Evaluating audiological intervention options for

people with dementia living in aged care homes

Anthea Bott,1,2 Carly Meyer,1,2 Louise Hickson1,2

1 The University of Queensland, School of Health and Rehabilitation Sciences 2 The HEARing Cooperative Research Centre

Background Within aged-care homes (ACHs), prevalence of hearing

impairment and dementia is 83% and 50%, respectively.

Accordingly, HI and dementia is the most commonly reported

dual communication disability within ACHs (1).

Current gold-standard for audiological rehabilitation (fitting

hearing aids) has poor uptake and outcomes within ACHs (2-4).

Limited research exploring the uptake and outcomes of

alternative audiological interventions for people with dementia

within ACHs, such as assistive listening devices (ALDs) or

communication programs.

In order to provide client-centered care in audiological

rehabilitation clients need to be provided with options. One way

audiologists can facilitate a discussion regarding options is by

using a decision aid (5).

Impact when dementia and HI co-occur and are

not appropriately addressed Negative effects of HI on communication are superimposed on

the negative impacts of dementia, a concept referred to as

excess disability (6).

Dementia negatively impacts on memory and language, which

can result in the following communication difficulties: word-

finding difficulties, difficulty initiating and following conversations

and restricted verbal output.

When not addressed, higher rates of depression & social

isolation (7).

Study 1 Aim: To explore the communication needs of people with

dementia and their family and professional caregivers; and how

these needs are currently being addressed in their audiological

management.

Participants: There are three groups of participants including:

people with dementia and HI who live in an ACH, ACH staff and

audiologists who provide services to residents with dementia in

the ACH.

Method: Semi-structured, in-depth interviews followed by

thematic analysis. People with dementia will be interviewed with

a personal/professional caregiver.

Anticipated outcome: An in-depth understanding of the unmet

needs of people with dementia and HI, and their family and

professional caregivers, within an ACH. This knowledge will then

inform which audiological options should be presented to this

population.

Create, pilot and refine an e-based audiological decision

aid for people with dementia living in ACHs (see figure 1 for

example of a decision aid)

Study 2 Aim: To examine the uptake and outcomes of audiological

rehabilitative options provided to people with dementia and HI

who live in an ACH.

Participants: People with dementia and HI living in an ACH and

an accompanying family member or professional caregiver.

Method:

Anticipated outcome:

1) Evidence for e-based shared decision making in audiology

for people with dementia .

2) Evidence base for a range of audiological rehabilitation

interventions for people with dementia and HI who reside in

ACHs.

creating sound value www.hearingcrc.org

References

1.Worrall L, Hickson L, Dodd B. Screening for Communication Impairment in Nursing Homes and Hostels. Australian Journal of Human Communication Disorders. 1993;21(2):53-64

2.Linssen AM, Joore MA, Theunissen EJJM, Anteunis LJC. The effects and costs of a hearing screening and rehabilitation program in residential care homes for the elderly in the Netherlands. American

Journal of Audiology. 2013;22(1):186-9.

3. Cohen-Mansfield J, Taylor JW. Hearing aid use in nursing homes. Part 1: Prevalence rates of hearing impairment and hearing aid use. J Am Med Dir Assoc. 2004;5(5):283-8.

4. Cohen-Mansfield J, Taylor JW. Hearing aid use in nursing homes. Part 2: Barriers to effective utilization of hearing AIDS. J Am Med Dir Assoc. 2004;5(5):289-96.

5.Laplante-Lévesque, A., Hickson, L., Worrall, L. (2010). A qualitative study of shared decision making in rehabilitative audiology. Journal of the Academy of Rehabilitative Audiology, 48, 27-43.

6.Slaughter S, Bankes J. The Functional Transitions Model: maximizing ability in the context of progressive disability associated with Alzheimer disease. Can J Aging. 2007;26(1):39e47.

7. Gopinath B, Hickson L, Schneider J, McMahon CM, Burlutsky G, Leeder SR, et al. Hearing-impaired adults are at increased risk of experiencing emotional distress and social engagement restrictions five

years later. Age and ageing. 2012;41(5):618-23.

8. Slaughter SE, Hopper T, Ickert C, Erin DF. Identification of hearing loss among residents with dementia: perceptions of health care aides. Geriatr Nurs. 2014;35(6):434-40.

Figure 1. Decision aid excerpt (5).

Use e-based decision aid to discuss

rehabilitation options with participant dyad

Elicit decision with dyad and provide further

information on how to access chosen option

Explore outcome of audiological rehabilitation

option with participant dyad

Quantitative Outcomes

Proportion of people who

choose each option

Change in hearing

disability (e.g. HHQ)

Change in third-party

disability (e.g. SOS-

HEAR)

Change in caregiving

experience (e.g. Positive

Aspects of Caregiving)

Qualitative Outcomes

Semi-structured

interviews with

participant dyads