Multidisciplinary Approaches and Community-Based Interventions: Adaptable Strategies for Managing Sensory Impairments in Older Adults.

Sensory impairments including hearing and vision loss are becoming increasingly prevalent among older adults worldwide, and are adversely affecting their quality of life, independence and cognitive health. This article focuses on the global rise of sensory impairments in the ageing population and evaluates the efficacy of multidisciplinary interventions for management and prevention, including assistive-technology-based medicine, exercise programs and cognitive strategies. Drawing from a wide range of studies, we emphasize the importance of developing globally adaptable, community-based solutions that not only address the direct challenges posed by sensory impairments but also their broader implications for cognitive decline. Additionally, we highlight the need for continuous international research to fine-tune these interventions, to ensure they are holistic and responsive to the diverse needs of older adults across different regions worldwide.

Hearing loss, hearing aid use, and performance on the Montreal cognitive assessment (MoCA): findings from the HUNT study in Norway.

Purpose: To evaluate the associations between hearing status and hearing aid use and performance on the Montreal Cognitive Assessment (MoCA) in older adults in a cross-sectional study in Norway. Methods: This study utilized data from the fourth wave of the Trøndelag Health Study (HUNT4, 2017-2019). Hearing thresholds at frequencies of 0.5, 1, 2, and 4 kHz (or PTA4) in the better hearing ear were used to determine participants' hearing status [normal hearing (PTA4 hearing threshold, ≤ 15 dB), or slight (PTA4, 16-25 dB), mild (PTA4, 26-40 dB), moderate (PTA4, 41-55 dB), or severe (PTA4, ≥ 56 dB) hearing loss]. Both standard scoring and alternate MoCA scoring for people with hearing loss (deleting MoCA items that rely on auditory function) were used in data analysis. The analysis was adjusted for the confounders age, sex, education, and health covariates. Results: The pattern of results for the alternate scoring was similar to that for standard scoring. Compared with the normal-hearing group, only individuals with moderate or severe hearing loss performed worse in the MoCA. In addition, people with slight hearing loss performed better in the MoCA than those with moderate or severe hearing loss. Within the hearing loss group, hearing aid use was associated with better performance in the MoCA. No interaction was observed between hearing aid use and participants' hearing status with performance on the MoCA test. Conclusion: While hearing loss was associated with poorer performance in the MoCA, hearing aid use was found to be associated with better performance in the MoCA. Future randomized control trials are needed to further examine the efficacy of hearing aid use on the MoCA performance. When compared with standard scoring, the alternate MoCA scoring had no effect on the pattern of results.

Clinical placement education during the coronavirus disease 2019 pandemic shapes new nurses: A qualitative study.

Background: Many newly qualified nurses experience transition challenges because they feel unprepared for the reality of the nursing profession owing to the theory-practice gap. Transition challenges amongst newly qualified nurses have profound consequences for the nursing profession and patient care. A detailed and nuanced understanding of the complexity in transition-related challenges during extraordinary conditions like the coronavirus disease 2019 pandemic is needed for newly qualified nurses to remain in the nursing profession. Objective: This study explored the experience of newly qualified nurses entering the nursing profession who had their clinical placement education missed, shortened, or substituted since they had to serve as health care assistants during the coronavirus disease 2019 pandemic. Design: An exploratory and descriptive study design was used. Settings: Workplaces for newly qualified nurses. Participants: A purposive sample of 10 newly qualified Norwegian nurses working in various clinical placement nursing settings were included. Methods: Data were collected in April and May 2022 via individual interviews conducted via Zoom. Thematic analysis was applied to identify themes. Triangulation was employed to ensure trustworthiness. Findings: Three major themes emerged: relational aspects of nursing, practical aspects of nursing, and inadequacies in the pedagogical plan of teaching and learning. The themes indicate that the limited or suspended clinical placement education during the pandemic affected the competence of newly qualified nurses. Conclusions: During the coronavirus disease 2019 pandemic, clinical placement education for student nurses was limited or suspended owing to safety concerns. The short clinical placement durations affected the competence of newly qualified nurses, as they lacked exposure to real-world patient care scenarios as in non-pandemic times. Furthermore, our findings indicate that newly qualified nurses' clinical placement experiences provide important knowledge and insight for educators in terms of education and support for future student nurses going into situations with short clinical placement hours. The conclusion highlights the implications of the findings and recommendations and the need for further support and education for newly qualified nurses after the pandemic. Study registration details: The study was approved by the Norwegian Social Data Service (project number 396247). The registration date was 2021-11-04. Tweetable abstract: Transition-related challenges became more prominent during the coronavirus disease 2019 pandemic than during non-pandemic times.

Hearing loss, hearing aid use, and subjective memory complaints: Results of the HUNT study in Norway.

Objective: This study aimed to explore the association between hearing loss severity, hearing aid use, and subjective memory complaints in a large cross-sectional study in Norway. Methods: Data were drawn from the fourth wave of the Trøndelag Health Study (HUNT4 Hearing, 2017-2019). The hearing threshold was defined as the pure-tone average of 0.5, 1, 2, and 4 kHz in the better ear. The participants were divided into five groups: normal hearing or slight/mild/moderate/severe hearing loss. Subjective self-reported short-term and long-term memory complaints were measured by the nine-item Meta-Memory Questionnaire (MMQ). The sample included 20,092 individuals (11,675 women, mean age 58.3 years) who completed both hearing and MMQ tasks. A multivariate analysis of variance (adjusted for covariates of age, sex, education, and health cofounders) was used to evaluate the association between hearing status and hearing aid use (in the hearing-impaired groups) and long-term and short-term subjective memory complaints. Results: A multivariate analysis of variance, followed by univariate ANOVA and pairwise comparisons, showed that hearing loss was associated only with more long-term subjective memory complaints and not with short-term subjective memory complaints. In the hearing-impaired groups, the univariate main effect of hearing aid use was only observed for subjective long-term memory complaints and not for subjective short-term memory complaints. Similarly, the univariate interaction of hearing aid use and hearing status was significant for subjective long-term memory complaints and not for subjective short-term memory complaints. Pairwise comparisons, however, revealed no significant differences between hearing loss groups with respect to subjective long-term complaints. Conclusion: This cross-sectional study indicates an association between hearing loss and subjective long-term memory complaints but not with subjective short-term memory complaints. In addition, an interaction between hearing status and hearing aid use for subjective long-term memory complaints was observed in hearing-impaired groups, which calls for future research to examine the effects of hearing aid use on different memory systems.

Preventive Home Visit (PHV) Screening of Hearing and Vision Among Older Adults in Tórshavn, Faroe Islands: A Feasibility Study in a Small-Scale Community.

PURPOSE: Hearing and vision loss are common in later life but often overlooked and undertreated. The study aims to examine hearing and vision as part of preventive home visits (PHV) among 76-year-old home-dwelling citizens in Tórshavn, the capital of Faroe Islands. PATIENTS AND METHODS: In this cross-sectional study, three specially trained nurses conducted the examinations and tests, for this purpose, in the community health-centre. RESULTS: A total of 74 individuals participated (56% participation rate) of whom 77% had some degree of hearing impairment, 89% had visual impairment and 22% had dual sensory loss. A significant correlation between self-reported hearing ability and clinical findings was found, whereas self-reported vision did not correlate significantly with test-results. CONCLUSION: Results indicate that implementing clinical assessments of hearing and vision as part of preventive home visits would benefit people receiving visits, and society by helping maintain the conditions that allow them to stay in their own homes for as long as possible.

Acceptance and adjustment: A qualitative study of experiences of hearing and vision impairments and daily life among oldest old recipients of home care.

INTRODUCTION: The severity of age-related hearing and vision impairments increases with age. Such sensory impairments are risk factors for functional decline, reduced social participation, withdrawal, depression and accidents, and hence they make people vulnerable and adversely affect their quality of life. AIM: The aim of this study was to explore how the oldest old recipients of home care experience sensory impairments in daily life. DESIGN: An inductive, descriptive research design was used. METHOD: Ten recipients of home care with a mean age of 89 years were interviewed in their homes. The study was implemented in accordance with the suggestions from Elo and Kyngäs for inductive content analysis. FINDINGS: The main theme concerned acceptance and adjustment in daily life. Subcategories concerning the category of reduced hearing were identified as "acceptable though annoying" and "hesitant about using hearing aids." Subcategories concerning the category of reduced vision were "reading is increasingly challenging" and "living with vision diseases." The third category of feeling weak was elucidated in the subcategories "troublesome bodily changes" and "strenuous days with limited energy." CONCLUSIONS: It is imperative to recognise that the oldest old are in a distinct phase of the lifespan. Despite this population being aware of their hearing and vision impairments, they do not always have the strength to alter the situation. Instead they accept it; they often struggle with more serious health challenges. Therefore, they are not prioritising using their limited energy reserves to try to improve or optimise their hearing and vision impairments themselves. IMPLICATIONS FOR PRACTICE: The oldest old with sensory impairments cannot be expected to perform all the necessary activities of daily living or address their functional sensory impairments. Close monitoring and assistance need to be applied to the oldest old.

Discrepancy between self-assessments and standardised tests of vision and hearing abilities in older people living at home: an ROC curve analysis.

AIMS AND OBJECTIVES: To determine whether there is consistency between self-assessments and standardised tests of vision and hearing abilities in older people. BACKGROUND: Home-based detection of vision and hearing impairments in older people are generally based on self-assessments of vision and hearing abilities. DESIGN: Cross-sectional descriptive study. METHODS: Receiver operating characteristic analysis was used to compare self-assessments of vision and hearing abilities with a gold-standard test. The vision and hearing abilities of 93 people aged ≥80 years in the home-care setting were screened with a LogMAR chart, a pure-tone audiometer, and a self-assessment screen. RESULTS: Comparison of findings using the cut-off points on the self-assessment scale with those of the gold-standard tests yielded 40 false negatives for vision and 18 false negatives for hearing, indicating that a significant proportion of older people report their vision and hearing abilities as being good when standardised tests indicate that they are not. Alternative cut-off points on the self-assessment scale were tested, but no cut-off point was found to provide a sound basis for identifying vision and hearing impairments. CONCLUSION: The area under the receiver operating characteristic curve for self-assessment of vision was 69%, indicating that the self-assessment questions constituted a poor test. It appears that results from self-assessments cannot be relied upon to accurately identify visual acuity. The area under the receiver operating characteristic curve for the self-assessment of hearing was 73%, which may therefore be considered a "fair" test. However, self-assessment of hearing is still insufficient for detecting hearing impairment. RELEVANCE TO CLINICAL PRACTICE: Vision and hearing abilities are crucially important to managing daily living. In addition to treatments for suppressing the further development of existing diseases, standardised tests could be a good starting point for health prevention and promotion. Nurses should apply standardised tests to detect sensory impairments in older people.

An intervention designed to improve sensory impairments in the elderly and indoor lighting in their homes: an exploratory randomized controlled trial.

BACKGROUND: Vision and hearing impairments in the elderly (aged over 80 years) and poor indoor lighting conditions in a home-care setting are risk factors for functional decline, reduced social participation, withdrawal, and accidents. OBJECTIVE: We aimed to evaluate the changes in vision, hearing, and lighting conditions in the homes of participants aged over 80 years after implementation of a clinical intervention. METHODS: We undertook an exploratory randomized, controlled experimental study of sensory impairments and lighting conditions in the homes of elderly aged over 80 years who received home care. The intervention group (IG) received advice and encouragement to improve their vision, hearing, and indoor lighting conditions in the home, with a 10-week follow-up period. The control group (CG) received their usual care and underwent the same vision and hearing tests but were provided no intervention. RESULTS: Vision and hearing (self-assessed) and tested by Wilcoxon rank-sum test were significantly better (P=0.025 and P=0.008, respectively) in the IG after the intervention and follow-up. The test between the groups showed a significance of P=0.026 for visual acuity and P=0.098 for pure-tone average. The maximum and minimum lighting levels were significantly improved in the IG after the intervention (P=0.002 and P=0.039, respectively) but were unchanged in the CG. CONCLUSION: Several of the IG participants did not follow all of the advice; however, among those who did, vision, hearing, and lighting conditions were all significantly improved. It appears that modest interventions have great potential for improving vision and hearing. Older patients in the home-care setting cannot be expected to take the necessary action to improve their sensory impairments by themselves. They require close monitoring, help from a specialist, and help to improve the indoor lighting conditions in their homes.

Sensory impairments in community health care: a descriptive study of hearing and vision among elderly Norwegians living at home.

BACKGROUND: Hearing and vision impairments increase with age and are common risk factors for functional decline reduced social participation and withdrawal. OBJECTIVE: Describe the hearing and vision of home care patients older than 80 years. METHODS: Ninety-three older adults (80+ years) receiving home care were screened for hearing and vision in their homes. Data were collected using a HEINE Mini 3000(®) Otoscope to examine the eardrum and presence of earwax, an Entomed SA201-IV portable pure-tone audiometer to measure the pure-tone average (PTAV), a logarithm of the minimum angle of resolution chart to measure visual acuity (VA), and the Combined Serious Sensory Impairment interview guide. RESULTS: Slight and moderate hearing impairments were found in 41% and 47% of the population, respectively (mean PTAV =40.4 dB for the better ear), and 40% and 56% had impaired and slightly impaired vision, respectively (mean VA =0.45 for the better eye). The participants' self-assessments of hearing and vision were only weakly correlated with PTAV and VA values. The visual function was significantly worse in men than in women (P=0.033). Difficulty in performing instrumental activities of daily living because of hearing and vision impairments was experienced by 17% of the participants, whereas 76% experienced no difficulties. When many people were present, 72% of the participants found it difficult to understand speech. Nearly 30% found it tiring to read, and 41% could not read very small print. CONCLUSION: The patients' self-assessments of their hearing and vision did not correlate strongly with their VA and PTAV scores. Asking the elderly about their overall hearing and vision ability is not sufficient for detecting sensory impairment, and asking more specific questions about what they could not hear and see was not an adequate indicator of the patients' hearing and vision problems. To detect hearing and vision impairments among elderly home care patients, standardized measurements of their hearing and vision are necessary.