‘Dual Sensory Loss Protocol’ for Communication and Wellbeing of Older Adults With Vision and Hearing Impairment – A Randomized Controlled Trial

Abstract

ObjectivesMany older adults with visual impairment also have significant hearing loss. The aim was to investigate the effectiveness of a newly developed Dual Sensory Loss (DSL) protocol on communication and wellbeing of older persons with DSL and their communication partners (e.g., spouse or child) in the Netherlands and Belgium.MethodsParticipants (N = 131) and their communication partners (n = 113) were randomized in the “DSL-protocol” intervention group or a waiting-list control group. The intervention took 3 to 5 weeks. Occupational therapists focused on optimal use of hearing aids, home-environment modifications and effective communication strategies. The primary outcome was the Communication Strategies domain of the Communication Profile for the Hearing Impaired (CPHI). Secondary outcomes measured in participants were the Low Vision Quality Of Life Adjustment subscale, the Center for Epidemiological Studies - Depression Scale, De Jong Gierveld Loneliness Scale and the Fatigue Assessment Scale. The Hearing Handicap and Disability Inventory (HHDI) - Reaction of Others subscale and the Care-related Quality of Life - 7 Dimensions was measured in communication partners. Measurements were taken at baseline and 3-month follow-up. Linear mixed models (LMM) were used to analyze effects between groups over time for every outcome measure.ResultsIntention-to-treat analyses showed a significant effect of the DSL-protocol on the use of verbal strategies (effect size SMD = 0.60, 95% CI: 0.25 to 0.95) in favor of the control group, however, this effect was non-significant after adjustment for confounding. Effect sizes of other outcomes varied between −0.23 [−0.57, 0.12] and 0.30 [−0.05, 0.64]. The LMM showed a significant effect on the HHDI-Reaction of others scale in favor of communication partners in the treatment group, however, the effect did not remain significant at a 0.01 significance level and the effect size was very small and non-significant 0.12, 95% CI [−0.27 to 0.51]. Adjusted analyses did not reveal treatment effects.ConclusionThe DSL-protocol did not clearly contribute to the enhancement of communication and wellbeing in DSL-patients. Possible reasons for the lack of effects are OTs not being comfortable giving advice on communication and psychosocial issues or the short-term treatment and follow-up period. Further study is warranted to find out how the protocol may be adapted or whether it is necessary to involve mental healthcare professionals.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NTR2843.

Chronic vestibular syndromes in the elderly: Presbyvestibulopathy—an isolated clinical entity?

“…Furthermore, the data suggest that mild bilateral vestibular hypofunction might become clinically relevant as a concomitant factor in cases with multisensory deficits also contributing to and hindering central compensation. This interpretation is supported by analogous data in the elderly for presbyopia and presbyacusis, in which coexistence of sensory deficits led to higher clinical impairment [38,39].…”

Dual Sensory Impairment as a Predictor of Loneliness and Isolation in Older Adults: National Cohort Study

“…One possible reason is that SIs influence loneliness by affecting communication with their closest relatives or friends, as loneliness is not caused by being alone but rather by the unmet affective gain of their closest relationship [ 38 ]. Previous studies have indicated that older adults with DSI were more prone to experiencing a breakdown in communication compared with those without SIs [ 39 , 40 ]. Older adults with HI may feel frustrated or embarrassed over their difficulty communicating, resulting in loneliness [ 41 ].…”

Continuum of Care for Older Adults With Concurrent Hearing and Vision Impairment: A Systematic Review

“…The protocol was delivered by occupational therapists (OTs) working in low-vision services and consisted of: (a) optimal use of hearing aids; (b) use of assistive devices and adaptations to the living environment; and (c) coping with DSI and use of effective communication strategies. Although no statistically significant effects of the protocol emerged (effect size standardized mean difference: 0.60), the researchers suggested further studies, adapting the protocol, providing a larger number of OT appointments, and involving social workers or other mental health professionals in the process ( Vreeken et al, 2020 ).…”

“…Nine studies focused on seven tools for health care assessments and/or interventions to improve health care for older adults with DSI ( Arauz et al, 1997 ; Bruhn & Dammeyer, 2018 ; Dalby et al, 2009 ; Dupuis et al, 2015 ; Hovaldt et al, 2018 ; Roets-Merken et al, 2014 ; Takano et al, 2016 ; Urqueta Alfaro et al, 2019 ; Vreeken et al, 2020 ). Of all the tools reported, five were standardized clinical assessment instruments.…”

“…Dual Sensory Loss (DSL) protocol. In a randomized controlled trial study in Netherlands and Belgium, a group of researchers investigated the effectiveness of a newly developed DSL protocol on the well-being and communication of 131 older adults with DSI and their communication partners ( Vreeken et al, 2020 ). The protocol was delivered by occupational therapists (OTs) working in low-vision services and consisted of: (a) optimal use of hearing aids; (b) use of assistive devices and adaptations to the living environment; and (c) coping with DSI and use of effective communication strategies.…”