Chyrisse Heine

The communication and psychosocial perceptions of older adults with sensory loss: a qualitative study

Sensory loss (visual and/or hearing loss) is prevalent in older adults. Decreased vision and/or hearing acuity often result in poor communication and psychosocial functioning. This qualitative study explores the communication and psychosocial perceptions of a group of older adults with single or dual sensory loss. The aims were to identify the communication difficulties and conversational strategies used by the subjects, and to explore their perceptions of their social adjustment, quality of life and physical and mental well-being. The participants were all older adults with sensory loss who attended the Vision Australia Foundation. In-depth interviews revealed that the participants experienced frequent communication difficulties. They identified the personal, situational and environmental triggers responsible for communication breakdown, and they described the compensation and avoidance strategies that they used. The participants acknowledged that frequent communication breakdown resulted in decreased socialisation. The problems of adjusting to sensory loss, depression, anxiety, lethargy and social dissatisfaction were cited as factors that affected their physical and mental well-being, while being optimistic, coping with their sensory loss, and maintaining social contact contributed to an improved quality of life. All participants expressed interest in being involved in further communication intervention programmes.

Communication perceptions of older adults with sensory loss and their communication partners: implications for intervention.

Introduction: Vision and hearing loss are prevalent disorders in older adults although their effects on communication are not well documented. Method: The purpose of this study was to investigate the perceptions of older adults with sensory loss and their communication partners with regard to their communication, situational difficulties and conversational needs. Results: Questionnaire results revealed that the sensory loss group experienced a range of functional vision and hearing difficulties. Over two-thirds of subjects reported frequent conversational difficulty, particularly in background noise and group conversations. Most subjects used clarification requests (mainly non-specific clarification and repetition requests) to overcome misunderstandings. By contrast, the communication partners reported few communication difficulties and claimed that they proactively eliminated or controlled environmental, speaker and listener variables to optimize conversation. The most frequently reported strategy was repetition. Conclusion: The findings suggest that older adults with sensory loss experience communication disruptions, which in many instances are not resolved. To optimize communication efficacy in this population, a communication training programme for people with sensory loss and their communication partners is highly recommended.

Mental health and dual sensory loss in older adults: A systematic review

Mental health is a core component of quality of life in old age. Dual Sensory Loss (DSL; combined vision and hearing loss) is prevalent in older adults and has been correlated with decreased levels of well-being. This systematic review aimed to critically review and summarize the evidence from studies that examined the mental health of older adults with DSL. In accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) statement, specific databases were searched and eight articles were selected for final review. Seven studies investigated the association between DSL and depression or depressive symptoms, whilst one study explored the relationship between DSL and quality of life. No studies investigated the impact of DSL on anxiety. Overall, results of this review suggested that there is a significant relationship between DSL and decreased mental health with those with DSL either displaying depressive symptoms or being at risk for developing depression. Future research should focus on comparative studies of older people with and without sensory loss, as well as targeted studies of older people with dual sensory loss, that incorporate well-defined and valid measures of sensory loss and mental health.

Screening Receptive Communication of Older Adults in Residential Care

Receptive communication of 341 older adults was evaluated in 9 nursing homes. The following assessments were conducted: case history, otoscopic examination, visual perception of facial movements, h...

Dual Sensory Loss in Older Adults: A Systematic Review

PURPOSE OF THE STUDY Combined vision and hearing loss [dual sensory loss (DSL)] is commonly experienced by older adults. The literature on comorbidities and outcomes associated with DSL in older adults is limited and thus a systematic review was conducted to explore the existing research and identify gaps in the evidence base. DESIGN AND METHODS A review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews. Forty-two articles were selected for review. RESULTS Although several studies evaluated DSL and its comorbidities and impacts, few fully met the criteria for good study design. Reviewed studies primarily investigated DSL and its comorbidities using cross-sectional methods and varying methods of vision and hearing assessment. Many of the studies were large population studies that did not provide sufficient information to draw valid conclusions about the impact of DSL in older adults. IMPLICATIONS Studies focusing specifically on sensory loss in older people across a broad age range are needed to inform clinical practice so that DSL and its impacts in older adults can be identified and managed, leading to improved quality of life for this population.

Trajectories of older adults' hearing difficulties: Examining the influence of health behaviors and social activity over 10 years

The aims of the present study were to describe the trajectories of self‐reported hearing difficulties over time, and evaluate the impacts of age, sex, lifestyle factors and social activity, in explaining individual differences in patterns of change over time.

Trajectories of older adults' hearing difficulties

The aims of the present study were to describe the trajectories of self‐reported hearing difficulties over time, and evaluate the impacts of age, sex, lifestyle factors and social activity, in explaining individual differences in patterns of change over time.

Central Auditory Processing Disorder: a systematic search and evaluation of clinical practice guidelines.

RATIONALE, AIMS AND OBJECTIVES An increased interest in Central Auditory Processing Disorder has seen the publication of several guidelines to help inform clinical practice. The aim of this study was to conduct a systematic search and critically evaluate published guidelines to inform the ongoing development of evidence-based practice in this area. METHOD A systematic search of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews guidelines. Nominated guidelines were then critiqued using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. RESULTS Five clinical practice guidelines in the area of Central Auditory Processing Disorder were identified. The British Society of Audiology guideline achieved the highest rating for scope and purpose, rigour of development and applicability and overall score. CONCLUSIONS The AGREE II tool is an effective way to critically evaluate the quality of methodological reporting of clinical practice guidelines in the area of Central Auditory Processing Disorder and provides direction for the ongoing development of these guidelines in the future.

Speech therapy with a group of hearing-impaired adolescents I: a sociolinguistic analysis of therapy sessions

Speech therapy conversations between five dyads, comprising senior speech pathology students and hearing-impaired adolescents enrolled in a Total Communication programme, were videorecorded for five weekly sessions. Samples over one-minute intervals at the start, middle and end of the sessions were analysed for topic initiations and initiators, conversational turns, and responses to questions according to the communication modes: speech; sign or gesture; and speech combined with sign or gesture. Statistical analyses explored differences between dyads, conversational partners, sessions, and intervals, and their inter actions, in relation to mode. The results are discussed with reference to changes in conversational competence with therapy.

Dual sensory loss and its mental health impacts: where to now?

It is common for older people to experience deterioration of their vision or hearing as they age. The combined effect of vision and hearing loss [known as Dual Sensory Loss (DSL)] is prevalent in the older adult population, occurring in up to 69% of adults aged 65 years and over (Wittich et al., 2012). Concomitant with this impairment is the risk of diminishing physical and mental health (Kiely et al., 2013), decreased communication interactions (Heine and Browning, 2002), and social isolation (Brennan et al., 2006). As eluded in the Heine and Browning (2002) article, in people with DSL, mental health consequences including depression, anxiety disorders, and cognitive aging have not been thoroughly and systematically investigated contributing to a sparse literature on which to base clinical practice. The issues that arise are: what barriers impede early diagnosis and management of DSL and its mental health impacts, and how are these conditions identified and managed in clinical practice? The identification of DSL is complicated especially since older adults often acquire this disorder slowly as they age, making DSL difficult to detect particularly in its mild form in either or both of the sensory domains. The research also supports the notion that older people with unisensory loss and those with DSL are not affected by the same impacts, and may not seek or need the same assistance especially if DSL is not identified at the time that unisensory loss is identified. McDonnall (2009) investigated the effect of DSL on depressive symptoms and whether people with DSL were more likely than those with a single sensory loss to experience depressive symptoms. The results of this study suggested that older adults with DSL were likely to experience symptoms of depression similar to those participants with vision loss, but significantly more likely to experience symptoms of depression than participants with hearing loss only. The impacts of unisensory loss and DSL also vary over time. Outcomes of a longitudinal study conducted by Brennan et al. (2006), suggested that in older adults, at baseline, DSL was associated with higher levels of functional disability compared to those adults with unisensory loss; however, the effect gradually diminished over time. These studies highlight the need for professionals to be vigilant in the detection of DSL and not overlook the possibility of an older adult having DSL even if they present symptoms in only one of the domains of vision or hearing loss. For older adults themselves, numerous barriers to seeking assistance for their sensory losses may exist. It is common for older adults (especially those with DSL) to experience a range of physical and mental health conditions as they age. For example, Crews and Campbell (2004) found that older people with DSL are 2.4 times more likely to report heart disease, 3.6 times more likely to have reported a stroke, and 2.7 times more likely to report depression. It is thus possible that for older adults with DSL, their sensory loss may take on less importance as a priority compared to the other health conditions that may exist co-morbidly. For those with DSL, examples of further barriers preventing health seeking behaviors may include reduced mobility and independence and increased depression (Crews and Campbell, 2004; Brennan et al., 2006). Vision and hearing health services are usually one-dimensional and the vision or hearing service provider may not be aware of the need for multidisciplinary collaboration. Although separate vision and hearing screening guidelines exist in the US (see U.S. Preventive Services Task Force, 2009, 2012), these are not necessarily adopted in other countries, do not cover DSL, and do not include screening for possible impacts of DSL such as mental health. One example of a multidimensional approach is the Joint Commissioning Strategy for People with Sensory Impairment 2011–2015 proposed by the Surrey County Council, UK1. This strategy includes increasing awareness of DSL, ensuring services for this population group meet their complex needs (for example, older adults with DSL and dementia) and that suitable services are offered for those with DSL. Since DSL and its impacts cross numerous domains, the pathway for service provision is unclear. Professionals are thus encouraged to extend their skills to be able to screen for both sensory losses and identify associated impacts (such as depression and social isolation) so that appropriate referrals can be made. Multidisciplinary collaboration in the management process is necessary so that the best outcome can be achieved for those with DSL (Heine et al., 2002). In order to encourage optimal mental health, successful aging and sustain quality of life for older adults with DSL, appropriate identification and effective management of older people with DSL is essential. In this regard, a number of points are highlighted including lack of credible and representative research investigating the impacts of DSL on mental health, guidelines regarding pathways for diagnosis and management of DSL in general and more specifically in those with mental health issues, and collaboration among the numerous professionals working in this field including medical and allied health professionals such as medical practitioners and specialists, audiologists, optometrists, and psychologists.