Managing comorbid cognitive impairment and hearing loss in older adults: a UK survey of audiology and memory services.

BACKGROUND: midlife hearing loss is a potentially modifiable risk factor for dementia. Addressing comorbid hearing loss and cognitive impairment in services for older adults may offer opportunities to reduce dementia risk. OBJECTIVE: to explore current practice and views amongst UK professionals regarding hearing assessment and care in memory clinics and cognitive assessment and care in hearing aid clinics. METHODS: national survey study. Between July 2021 and March 2022, we distributed the online survey link via email and via QR codes at conferences to professionals working in National Health Service (NHS) memory services and audiologists working in NHS and private adult audiology services. We present descriptive statistics. RESULTS: 135 professionals working in NHS memory services and 156 audiologists (68% NHS, 32% private sector) responded. Of those working in memory services, 79% estimate that >25% of their patients have significant hearing difficulties; 98% think it useful to ask about hearing difficulties and 91% do so; 56% think it useful to perform a hearing test in clinic but only 4% do so. Of audiologists, 36% estimate that >25% of their older adult patients have significant memory problems; 90% think it useful to perform cognitive assessments, but only 4% do so. Main barriers cited are lack of training, time and resources. CONCLUSIONS: although professionals working in memory and audiology services felt addressing this comorbidity would be useful, current practice varies and does not generally address it. These results inform future research into operational solutions to integrating memory and audiology services.

Impact of patient-held record on knowledge at 1-year follow-up for glaucoma patients: single-center randomized controlled trial.

PURPOSE: To assess whether provision of a personalized patient-held eye health summary (glaucoma personal record) improves patients' knowledge of glaucoma at 1-year follow-up. The National Institute for Clinical Excellence has recommended such an approach to ascertain if this may ultimately help slow disease progression. METHODS: Recruited patients, newly diagnosed with glaucoma conditions, were randomly allocated to receive standard clinical care or an additional glaucoma personal record, detailing the current state of each individual's eye condition. Mann-Whitney U test was applied for comparison of knowledge scores between groups at 1-year follow-up, using a validated questionnaire. Multiple linear regression analysis was applied to detect any factors significantly associated with a difference in glaucoma knowledge. RESULTS: A total of 122 patients were recruited; 57 controls and 44 intervention patients were tested for their glaucoma knowledge, equating to 83% retention rate. Out of a maximum available 100% converted score, the median scores were 58% and 53% for the control and intervention arm, respectively (p = 0.85). Regression analysis showed that age (p = 0.015) had a negative association and level of education (p = 0.002) had a positive association with glaucoma knowledge. CONCLUSIONS: The glaucoma personal record does not impact on a patient's knowledge of glaucoma in either a positive or negative way. Other approaches to improve health literacy among glaucoma patients, particularly for patients who are elderly or have a limited educational background, must be considered to improve patients' awareness and knowledge of their own condition. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number Registry: ISRCTN41306818.

The Health Of Patients' Eyes (HOPE) Glaucoma study. The effectiveness of a 'glaucoma personal record' for newly diagnosed glaucoma patients: study protocol for a randomised controlled trial.

BACKGROUND: Glaucoma involves progressive optic nerve fibre loss, subsequently leading to irreversible and disabling visual field defects. In Europe, the prevalence of glaucoma is approximately 2.2 % of all people aged over 40 years; this equates to 12 million people. Glaucoma patients require regular lifelong follow-up, contributing to a large financial and resource burden for the National Health Service (NHS) in the UK. This study aims to determine whether providing newly diagnosed glaucoma patients with a personalised client-held eye health summary ('glaucoma personal record'), improves patients' knowledge of their glaucoma condition. A potential long-term benefit could be improved self-management and henceforth a slower rate of deterioration. METHODS/DESIGN: HOPE Glaucoma is a 3-year, prospective, parallel-group, pragmatic, single-centred, randomised controlled trial. An anticipated 122 adults, newly diagnosed with glaucoma (including ocular hypertension, suspected glaucoma and/or chronic open-angle glaucoma) will be recruited from a nurse-led ophthalmology outpatient clinic at a medium-sized NHS Trust. Participants will be randomly allocated to receive standard clinical care (control arm) or standard care plus a glaucoma personal record, detailing the current state of their condition (interventional arm). Participant assessments are designed to test whether provision of a glaucoma personal record 1) improves patient knowledge of glaucoma and 2) contributes to improvements in clinical outcomes, i.e. delay of visual field loss. The primary outcome measure is better client knowledge of glaucoma at the 9-12 month follow-up visit. Secondary outcome measures include the rate of visual field loss and patient-reported outcome measures on visual function (National Eye Institute VFQ - 25) measured at baseline, 9-12 months, 24 months and 36 months. Estimating a 20 % drop-out rate, the study will have 90 % power to detect a mean two-point difference in glaucoma knowledge score between groups at 5 % significance - based on two-sided Mann-Whitney U test. DISCUSSION: If a glaucoma personal record is found to significantly improve glaucoma patients' knowledge of their condition, this intervention could potentially provide a low-cost, straightforward tool to educate and engage glaucoma patients. Subsequently, this could have the potential to increase patient self-management and therefore allow glaucoma patients to prolong their sight functionality for longer. TRIAL REGISTRATION: ISRCTN41306818 , registered on 22 August 2013.