New horizons in holistic, person-centred health promotion for hearing healthcare

Over the course of a lifetime, the risk of experiencing multiple chronic conditions (multimorbidity) increases, necessitating complex healthcare regimens. Healthcare that manages these requirements in an integrated way has been shown to be more effective than services that address specific diseases individually. One such chronic condition that often accompanies aging is hearing loss and related symptoms, such as tinnitus. Hearing loss is not only highly prevalent in older adults but is also a leading cause of disability. Accumulating evidence demonstrates an interplay between auditory function and other aspects of health. For example, poorer cardiometabolic health profiles have been shown to increase the risk of hearing loss, which has been attributed to microvascular disruptions and neural degeneration. Additionally, hearing loss itself is associated with significantly increased odds of falling and is a potentially modifiable risk factor for cognitive decline and dementia. Such evidence warrants consideration of new possibilities – a new horizon – for hearing care to develop a holistic, person-centred approach that promotes the overall health and wellbeing of the individual, as well as for audiology to be part of an interdisciplinary healthcare service. To achieve this holistic goal, audiologists and other hearing healthcare professionals should be aware of the range of conditions associated with hearing loss and be ready to make health promoting recommendations and referrals to the appropriate health practitioners. Likewise, healthcare professionals not trained in audiology should be mindful of their patients’ hearing status, screening for hearing loss or referring them to a hearing specialist as required.</p

Combined impairments in vision, hearing and cognition are associated with greater levels of functional and communication difficulties than cognitive impairment alone: Analysis of interRAI data for home care and long-term care recipients in Ontario

<div><p>Objectives</p><p>The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada.</p><p>Methods</p><p>Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments.</p><p>Results</p><p>The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group.</p><p>Conclusions</p><p>The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.</p></div

Cognition, mood, and behavioral patterns of older home care clients in Ontario based on the presence of hearing and vision impairments and/or cognitive impairments.

<p>Cognition, mood, and behavioral patterns of older home care clients in Ontario based on the presence of hearing and vision impairments and/or cognitive impairments.</p

Cognition, mood, and behavioral patterns of older adults residing in a long-term care facility in Ontario based on the presence of hearing and vision impairments and/or cognitive impairments.

<p>Cognition, mood, and behavioral patterns of older adults residing in a long-term care facility in Ontario based on the presence of hearing and vision impairments and/or cognitive impairments.</p

Distribution of long-term care residents with hearing and vision sensory and/or cognitive impairments.

<p>In this sample, 6.1% (n = 6,692) had none of these impairments.</p

Demographic characteristics of older adults residing in a long-term care facility in Ontario based on the presence of hearing and vision impairments and/or cognitive impairments.

<p>Demographic characteristics of older adults residing in a long-term care facility in Ontario based on the presence of hearing and vision impairments and/or cognitive impairments.</p

Communication ability and social functioning of older adults residing in a long-term care facility in Ontario based on the presence of vision and hearing impairments and/or cognitive impairments.

<p>Communication ability and social functioning of older adults residing in a long-term care facility in Ontario based on the presence of vision and hearing impairments and/or cognitive impairments.</p

Age stratification for degree of difficulty in being understood in long-term care residents with hearing and vision sensory and/or cognitive impairments.

<p>Age stratification for degree of difficulty in being understood in long-term care residents with hearing and vision sensory and/or cognitive impairments.</p

Physical indicators of health and diagnoses of older adults residing in a long-term care facility in Ontario based on the presence of vision and hearing impairments and/or cognitive impairments.

<p>Physical indicators of health and diagnoses of older adults residing in a long-term care facility in Ontario based on the presence of vision and hearing impairments and/or cognitive impairments.</p

Physical indicators of health and diagnoses of home care clients in Ontario based on the presence of hearing and vision sensory and/or cognitive impairments.

<p>Physical indicators of health and diagnoses of home care clients in Ontario based on the presence of hearing and vision sensory and/or cognitive impairments.</p