Loneliness and objective social isolation are differentially associated with anomalous perceptions in community-dwelling older adults.

INTRODUCTION: Anomalous perceptions are characterised by the subjective experience of a range of distorted and/or hallucinatory percepts. Whilst considerable attention has been paid to the neurocognitive processes contributing to anomalous perceptions amongst older adults, less is known about the social factors (e.g. social isolation, loneliness). Furthermore, it is unknown whether loneliness and social isolation are associated with different types of anomalous perceptions, including anomalous body-centred self-experiences and anomalous external experiences. METHODS: This study examined the cross-sectional relationships between loneliness, objective social isolation, and anomalous perceptions in a sample of community-dwelling older adults (N = 242, Mage = 71.87 ± 7.73, range = 52-91, 67.8% female) using structural equation modelling. RESULTS: Higher levels of loneliness were associated with more anomalous body-centred self-experiences and anomalous external experiences. Those reporting more loneliness also reported higher levels of anxiety and depression; however, the relationship between loneliness and anomalous perceptions was not mediated by these factors. Social disconnection from a religious group was associated with more anomalous external experiences and being married/living with a partner was associated with more anomalous body-centred self-experiences. CONCLUSIONS: These findings suggest that loneliness and social isolation have differential associations with anomalous perceptions in older adults and provide additional evidence that attending to loneliness in older adults is important.

Utilisation of tele-audiology practices in Australia during the COVID-19 pandemic: Perspectives of audiology clinic owners, managers and reception staff.

OBJECTIVE: To canvas the views of Australia-based hearing healthcare clinic owners/managers and reception staff regarding the utilisation, experiences and perspectives of providing tele-audiology services during the COVID-19 pandemic. DESIGN: A national prospective self-report survey was completed online. Data were analysed using descriptive statistics. STUDY SAMPLE: Twenty-one clinic owners/managers (Mage 54.43 years, 15 female) and 58 reception staff (Mage 42.88 years, 49 female) from Australia-based hearing clinics. RESULTS: Clinic owners/managers reported an increase in use of tele-audiology services as compared to pre-COVID-19. Reception staff reported providing more advice and support to clients over the phone. Both clinic owners/managers and reception staff indicated key barriers to providing tele-audiology services to include concerns about their clients' digital and technological literacy and the perception that in-the-clinic appointments deliver better client outcomes than tele-audiology appointments. CONCLUSIONS: The increased utilisation of tele-audiology services observed appears to be largely influenced by COVID-19 related factors (e.g. maintaining client and staff safety and increased funding). It is therefore possible that utilisation of tele-audiology service may drop once the threat of the pandemic has subsided. Perceived barriers relating to clients' digital literacy and the effectiveness of tele-audiology services require attention to safeguard the future of tele-audiology service delivery in Australia.

Barriers and facilitators to tele-audiology service delivery in Australia during the COVID-19 pandemic: perspectives of hearing healthcare clinicians.

OBJECTIVE: To explore the utilisation, safety, cost, and patient outcomes of delivering tele-audiology services during the COVID-19 pandemic. DESIGN: A national cross-sectional self-report online survey asking participants to reflect on interactions with hearing services between April and October 2020. Data were analysed using descriptive statistics. The COM-B model of behaviour change guided survey creation and the presentation of a subset of the results. STUDY SAMPLE: 249 Australia-based hearing healthcare clinicians (age range 23-74 years; 162 female). RESULTS: Clinicians reported an increase in the use of tele-audiology services, with key drivers relating to keeping their patients safe and keeping businesses running. Clinicians generally viewed the provision of tele-audiology services as successful and resulting in improved patient outcomes. Overall, clinicians were highly motivated to provide tele-audiology services, and they expressed being confident in their knowledge and understanding of tele-audiology service delivery. Barriers to providing tele-audiology services included concerns about the reliability of the results obtained from remote assessments, as well as concerns around information security and privacy issues. CONCLUSIONS: Clinicians' motivations to use tele-audiology services appeared to be driven by their desire to maintain COVID-safe practices during the pandemic and by the COVID-driven increase in availability of funding for tele-audiology services.

Teleaudiology Services in Australia: A National Survey of Hearing Health Care Consumers Amid the COVID-19 Pandemic.

PURPOSE: The aim of this study was to investigate the perspectives of Australia-based hearing health care consumers regarding the (a) provision and utilization of teleaudiology services, (b) experiences with teleaudiology, and (c) barriers and enablers to future teleaudiology use. METHOD: A national prospective self-report online survey was completed between April and October 2020, amid COVID-19. Data were analyzed using descriptive statistics (closed-answer items) and content analysis (open-text responses). A total of 381 participants (Mage = 72.07 years ± 10.08, 142 females) were recruited from different states and territories of Australia. RESULTS: Despite positive outcomes reported by those who undertook teleaudiology appointments during COVID-19, results indicate low-consumer teleaudiology uptake. It can be inferred that consumers were not aware of teleaudiology as an appointment option, clinicians/clinic staff had not informed and/or supported teleaudiology as an option, and biases existed that prevented teleaudiology being more widely adopted. It is unclear whether consumers who were eligible for government subsidies understood that teleaudiology appointments were reimbursed through government funding. Barriers to future teleaudiology uptake were largely related to concerns regarding confidentiality and privacy. CONCLUSION: Low consumer uptake of teleaudiology appointments appears to be driven by consumer preference for in-person services, which appears to be driven by lack of knowledge regarding the availability and effectiveness of teleaudiology. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25619808.

Exploring Current Practice, Knowledge, and Training Needs for Managing Psychosocial Concerns in the Audiology Setting: Perspectives of Audiologists, Audiology Reception Staff, and Managers.

Purpose The purpose of this study was to explore the current practices and training requirements for supporting clients experiencing psychosocial concerns in the audiology setting, from the perspectives of audiology clinicians, managers, and reception staff. Method Convenience sampling was used to recruit audiologists, reception staff, and clinic managers (N = 13, M age = 32.2 ± 8.1, range: 25-47 years, 11 female) through a large hearing services provider in Western Australia. A semistructured focus group was used to elicit participant views regarding current experiences relating to clients who express psychosocial concerns in the audiology setting, familiarity with psychosocial interventions, and training requirements for delivery of psychosocial interventions in the audiological setting. Results Twenty-four subthemes were identified across six themes: (1) awareness of psychosocial well-being, (2) the role of others, (3) identifying client's psychosocial needs, (4) managing client's psychosocial needs, (5) barriers to providing psychosocial support, and (6) broadening audiological services to include psychosocial support. Conclusions Participants reported an awareness of their clients' psychosocial challenges within the audiology setting, yet they described uncertainty in how best to respond in providing support and whether this was within their scope of practice. A majority of audiology staff expressed desire and motivation to broaden the scope of their service in order to better address their clients' hearing loss-related psychosocial needs.

Addressing Emotional and Psychological Problems Associated With Hearing Loss: Perspective of Consumer and Community Representatives.

PURPOSE: Hearing loss causes emotional distress and can contribute to the development of psychological difficulties, yet emotional and psychological issues are not addressed within current audiology services. The purpose of this study was to use focus groups with consumer and community representatives to explore how we might improve the provision of support for clients experiencing emotional and psychological issues in relation to their hearing loss. PARTICIPANTS: Adults with hearing loss (n = 19) and their significant others (n = 9), as well as 10 hearing health care professionals (n = 4 hearing health care clinicians, n = 4 reception staff, and n = 2 clinical managers), participated in consumer and community engagement focus groups. METHOD: Consumer and community representatives were tasked with (a) identifying the stakeholders involved in supporting adults experiencing emotional or psychological difficulties on account of their hearing loss, (b) describing the behaviors undertaken by each stakeholder group, and (c) selecting target behavior(s) that could optimally form the basis of an intervention program to improve the quality and frequency of support provided to people experiencing emotional and psychological problems in the audiology setting. RESULTS: Participants identified 12 stakeholder groups involved in supporting adults with hearing loss experiencing emotional and psychological problems. The three behaviors voted by participants to be the most promising for a behavioral intervention included the clinician (a) asking about, (b) providing information on, and (c) delivering therapeutic intervention for emotional and psychological well-being within audiological service provision. CONCLUSION: Consumer and community stakeholder representatives indicate a general desire for hearing health care clinicians to deliver support for the emotional and psychological issues that arise relating to hearing loss.

Perspectives on Mental Health Screening in the Audiology Setting: A Focus Group Study Involving Clinical and Nonclinical Staff.

PURPOSE: Audiology clinical guidelines recommend the use of mental health screening tools; however, they remain underutilized in clinical practice. As such, psychological concerns are frequently undetected in adults with hearing loss. This study aimed to better understand audiology clinic staff's perspectives (including audiologists, audiometrists, reception staff, and clinic managers) on how to improve detection of poor mental health by (a) exploring the role of audiology clinic staff in detecting psychological concerns in adults with hearing loss and (b) investigating the appropriateness, acceptability, and usability of several screening tools in an audiology setting. METHOD: Eleven audiology clinic staff (M age = 33.9 ± 7.3, range: 25-51 years) participated in a semistructured focus group. First, participants discussed the role of audiology clinic staff in detecting psychological difficulties in adults with hearing loss, including current practices and needs for improving practices. Second, participants discussed the appropriateness, acceptability, and usability of nine standardized mental health screening tools commonly used in wider health care settings. RESULTS: Audiology clinic staff described their role in being aware of, and detecting, psychological difficulties, as well as their part in promoting an understanding of the link between hearing loss and mental health. Participants described the need to provide support following detection, and highlighted barriers to fulfilling these roles. The use of mental health screening tools was considered to be client and context specific. The language used within the screener was identified as an important factor for its acceptability by audiology clinic staff. CONCLUSIONS: Audiology clinic staff acknowledged that they have an important role to play in the detection of psychological difficulties and identified the core barriers to using screening tools. Future research may explore the possibility of developing a mental health screening tool specific to the unique experiences of adults with comorbid hearing loss and mental health concerns. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.16702501.

Factor structure and age invariance of the Cardiff Anomalous Perceptions Scale (CAPS) in healthy older and younger adults.

Although anomalous perceptual experiences are common in healthy older adults, they remain poorly characterized. In particular, it is unclear whether the phenomenology of these experiences differs between healthy older and younger adults. The current study examined similarities and differences in the factor structure of the Cardiff Anomalous Perceptions Scale (CAPS) in healthy, community-dwelling older (n = 194; Mage = 71.89, SD = 7.74, range = 52-91; 69.1% female) and younger adults (n = 421, Mage = 19.40, SD = 2.44, range = 17-34; 69.6% female; N = 615), using exploratory and confirmatory factor analysis, together with measurement invariance testing. The results found that a 2-factor correlated model comprising 23 of the original 32 CAPS items provided the best fit to the data. Further, scalar invariance was found between the two samples, indicating equivalence of the factor structure, factor loadings, and thresholds by age group. Compared with younger adults, the latent group means of older adults were also found to be equal on Factor 1, but significantly lower on Factor 2. Evidence of scalar age invariance on the CAPS suggests that this tool is valid for making comparisons between older and younger adults on two dimensions of anomalous perceptual experiences. Further, the results suggest that anomalous perceptions in the general community may be characterized by two components: anomalous body-centered self-experiences (e.g., alterations in body, touch, smell, and taste perception) and anomalous external experiences (e.g., auditory, visual, and sensed presence hallucinations); each of which may have different causes, correlates, and consequences for healthy ageing. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Hallucinations in Older Adults: A Practical Review.

Older adults experience hallucinations in a variety of social, physical, and mental health contexts. Not everyone is open about these experiences, as hallucinations are surrounded with stigma. Hence, hallucinatory experiences in older individuals are often under-recognized. They are also commonly misunderstood by service providers, suggesting that there is significant scope for improvement in the training and practice of professionals working with this age group. The aim of the present article is to increase knowledge about hallucinations in older adults and provide a practical resource for the health and aged-care workforce. Specifically, we provide a concise narrative review and critique of (1) workforce competency and training issues, (2) assessment tools, and (3) current treatments and management guidelines. We conclude with a brief summary including suggestions for service and training providers and future research.