The need for improved cognitive, hearing and vision assessments for older people with cognitive impairment: a qualitative study.

Lucas Wolski,Chryssoula Thodi,Anna Pavlina Charalambous,Jemma Regan,Ines Himmelsbach,Iracema Leroi,Roxane Villeneuve,Catherine Helmer,Piers Dawes,Juliana Prokopiou,Abebaw Mengistu Yohannes

doi:10.1186/s12877-019-1336-3

Abstract

BackgroundHearing and vision (sensory) impairments are highly prevalent in people with dementia (PwD) and exacerbate the impact of living with dementia. Assessment of sensory or cognitive function may be difficult if people have concurrent dual or triple impairments. Most standard cognitive assessment tests are heavily dependent on having intact hearing and vision, and impairments in these domains may render the assessments unreliable or even invalid. Likewise, dementia may impede on the accurate reporting of symptoms that is required for most hearing and vision assessments. Thus, there is an urgent need for hearing, vision and cognitive assessment strategies to be adapted to ensure that appropriate management and support can be provided.ObjectiveTo explore the perspectives of PwD and the care partners regarding the need for accurate hearing, vision and cognitive assessments.MethodsWe conducted focus groups and semi-structured interviews regarding the clinical assessment for cognitive, hearing and visual impairment. Participants (n = 18) were older adults with mild to moderate dementia and a sensory impairment as well as their care partners (e.g. a family member) (n = 15) at three European sites. The qualitative material was analysed according to Mayring’s summative content analysis approach.ResultsParticipants reported that hearing, vision and cognitive assessments were not appropriate to the complex needs of PwD and sensory comorbidity and that challenges in communication with professionals and conveying unmet needs and concerns by PwD were common in all three types of clinical assessments. They felt that information about and guidance regarding support for the condition was not adequate in the assessments and that information sharing among the professionals regarding the concurrent problems was limited. Professionals were reported as being concerned only with problems related to their own discipline and had limited regard for problems in other domains which might impact on their own assessments.ConclusionsThe optimal assessment and support for PwD with multiple impairments, more comprehensive, yet easy to understand, information regarding these linked to conditions and corrective device use is needed. Communication among health care professionals relevant to hearing, vision and cognition needs to be improved.

Highlights

Hearing and vision impairments are highly prevalent in people with dementia (PwD) and exacerbate the impact of living with dementia
They felt that information about and guidance regarding support for the condition was not adequate in the assessments and that information sharing among the professionals regarding the concurrent problems was limited
Professionals were reported as being concerned only with problems related to their own discipline and had limited regard for problems in other domains which might impact on their own assessments

Summary

Introduction

Hearing and vision (sensory) impairments are highly prevalent in people with dementia (PwD) and exacerbate the impact of living with dementia. Over 90% of older adults with cognitive impairment have hearing loss [19], and nearly one third of people with dementia (PwD) have vision impairment [5]; the proportion of older people with triple impairments is increasing. In spite of this high rate of comorbidity, hearing and vision impairments continue to be under-recognised, under-diagnosed and under-treated ([1, 5, 9, 16]; Leroi et al, 2018, [55]).

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