ABSTRACT
Background and Objectives: A global report estimates up to 2% of the world population experience concurrent hearing and vision impairment (dual sensory impairment [DSI]). Older adults with DSI are often frequent users of health care, yet the evidence is limited to inform care delivery for this population. This systematic review aimed to synthesize evidence on tools and strategies for screening, assessment, and interventions that promote a continuum of care for older adults with DSI. Research Design and Methods: The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews. Electronic databases (CINAHL, Embase, MEDLINE, PsycINFO, Cochrane Library, Global Health, and Web of Science) and clinical trial registries (ISRCTN Registry, WHO ICTRP, and ClinicalTrials.gov) were searched. The quality appraisal was performed using the Mixed Methods Appraisal Tool. Results: Of 4,775 identified references, 28 records were selected. The review identified 7 tools and 7 strategies for DSI-specific screening, assessments, and/or interventions. Some of the most promising tools were the interRAI Community Health Assessment with deafblind supplement, adapted Montreal Cognitive Assessment, and the Severe Dual Sensory Loss screening tool. Useful strategies included the use of alternative forms of communication, assistive devices or technology, education and training for service providers, and training of older adults on the use and maintenance of assistive aids/technology. However, quality appraisal indicated a need for more robust evidence to inform clinical practice. Discussion and Implications: Reviewed evidence pinpointed the need for training for health care providers on DSI-specific challenges and supports and the use of integrated multidisciplinary care for older adults. Future studies need to explore the development and evaluation of tools and interventions to improve the continuum of care for this group. Systematic Review Registration: PROSPERO registration # CRD42020180545.
ABSTRACT
Research Objectives To explore the barriers to health and rehabilitation care for older Canadians with concurrent hearing and vision loss (dual sensory loss/DSL) during the COVID-19 pandemic. Design A mixed-methods study design was employed to explore and integrate the perspectives of older Canadians with DSL, their caregivers who accompany them on clinical visits, and their health and rehabilitation care providers. Data were generated from qualitative interviews with 32 older Canadians with DSL and 32 caregivers, and through an online survey with 228 health and rehabilitation care providers. Various accessible modes of communication were used to conduct interviews with older adults with DSL. Thematic analysis was used to analyze qualitative data, whereas descriptive statistics were used for quantitative survey data. Setting Health and rehabilitation care settings in Canada. Participants 32 older Canadians with DSL, 32 caregivers, and 228 health and rehabilitation care providers (HRCPs) in Canada. Interventions Not applicable. It was an exploratory study. Main Outcome Measures Access to health and rehabilitation care during the pandemic. Results Results highlighted that having DSL, at a time of pandemic-related regulations, increased the adverse consequences on their healthcare experiences. Identified barriers in care delivery were challenges in communication and identification of DSL due to use of masks and personal protective equipment, lack of training on DSL-specific care among HRCPs, lack of time and limited support to overcome communication difficulties for older adults with DSL, difficulty using technologies for tele/virtual health approaches for older adults, and restrictions in caregiver accompaniment. Conclusions Our results highlight that the pandemic heightened the health inequities for this vulnerable group as experienced by older adults with DSL and their caregivers. The telehealth model of care that is currently being used overlooks the accessibility and communication needs of older adults with DSL. Training of HRCPs and informal caregivers on DSL-specific communication and accessibility is critical to ensure equitable care for older adults with DSL. Author(s) Disclosures No conflict of interest to declare.
ABSTRACT
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in March 2020, caused over 6 million coronavirus disease (COVID-19) related deaths worldwide (1, 2). Access to and delivery of rehabilitation care were severely disrupted, and patients have faced several challenges during the COVID-19 outbreak (3). These challenges include addressing new functional impairments faced by survivors of COVID-19 and infection prevention to avoid the virus spreading to healthcare workers and other patients not infected with COVID-19 (4-7). In this scoping review, we aimed to develop rehabilitation recommendations during the COVID-19 pandemic across the continuum of rehabilitation care. Established frameworks were used to guide the scoping review methodology. Medline, Embase, PubMed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. We included articles and reports if they were focused on rehabilitation recommendations for COVID-19 survivors or the general population at the time of the COVID-19 pandemic. Two team members used a pre-tested Data Extraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the GRADE approach. We retrieved 6,468 citations, of which 2,086 were eligible after removing duplicates. We excluded 1,980 citations based on the title and the . Of the full-text articles screened, we included 106 studies. We presented recommendations based on the patient journey at the time of the pandemic. We assessed the evidence to be of overall fair quality and strong for the recommendations. We have combined the latest research results and accumulated expert opinions on rehabilitation to develop acute and post-acute rehabilitation recommendations in response to the global COVID-19 pandemic. Further and ongoing updates are warranted in order to incorporate the emerging evidence into rehabilitation guidelines. This symposium is sponsored by the COVID-19 and Frailty Task Force from the Aging Research and Geriatric Rehabilitation Networking Groups.
ABSTRACT
Objective(s) The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in March 2020, caused over 6 million coronavirus disease (COVID-19) related deaths worldwide (1, 2). Access to and delivery of rehabilitation care were severely disrupted, and patients have faced several challenges during the COVID-19 outbreak (3). These challenges include addressing new functional impairments faced by survivors of COVID-19 and infection prevention to avoid the virus spreading to healthcare workers and other patients not infected with COVID-19 (4-7). In this scoping review, we aimed to develop rehabilitation recommendations during the COVID-19 pandemic across the continuum of rehabilitation care. Data Sources Established frameworks were used to guide the scoping review methodology. Medline, Embase, PubMed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. Study Selection We included articles and reports if they were focused on rehabilitation recommendations for COVID-19 survivors or the general population at the time of the COVID-19 pandemic. Data Extraction Two team members used a pre-tested Data Extraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the GRADE approach. Data Synthesis We retrieved 6,468 citations, of which 2,086 were eligible after removing duplicates. We excluded 1,980 citations based on the title and the . Of the full-text articles screened, we included 106 studies. We presented recommendations based on the patient journey at the time of the pandemic. We assessed the evidence to be of overall fair quality and strong for the recommendations. Conclusions We have combined the latest research results and accumulated expert opinions on rehabilitation to develop acute and post-acute rehabilitation recommendations in response to the global COVID-19 pandemic. Further and ongoing updates are warranted in order to incorporate the emerging evidence into rehabilitation guidelines. Author(s) Disclosures This symposium is sponsored by the COVID-19 and Frailty Task Force from the Aging Research and Geriatric Rehabilitation Networking Groups.
ABSTRACT
Introduction: As the prevalence of age-related sensory impairment increases, more evidence emerges on the association between uni-sensory and cognitive impairment (CI) in older adults. However, the link between CI and concurrent hearing and vision impairment (referred to as dual sensory impairment/DSI) is not well-understood, and this combined effect may be additive or multiplicative. Moreover, the existing evidence on CI in older adults with DSI is scattered and limited. Through this systematic scoping review, we aim to map existing evidence on CI in older adults with DSI, and to summarize what is known about the prevalence, incidence and risk factors of CI, and tools used to screen or assess CI in older adults with DSI. Methods and Analysis: We will use the Joanna Briggs Institute framework to perform the review. Eleven databases [MEDLINE, CINAHL/EBSCO, EMBASE, Mednar, WorldWideScience, PsycEXTRA, OAIster, OpenGrey (SIGLE), Global Health, PsycINFO, and Web of Science] and clinical trial registries (ISRCTN Registry, WHO ICTRP, and ClinicalTrials.gov) will be searched. Study selection will be completed using Covidence, and data will be extracted using an a priori data extraction tool. To be included, studies had to be peer-reviewed, had older adults with DSI as the focal population, and are related to CI. Data will be presented using a narrative summary with emphasis on implications for future research and practice. Discussion: Reliable cognitive screening is of the utmost importance for prevention and treatment of CI within DSI population. The study findings will have significant implications for health services delivery and policy research. The summarized findings on the prevalence, incidence, associated risk factors, and CI screening and assessment tools will inform geriatric care. The review will also document knowledge gaps on CI in the DSI population and identify areas of interest for future studies. Ethics and Dissemination: The scoping study, being a review of existing documents, does not require ethics approval. The findings will be disseminated with relevant stakeholders using knowledge translation activities such as scientific presentations and publications. We intend to use the findings to conduct a Delphi study to evaluate which CI tools are suitable for older population with DSI.
ABSTRACT
BACKGROUND: Age-related vision impairments and dementia both become more prevalent with increasing age. Research into the mechanisms of these conditions has proposed that some of their causes (eg, macular degeneration/glaucoma and Alzheimer's disease) could be symptoms of an underlying common cause. Research into sensory-cognitive aging has provided data that sensory decline may be linked to the progression of dementia through reduced sensory stimulation. While hearing loss rehabilitation may have a beneficial effect on cognitive functioning, there are no data available on whether low vision rehabilitation, specifically for reading, could have a beneficial effect on cognitive health. OBJECTIVE: The research questions are: (1) Does low vision rehabilitation reduce reading effort? (2) If so, does reduced reading effort increase reading activity, and (3) If so, does increased reading activity improve cognitive functioning? The primary objective is to evaluate cognition before, as well as at 6 months and 12 months after, 3 weeks of low vision reading rehabilitation using magnification in individuals with age-related macular degeneration, with or without coexisting hearing impairments. We hypothesize that improvements postrehab will be observed at 6 months and maintained at 12 months for participants with vision loss and less so for those with dual sensory loss. The secondary objective is to correlate participant characteristics with all cognitive outcomes to identify which may play an important role in reading rehabilitation. METHODS: We employ a quasiexperimental approach (nonrandomized, pre-post intervention study). A 3x3 design (3 groups x 3 time points) allows us to examine whether cognitive performance will change before and after 6 months and 12 months of a low vision reading intervention, when comparing 75 low vision and 75 dual sensory impaired (vision & hearing) participants to 75 age-matched healthy controls. The study includes outcome measures of vision (eg, reading acuity and speed), cognition (eg, short-term and long-term memory, processing speed), participant descriptors, demographics, and clinical data (eg, speech perception in noise, mental health). RESULTS: The study has received approval, and recruitment began on April 24, 2019. As of March 4, 2021, 38 low vision and 7 control participants have been enrolled. Lockdown forced a pause in recruitment, which will recommence once the COVID-19 crisis has reached a point where face-to-face data collection with older adults becomes feasible again. CONCLUSIONS: Evidence of protective effects caused by reading rehabilitation will have a considerable impact on the vision rehabilitation community and their clients as well as all professionals involved in the care of older adults with or without dementia. If we demonstrate that reading rehabilitation has a beneficial effect on cognition, the demand for rehabilitation services will increase, potentially preventing cognitive decline across groups of older adults at risk of developing macular degeneration. TRIAL REGISTRATION: ClinicalTrials.gov NCT04276610; Unique Protocol ID: CRIR-1284-1217; https://clinicaltrials.gov/ct2/show/NCT04276610. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/19931.