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Cochlear implants are a standard treatment for adults with severe to profound hearing loss. Around 2.5% of adults have severe to profound hearing loss, with three quarters of these people being older than 60 years. Approximately 20% of adults aged over 60 have cognitive impairment. Severe to profound hearing loss is therefore frequently comorbid with cognitive impairment. The aim of this scoping review is to provide a critical descriptive analysis of the outcomes of cochlear implantation for people living with cognitive impairment.

Remote hearing screening and assessment may improve access to, and uptake of, hearing care. This review, the most comprehensive to date, aimed to (i) identify and assess functionality of remote hearing assessment tools on smartphones and online platforms, (ii) determine if assessed tools were also evaluated in peer-reviewed publications and (iii) report accuracy of existing validation data.Protocol was registered in INPLASY and reported according to PRISMA-Extension for Scoping Reviews.In total, 187 remote hearing assessment tools (using tones, speech, self-report or a combination) and 101 validation studies met the inclusion criteria. Quality, functionality, bias and applicability of each app were assessed by at least two authors.Assessed tools showed considerable variability in functionality. Twenty-two (12%) tools were peer-reviewed and 14 had acceptable functionality. The validation results and their quality varied greatly, largely depending on the category of the tool.The accuracy and reliability of most tools are unknown. Tone-producing tools provide approximate hearing thresholds but have calibration and background noise issues. Speech and self-report tools are less affected by these issues but mostly do not provide an estimated pure tone audiogram. Predicting audiograms using filtered language-independent materials could be a universal solution.

Cochlear implants are a standard treatment for adults with severe to profound hearing loss. Around 2.5% of adults have severe to profound hearing loss, with three quarters of these people being older than 60 years. Approximately 20% of adults aged over 60 have cognitive impairment. Severe to profound hearing loss is therefore frequently comorbid with cognitive impairment. The aim of this scoping review is to provide a critical descriptive analysis of the outcomes of cochlear implantation for people living with cognitive impairment.

Many long-term care home (LTCH) residents have dementia and hearing loss, causing communication difficulties and agitation. Residents rely on staff for hearing support, but provision is often inconsistent. This study used the Behaviour Change Wheel’s Capability, Opportunity and Motivation model to understand why LTCH staff do or do not, provide hearing support to residents with dementia who they believe could benefit from it. An online survey exploring hearing support provision, capabilities, opportunities, motivations and demographics. Data were analysed using descriptive statistics, within-participants ANOVA and multiple linear regression. 165 LTCH staff. Staff provided hearing support to 50% of residents with dementia who they thought would benefit. Self-reported physical and psychological capabilities (skills/knowledge) were significantly higher than physical opportunity (having time/resources). The physical capability was significantly higher than social opportunity (collaborative working) and reflective motivation (feeling motivated). Lower levels of hearing support provision were predicted by LTCH funding (private vs. local authority), job role (care assistant vs. nurse) and fewer physical opportunities. Boosting capabilities through training alone may not be as effective as increasing opportunities via environmental restructuring. Opportunities may include strengthening working relationships with audiologists and ensuring hearing and communication aids are available within LTCHs.

Protocol for a forthcoming scoping review on hearing health among Australian immigrants.

Protocol for scoping review on hearing care services for adults with hearing loss in Malaysia

Objectives: adverse prenatal and early childhood development may increase susceptibility of hearing loss in adulthood. The objective was to assess whether indices of early development are associated with adult-onset hearing loss in adults ≥18 years.Design: in a systematic review and meta-analysis, four electronic databases were searched for studies reporting associations between indices of early development (birth weight and adult height) and adult-onset hearing loss in adults ≥18 years. We screened studies, extracted data, and assessed risk of bias. Authors were contacted to provide adjusted odds ratios from a logistic regression model for relationships between birth weight/adult height and normal/impaired hearing enabling a two-step individual patient data random-effects meta-analysis to be carried out. The study is registered with PROSPERO, CRD42020152214.Results: four studies of birth weight and seven of adult height were identified. Three studies reported smaller birth weight associated with poorer adult hearing. Six studies reported shorter height associated with poorer hearing. Risk of bias was low to moderate. Four studies provided data for two-step individual patient data random-effects meta-analysis. Odds of hearing impairment were 13.5% lower for every 1 kg increase in birth weight [OR: 0.865 (95% confidence interval: 0.824 to 0.909)] in adulthood over two studies (N=81,289). Every 1 cm increase in height was associated with a 3% reduction in the odds of hearing impairment [OR: 0.970 (95% confidence interval: 0.968 to 0.971)] over four studies (N=156,740).Conclusions: emerging evidence suggests that adverse early development increases the likelihood of hearing impairment in adulthood. Research and public health attention should focus on the potential for prevention of hearing impairment by optimizing development in early life.

Objectives: To determine population-based risks of adverse effects on hearing and well-being outcomes associated with unilateral hearing impairment.Design: A group of 40-69-year-old adults (n = 861) who reported being able to hear only in one ear and having speech reception thresholds (SRTs) in noise indicating normal hearing in that ear (SRT_N/?) was selected from the UK Biobank cohort. The UK Biobank participants with SRTs indicating either normal (SRT_N/N, n = 95,514) or symmetrically impaired hearing in both ears (SRT_I/I, n = 17,429) were selected as comparison groups. Self-reported difficulty following conversations in noise, tinnitus presence, feelings depressed, lonely, unhappy, and being in poor health or dissatisfied with health were selected as hearing and well-being outcomes. Logistic regression models were used to evaluate the risks of reporting adverse outcomes associated with SRT_N/? compared to SRT_N/N and SRT_I/I whilst controlling for numerous factors linked to hearing and general health. Results: People with SRT_N/? were significantly more likely to report difficulties following conversations in noise (Odds Ratio = 10.61, 95% Confidence Interval = 8.83 to 12.75), tinnitus (4.04, 3.51 to 4.66), poor health (1.35, 1.15 to 1.58), health dissatisfaction (1.22, 1.00 to 1.47), and loneliness (1.28, 1.08 to 1.51) compared to people with SRT_N/N. Well-being outcomes were similar in the SRT_N/? and SRT_I/I groups. However, difficulties following conversations in noise (5.35, 4.44 to 6.44) and tinnitus presence (2.66, 2.31 to 3.08) were significantly more likely with SRT_N/? than with SRT_I/I. The SRT_N/? was associated with increased risk of self-reported poor health by 18% (Relative Risk = 1.18, 95% Confidence Interval = 1.06 to 1.32) and loneliness by 24% (1.24, 1.07 to 1.43) compared with SRT_N/N. The risk of reporting difficulties following conversations in noise increased by 64% (1.64, 1.58 to 1.71) and tinnitus presence by 84% (1.84, 1.69 to 2.01) compared to SRT_I/I. The effect of SRT_N/? on reporting poor health was similar to that from having other health problems such as hypertension or high cholesterol.Conclusions: The large increases in the risks of reporting adverse hearing-related outcomes associated with unilateral hearing impairment suggest its specific impact on hearing function in everyday situations. The increased risk of loneliness and poor health indicates that one normally functioning ear is also insufficient to protect against the adverse psychosocial impacts of unilateral hearing impairment. This impact was still significant after controlling for various health-related factors and can lead to perception of poor health comparable to that with having medical problems contributing to life-threatening conditions such as heart disease. The findings suggest the need for effective interventions to address the hearing-related problems and their impact on well-being in people with unilateral hearing impairment.

Supplemental material, sj-pdf-1-tia-10.1177_2331216520969472 for A Quasi-Randomized Controlled Trial of the I-PLAN Intervention to Promote Hearing Aid Use Among First-Time Adult Hearing Aid Users by Afzarini H. Ismail, Kevin J. Munro, Christopher J. Armitage, Antonia Marsden and Piers D. Dawes in Trends in Hearing

Supplemental material, sj-pdf-1-tia-10.1177_2331216520969472 for A Quasi-Randomized Controlled Trial of the I-PLAN Intervention to Promote Hearing Aid Use Among First-Time Adult Hearing Aid Users by Afzarini H. Ismail, Kevin J. Munro, Christopher J. Armitage, Antonia Marsden and Piers D. Dawes in Trends in Hearing

Additional file 1.

Objectives: People with dementia (PwD) frequently experience hearing and vision impairment that is underrecognized and undertreated, resulting in reduced quality of life. Managing these impairments may be an important strategy to improve outcomes in PwD. Our objective was to field-trial a multifaceted sensory intervention (SI) to enhance hearing and vision in PwD.\ud \ud Design: An international single-arm open-label feasibility, acceptability, and tolerability study.\ud \ud Setting: Home-based setting in the United Kingdom, France, and Cyprus.\ud \ud Participants: Adults aged 60 years and older with mild-to-moderate dementia and uncorrected or suboptimally corrected hearing and/or vision impairment, and their study partners (n = 19 dyads).\ud \ud Intervention: A sensory intervention (SI), comprising assessment of hearing and vision, fitting of corrective devices (glasses, hearing aids), and home-based support from a sensory support therapist for device adherence and maintenance, communication training, referral to support services, environmental sensory modification, and optimization of social inclusion.\ud \ud Measurements: Ratings of study procedure feasibility, and intervention acceptability/tolerability, ascertained through questionnaires, participant diaries, therapist logbooks, and semistructured interviews.\ud \ud Results: We successfully delivered all intervention components, and these were received and enacted as intended in all those who completed the intervention. No serious adverse events were reported. Acceptability (ie, understanding, motivation, sense of achievement) and tolerability (ie, effort, fatigue) ratings of the intervention were within a priori target ranges. We met recruitment and retention (93.8%) targets in two of the three sites. Participants completed more than 95% of diary entries, representing minimal missing data. Delays in the logistics circuit for the assessment and delivery of hearing aids and glasses were identified, requiring modification. The need for minor modifications to some outcome measures and the inclusion criteria were identified.\ud \ud Conclusion: This is the first study combining home-based hearing and vision remediation in PwD. The positive feasibility, acceptability, and tolerability findings suggest that a full-scale efficacy trial, with certain modifications, is achievable.

Background Hearing and vision impairments are highly prevalent in people with dementia and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimise sensory impairment and support sensory function may be a means of improving dementia-related outcomes. The SENSE-Cog trial will test whether a home-based multi-part sensory intervention is effective in improving quality of life and other key outcomes in people with dementia and hearing or vision problems (or both) and their companions. Methods This is an European, multi-centre, observer-blind, pragmatic, randomised controlled trial. Three hundred fifty four people with dementia and hearing or vision impairment (or both) and their companions will be randomly assigned to receive either “care as usual” or a multi-component sensory intervention including assessment and correction of hearing or vision impairments (or both), home-based (maximum 10 visits over 18 weeks), therapist-delivered sensory support (that is, adherence to devices; improving the sensory environment (that is, lighting), communication training, and sign-posting to other support agencies). Change from baseline to intervention end (18 weeks) and post-intervention (36 weeks) will be compared between the two arms in the following outcomes: quality of life (primary endpoint), sensory and cognitive functional ability, relationships, mental well-being, health resource utilisation and cost-effectiveness. Discussion This is one of two articles outlining the SENSE-Cog trial. Here, we describe the protocol for the effectiveness of the SENSE-Cog intervention. A parallel and complementary process evaluation will be described elsewhere. If the SENSE-Cog trial demonstrates that the sensory intervention improves outcomes in dementia, we will make a toolkit of training materials, resources and information available to health and social care providers to implement the intervention in routine practice. This will be a significant contribution to the therapeutic management of people with dementia and sensory impairment. Trial registration ISRCTN (Trial ID: ISRCTN17056211) on 19 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-018-2973-0) contains supplementary material, which is available to authorized users.

BackgroundBest‐practice guidelines recommend that appropriate support be provided to public contributors to facilitate their involvement in research. One form of support is research awareness training. Older people with dementia and care partners were involved in four Research User Groups (RUGs) in the UK, France, Cyprus and Greece. We delivered research awareness training (RAT) to the RUGs. The aim of this study was to evaluate the acceptability and perceived outcomes of the training from the perspective of RUG members.MethodsAt the end of each research training session, participants completed the Training Acceptability Rating Scale‐section 2, which records the respondent's impressions of the training process and the outcomes of training. Participants were also invited to take part in semi‐structured interviews at the end of the programme.ResultsThirty‐four RUG members completed the TARS‐section 2 with 23 completing semi‐structured interviews. Over two‐thirds (67%) of participants rated their overall satisfaction with the RAT ‘a great deal’. Qualitative responses indicated that participants found group work to be beneficial for learning, the structure of training activities and topics covered appropriate. The type and format of the training materials were viewed as helpful, and they valued the new knowledge gained.ConclusionsThe training contents were applicable, useful and relevant to the participants’ role within the research. We highlight the importance of facilitating participation by (a) fostering awareness of relevant research issues and (b) tailoring delivery of training according to the needs of the participants.

Objectives - Accumulating evidence points to a relationship between hearing function and cognitive ability in later life. However, the exact mechanisms of this relationship are still unclear. This study aimed to characterise latent cognitive trajectories in recall memory and identify their association with subsequent risk of hearing impairment. Methods - We analysed data from the English Longitudinal Study of Ageing Wave 1 (2002/03) until Wave 7 (2014/15). The study population consisted of 3,615 adults aged 50+ who participated in the first wave of the English Longitudinal Study of Ageing, who had no self-reported hearing impairment in Wave 1, and who underwent a hearing test in Wave 7. Respondents were classified as having hearing impairment if they failed to hear tones quieter than 35 dB HL in the better ear. Results - The trajectories of recall memory scores were grouped using latent class growth mixture modelling and were related to the presence of hearing impairment in Wave 7. Models estimating 1-class through 5-class recall memory trajectories were compared and the best-fitting models were 4-class trajectories. The different recall memory trajectories represent different starting points and mean of the memory scores. Compared to respondents with the highest recall memory trajectory, other trajectories were increasingly likely to develop later hearing impairment. Conclusions - Long-term changes in cognitive ability predict hearing impairment. Further research is required to identify the mechanisms explaining the association between cognitive trajectories and hearing impairment, as well as to determine whether intervention for maintenance of cognitive function also give benefit on hearing function among older adults.

Objectives We aimed to determine whether self-assessed single (hearing or visual) and dual sensory (hearing and visual) impairments are associated with cognitive decline and incident possible cognitive impairment, no dementia (CIND) and probable dementia. Method Data were drawn from the 1996–2014 surveys of the Health and Retirement Study (HRS), involving 19,618 respondents who had no probable dementia and who were aged 50 years or older at the baseline. We used linear mixed models to test the association between self-assessed sensory impairment and cognitive decline followed by a Cox proportional hazard model to estimate the relative risk of incident possible CIND and probable dementia associated with the presence of sensory impairment. Results Respondents with self-assessed single and dual sensory impairment performed worse in cognitive tests than those without sensory impairment. The fully adjusted incidence of developing possible CIND was 17% higher for respondents with hearing impairment than those without hearing impairment. Respondents with visual impairment had 35% and 25% higher risk for developing possible CIND and probable dementia, respectively, than those without visual impairment. Respondents with dual sensory impairment at baseline were 38% and 26% more likely to develop possible CIND and probable dementia, respectively, than those with no sensory impairment. Discussion Self-assessed sensory impairment is independently associated with cognitive decline and incident possible CIND and probable dementia. Further studies are needed to identify the mechanism underlying this association and to determine whether treatment of sensory impairment could ameliorate cognitive decline and delay the onset of dementia among older adults.

OBJECTIVES: To test whether hearing aid use alters cognitive trajectories in older adults. DESIGN: US population-based longitudinal cohort study SETTING: Data were drawn from the Health and Retirement Study (HRS), which measured cognitive performance repeatedly every 2 years over 18 years (1996-2014). PARTICIPANTS: Adults aged 50 and older who who took part in a minimum of 3 waves of the HRS and used hearing aids for the first time between Waves 4 and 11 (N=2,040). MEASUREMENTS: Cognitive outcomes were based on episodic memory scores determined according to the sum of immediate and delayed recall of 10 words. RESULTS: Hearing aid use was positively associated with episodic memory scores (β=1.53, p

Supplemental material, Supplemental Material2 for Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics by Ibrahim Almufarrij, Kevin J. Munro, Piers Dawes, Michael A. Stone and Harvey Dillon in Trends in Hearing

Supplemental material, Supplemental Material1 for Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics by Ibrahim Almufarrij, Kevin J. Munro, Piers Dawes, Michael A. Stone and Harvey Dillon in Trends in Hearing

Supplemental material, TIA885571 Supplemetal Material for Hearing Difficulties and Tinnitus in Construction, Agricultural, Music, and Finance Industries: Contributions of Demographic, Health, and Lifestyle Factors by Samuel Couth, Naadia Mazlan, David R. Moore, Kevin J. Munro and Piers Dawes in Trends in Hearing

Additional file 2. Assessment needs guideline - Care Partner. Interview guideline focusing on the perception and experience of different assessments in the care partner.

Objective: To conduct a systematic review of the evidence in relation to what hearing healthcare professionals do during hearing aid consultations and identifying which behaviours promote hearing aid use and benefit among adult patients.Design: Searches were performed in electronic databases MEDLINE, EMBASE, CINAHL, PsycInfo, Web of Science, PubMed and Google Scholar. The Crowe Critical Appraisal Tool and Melnyk Levels of Evidence were used to assess quality and level of evidence of eligible studies. Behaviours of hearing healthcare professionals were summarised descriptively.Study Sample: 17 studies met the inclusion criteria.Results: Twelve studies described behaviours of audiologists and five studies were intervention studies. Audiologists were typically task- or technically-oriented and/or dominated the interaction during hearing aid consultations. Two intervention studies suggested that use of motivational interviewing techniques by audiologists may increase hearing aid use in patients.Conclusions: Most studies of clinicians' behaviours were descriptive, with very little research linking clinician behaviour to patient outcomes. The present review sets the research agenda for better-controlled intervention studies to identify which clinician behaviours better promote patient hearing aid outcomes and develop an evidence base for best clinical practice.

Supplemental material, Supplemental Material4 for Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics by Ibrahim Almufarrij, Kevin J. Munro, Piers Dawes, Michael A. Stone and Harvey Dillon in Trends in Hearing

Additional file 1. Assessment needs guideline - PwD. Interview guideline focusing on the perception and experience of different assessments in the PwD.

Full Search Terms Full search terms used in database searches. (DOCX 12 kb)

Data extraction form Data extraction form used. (DOCX 11 kb)

Supplemental material, Supplemental Material3 for Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics by Ibrahim Almufarrij, Kevin J. Munro, Piers Dawes, Michael A. Stone and Harvey Dillon in Trends in Hearing

BackgroundHearing and vision impairments are highly prevalent in people with dementia and may have a negative impact on quality of life and other dementia-related outcomes. Intervening to optimise sensory impairment and support sensory function may be a means of improving dementia-related outcomes. The SENSE-Cog trial will test whether a home-based multi-part sensory intervention is effective in improving quality of life and other key outcomes in people with dementia and hearing or vision problems (or both) and their companions.MethodsThis is anEuropean, multi-centre, observer-blind, pragmatic, randomised controlled trial. Three hundred fifty four people with dementia and hearing or vision impairment (or both) and their companions will be randomly assigned to receive either care as usual or a multi-component sensory intervention including assessment and correction of hearing or vision impairments (or both), home-based (maximum 10 visits over 18weeks), therapist-delivered sensory support (that is, adherence to devices; improving the sensory environment (that is, lighting), communication training, and sign-posting to other support agencies). Change from baseline to intervention end (18weeks) and post-intervention (36weeks) will be compared between the two arms in the following outcomes: quality of life (primary endpoint), sensory and cognitive functional ability, relationships, mental well-being, health resource utilisation and cost-effectiveness.DiscussionThis is one of two articles outlining the SENSE-Cog trial. Here, we describe the protocol for the effectiveness of the SENSE-Cog intervention. A parallel and complementary process evaluation will be described elsewhere. If the SENSE-Cog trial demonstrates that the sensory intervention improves outcomes in dementia, we will make a toolkit of training materials, resources and information available to health and social care providers to implement the intervention in routine practice. This will be a significant contribution to the therapeutic management of people with dementia and sensory impairment.Trial registrationISRCTN (Trial ID: ISRCTN17056211) on 19 February 2018.

PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist Guidance and checklist for PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. (DOCX 105 kb)

Supplemental material, Supplemental Material5 for Direct-to-Consumer Hearing Devices: Capabilities, Costs, and Cosmetics by Ibrahim Almufarrij, Kevin J. Munro, Piers Dawes, Michael A. Stone and Harvey Dillon in Trends in Hearing

Objectives: To test whether hearing aid use alters cognitive trajectories in older adults. Design: US population-based longitudinal cohort study. Setting: Data were drawn from the Health and Retirement Study (HRS), which measured cognitive performance repeatedly every 2 years over 18 years (1996–2014). Participants: Adults aged 50 and older who who took part in a minimum of 3 waves of the HRS and used hearing aids for the first time between Waves 4 and 11 (N=2,040). Measurements: Cognitive outcomes were based on episodic memory scores determined according to the sum of immediate and delayed recall of 10 words. Results: Hearing aid use was positively associated with episodic memory scores (β=1.53, p

SENSE-Cog Researchers Interview Guide. One to one semi structured interview guide. (DOCX 12 kb)

RUG Members Focus Groups Interview guide. Focus group interview guide. (DOCX 12 kb)

RUG Members Interview Topic guide. RUG one to one semi structured interview guide (DOCX 16 kb)

Support and Learning Needs Form. Support and Learning Needs Form used during introductory meeting with RUG members to establish individual needs/preferences for resources during RUG meeting and training sessions. (DOCX 69 kb)

Objective: To test whether hearing aid use alters cognitive trajectories in older adults.Design, setting, and participants: Data were drawn from the Health and Retirement Study (HRS), a US population-based longitudinal cohort study with cognitive performance measured repeatedly every 2 years over 18 years (1996-2014). This study included 1,586 adults aged 50 and older who who took part in a minimum of three waves of the HRS and who used hearing aids for the first time between Wave 4 and Wave 11.Measurements: Cognitive outcomes were based on episodic memory scores determined by the sum of immediate and delayed recall of 10 words.Results: Hearing aid use was positively associated with episodic memory scores (β=1.24, p

Easy access participant information sheet and consent form. Examples of the easy access participant information sheet and consent form used with SENSE-Cog RUGs to ensure informed participation in the evaluation study. (DOCX 3311 kb)

Data extraction form. (DOC 42 kb)

Data extraction form. (DOC 42 kb)

Characteristics of resource and QoL measures. (DOC 28 kb)

Objectives/Hypothesis Age‐related hearing loss has a genetic component, but there have been limited genetic studies in this field. Both N‐acetyltransferase 2 and apolipoprotein E genes have previously been associated. However, these studies have either used small sample sizes, examined a limited number of polymorphisms, or have produced conflicting results. Here we use a haplotype tagging approach to determine association with age‐related hearing loss and investigate epistasis between these two genes. Study Design Candidate gene association study of a continuous phenotype. Methods We investigated haplotype tagging single nucleotide polymorphisms in the N‐acetyltransferase 2 gene and the presence/absence of the apolipoprotein E ε4 allele for association with age‐related hearing loss in a cohort of 265 Caucasian elderly volunteers from Greater Manchester, United Kingdom. Hearing phenotypes were generated using principal component analysis of the hearing threshold levels for the better ear (severity, slope, and concavity). Genotype data for the N‐acetyltransferase 2 gene was obtained from existing genome‐wide association study data from the Illumina 610‐Quadv1 chip. Apolipoprotein E genotyping was performed using Sequenom technology. Linear regression analysis was performed using Plink and Stata software. Results No significant associations (P value, > 0.05) were observed between the N‐acetyltransferase 2 or apolipoprotein E gene polymorphisms and any hearing factor. No significant association was observed for epistasis analysis of apolipoprotein E ε4 and the N‐acetyltransferase 2 single nucleotide polymorphism rs1799930 (NAT2*6A). Conclusion We found no evidence to support that either N‐acetyltransferase 2 or apolipoprotein E gene polymorphisms are associated with age‐related hearing loss in a cohort of 265 elderly volunteers. Level of Evidence N/A. Laryngoscope, 125:E33–E38, 2015

Hearing loss is associated with anecdotal reports of fatigue during periods of sustained listening. However, few studies have attempted to measure changes in arousal, as a potential marker of fatigue, over the course of a sustained listening task. The present study aimed to examine subjective, behavioral, and physiological indices of listening-related fatigue. Twenty-four normal-hearing young adults performed a speech-picture verification task in different signal-to-noise ratios (SNRs) while their pupil size was monitored and response times recorded. Growth curve analysis revealed a significantly steeper linear decrease in pupil size in the more challenging SNR, but only in the second half of the trial block. Changes in pupil dynamics over the course of the more challenging listening condition block suggest a reduction in physiological arousal. Behavioral and self-report measures did not reveal any differences between listening conditions. This is the first study to show reduced physiological arousal during a sustained listening task, with changes over time consistent with the onset of fatigue.

OBJECTIVES: Hearing, vision, and cognitive impairment commonly co-occur in older adults. Improving sensory function may positively impact outcomes in people with dementia (PwD). We developed a "sensory intervention" (SI) to support hearing and vision in PwD. Here, we report the findings of an international open-label field trial, and nested case series, to explore the impact of the SI on dementia-related outcomes.METHODS: This was a home-based trial conducted in France, England, and Cyprus. Participants were people with mild-to-moderate dementia and hearing and/or vision impairment (n = 19) and their study partners (unpaid carers; n = 19). The "basic" SI included a hearing and vision assessment and provision of glasses and/or hearing aids. A subsample received the "extended" SI with additional weekly visits from a sensory support therapist (SST). Exploratory analyses of dementia-related, health utility and resource utilisation outcomes were performed.RESULTS: Quality of life (QoL) and sensory functional ability improved. Change in QoL exceeded the threshold for a minimum clinically important difference. There was a modest improvement (in absolute terms) post intervention in behavioural disturbance, self-efficacy, and relationship satisfaction. Study partner time assisting instrumental activities of daily living (iADL) and supervision decreased by about 22 and 38 hours per month, respectively, although time for personal ADL support increased. Qualitative data supported effectiveness of the intervention: PwD were more socially engaged, less isolated, less dependent on study partners, and had improved functional ability and communication.CONCLUSIONS: These findings support the need for a definitive randomised controlled trial (RCT) to evaluate the effectiveness of the intervention.

SPIRIT 2013 Checklist: Recommended items to address in a clinical trial protocol and related documents. (DOC 123 kb)

Aging-related sensory impairments are among the most common and disabling comorbidities in people with dementia (PwD). This study explored the unmet support care needs (SCNs) from the perspectives of people with hearing and/or vision impairment in dementia (PwD), and their care partners in Europe. This was a two-phase mixed methods study. We administered standardized questionnaires of SCNs and quality of life (QoL) to PwD with hearing and/or vision impairment (n = 97), and their care partners (n = 97) in the UK, France, and Cyprus. Next, a purposive sub-sample of 34 participants (PwD and care partners) participated as focus groups (FGs) or semi-structured interviews to explore their SCNs in depth. Over 94% of the participants reported unmet SCNs (median, 13 (range 5–23)). Nearly three-quarters reported SCNs in the moderate to high range, with the most prevalent unmet SCNs for PwD being in the psychological (>60%) and physical domains (>56%), followed by the need for health information (>46%). Emergent qualitative themes were: (1) the need for tailored support care interventions; (2) care burden, social isolation, and loneliness arising from the combined problems; (3) the need for adequate support from professionals from the different fields, including education around the use of sensory aids. Both study phases revealed that SCNs were highly individualized. This cross-national study revealed that PwD with sensory impairment and their care partners experience a wide range of unmet SCNs, the interactions between sensory impairments, SCNs and QoL are also complex. A tailored intervention could address these unmet SCNs, including additional support with sensory aids, psychological support, more information about concurrent impairments, and joined up health systems providing care.Implications for rehabilitationA majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs.The needs of care partners including the risk of loneliness and social isolation, need to be considered.Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education. A majority of participants with combined age-related hearing, vision, and cognitive impairment had unmet SCNs. The needs of care partners including the risk of loneliness and social isolation, need to be considered. Individually tailored, specific interventions for hearing, vision, and cognitive impairment should incorporate physical and psychological support, as well as education.

BackgroundOptimising hearing and vision function may be important in improving a range of outcomes for people living with dementia (PwD) and their companions. The SENSE-Cog cross-national randomised controlled trial (RCT) is evaluating the effectiveness of a sensory intervention (SI) to improve quality of life for PwD with concurrent hearing and/or vision impairment, in five European countries. To ascertain how or why the intervention will, or will not, achieve its outcomes, we have designed a process evaluation to explore potential discrepancies between expected and observed outcomes. This will also help us to understand how context may influence the outcomes. Here we describe the protocol for this process evaluation, which is embedded within the RCT.Methods/designWe will use a mixed methods approach with a theoretical framework derived from the UK Medical Research Council’s’ guidance on process evaluations. It will include the following: (1) evaluating how key aspects of the intervention will bedelivered, which will be important to scale the intervention in real world populations; (2) characterising thecontextualissues, which may shape the delivery and the impact of the intervention in different countries; and (3) investigating possiblecausal mechanismsthrough analyses of potential moderators and mediators. To avoid bias, we will analyse the process data before the analysis of the main effectiveness outcomes.DiscussionThis evaluation will provide insight into how the complex SENSE-Cog SI will be tailored, enacted and received across the different European contexts, all of which have unique health and social care economies. The findings will provide insight into the causal mechanisms effecting change, and will determine whether we should implement the intervention, if effective, on a wider scale for PwD and concurrent sensory impairment.Trial registrationISRCTN,ISRCTN17056211. Registered on 19 February 2018.

PRISMA-P 2015 checklist. (DOC 82 kb)