Addressing Hearing and Vision Impairment in Long-Term Care: An Important and Often-Neglected Care Priority

Topical review: Challenges and solutions for eye care in long-term care

BACKGROUND

The prevalence of visual impairment among individuals living in long-term care (LTC) is substantial, yet eye care is often disregarded and inadequately addressed. This neglect contributes to a decline in quality of life for residents. Thus, understanding the challenges faced by stakeholders in providing eye care for residents might suggest opportunities to improve eye health outcomes.

AIM

This study aimed to identify factors influencing access to eye care services in LTC, focusing on key stakeholders including residents, family members, aged care staff, and eye care professionals.

METHODS

We included studies on vision/eye care-related challenges and/or management of eye conditions for people living in LTC facilities. We performed literature searches using Cochrane Database of Systematic Reviews, PubMed, CINAHL/EBSCO, EMBASE, APA PsycINFO, and Web of Science database. The search was limited to articles in English language, published between January 2013 and September 2023. Factors influencing the vision/eye care for residents were mapped to respective stakeholders, and we visualized how they interacted within the LTC system in providing eye care.

RESULTS

Eleven studies were included in the review. We found that the challenges to appropriate eye care in LTC are present across all stakeholder groups. These challenges include limited awareness of eye health, logistical difficulties in coordinating and managing eye care within LTC settings, and negative beliefs and attitudes toward prioritizing eye care for residents.

CONCLUSIONS AND IMPLICATIONS

This review highlights that barriers to eye care in LTC communities exist at multiple levels and involve a range of stakeholders. In order to improve eye care, interventions should be at the system level, considering the influence of all key stakeholders rather than employing a targeted approach.

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

INTRODUCTION

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

METHODS AND ANALYSIS

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

CONCLUSION

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

What impact does hearing impairment have on cognitive health in older married couples in China?

Hearing impairment is a common geriatric health problem and chronic stressor, and it is associated with poor cognitive outcomes. However, little is known about the impact of hearing impairment in married couples, particularly its potential spillover effects on the cognitive health among spouses of individuals with impairment. Drawing on a stress-proliferation perspective, we used actor-partner interdependence models to examine (1) whether an individual's hearing impairment influences their spouse's cognitive function; and (2) whether AL, symptoms of depression, and social participation serve as mediators for such an association. We utilized data from the 2015 (baseline) and 2018 (3-year follow-up) waves of the China Health and Retirement Longitudinal Study. 4434 couples were included at baseline, and 2190 couples remained after the 3-year follow-up. Hearing impairment among married women was associated with negative impacts on their spouses' cognitive function. Symptoms of depression and social participation may have served as potential mediators in this relationship. For married men, there was no statistically significant association between hearing impairment and spouses' cognitive function. Our findings suggest that hearing impairment among one spouse can lead to negative impacts on the other, but that this effect may depend on gender. Early diagnosis and couple-based interventions for hearing impairment are important for the cognitive health of both hearing-impaired individuals and their spouses.

Antimicrobial Properties of Capsaicin: Available Data and Future Research Perspectives

Capsaicin is a phytochemical derived from plants of the genus Capsicum and subject of intensive phytochemical research due to its numerous physiological and therapeutical effects, including its important antimicrobial properties. Depending on the concentration and the strain of the bacterium, capsaicin can exert either bacteriostatic or even bactericidal effects against a wide range of both Gram-positive and Gram-negative bacteria, while in certain cases it can reduce their pathogenicity by a variety of mechanisms such as mitigating the release of toxins or inhibiting biofilm formation. Likewise, capsaicin has been shown to be effective against fungal pathogens, particularly Candida spp., where it once again interferes with biofilm formation. The parasites Toxoplasma gondi and Trypanosoma cruzi have been found to be susceptible to the action of this compound too while there are also viruses whose invasiveness is significantly dampened by it. Among the most encouraging findings are the prospects for future development, especially using new formulations and drug delivery mechanisms. Finally, the influence of capsaicin in somatostatin and substance P secretion and action, offers an interesting array of possibilities given that these physiologically secreted compounds modulate inflammation and immune response to a significant extent.