE, Nielsen NN, McPhillips EA, Lapane KL. Social engagement and cognitive impairment among nursing home residents: The role of sensory impairment. Arch Gerontol Geriatr 2024; 122:105397. [PMID: 38484670 PMCID: PMC11073896 DOI: 10.1016/j.archger.2024.105397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/23/2024] [Accepted: 03/02/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND AND OBJECTIVES Using US national nursing home data, this cross-sectional study sought to evaluate 1) the association between lack of social engagement and level of cognitive impairment; and 2) the extent to which this association differs by hearing and visual impairment. RESEARCH DESIGN AND METHODS Our sample included 793,846 nursing home residents aged ≥ 50 years. The Index of Social Engagement was categorized as none/lower (0, 1, 2) or higher levels (3 through 6). Cognitive Performance Scale was grouped as intact/mild (0, 1, 2), moderate (3, 4), or severe (5, 6). Multinomial models provided adjusted odds ratio (aOR) and 95 % confidence intervals (CI) between none/lower social engagement and cognitive impairment. We estimated relative excess risk due to interaction (RERI) to quantify the joint effects of social engagement and sensory impairment types. RESULTS Overall, 12.6 % had lower social engagement, 30.3 % had hearing impairment, and 40.3 % had visual impairment. Compared to residents with high social engagement, those with lower social engagement were more likely to have moderate/severe cognitive impairment (aORmoderate = 2.21, 95 % CI 2.17-2.26; aORsevere = 6.49, 95 % CI 6.24-6.74). The impact of low social engagement on cognitive impairment was more profound among residents with hearing impairment and/or visual impairment (RERIhearing = 3.89, 95 % CI 3.62-4.17; RERIvisual = 25.2, 95 % CI 23.9-26.6)). DISCUSSION AND IMPLICATIONS Residents with lower social engagement had higher levels of cognitive impairment. Residents with sensory impairments are potentially more susceptible to the negative impact of lower levels of social engagement on level of cognitive impairment.
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Affiliation(s)
- Shu Xu
- Department of Gerontology, University of Massachusetts Boston, Boston, MA, USA; Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - William M Jesdale
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Catherine E Dubé
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Natalia N Nielsen
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Emily A McPhillips
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Kate L Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.
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2
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Dawes P, Arru P, Corry R, McDermott JH, Garlick J, Guest H, Howlett E, Jackson I, James R, Keane A, Murray C, Newman W, Visram A, Munro KJ. Patient and public involvement in hearing research: opportunities, impact and reflections with case studies from the Manchester Centre for Audiology and Deafness. Int J Audiol 2024; 63:146-154. [PMID: 36573267 DOI: 10.1080/14992027.2022.2155881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 12/01/2022] [Accepted: 12/02/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Patient and public involvement (PPI) in research improves relevance to end users and improves processes including recruitment participants. PPI in our research has gone from being non-existent to ubiquitous over a few years. We provide critical reflections on the benefits and challenges of PPI. DESIGN Case studies are reported according to a modified GRIP2 framework; the aims, methodology, impact of PPI and critical reflections on each case and our experiences with PPI in general. STUDY SAMPLE We report five UK projects that included PPI from teenagers, families, people living with dementia, autistic people, and people from South Asian and d/Deaf communities. RESULTS Our experience has progressed from understanding the rationale to grappling methodologies and integrating PPI in our research. PPI took place at all stages of research, although commonly involved input to design including recruitment and development of study materials. Methodologies varied between projects, including PPI co-investigators, advisory panels and online surveys. CONCLUSION On-going challenges include addressing social exclusion from research for people that lack digital access following increasing on-line PPI and involvement from underserved communities. PPI was initially motivated by funders; however the benefits have driven widespread PPI, ensuring our research is relevant to people living with hearing loss.
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Affiliation(s)
- Piers Dawes
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Paolo Arru
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - John Henry McDermott
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester, UK
| | | | - Hannah Guest
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Emily Howlett
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | - Iain Jackson
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Rachel James
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Annie Keane
- Vocal, Manchester University NHS Foundation Trust, Manchester, UK
| | - Carlyn Murray
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - William Newman
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
- Evolution, Infection and Genomics, School of Biological Sciences, University of Manchester, Manchester, UK
| | - Anisa Visram
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Kevin J Munro
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
- Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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3
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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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4
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Piano MEF, Nguyen BN, Gocuk SA, Joubert L, McKendrick AM. Primary eyecare provision for people living with dementia: what do we need to know? Clin Exp Optom 2023; 106:711-725. [PMID: 36375138 DOI: 10.1080/08164622.2022.2140032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/16/2022] Open
Abstract
Dementia comprises a group of brain disorders characterised by loss of cognitive function. Sensory loss, predominantly vision (the focus of this review) and hearing, is a significant problem for people living with dementia. Eyecare practitioners such as optometrists therefore play an important role in identifying and addressing vision-related care needs. To support provision of high quality "dementia-friendly" eyecare, this scoping review summarises recent primary research findings and available clinical practice guidelines, to identify research gaps relating to vision and dementia, and make recommendations for future research and clinical practice. The review set a priori guidelines for the population, concept and context based on the review questions. Primary research papers (2016-2021) were included via 3-step search strategy: preliminary search to index terms, full search, search reference lists of included articles for further inclusions. Additionally, websites of eyecare professional bodies in English-speaking countries were searched to identify current clinical eyecare practice guidelines relating to dementia. Study characteristics (e.g. country, study design) were reported descriptively. Patterns within findings/recommendations from included sources were identified using thematic analysis and reported as themes. 1651 titles/abstracts and 161 full-text articles were screened for eligibility. Three clinical practice guidelines were also identified. The final review included 21 sources: 18 primary research papers and 3 clinical practice guidelines. The thematic analysis reported five key themes: Diagnosis/Screening, dementia progression, findings on clinical visual testing, tailored approach to care, improving care. This scoping review demonstrated limited information about current practices of optometrists working with people living with dementia. Recent evidence reinforces the continuing need for improved eyecare for people living with dementia, taking into account their specific needs with an individualised approach. Up-to-date practical recommendations are synthesised for eyecare providers before, during and after a consultation with a person living with dementia, to better support their care.
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Affiliation(s)
- Marianne E F Piano
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
- National Vision Research Institute, Australian College of Optometry, Carlton, Australia
| | - Bao N Nguyen
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Sena A Gocuk
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Lynette Joubert
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Allison M McKendrick
- Department of Optometry and Vision Sciences, School of Health Sciences, The University of Melbourne, Melbourne, Australia
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5
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Lee J, Jang SN, Kim CS. Patterns and determinants of health and social care service needs among community-dwelling older adults. Geriatr Nurs 2023; 51:69-75. [PMID: 36921395 DOI: 10.1016/j.gerinurse.2023.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/16/2023]
Abstract
AIM Using Anderson's behavioral model, we examined the patterns and determinants associated with older adults' needs for community- and institution-based care services. METHODS Participants included 411 community-dwelling older adults from the 2020 National Survey of Older Koreans. Logistic regression analyses were performed to examine factors associated with service needs among older adults. RESULTS The need was greatest for movement support services. Enabling factors (marital status, co-residence with children, receipt of financial assistance for medical expenses, social participation, and satisfaction with healthcare facilities) were associated with service needs. Long-term care beneficiary status, activities of daily living limitations, depressive symptoms, hypertension, and vision impairment were also significant factors. CONCLUSIONS Older adults with physical disabilities, depressive symptoms, and limited resources for care require prioritization in support policies to promote aging in place. Both health and social care needs should be addressed in long-term care to enhance social participation among older adults.
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Affiliation(s)
- Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea.
| | - Soong-Nang Jang
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of Korea; Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea.
| | - Cheong-Seok Kim
- Department of Sociology, Dongguk University-Seoul, Seoul, Republic of Korea
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Chidambaram P, Sreeganga SD, Sanjeev A, Suwasrawala SS, Gadicherla S, Krishnappa L, Ramaprasad A. Access to Geriatric Disability Care in India: A Roadmap for Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10018. [PMID: 36011654 PMCID: PMC9408015 DOI: 10.3390/ijerph191610018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
This paper presents an ontological review of the global research on access to geriatric disability care and a roadmap for future research to address the problem in India. First, the dominant research focus is on resources (human, financial, and spatial) that affect access to disability care; there is little focus on informational and technological resources. Second, functional disabilities are the dominant focus of the research, followed by cognitive, mental, and locomotor disabilities; there is little focus on speech, hearing, and visual disabilities. Third, barriers, inhibitors, and catalysts of physical access are the dominant focus, with relatively less focus on virtual access; there is very little emphasis on the drivers to access. Fourth, the primary, although not dominant, focus is on access for urban and rural populations; there is very little focus on access for underserved and indigenous populations. Future research must address these gaps systematically to improve access. This paper adds: (a) a systemic framework for the study of an important, complex, emerging problem; (b) a systematic review of the global research on the problem; and (c) a research roadmap to address the emerging problem in India.
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Affiliation(s)
| | - S. D. Sreeganga
- Ramaiah Public Policy Center, School of Social Sciences, Ramaiah University of Applied Sciences, Bengaluru 560 054, Karnataka, India
| | - Anupama Sanjeev
- Management-Academics, Higher Education, Atria University, Bengaluru 560 024, Karnataka, India
| | - Sarah Shabbir Suwasrawala
- Ramaiah Public Policy Center, School of Social Sciences, Ramaiah University of Applied Sciences, Bengaluru 560 054, Karnataka, India
| | - Suman Gadicherla
- Department of Community Medicine, Ramaiah Medical College, Bengaluru 560 054, Karnataka, India
| | - Lalitha Krishnappa
- Department of Community Medicine, Ramaiah Medical College, Bengaluru 560 054, Karnataka, India
| | - Arkalgud Ramaprasad
- Department of Information and Decision Sciences, University of Illinois at Chicago, Chicago, IL 60607, USA
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7
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Luo Y, Zhang Q, Han L, Shen Z, Chen Y, Wang K, Huang Z, De Fries CM, Cao G, Su H, Xu H, Chen Z, Ren Z, Hu Y, Xu B. Trends in the prevalence of vision impairment among the oldest-old Chinese population from 1998 to 2018. J Glob Health 2022; 12:11006. [PMID: 35862489 DOI: 10.7189/jogh.12.11006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Vision impairment has become a prominent public health issue worldwide. However, little is known about vision impairment prevalence trends among the oldest-old adults in China. This study aimed to examine 20-year trends in the prevalence of vision impairment among the oldest-old Chinese adults and explore the contributions of sociodemographic variables, health behaviours, and chronic conditions to the trends. Methods This retrospective longitudinal study used data from the Chinese Longitudinal Healthy Longevity Survey during 1998-2018. A total of 45 849 participants aged ≥80 years at study entry were included. Vision impairment was assessed by an adapted Landolt-C chart at each wave. We examined unadjusted and adjusted nonlinear trends using generalized estimating equation models incorporating a natural cubic spline. We conducted linear regression models to estimate absolute annual prevalence changes and determine the contributions of sociodemographic variables, health behaviours, and chronic conditions to the trends. Results The fully adjusted prevalence doubled from 5.5% (95% confidence interval (CI) = 5.1%-6.0%) in 1998 to 10.7% (95% CI = 9.9%-11.5%) in 2011 and slightly increased to 11.1% (95% CI = 10.3%-12.0%) in 2018 among the oldest-old Chinese population. Glaucoma, cataracts, cognitive impairment, hearing impairment, and urban residence were significant contributors to changes in vision impairment prevalence during 1998-2018. Differences in vision impairment prevalence associated with glaucoma and cataracts narrowed since 2005. Disparities in the trends among cognitively impaired and unimpaired older adults remained unchanged over time. Similar results were observed in older people with and without hearing impairment. Conclusions Vision impairment prevalence among the oldest-old Chinese population increased from 1998 to 2011 and remained stable from 2011 to 2018. Future work is needed to improve the prevention and management of chronic diseases associated with vision impairment to reduce its prevalence.
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Affiliation(s)
- Yan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Qin Zhang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
| | - Ling Han
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zhongchen Shen
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Yuming Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Kaipeng Wang
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Ziting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Carson M De Fries
- Graduate School of Social Work, University of Denver, Denver, Colorado, USA
| | - Guiying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hexuan Su
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Huiwen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zishuo Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Zeqin Ren
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China.,Eye Disease and Optometry Institute, Peking University People's Hospital, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.,Medical Informatics Center, Peking University, Beijing, China
| | - Beibei Xu
- Medical Informatics Center, Peking University, Beijing, China
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8
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Ma X, Wei J, Congdon N, Li Y, Shi L, Zhang D. Longitudinal Association Between Self-Reported Sensory Impairments and Episodic Memory among Older Adults in China: A Prospective Cohort Study. J Geriatr Psychiatry Neurol 2022; 35:382-391. [PMID: 33792435 DOI: 10.1177/08919887211006467] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sensory impairments, such as visual and hearing impairments, and cognitive decline are prevalent among mid-age and older adults in China. With 4-year longitudinal data from the China Health and Retirement Longitudinal Study, we assessed the association between self-reported sensory impairments and episodic memory. Multivariate linear mixed-effects models were used to estimate the association of baseline sensory impairment in 2011-2012 with cognitive decline at 2- and 4-year follow-up visits. Among the 13,097 participants, longitudinal associations were identified between having hearing loss (β = -0.14, 95% CI: -0.22, -0.05), having both poor hearing and vision (β = -0.14, 95% CI: -0.23, -0.04) and decline in immediate word recall over 4 years, compared to those without self-reported sensory impairment. In addition, these associations were more significant among those aged 60 and older and among women. Further research is needed to investigate these associations in the longer term, providing evidence to support interventions that can prevent or delay sensory impairments and preserve cognitive functions in older adults.
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Affiliation(s)
- Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jingkai Wei
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lu Shi
- Department of Public Health Sciences, College of Behavioral, Social and Health Sciences, Clemson University, SC, USA
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
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9
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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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10
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Dawes P, Leroi I, Chauhan N, Han W, Harbishettar V, Jayakody DM, Jones L, Konstantinou A, Maharani A, Martini A, Politis A, Prabhakar S, Prew S, Prouskas C, Russell G, Sturrock A, Sunarti S, Taylor J, Vorvolakos T, Worthington M. Hearing and vision health for people with dementia in residential long term care: Knowledge, attitudes and practice in England, South Korea, India, Greece, Indonesia and Australia. Int J Geriatr Psychiatry 2021; 36:1531-1540. [PMID: 33929059 PMCID: PMC8518517 DOI: 10.1002/gps.5563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/01/2021] [Accepted: 04/17/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Up to 90% of people with dementia in long term care (LTC) have hearing and/or vision impairment. Hearing/vision difficulties are frequently under-recognised or incompletely managed. The impacts of hearing/vision impairment include more rapid cognitive decline, behavioural disturbances, reduced quality of life, and greater care burden. This research investigated LTC staff knowledge, attitudes and practice regarding hearing/vision care needs for residents with dementia. METHODS A survey of staff in LTC facilities in England, South Korea, India, Greece, Indonesia and Australia. Respondents used a five-point scale to indicate agreement or YES/NO response to questions regarding sensory-cognitive care knowledge (what is known); attitudes (what is thought); practice (what is done). RESULTS Respondents reported high awareness of hearing/vision care needs, although awareness of how to identify hearing/vison difficulties or refer for assessment was low. Most felt that residents were not able to use hearing/vision devices effectively due to poor fit, being poorly tolerated or lost or broken devices. A substantial minority of respondents reported low confidence in supporting use of assistive hearing/vision devices, with lack of training the main reason. Most staff did not undertake routine checking of hearing/vision devices, and it was rare for facilities to have designated staff responsible for sensory needs. Variation among countries was not significant after accounting for staff experience and having received dementia training. CONCLUSIONS There is a need to improve sensory support for people with dementia in LTC facilities internationally. Practice guidelines and training to enhance sensory-cognitive knowledge, attitudes and practice in professional care teams is called for.
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Affiliation(s)
- Piers Dawes
- Department of LinguisticsMacquarie UniversitySydneyAustralia,Manchester Centre for Audiology and DeafnessUniversity of ManchesterManchesterUK
| | - Iracema Leroi
- Global Brain Health InstituteTrinity College DublinDublinIreland,Division of Neuroscience and Experimental PsychologyUniversity of ManchesterManchesterUK
| | - Nisha Chauhan
- Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Woojae Han
- Division of Speech Pathology and AudiologyHallym UniversityChuncheonRepublic of Korea
| | | | | | - Louise Jones
- Northumbria Healthcare NHS Foundation TrustNorth TynesideUK
| | - Adamos Konstantinou
- Department of PsychiatryLarissa University General HospitalFaculty of MedicineUniversity of ThessalyLarisaGreece
| | - Asri Maharani
- Division of Nursing, Midwifery and Social WorkUniversity of ManchesterManchesterUK
| | | | - Antonios Politis
- Department of PsychiatryNational and Kapodistrian University of AthensEginition HospitalAthensGreece,Department of PsychiatryDivision of Geriatric Psychiatry and NeuropsychiatryJohn’s Hopkins Medical SchoolBaltimoreUSA
| | | | - Sandra Prew
- NIHR Clinical Research Network (CRN) West MidlandsBirminghamUK
| | | | | | | | - Sri Sunarti
- Division of Geriatric and Medical GerontologyDepartment of Internal MedicineMedical FacultyBrawijaya UniversityMalangIndonesia
| | | | - Theofanis Vorvolakos
- Department of PsychiatryAlexandroupolis University General HospitalFaculty of Medicine, Democritus University of ThraceAlexandroupolisGreece
| | - Mark Worthington
- Lancashire & South Cumbria NHS Foundation TrustSceptre Point, Sceptre WayPrestonUK
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Littlejohn J, Bowen M, Constantinidou F, Dawes P, Dickinson C, Heyn P, Hooper E, Hopper T, Hubbard I, Langenbahn D, Nieman CL, Rajagopal M, Thodi C, Weinstein B, Wittich W, Leroi I. International Practice Recommendations for the Recognition and Management of Hearing and Vision Impairment in People with Dementia. Gerontology 2021; 68:121-135. [PMID: 34091448 PMCID: PMC10072340 DOI: 10.1159/000515892] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. METHODS We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the World Health Organization Handbook for Guideline Development. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. RESULTS The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, which are classified into 6 domains of "awareness and knowledge," "recognition and detection," "evaluation," "management," "support," and "services and policies." Pragmatic options for implementation for each domain were then developed. CONCLUSION This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.
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Affiliation(s)
- Jenna Littlejohn
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
- Deafness Support Network, Cheshire, UK
| | - Michael Bowen
- Research Department, The College of Optometrists, London, UK
| | - Fofi Constantinidou
- Department of Psychology and Center for Applied Neuroscience, University of Cyprus, Nicosia, Cyprus
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, University of Manchester, Manchester, UK
- The Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Christine Dickinson
- Division of Pharmacy and Optometry, University of Manchester, Manchester, UK
| | - Patricia Heyn
- Department of Physical Medicine & Rehabilitation, University of Colorado, Aurora, CO, USA
| | - Emma Hooper
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK
- Department of Occupational Therapy, Institute of Health, University of Cumbria, Lancaster, UK
| | - Tammy Hopper
- Department of Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | - Isabel Hubbard
- Communication Sciences and Disorders, University of Kentucky, Lexington, KY, USA
| | - Donna Langenbahn
- Department of Rehabilitation, NYU School of Medicine, New York, NY, USA
| | - Carrie L. Nieman
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Chryssoula Thodi
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Barbara Weinstein
- Graduate Center, CUNY, NYU Langone Medical Center, New York, NY, USA
| | - Walter Wittich
- School of Optometry, Center for Interdisciplinary Rehabilitation Research of Greater Montreal, Université de Montréal, Montreal, QC, Canada
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Republic of Ireland
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Andrusjak W, Barbosa A, Mountain G. Hearing and vision care provided to older people residing in care homes: a cross-sectional survey of care home staff. BMC Geriatr 2021; 21:32. [PMID: 33419404 PMCID: PMC7791835 DOI: 10.1186/s12877-020-01959-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 12/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Hearing and vision loss in older people has been proven to affect physical and mental health and increase the speed of cognitive decline. Studies have demonstrated that certain practices and improved staff knowledge increase the effective care of residents’ ears and eyes, yet it is not known which practices are being implemented in care homes. This study aimed to identify the gaps in staff knowledge regarding hearing and vision difficulties in older residents, and which practices known to improve ear and eye care in older care home residents are not commonly implemented in care homes in England. Methods This study used a cross-sectional survey design. Survey questions were informed by the existing literature and were focused on practices, staff knowledge, and other aspects that have shown to affect residents’ hearing and vision care. A convenience sample of care home staff were recruited from care homes across England between November 2018 and February 2019 via email and in paper format. Descriptive statistics and Chi-Square analysis were applied to identify the factors influencing the care being provided to care home residents. Results A total of 400 care home staff responded from 74 care homes. The results revealed that less than half of staff respondents reported to use screening tools to identify hearing (46%) and vision impairments (43.8%); that care homes rarely have access to other assistive devices for hearing (16%) and vision loss (23.8%), and that audiology services do not regularly assess care home residents (46.8%). A majority of staff who responded were not confident in ear and eye care. Responses were found to be influenced by the respondents’ job role, length of time working in care homes and also the care home type. Findings confirmed a lack of standardised practice and the importance of shared communication for promulgation of best practice. Conclusion This study has identified that some practices known to facilitate ear and eye care are not commonly applied in a sample of English care homes. It has also shown that care home staff knowledge of ear and eye care is inconsistent. The information derived from this survey can be used to inform guidelines for best practice and inform needs for future research. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-020-01959-0.
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Affiliation(s)
- Wendy Andrusjak
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Dementia, Richmond Road, Bradford, BD7 1DP, UK.
| | - Ana Barbosa
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Dementia, Richmond Road, Bradford, BD7 1DP, UK
| | - Gail Mountain
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Dementia, Richmond Road, Bradford, BD7 1DP, UK
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Völter C, Götze L, Dazert S, Wirth R, Thomas JP. Impact of Hearing Loss on Geriatric Assessment. Clin Interv Aging 2020; 15:2453-2467. [PMID: 33408469 PMCID: PMC7779803 DOI: 10.2147/cia.s281627] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background Due to the aging society, the incidence of age-related hearing loss (ARHL) is strongly increasing. Hearing loss has a high impact on various aspects of life and may lead to social isolation, depression, loss of gain control, frailty and even mental decline. Comorbidity of cognitive and sensory impairment is not rare. This might have an impact on diagnostics and treatment in the geriatric setting. Objective The aim of the study was to evaluate the impact of hearing impairment on geriatric assessment and cognitive testing routinely done in geriatrics. Material and Methods This review is based on publications retrieved by a selective search in Medline, including individual studies, meta-analyses, guidelines, Cochrane reviews, and other reviews from 1960 until August 2020. Results Awareness of sensory impairment is low among patients and health professionals working with elderly people. The evaluation of the hearing status is not always part of the geriatric assessment and not yet routinely done in psychiatric settings. However, neurocognitive testing as an important part can be strongly influenced by auditory deprivation. Misunderstanding of verbal instructions, cognitive changes, and delayed central processes may lead to a false diagnosis in up to 16% of subjects with hearing loss. To minimize this bias, several neurocognitive assessments were transformed into non-auditory versions recently, eg the most commonly used Hearing-Impaired Montreal Cognitive Assessment (HI-MoCA). However, most of them still lack normative data for elderly people with hearing loss. Conclusion Hearing loss should be taken into consideration when performing geriatric assessment and cognitive testing in elderly subjects. Test batteries suitable for ARLH should be applied.
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Affiliation(s)
- Christiane Völter
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital, Bochum 44787, Germany
| | - Lisa Götze
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital, Bochum 44787, Germany
| | - Stefan Dazert
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital, Bochum 44787, Germany
| | - Rainer Wirth
- Department of Geriatric Medicine, Ruhr-University Bochum, Marien Hospital Herne, Herne 44625, Germany
| | - Jan Peter Thomas
- Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr-University Bochum, St. Elisabeth-Hospital, Bochum 44787, Germany
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Leroi I, Constantinidou F, Langenbahn D, Heyn P, Yeung WK, Dawes P. Hearing and Vision Impairment in People With Dementia: A Guide for Clinicians. Arch Phys Med Rehabil 2020; 101:1667-1670. [DOI: 10.1016/j.apmr.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 11/26/2022]
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Leroi I. "Losing my glasses…losing my mind": Perspectives on sensory impairment, loneliness, social isolation and dementia. Int J Geriatr Psychiatry 2020; 35:335-337. [PMID: 31943355 DOI: 10.1002/gps.5265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
- University of Manchester, Manchester, UK
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