Assessing and managing concurrent hearing, vision and cognitive impairments in older people: an international perspective from healthcare professionals

Background: there is a significant gap in the understanding, assessment and management of people with dementia and concurrent hearing and vision impairments. / Objective: from the perspective of professionals in dementia, hearing and vision care, we aimed to: (1) explore the perceptions of gaps in assessment and service provision in ageing-related hearing, vision and cognitive impairment; (2) consider potential solutions regarding this overlap and (3) ascertain the attitudes, awareness and practice, with a view to implementing change. / Methods: our two-part investigation with hearing, vision, and dementia care professionals involved: (1) an in-depth, interdisciplinary, international Expert Reference Group (ERG; n = 17) and (2) a wide-scale knowledge, attitudes and practice survey (n = 653). The ERG involved consensus discussions around prototypic clinical vignettes drawn from a memory centre, an audiology clinic, and an optometry clinic, analysed using an applied content approach. / Results: the ERG revealed several gaps in assessment and service provision, including a lack of validated assessment tools for concurrent impairments, poor interdisciplinary communication and care pathways, and a lack of evidence-based interventions. Consensus centred on the need for flexible, individualised, patient-centred solutions, using an interdisciplinary approach. The survey data validated these findings, highlighting the need for clear guidelines for assessing and managing concurrent impairments. / Conclusions: this is the first international study exploring professionals’ views of the assessment and care of individuals with age-related hearing, vision and hearing impairment. The findings will inform the adaptation of assessments, the development of supportive interventions, and the new provision of services

Int J Geriatr Psychiatry

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

NEUROPSYCHOPHARMACOLOGIC STUDIES OF MARIJUANA: SOME SYNTHETIC AND NATURAL THC DERIVATIVES IN ANIMALS AND MAN *

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74859/1/j.1749-6632.1971.tb13996.x.pd

Climate of migration? How climate triggered migration from southwest Germany to North America during the 19th century

This paper contributes to the ongoing debate on the extent to which climate and climatic change can have a negative impact on societies by triggering migration, or even contribute to conflict. It summarizes results from the transdisciplinary project Climate of migration (funded 2010–2014), whose innovative title was created by Franz Mauelshagen and Uwe Lübken. The overall goal of this project was to analyze the relation between climatic and socioeconomic parameters and major migration waves from southwest Germany to North America during the 19th century. The article assesses the extent to which climatic conditions triggered these migration waves. The century investigated was in general characterized by the Little Ice Age with three distinct cooling periods, causing major glacier advances in the alpine regions and numerous climatic extremes such as major floods, droughts and severe winter. Societal changes were tremendous, marked by the warfare during the Napoleonic era (until 1815), the abolition of serfdom (1817), the bourgeois revolution (1847/48), economic freedom (1862), the beginning of industrialization accompanied by large-scale rural–urban migration resulting in urban poverty, and finally by the foundation of the German Empire in 1871.The presented study is based on quantitative data and a qualitative, information-based discourse analysis. It considers climatic conditions as well as socioeconomic and political issues, leading to the hypothesis of a chain of effects ranging from unfavorable climatic conditions to a decrease in crop yields to rising cereal prices and finally to emigration. These circumstances were investigated extensively for the peak emigration years identified with each migration wave. Furthermore, the long-term relations between emigration and the prevailing climatic conditions, crop yields and cereal prices were statistically evaluated with a sequence of linear models which were significant with explanatory power between 22 and 38 %

Selbstberichtetes Sehvermögen in der (gerontologischen) Versorgungsforschung und -praxis – ein Plädoyer zur Öffnung

The use of self-reported vision is an integral part of most population surveys and is primarily used for healthcare monitoring. Since the patient's assessment is not always consistent with the objectively measured clinical parameters, the majority of the literature looks critically at the adequacy of self-reported vision, particularly with respect to answering epidemiological questions; however, it is often misunderstood that self-reported vision measures far more than the directly derived information show. This article shows the complexity of self-reported vision and discusses the importance of health services research and practice, with a special focus on the topic of vision in old age. From the explanations it becomes clear that the self-estimation of vision by a person is determined by various factors apart from the pure organ function and that the need for action and diagnostic conclusions can only be derived from self-reports. This is essential if vision is to be understood as a multifactorial condition and empirically practiced using different survey instruments. The article shows that self-reported vision is a good indicator of the quality of care in its entirety

Reconstruction of flood events based on documentary data and transnational flood risk analysis of the Upper Rhine and its French and German tributaries since AD 1480

This paper presents the long-term analysis of flood occurrence along the southern part of the Upper Rhine River system and of 14 of its tributaries in France and Germany covering the period starting from 1480 BC. Special focus is given on the temporal and spatial variations of flood events and their underlying meteorological causes over time. Examples are presented of how long-term information about flood events and knowledge about the historical aspect of flood protection in a given area can help to improve the understanding of risk analysis and therefor transnational risk management. Within this context, special focus is given to flood vulnerability while comparing selected historical and modern extreme events, establishing a common evaluation scheme. <br><br> The transnational aspect becomes especially evident analyzing the tributaries: on this scale, flood protection developed impressively different on the French and German sides. We argue that comparing high technological standards of flood protection, which were initiated by the dukes of Baden on the German side starting in the early 19th century, misled people to the common belief that the mechanical means of flood protection like dams and barrages can guarantee the security from floods and their impacts. This lead to widespread settlements and the establishment of infrastructure as well as modern industries in potentially unsafe areas until today. The legal status in Alsace on the French side of the Rhine did not allow for continuous flood protection measurements, leading to a constant – and probably at last annoying – reminder that the floodplains are a potentially unsafe place to be. From a modern perspective of flood risk management, this leads to a significant lower aggregation of value in the floodplains of the small rivers in Alsace compared to those on the Baden side – an interesting fact – especially if the modern European Flood directive is taken into account