Eyes

Introduction

Hearing loss affects 12 million people in the UK, it can have a severe negative impact on individuals, especially their communication, cognition and quality of life. Commonly reported effects of hearing loss are social isolation and mental health problems (e.g. anxiety and depression). There are a number of interventions for hearing loss, including hearing aids and cochlear implants. However, many individuals delay seeking treatment. This may be due to limited ­awareness of hearing loss and its consequences amongst the public. In addition, there is a large stigma surrounding hearing loss and having hearing aids.

This study will investigate the representations of hearing loss in the UK news media, particularly its impact on mental health, and identify ways to improve these representations.

Methods
Using Nexis (a database of news), we will examine newspaper articles featuring hearing loss during 2022. Multimodal critical discourse analysis will be used, which regards communicative choices (here, images and text) as both reflecting and shaping society, including by contributing to or challenging stigma. Patient and public involvement representatives will be consulted throughout regarding research objectives methods and the data interpretation.

Results

Results suggest that hearing loss is often described using celebrity accounts, often these individuals were younger adults. Many articles included inspirational stories of those with hearing loss, however the PPI group recommended that newspaper stories should provide a diverse representation of hearing loss. Inaccurate and outdated language was used to describe hearing devices. Mental health problems commonly discussed were depression, social isolation and dementia.

Discussion

The research will inform best practice recommendations for representing hearing loss in the public domain, which could be applied by healthcare organisations, research centres, charities and media outlets to help destigmatise hearing loss.

A Scoping Review of Guidelines and Resources to Promote Evidence-Based Prescribing for Older People with Sensory Impairment (OPwSI)

BC Morrison1; E Asante2; MR Lennon2; MC Watson1

1. Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow; 2. Department of Computer and Information Sciences, University of Strathclyde, Glasgow

Introduction

By 2030, hearing impairment is expected to affect one in four people globally (WHO, 2022) and one in five in the UK (Hearing Link, 2023). Visual impairment is projected to impact 2.7 million people in the UK by 2030 (ONS, 2020), rising to 4 million by 2050. The prevalence of hearing and visual impairment (hereafter referred to as sensory impairment (SI)) increases with age and older people with SI often experience substantial challenges with medicine management compared with older people without SI (Alhusein, 2019). This review aimed to identify guidelines and resources for prescribing decisions for older people with sensory impairment (OPwSI).

Methods

Standard Joanna Briggs Institute [JBI] methodology (Page, 2021) for scoping reviews was used. Electronic databases were searched: MEDLINE (Ovid), EMBASE (Ovid), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Qualitative and quantitative studies published between January 2012 and April 2023 were included. Grey literature sources, including Google and Google Scholar, were also searched. Eligible studies focused on prescribing behaviour for OPwSI (aged ≥ 65 years) in primary care settings. Duplicate independent screening and data extraction was undertaken and critical appraisal was completed for all included studies.

Results

A total of 3,590 records were identified through database searching and 10 full-text articles were retrieved. Grey literature identified a further 61 records. Despite extensive searches, no studies or resources fulfilled the inclusion criteria. Several generic guidelines and resources were identified related to medicines and safe prescribing for older adults in general i.e., without specified SIs.

Conclusions

This review highlights a dearth of guidelines or other resources to support safe and effective prescribing for OPwSI. There is an urgent need to provide bespoke guidance and/or the modification of existing guidelines, to address the additional medicine-related needs of OPwSI.

Introduction

Although hearing loss is the foremost cause of years lived with disability in people over 70, it remains commonly underrecognised ^[1,2]. Health of the UK signing deaf community is reportedly worse than the general population, often due to resulting undertreatment of associated co-morbidities including visual impairment, falls and dementia ^[3,4].

Local Problem

There is an estimated 21% prevalence of ≥25dBHL hearing loss within the Wolverhampton adult population, this increasing with age ^[5]. A large number of inpatients admitted to the Older Adult Medicine (OAM) wards at New Cross Hospital have clinically evident sensory impairment, impacting upon interactions with healthcare staff. This project identified the current methods through which hearing and/or visual impairment is formally screened for and documented within the OAM Department of a large district general hospital, targeting interventions towards mitigating barriers faced in sensory assessment.

Methods and Intervention

Baseline and post-intervention documentation of sensory impairment was collected from admission and bedside notes of 23 inpatients during each cycle. A multidisciplinary focus group of medical, nursing and practice education facilitators identified a marked underutilisation of bedside alert signs (4%), prompting creation of a redesigned bedside poster with a greater focus on sensory aid functionality.

Results

60% of posters were utilised 10 days after introduction, with an increase from 4% to 36% in recording of known sensory impairment being observed. 100% and 25% of inpatients with correctly functioning hearing aids and spectacles were documented respectively. 100% of patients admitted through frailty intervention streams were assessed for sensory loss, compared to 0% admitted via the unselected medical take.

Conclusions

Improved bedside alert posters provided initial evidence as a sustainable improvement in supporting inpatients with sensory impairment. Incorporating positive lessons from frailty team practice will assist in developing future education sessions, highlighting intended sign usage and transferrable sensory assessment methods for involved healthcare teams.

References

1. Hearing Matters. Action on Hearing Loss. 2015. Available at: https://shorturl.at/tBEST [Accessed: 23 Nov 2023].

2. Healthy Ageing Evidence Review. 2011. Age UK, N.D. Available at: https://shorturl.at/fqAOW [Accessed: 11 Nov 2023].

3. Emond et al., 2015. The current health of the signing Deaf community in the UK compared with the general population: a cross sectional study. BMJ Open 2015.

4. Vos, T et al., 2015. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. Vol. 386 (9995) pp. 743–800.

5. Prevalence estimates provided by Professor A C Davis, using prevalence from Davis (1995) Hearing in Adults, updated with ONS (2014) National Population Projections. Available at: http://www.ons.gov.uk/ons/rel/npp/national-population-projections/2014-… [Accessed: 11 Nov 2023].

Objective

To conduct a QIP to ensure that >80% of DAU patients’ vision was assessed via the VAT as per National Audit of Falls Prevention Guidance.

Background

Patients with visual impairment are twice as likely to fall than those without. The NAIF 2015 report identified <50% of elderly patients had their vision assessed in hospital; also evident at Southend Hospital.

Methods

Data collection from 56 patients over 8 weeks following weekly interventions helped us analyse their impact on VAT use. Control data (week 1) was pre-intervention.

Intervention

Six interventions were applied over 7 weeks: teaching to nurses, HCAs and doctors about VAT; email to Geriatrics team; reminder email to DAU nursing team and a feedback questionnaire.

Results and Discussion

Mean age was 82 and 38% of patients attending DAU had an ophthalmic history. Pre-intervention (week 1) identified 0% VAT use. In week 2, there was a 75% increase in VAT use after teaching nursing and HCA staff. In week 3, there was only 12.5% VAT use after the poster intervention. In week 4, there was a 25% uptake on VAT use with no intervention.

Week 5’s intervention witnessed 100% in VAT use, which remained high in week 6 (85.7%), 7 (100%) and 8 (100%). The final intervention questionnaire highlighted that 100% of staff were (i) previously unaware of VAT, (ii) agreed on its importance in assessment of elderly patients, (iii) found teaching adequate, (iv) thought there was enough awareness on VAT use via the QIP, (v) agreed that an incomplete VAT was due to inability to undertake section 4 and 5.

Conclusion

VAT use identified 3 ophthalmic problems that would have otherwise not been managed. While the QIP did not meet the target of >80% VAT use, it successfully informed DAU staff in proper conduct of VAT in falls patients.

Introduction: Falls are a leading cause of mortality and morbidity in older people and the risk of falling is exacerbated by underlying mental health conditions and associated treatments. NICE recommends that people who fall should undergo multifactorial assessment including a post-fall protocol with assessment for injury before being safely moved, a timely medical examination (within a maximum of 12 hours or 30 minutes if fast-tracked), neurological observations (if there is suspicion of head injury or unwitnessed fall) and a medication review. Aim: We aimed to assess the quality of post-falls assessment and documentation in order to identify areas for improvement to reduce potential harm from injuries and implement strategies to reduce further falls. Methods: We identified ten falls over a 3-month period on two old age psychiatric inpatient wards. Data collected from e-notes was analysed for assessment for injuries, medical review, neurological observations and medication review. We also looked whether patients had OT/Physio input post-falls and MDT discussion to determine the likely cause for fall. Results: Only 40% of patients had a medical assessment completed within 12 hours. There was suspicion of head injury in 40% of patients but none of them had neurological observations completed. In 20% of falls, an MDT discussion took place to determine likely cause of fall and patients had their medications reviewed post-falls. Almost 90% had OT/physio input post-falls. Conclusion: We have since conducted a survey among healthcare professionals to identify common knowledge gaps that can be targeted to improve quality of care post-falls and conducted teaching sessions on relevant themes. Feedback has showed participants confidence has significantly improved in post-falls assessment. We have also created a weekly falls review meeting and designed and displayed a post-falls board with all necessary information. We aim to re-audit our practice now that changes have been implemented.

Introduction

Dementia and hearing loss (HL) are becoming increasingly prevalent in society and commonly co-exist. People living with concurrent conditions have complex needs and face additional barriers to diagnosis and management. There is a paucity of research regarding the current and optimal management of HL in people living with dementia. This research aimed to: (1) examine the current clinical provision for people living with HL and dementia within UK audiology services, and (2) explore recommendations for the management of co-existing HL and dementia from professionals and people living with these conditions.

Methods

This was an online, qualitative study with three stages: (1) open-ended survey of 37 audiologists, (2) semi-structured interviews with 13 audiologists, and (3) semi-structured workshops with seven people with lived experience of HL and/or dementia.

Results

Audiologists used various adapted and additional hearing assessments for people with dementia. Audiological interventions for people with dementia included adapted hearing aids, alternative interventions/devices, and involvement of other services/professions. Approaches to ongoing audiological care for people with dementia included providing frequent follow-ups and face-to-face, rather than remote, follow-ups. Overarching approaches to audiological care for this population involved patient-centredness, specialist training, increased carer involvement, and adjusted appointment duration. However, there are no standard procedures/guidelines relating to dementia in UK audiology services. Recommendations included enhanced training in dementia and HL across health and social care, improved multidisciplinary collaboration, appropriate carer involvement, and greater personalised care.

Conclusions

Currently, there is no standard practice for assessing and managing HL in people with dementia in UK audiology services. Although this study identified several beneficial strategies and approaches, there remain significant areas for improvement. The study results could be used in the future to produce national guidelines and training programmes for the assessment and management of HL in people with dementia, which would reduce disparities in care.

Introduction

The prevalence of eye disease and visual impairment in care home residents is disproportionately higher compared to the general population. Access to eye care services and treatment can be variable for this vulnerable population.

Objective

This narrative synthesis reviews the available evidence of services and interventions for delivering eye care to care home residents. The key review questions: 1. What is the existing evidence for eye care interventions or services (including service configuration) for care home residents? 2. Does the provision of these interventions or services improve outcomes?

Methods

Literature search of EMBASE/MEDLINE for original papers published since 1995. Two reviewers independently reviewed abstracts/papers. Data was extracted and evaluated using narrative synthesis.

Results

13 original papers met the inclusion criteria. On-site optometrist-led services improved diagnosis and management of eye conditions, with one study showing 53% of residents benefited from direct ophthalmology intervention. Provision of interventions such as cataract surgery, refractive error correction and low vision rehabilitation improved visual acuity and vision-related quality of life but did not improve cognitive or physical function, depression or health-related quality of life. There was little UK-based literature to inform eye service design or interventions to improve outcomes.

Conclusion

Care home based eye assessments improve the management of eye conditions. Interventions improve visual acuity and vision-related quality of life. Further research and/or clinical service scoping is needed to better understand current UK services, access difficulties or examples of good practice as well as to identify and test cost-effective service models for this vulnerable group.