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Cross H, Armitage CJ, Dawes P, Leroi I, Millman RE. "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. Disabil Rehabil 2024; 46:3303-3313. [PMID: 37641847 PMCID: PMC11259204 DOI: 10.1080/09638288.2023.2245746] [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: 02/14/2023] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023]
Abstract
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.
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Affiliation(s)
- Hannah Cross
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, The University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia
| | - Iracema Leroi
- Global Brain Health Institute and School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rebecca E. Millman
- Manchester Centre for Audiology and Deafness, School of Health Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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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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Koerber RM, Kokorelias KM, Sinha SK. The clinical use of personal hearing amplifiers in facilitating accessible patient-provider communication: A scoping review. J Am Geriatr Soc 2024; 72:2195-2205. [PMID: 38299694 DOI: 10.1111/jgs.18784] [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: 09/24/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Abstract
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.
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Affiliation(s)
- Raphaelle M Koerber
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada
- Department of Internal Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Kristina M Kokorelias
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada
- Department of Occupational Sciences and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- National Institute on Ageing, Toronto Metropolitan University, Toronto, Canada
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada
- National Institute on Ageing, Toronto Metropolitan University, Toronto, Canada
- Division of Geriatric Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Geriatric Medicine and Gerontology, Hopkins University School of Medicine, Baltimore, Maryland, USA
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Cross H, Armitage CJ, Dawes P, Leroi I, Millman RE. Capabilities, opportunities and motivations of staff to provide hearing support to long-term care home residents with dementia. Int J Audiol 2024; 63:519-526. [PMID: 37382285 PMCID: PMC11225945 DOI: 10.1080/14992027.2023.2227764] [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: 02/11/2023] [Accepted: 06/09/2023] [Indexed: 06/30/2023]
Abstract
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.
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Affiliation(s)
- Hannah Cross
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
| | - Christopher J. Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Hearing Research (CHEAR), School of Health and Rehabilitation Sciences, University of Queensland, Saint Lucia, Australia
| | - Iracema Leroi
- Global Brain Health Institute and School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rebecca E. Millman
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Branding M, Fleischmann N, Wittland M. [Hearing in the elderly: Employees' perspectives on hearing care in long-term care facilities. A qualitative study]. Pflege 2024. [PMID: 38809026 DOI: 10.1024/1012-5302/a000995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
Hearing in the elderly: Employees' perspectives on hearing care in long-term care facilities. A qualitative study Abstract: Background: Hearing impairment is common among the elderly. More than half of individuals 80 years and older exhibit severe hearing loss, and few retain good hearing performance. This impairment significantly affects both community participation and nursing care. Aim: This study aimed to examine the impact of hearing impairment on everyday life of employees and residents at long-term care facilities. We further sought to identify how employees perceive hearing care in order to identify potential for improvement. Methods: This sub-project of a larger study comprised guided focus groups with employees of long-term care facilities. The sample included six focus groups of nurses and nursing care assistants from long-term care facilities (n = 42). Collected data were analyzed using qualitative content analysis. Results: Hearing impairment hinders elderly resident participation in the nursing process and complicates daily communication between residents and nursing staff. Hearing impaired residents are less able to take part in group activities and tend to withdraw from the community. Lack of an effective hearing support structure renders hearing care services inaccessible to some residents. Conclusions: Optimized service structures, targeted assistance and training opportunities for employees specific to hearing impairment can provide sustainable hearing care for the elderly.
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Affiliation(s)
- Melina Branding
- Fakultät V - Diakonie, Gesundheit und Soziales, Abteilung Pflege und Gesundheit, Hochschule Hannover, Deutschland
| | - Nina Fleischmann
- Fakultät V - Diakonie, Gesundheit und Soziales, Abteilung Pflege und Gesundheit, Hochschule Hannover, Deutschland
| | - Michael Wittland
- Fakultät V - Diakonie, Gesundheit und Soziales, Abteilung Pflege und Gesundheit, Hochschule Hannover, Deutschland
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Umaefulam V, Safi S, Lingham G, Gordon I, Mueller A, Krishnam NS, Alves Carneiro VL, Yu M, Evans JR, Keel S. Approaches for delivery of refractive and optical care services in community and primary care settings. Cochrane Database Syst Rev 2024; 5:CD016043. [PMID: 38808577 PMCID: PMC11134311 DOI: 10.1002/14651858.cd016043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. In 2021, the World Health Assembly endorsed a global target of a 40-percentage-point increase in effective coverage of refractive error by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. This review will inform the development of technical guidance to support improvements in the testing and correction of refractive error among World Health Organization (WHO) member states. OBJECTIVES To determine the range of approaches for delivery of refractive and optical care services in community and primary care settings, and the methods employed for their evaluation. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and Global Health databases, grey literature, and annual reports and websites of relevant organizations involved in eye-care delivery from January 2002 to November 2022 to identify approaches for refractive and optical service delivery. SELECTION CRITERIA We included observational and interventional studies, reviews, and reports from relevant organizations related to delivering refractive services and optical services for preschool and school-aged children and adults in community and primary care settings published between January 2002 and November 2022. We searched for studies and reports published within the last 20 years because vision impairment due to uncorrected refractive error has only recently become a public health and eye health priority, therefore we did not expect to find much relevant literature until after 2002. DATA COLLECTION AND ANALYSIS Two review authors screened titles, abstracts and full texts, and extracted data. We resolved any discrepancies through discussion. We synthesized data, and presented results as tables, figures, and case studies. This project was led by the World Health Organization (WHO) Vision and Eye Care Programme. MAIN RESULTS We identified 175 studies from searches of databases and grey literature, 146 records from company reports, and 81 records from website searches of relevant organizations that matched our inclusion criteria. Delivery approaches for refractive and optical services in community care included school-based, pharmacy, and outreach models, whereas primary care approaches comprised vision centre, health centre, and a combination of vision or health centre and door-to-door delivery. In community care, school-based and outreach approaches were predominant, while in primary care, a vision-centre approach was mainly used. In the WHO African region, the school-based and outreach approaches were mainly reported while, in the Americas, the outreach approach was mostly used. Very few approaches for service delivery were reported in the WHO Eastern Mediterranean region. Prominent gaps exist in the evaluation of the approaches, and few studies attempted to evaluate the approaches for delivery of refractive and optical care services. AUTHORS' CONCLUSIONS We comprehensively describe a range of approaches for delivery of refractive and optical services in community and primary care. Further evaluation of their effectiveness will better inform the application of these service-delivery approaches. The study outcomes will help guide WHO member states in strengthening refractive and optical services at community and primary care levels. FUNDING This scoping review was supported by the Vision and Eye care Programme, World Health Organization and ATscale Global Partnership. REGISTRATION The protocol of this scoping review was published in the Open Source Framework.
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Affiliation(s)
- Valerie Umaefulam
- Vision and Eye Care Programme, World Health Organization, Geneva, Switzerland
| | - Sare Safi
- Ophthalmic Epidemiology Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Gareth Lingham
- Centre for Eye Research Ireland, Environmental Sustainability and Health Institute, Technological University Dublin, Dublin, Ireland
- Centre for Ophthalmology and Visual Science, Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Iris Gordon
- International Centre for Eye Health (ICEH), London School of Hygiene & Tropical Medicine, London, UK
| | - Andreas Mueller
- Noncommunicable Diseases, World Health Organization, Melbourne, Australia
| | | | - Vera L Alves Carneiro
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Mitasha Yu
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Jennifer R Evans
- International Centre for Eye Health (ICEH), London School of Hygiene & Tropical Medicine, London, UK
| | - Stuart Keel
- Vision and Eye Care Programme, World Health Organization, Geneva, Switzerland
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Cross H, Dawes P, Hooper E, Armitage CJ, Leroi I, Millman RE. Effectiveness of Hearing Rehabilitation for Care Home Residents With Dementia: A Systematic Review. J Am Med Dir Assoc 2021; 23:450-460.e4. [PMID: 34921761 DOI: 10.1016/j.jamda.2021.11.011] [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] [Received: 06/17/2021] [Revised: 11/10/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To report the effectiveness of, and barriers and facilitators to, hearing rehabilitation for care home residents with dementia. DESIGN Systematic review. SETTING AND PARTICIPANTS Care home residents with dementia and hearing loss. METHODS No restrictions on publication date or language were set and gray literature was considered. Eligible studies were critically appraised and presented via a narrative review. RESULTS Sixteen studies, most of low to moderate quality, were identified. Hearing rehabilitation, including hearing devices, communication techniques, and visual aids (eg, flashcards), was reported to improve residents' communication and quality of life and reduce agitation, with improvements in staff knowledge of hearing loss and job satisfaction. Residents' symptoms of dementia presented barriers, for example, losing or not tolerating hearing aids. Low staff prioritization of hearing loss due to time pressures and lack of hearing-related training for staff were further barriers, particularly for residents who required assistance with hearing devices. Adopting a person-centered approach based on residents' capabilities and preferences and involving family members facilitated hearing device use. CONCLUSIONS AND IMPLICATIONS Residents with dementia can benefit from hearing rehabilitation. Identifying and implementing efficient, individualized hearing rehabilitation is necessary for those with complex cognitive needs. Increased funding and support for the social care sector is required to address systemic issues that pose barriers to hearing rehabilitation, including time pressures, lack of training for staff and access to audiology services for residents.
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Affiliation(s)
- Hannah Cross
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, United Kingdom.
| | - Piers Dawes
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, United Kingdom; School of Health and Rehabilitation Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Australia
| | - Emma Hooper
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, United Kingdom; Department of Rehabilitation and Sports Science, Institute of Health, University of Cumbria, United Kingdom
| | - Christopher J Armitage
- Manchester Centre for Health Psychology, University of Manchester, Manchester, United Kingdom; Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom; NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Iracema Leroi
- Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Rebecca E Millman
- Manchester Centre for Audiology and Deafness, School of Health Sciences, University of Manchester, Manchester, United Kingdom; NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
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Sloane PD, Whitson H, Williams SW. Addressing Hearing and Vision Impairment in Long-Term Care: An Important and Often-Neglected Care Priority. J Am Med Dir Assoc 2021; 22:1151-1155. [PMID: 34088504 DOI: 10.1016/j.jamda.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 04/19/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023]
Affiliation(s)
- Philip D Sloane
- Cecil G. Sheps Center for Health Services Research and Departments of Family Medicine and Internal Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
| | - Heather Whitson
- Departments of Medicine and Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - Sharon Wallace Williams
- Division of Speech and Hearing Sciences, Department of Allied Health Sciences, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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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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