Grand Round Hearing Loss, Dementia & Cognition - Dr Brian Crosbie Emma Hooper Dr Jenna Littlejohn
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Dr Brian Crosbie Emma Hooper Dr Jenna Littlejohn Grand Round Hearing Loss, Dementia & Cognition
ORCHARD
Optimising hearing-related communication for care home
residents with dementia
Realist Synthesis Process
Refining
Refining ideas using
ideas using
Lit & CEG
Lit CEG
Exploring ideas
Verifying and building Exploring ideas with the
with the context
on ideas- with literature context expert group
expert group
(CEGS)
& CEGs
(CEGS)
Context expert groups
• Care home staff
Testing
Testing and refining
and refining • CH managers
ideas
ideas • Audiologists
• Patient & Public involvement
• Nurses
Devising
Devising guidelines,
guidelines,
developing
developing
interventions
interventions
ORCHARD
Five refined CMOs
1. Positive regard & empathy for residents-
leadership promotion of person centred care
CMO INTERACTION
2. Communication training on hearing loss and dementia-
raising importance of hearing communication
3. Knowing the person & responsive awareness of communication needs
increase awareness of individual’s unmet communication needs
Knowing the person
4. Supporting and monitoring residents’ hearing, protocols & care-planning
Knowing the person
to meet their hearing-related communication needs
5. Managing noise in the care homes environment
to optimise hearing-related communication
Emma Hooper slide
Jenna Littlejohn slide
Case Study: Robert 76 year old male – known as Bob Living with dementia with limited verbal communication. Diagnosed with Alzheimer’s in 2015, now recognised to be in late stage. Living in a specialist care home and his wife visits him daily. Bob used to be an engineer working in the car manufacturing industry. Is a big fan of the Beatles and Elvis. Family will often play Bobs favourite records but he doesn’t seem to recognise or respond to them as he had in the past. Bob was an outgoing person and Chair of the local automotive club. During the clinic visit Bob was agitated, getting up from the chair and wandering around the room. Calmed and reassured by wife through tactile and raised verbal communication. ?
Case Study: Robert Assessment: Wife reports hearing loss for many years, unsure whether hearing has worsened or communication challenges as a result of stage of dementia. Unable to follow simple instructions unless clear context and raised voice. Otoscopy: NAD. Bob was happy to wear headphones and sit for a limited time with his wife close by. Audiometry: Consistent responses were observed through a mixture of behavioural responses. ?
Case Study: Robert Treatment: Simple to use HA chosen with mould fitting. Returned for HA fitting and verification Outcomes: Immediately after fitting, Bob seemed calmer and more aware of the environment and people around him. At FU reports of singing to his records and generally calmer and interacting more with other at home whilst wearing HA However, regular occasions of HA going missing with need to replace x 2 ?
Case Study: Robert
• What does your research tell us about what Bob might be experiencing in terms of his significant hearing loss
and dementia? Does this answer change depending in the stage or presentation of dementia?
• How can we make sure we learn about individuals from their relatives or people that know them well?
• Does your research indicate where it would be best for people with late stage dementia to undergo
assessment and how this could be undertaken?
• How can staff in the care home best support patients with hearing aids and understand their hearing
communication needs? talking points: team culture; leadership, context of care and hearing communication
support for residents?
• What do you think are the main gaps in research to inform care and support of Bob or people like him?
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