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Desjardins JL, Sotelo LR. Self-Reported Reasons for the Non-Use of Hearing Aids Among Hispanic Adults With Hearing Loss. Am J Audiol 2021; 30:709-716. [PMID: 34314258 DOI: 10.1044/2021_aja-21-00043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose To examine the self-reported reasons for the non-use of hearing aids among Mexican-American Hispanic adults who have hearing loss. Method A total of 122 Hispanic adults with hearing loss, who did not currently or previously use a hearing aid, participated in this study. Participants completed a comprehensive hearing health questionnaire and the Hearing Handicap Inventory Screening Questionnaire to examine the possible reasons for the non-use of hearing aids. Results Self-reported hearing loss, hearing handicap score, and health insurance status were the best predictors of an individual's willingness to use hearing aids to treat their hearing loss. The primary reasons cited for the non-use of hearing aids among Hispanics with hearing loss was the belief that their hearing impairment was not severe enough to warrant using a hearing aid and that hearing aids were unaffordable. Conclusions Greater public health education regarding the deleterious effects of untreated hearing loss and the positive impact of amplification on cognitive, social, and psychological health may be warranted to improve the usage rates of hearing aids in Hispanic adults.
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Affiliation(s)
| | - Loren R. Sotelo
- Department of Rehabilitation Sciences, The University of Texas at El Paso, TX
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2
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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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3
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Ray M, Dening T, Crosbie B. Dementia and hearing loss: A narrative review. Maturitas 2019; 128:64-69. [DOI: 10.1016/j.maturitas.2019.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
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4
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Mahmoudi E, Zazove P, Meade M, McKee MM. Association Between Hearing Aid Use and Health Care Use and Cost Among Older Adults With Hearing Loss. JAMA Otolaryngol Head Neck Surg 2019; 144:498-505. [PMID: 29710214 DOI: 10.1001/jamaoto.2018.0273] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Hearing loss (HL) is common among older adults and is associated with poorer health and impeded communication. Hearing aids (HAs), while helpful in addressing some of the outcomes of HL, are not covered by Medicare. Objective To determine whether HA use is associated with health care costs and utilization in older adults. Design, Setting, and Participants This retrospective cohort study used nationally representative 2013-2014 Medical Expenditure Panel Survey data to evaluate the use of HAs among 1336 adults aged 65 years or older with HL. An inverse propensity score weighting was applied to adjust for potential selection bias between older adults with and without HAs, all of whom reported having HL. The mean treatment outcomes of HA use on health care utilization and costs were estimated. Exposures Encounter with the US health care system. Main Outcomes and Measures (1) Total health care, Medicare, and out-of-pocket spending; (2) any emergency department (ED), inpatient, and office visit; and (3) number of ED visits, nights in hospital, and office visits. Results Of the 1336 individuals included in the study, 574 (43.0%) were women; mean (SD) age was 77 (7) years. Adults without HAs (n = 734) were less educated, had lower income, and were more likely to be from minority subpopulations. The mean treatment outcomes of using HAs per participant were (1) higher total annual health care spending by $1125 (95% CI, $1114 to $1137) and higher out-of-pocket spending by $325 (95% CI, $322 to $326) but lower Medicare spending by $71 (95% CI, -$81 to -$62); (2) lower probability of any ED visit by 2 percentage points (PPs) (24% vs 26%; 95% CI, -2% to -2%) and lower probability of any hospitalization by 2 PPs (20% vs 22%; 95% CI, -3% to -1%) but higher probability of any office visit by 4 PPs (96% vs 92%; 95% CI, 4% to 4%); and (3) 1.40 more office visits (95% CI, 1.39 to 1.41) but 0.46 (5%) fewer number of hospital nights (95% CI, -0.47 to -0.44), with no association with the number of ED visits, if any (95% CI, 0.01 to 0). Conclusions and Relevance This study demonstrates the beneficial outcomes of use of HAs in reducing the probability of any ED visits and any hospitalizations and in reducing the number of nights in the hospital. Although use of HAs reduced total Medicare costs, it significantly increased total and out-of-pocket health care spending. This information may have implications for Medicare regarding covering HAs for patients with HL.
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Affiliation(s)
- Elham Mahmoudi
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Philip Zazove
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Michelle Meade
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.,Department of Physical Medicine & Rehabilitation, School of Medicine, University of Michigan, Ann Arbor
| | - Michael M McKee
- Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Czwikla J, Schulz M, Heinze F, Kalwitzki T, Gand D, Schmidt A, Tsiasioti C, Schwinger A, Kloep S, Schmiemann G, Wolf-Ostermann K, Gerhardus A, Rothgang H. Needs-based provision of medical care to nursing home residents: protocol for a mixed-methods study. BMJ Open 2019; 9:e025614. [PMID: 31471429 PMCID: PMC6720143 DOI: 10.1136/bmjopen-2018-025614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/11/2019] [Accepted: 08/01/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Nursing home residents typically have greater needs for medical care than community-dwelling elderly. However, restricted cognitive abilities and limited mobility may impede their access to general practitioners and medical specialists. The provision of medical care in nursing homes may therefore be inappropriate in some areas of medical care. The purpose of this mixed-methods study is to systematically assess, evaluate and explain met and unmet medical care needs in German nursing homes and to develop solutions where medical care is found to be inappropriate. METHODS AND ANALYSIS First, statutory health insurance claims data are analysed to identify differences in the utilisation of medical care between nursing home residents and community-dwelling elderly with and without need for long-term care. Second, the health status and medical care of 500 nursing home residents are assessed and evaluated to quantify met and unmet medical care needs. Third, qualitative expert interviews and case conferences and, fourth, quantitative analyses of linked data are used to provide structural, case-specific and generalisable explanations of inappropriate medical care among nursing home residents. Fifth, a modified Delphi study is employed to develop pilot projects aiming to improve medical care in nursing homes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen on 23 November 2017. Research findings are disseminated through presentations at national and international conferences and publications in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER DRKS00012383.
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Affiliation(s)
- Jonas Czwikla
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Thomas Kalwitzki
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Daniel Gand
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Annika Schmidt
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | | | | | - Stephan Kloep
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Competence Center for Clinical Trials (KKSB), University of Bremen, Bremen, Germany
| | - Guido Schmiemann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Karin Wolf-Ostermann
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Care Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Ansgar Gerhardus
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
- Department for Health Services Research, Institute of Public Health and Nursing Research (IPP), University of Bremen, Bremen, Germany
| | - Heinz Rothgang
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
- High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
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6
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Giving permission to care for people with dementia in residential homes: learning from a realist synthesis of hearing-related communication. BMC Med 2019; 17:54. [PMID: 30827280 PMCID: PMC6398258 DOI: 10.1186/s12916-019-1286-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 02/11/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Managing hearing communication for residents living with hearing loss and dementia in long-term care settings is challenging. This paper explores how care can be effective in optimising hearing communication for residents living with dementia. We argue that the underlying notion of permission or authorisation allows care staff to do what they know will be effective in providing person-centred care that enhances hearing communication. The paper also indicates that this notion of permission can usefully be applied to other areas of care home practice. METHODS To address hearing-related communication in care homes, we conducted a realist synthesis (RS). As a theory-driven approach to reviewing literature, it also uses expert opinion to understand complex health situations. Using RS, we developed a theory surrounding the management of hearing-related communication in care homes. Applying formal processes to the literature search and data extraction, the analysis uncovered relevant mechanisms and contexts to help confirm, refute or refine our understanding of how hearing communication could be improved. RESULTS Forty-three papers were selected for the realist synthesis. The documents were analysed to construct five context-mechanism-outcome configurations (CMOCs). The CMOCs represent possible care interventions to optimise hearing-related communication in care homes for person living with dementia and hearing loss (PLWDHL). They include leadership promoting positive regard and empathy through person-centred care, communication training for staff, 'knowing the person' and relationship building for responsive awareness of residents' hearing needs, maintaining and monitoring hearing communication through care planning, and managing noise in the care home environment. CONCLUSIONS Leadership that provides appropriate training and resources is likely to enhance knowledge and skills, leading to staff feeling able and equipped to respond to the hearing-related communication needs of PLWDHL. Collaboration with local hearing services is likely to raise awareness of hearing loss among care home staff. Importantly, care staff require a sense of permission from leadership, to work with knowledge and autonomy in the interest of residents living with dementia and hearing loss.
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7
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Höbler F, Argueta-Warden X, Rodríguez-Monforte M, Escrig-Pinol A, Wittich W, McGilton KS. Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study. BMC Geriatr 2018; 18:235. [PMID: 30286718 PMCID: PMC6172849 DOI: 10.1186/s12877-018-0917-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 09/12/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses' current experiences of screening and caring for long-term care residents who have dementia and sensory impairment. METHODS As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis. RESULTS Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed. CONCLUSIONS Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.
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Affiliation(s)
- Fiona Höbler
- Toronto Rehabilitation Institute-University Health Network, 130 Dunn Ave, Toronto, M6K 2R7 Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON Canada
| | - Xochil Argueta-Warden
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130 Dunn Ave, Toronto, M6K 2R7 Canada
| | | | - Astrid Escrig-Pinol
- Toronto Rehabilitation Institute-University Health Network, 130 Dunn Ave, Toronto, M6K 2R7 Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Walter Wittich
- School of Optometry, Université de Montréal, 3744, rue Jean-Brillant, 260-7, Montréal, Québec, H3T 1P1 Canada
- CRIR/Centre de réadaptation MAB-Mackay du CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, Montréal, Québec, Canada
- CRIR/Institut Nazareth et Louis-Braille du CISSS de la Montérégie-Centre, Longueuil, Québec, Canada
| | - Katherine S. McGilton
- Toronto Rehabilitation Institute-University Health Network, 130 Dunn Ave, Toronto, M6K 2R7 Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 130 Dunn Ave, Toronto, M6K 2R7 Canada
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8
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Mamo SK, Oh E, Lin FR. Enhancing Communication in Adults with Dementia and Age-Related Hearing Loss. Semin Hear 2017; 38:177-183. [PMID: 28522892 DOI: 10.1055/s-0037-1601573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
For many adults with dementia, age-related hearing loss is undiagnosed and/or untreated. Untreated hearing loss can exacerbate common dementia-related behavioral symptoms, such as depression, apathy, agitation. Despite the potential benefits to the individual and the family, pursuing and adopting hearing aids for persons with dementia presents with many challenges. As such, this group of vulnerable older adults is well suited for alternative approaches that adopt an interventional audiology framework. This article reviews alternative hearing care models that we have tested when working with older adults with cognitive impairments. We have found that some individuals show improvements in dementia-related problem behaviors and/or in measures of social engagement after brief aural rehabilitation interventions that provide non-custom amplification. We have developed simple training materials to help family and professional caregivers use communication strategies and non-custom amplification. Providing services that can be integrated into the person's broader dementia care has the potential to improve communication and quality of life for individuals and families. There are opportunities in this population to provide basic, simple strategies and make substantial improvements as long as we adopt approaches that bring the services to the people, instead of bringing the people to us in the audiology clinic.
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Affiliation(s)
- Sara K Mamo
- Communication Disorders Department, University of Massachusetts School of Public Health and Health Sciences, Amherst, Massachusetts
| | - Esther Oh
- Department of Otolaryngology-Head/Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Frank R Lin
- Department of Otolaryngology-Head/Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of (Geriatric) Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Wright N, Stickley T, Mulla I, Bradshaw E, Buckley L, Archbold S. Hearing loss and dementia: an exploratory study of the views of audiologists. QUALITY IN AGEING AND OLDER ADULTS 2014. [DOI: 10.1108/qaoa-08-2014-0014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to explore audiologists, views and experiences of working with older adults with dementia.
Design/methodology/approach
– An online survey was distributed to audiologists working in the UK NHS and private sector via their professional organisations. A total of 312 audiologists took part in the study. The survey collected both quantitative and qualitative data. Basic descriptive statistics summarised the quantitative responses. The qualitative data were analysed using conventional thematic approaches.
Findings
– The quantitative data demonstrated that the vast majority of audiologists had treated someone with dementia (96 per cent). Despite this, 65 per cent of respondents did not feel adequately supported to help this service user population. Four overarching themes were used to explain the qualitative data: integrated and individualised care; formal (including training) vs experiential knowledge; the interaction between dementia and hearing and using the technology.
Research limitations/implications
– The self-selecting nature of the sample is a limitation which needs to be taken into account when considering the transferability and implications of the findings.
Practical implications
– Given the anticipated increase in rates of dementia within the population and the potential for hearing impairment to exacerbate the symptoms; this study highlights the unique role audiologists have. The need for more training and development for this professional group is also identified.
Originality/value
– This is one of the first papers to explore audiologists, views and experiences of working with people with dementia. As such, it highlights some interesting areas worthy of further research using both quantitative and qualitative methods.
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10
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Chen DS, Genther DJ, Betz J, Lin FR. Association between hearing impairment and self-reported difficulty in physical functioning. J Am Geriatr Soc 2014; 62:850-6. [PMID: 24779559 PMCID: PMC4084895 DOI: 10.1111/jgs.12800] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine whether hearing impairment, defined by using objective audiometry, is associated with multiple categories of self-reported physical functioning in a cross-sectional, nationally representative sample of older adults. DESIGN Multivariate secondary analysis of cross-sectional data. SETTING The 2005-06 and 2009-10 cycles of the National Health and Nutrition Examination Survey. PARTICIPANTS Adults aged 70 and older who completed audiometric testing (N = 1,669). MEASUREMENTS Hearing was measured using pure-tone audiometry. Physical functioning was assessed using a structured interview. RESULTS In a model adjusted for age and demographic and cardiovascular risk factors, greater hearing impairment (per 25 dB hearing level (HL)) was associated with greater odds of physical disability in activities of daily living (odds ratio (OR) = 1.4, 95% confidence interval (CI) = 1.1-1.9), instrumental activities of daily living (OR = 1.6, 95% CI = 1.2-2.2), leisure and social activities (OR = 1.5, 95% CI = 1.1-2.0), lower extremity mobility (OR = 1.4, 95% CI = 1.1-1.7), general physical activities (OR = 1.3, 95% CI = 1.1-1.6), work limitation (OR = 1.4, 95% CI = 1.0-1.9), walking limitation (OR = 1.6, 95% CI = 1.3-2.0), and limitation due to memory or confusion (OR = 1.4, 95% CI = 1.1-1.8). Hearing impairment was not associated with limitations in amount or type of work done (OR = 1.2, 95% CI = 1.0-1.6). CONCLUSION Hearing impairment in older adults is independently associated with greater disability and limitations in multiple self-reported categories of physical functioning.
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Affiliation(s)
- David S. Chen
- Department of School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Dane J. Genther
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Joshua Betz
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Frank R. Lin
- Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland
- Department of Geriatric Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland
- Center on Aging and Health, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Behrman S, Chouliaras L, Ebmeier KP. Considering the senses in the diagnosis and management of dementia. Maturitas 2014; 77:305-10. [PMID: 24495787 DOI: 10.1016/j.maturitas.2014.01.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Associations between dementia and impairments in hearing, vision, olfaction and (to a lesser degree) taste have been identified. Hearing impairment has been shown to precede cognitive decline, but it is not clear if the hearing loss is an early marker of dementia or a modifiable risk factor. Olfactory impairment is seen in many neurodegenerative conditions, but it has been shown that those with dementia have particular difficulties with the recognition and identification of odours rather than the detection, suggesting a link to impairment of higher cognitive function. Olfactory impairment has been shown to be predictive of conversion from mild cognitive impairment to Alzheimer's disease with 85.2% sensitivity. As cognitive function deteriorates, the world is experienced at a sensory level, with reduced ability to integrate the sensory experiences to understand the context. Thus, people with dementia are very sensitive to sensory experiences and their environment needs to be managed carefully to make it understandable, comfortable, and (if possible) therapeutic. Light can be used to stabilise the circadian rhythm, which may be disturbed in dementia. Music therapy, aromatherapy, massage and multisensory stimulation are recommended by NICE for the management of behavioural and psychological symptoms of dementia (BPSD), although the mechanisms behind such interventions are poorly understood and evidence is limited. Sensory considerations are likely to play a greater role in dementia care in the future, with the development of purpose-built dementia care facilities and the focus on non-pharmacological management strategies for BPSD.
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Affiliation(s)
- Sophie Behrman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Leonidas Chouliaras
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Klaus P Ebmeier
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK.
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Pryce H, Gooberman-Hill R. Foundations of an intervention package to improve communication in residential care settings: A mixed methods study. HEARING BALANCE AND COMMUNICATION 2013. [DOI: 10.3109/21695717.2012.756224] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Pryce H, Gooberman-Hill R. 'There's a hell of a noise': living with a hearing loss in residential care. Age Ageing 2012; 41:40-6. [PMID: 21890482 DOI: 10.1093/ageing/afr112] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hearing loss is common in older age. Research with older people in residential care settings has identified high prevalence of hearing loss and low uptake of hearing aids. Hearing loss in these settings is associated with reduced social engagement. Although hearing aids remain the default treatment for presbyacusic hearing loss, these are not well used. We do not know what other modifiable factors contribute to communication problems for older people with hearing loss living in residential care. OBJECTIVES To explore the factors affecting communicating with a hearing loss in residential care. METHODS An ethnographic study in two residential care homes comprised 19 sessions of observation, and in-depth interviews with 18 residents. Observations explored communication behaviour in everyday interactions, including mealtimes, structured groups and informal group activities. Interviews were informed by the observations and identified reasons for these behaviours and communication preferences. Observational data were recorded in field notes and interviews were audio-recorded and transcribed. Analysis was conducted using constant comparison methods. RESULTS Hearing loss affected whether residents were able to access social opportunities. Two key themes influenced this (i) contextual issues compounded communication difficulties and (ii) environmental noise restricted the residents' communication choices. Problems were observed at every mealtime and during formal and informal group activities. The use of hearing aids and access to hearing services did not improve social engagement. CONCLUSIONS Environmental and social factors are key to maximising communication opportunities. Improvements to communication in residential care settings could be based on changes in these with input from residents and staff. Further work is needed to develop effective communication strategies in residential care.
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Affiliation(s)
- Helen Pryce
- Centre for Hearing and Balance Studies, University of Bristol, 8 Woodland Road, Bristol BS8 1TN, UK.
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Audio-vestibular evaluation in patients with essential tremor. Eur Arch Otorhinolaryngol 2011; 269:1577-81. [PMID: 22037719 DOI: 10.1007/s00405-011-1801-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 09/28/2011] [Indexed: 10/15/2022]
Abstract
The aim of this study was to investigate audio-vestibular function in patients with essential tremor. Twenty-three patients with essential tremor (46 ears) and 21 health control subjects (42 ears) were included in the present study. Patients and comparison subjects were matched for age and gender. All patient and control subjects underwent pure tone audiometric test, tympanogram, transient-evoked otoacoustic emissions and auditory brainstem response. Vestibular system was evaluated by bitermal caloric test. Comparison of variables between the groups was performed. Investigation of the relationship between parameters about ET disease and hearing levels were also studied. Pure tone thresholds significantly differed between patients and controls in 250 and 500 Hz frequencies (p < 0.05). There was no statistically significant difference in 1,000, 2,000, 4,000, and 6,000 Hz frequencies in essential tremor patients in comparison to the control subjects. A correlation between tremor severity and audiometric scores in low frequencies was not found. In addition, statistical analysis did not demonstrate a correlation between audiometric scores and tremor duration. The otoacoustic emission responses were found significantly different in patient and control group. The latencies of waves I, V and I-V inter-peak latencies on the ABR were not different between the groups. Our findings indicated that, abnormalities are due to cochlea rather than the retro cochlear pathology which is responsible for hearing loss associated with essential tremor.
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Schneider BA, Pichora-Fuller K, Daneman M. Effects of Senescent Changes in Audition and Cognition on Spoken Language Comprehension. THE AGING AUDITORY SYSTEM 2010. [DOI: 10.1007/978-1-4419-0993-0_7] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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