Abstract
Background: There are few evidence-based non-pharmacological interventions adapted for people with dementia (PwD) in lower- and middle-income countries (LMIC). Thus, there is value in culturally adapting existing interventions from other settings. One such intervention for PwD involves hearing rehabilitation, which may improve dementia-related outcomes.Objective: To culturally adapt and evaluate the feasibility and acceptability of a multi-faceted hearing support intervention to enhance quality of life in PwD for a LMIC setting, Pakistan.Design: This was a study in three phases: (1) training and capacity building to deliver the study, including Patient and Public Involvement (PPI); (2) cultural adaptation of the intervention; and (3) delivery of a single-group feasibility study with a pre-test post-test design.Setting: Home-based intervention, in two cities of Pakistan.Participants: Adults aged ≥ 60 with mild-moderate dementia and uncorrected or partially corrected hearing impairment, and their study partners (n = 14).Intervention: An adapted hearing support intervention (HSI) comprising a full assessment of hearing function, fitting of hearing aids, and home-based support from a “hearing support practitioner.”Outcomes: Ratings of the feasibility of the study procedures, and acceptability/tolerability of the adapted intervention were ascertained through questionnaires, participant diaries, therapist logbooks and semi-structured interviews. A signal of effectiveness of the intervention was also explored using a battery of dementia-related outcome measures.Results: Following cultural adaptation and capacity building for study conduct and delivery, we successfully implemented all intervention components in most participants, which were well-received and enacted by participant dyads. Acceptability (i.e., understanding, motivation, sense of achievement) and tolerability (i.e., effort, fatigue) ratings and safety of the intervention were within a priori target ranges. Recruitment and retention targets required improvement, due to the COVID-19 pandemic outbreak, as well as the lack of a clear clinical diagnostic pathway for dementia in both sites. Areas for future modification were clearly identified, including: the assessment/delivery logistics circuit; procedures for arranging visits; communication among referring clinicians and the study team.Conclusion: This is the first study in a LMIC of sensory enhancement to improve dementia outcomes. Positive feasibility, acceptability and tolerability findings suggest that a full-scale effectiveness trial, with certain modifications is warranted.
Highlights
Cognitive decline and dementia are newly emerging as public health priorities in low- and middle-income countries (LMICs) due to aging of the population
We reported on the challenges inherent in introducing a patient and public involvement (PPI) model into LMIC settings where hierarchical social structures predominate, in the context of medical professional-patient relationships
The Hearing Support Intervention (HSI) that we developed for the SENSE-Cog Asia trial has core resonances with the European SENSE-Cog Sensory Support Intervention (SSI), outlined by Regan et al (11), it differed from the European version in several ways including that we did not specify the make and model of hearing aid that participants would receive and we included dementia awareness education for caregivers (Table 1)
Summary
Cognitive decline and dementia are newly emerging as public health priorities in low- and middle-income countries (LMICs) due to aging of the population. Hearing interventions may promote better outcomes for people with cognitive impairment, but consistent evidence for the positive impact is still lacking, highlighting the need for sufficiently powered randomized controlled trials of such interventions on outcomes relevant to people living with dementia (8). As highlighted by recent guidance for up scaling dementia research in Pakistan (10), developing and evaluating low cost, accessible interventions for PwD and their families in such low- and middle-income health economies such as South Asia, is essential to support the development of services. There are few evidence-based non-pharmacological interventions adapted for people with dementia (PwD) in lower- and middle-income countries (LMIC). There is value in culturally adapting existing interventions from other settings One such intervention for PwD involves hearing rehabilitation, which may improve dementia-related outcomes
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