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Background People with mild hearing loss at age 50 are twice as likely to develop dementia increasing to a five times greater risk for those with severe hearing loss. The prevalence of dementia and hearing impairment increase with age. Intact hearing enables cognition, facilitates social interaction and enhances communication. Hearing loss, social isolation and dementia are commonly interwoven. We recently commenced routine audiology screening in our memory service. Methods Consecutive patients with mild cognitive impairment attending a tertiary memory assessment and support service were referred for full audiology screening. People were routinely referred on basis of cognitive diagnosis, and not on the basis of perceived hearing loss. Assessment included ENT history, otoscopy, tympanometry, pure tone audiometry and speech audiometry to determine the presence, type and amount of any hearing loss present. This included speech discrimination testing – a functional test to determine processing of 10 phonetically balanced words with 100% being an optimal response. Results 20 people (12 women), mean age 72.3 (range 57-87) were assessed. The majority had amnestic MCI 18/20 (90%). 9/20 (45%) patients subjectively complained of hearing loss. 7/20 (35%) had history of occupational noise exposure. 12/20 (60%) had occlusion due to ear wax. Hearing loss identified: Mild 8/20 (40%); Moderate to severe 7/20 (35%); with Normal hearing in 5/20 (25%). High frequency hearing loss was noted in 19/20 (95%). Speech discrimination score was impaired in those with hearing loss: mean 89.4% (range 66-100). 6/20 (30%) received referral for hearing aids. Conclusion This study highlights the importance of incorporating an assessment of auditory acuity as part of memory assessment and post-diagnostic care-pathway for people with mild cognitive complaints given the established impact hearing loss has on the future risk for cognitive decline. Hearing loss is frequently unidentified and is a clear modifiable risk factor to promote brain health.

Background The frequently heterogeneous nature of a dementia presentation confers the need for a personalised approach to post-diagnostic supports. It’s an essential right for persons living with dementia (PlwD) and their families/supporters to have access to a comprehensive diagnosis and a responsive holistic pathway of care thereafter. We report our development of an integrated specialist-clinic/community post-diagnostic pathway responsive to the evolving personal needs of PlwD and their care-supporters. Methods This pathway was developed in an iterative inclusive-design methodology with input from hospital/community clinical specialists, health and social care professionals, senior nursing, PlwD and their care supporters. The post-diagnostic process starts at diagnosis disclosure, followed for all six-weeks later with a designated post diagnostic clinic, where a single point of contact to address any concerns in between visits is established. Results Iterative review cycles have identified integral components of an effective pathway: Guidance to live well with their personal manifestation of dementia; Acknowledgment of biopsychosocial elements of care; Timely access to comprehensive geriatric assessment via ambulatory hub MDT and/or and Integrated care team for older persons offering home assessment & intervention; Prevention of ‘harmful-events’ e.g. falls/delirium/hospitalisation; Timely access to therapies e.g. SLT/OT focussed on enhanced life at home/assistive technology; facilitation and planning of palliative care. Other aspects include signposting to community resources and forward planning e.g. Citizen’s Information Centres; Peer support and education through designated training; Promotion of brain health- Exercise Programmes; social/cognitive stimulation e.g. Men’s sheds, Walking groups & Memory Resource Rooms; Opportunities for research involvement; Enhanced relationships with national organisations e.g. embedded ASI dementia advisor. Conclusion This approach has developed into a fully integrated holistic care-pathway where specialist-clinic, ambulatory-hospital, community older persons, and third sector services work together to provide the right care, at the right time, in the right place for PlwD and their families.

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