Embedding audiological screening within memory clinic care pathway for individuals at risk of cognitive decline-patient perspectives.

BACKGROUND: With the evolving knowledge on hearing as a potentially modifiable mid-life risk factor for dementia, identification of people at risk becomes increasingly important. People with mild cognitive impairment (MCI) presenting to specialist memory services represent a key "at-risk" target population for audiological evaluation, but few services have established this pathway. This study sought to examine the patient experience and understanding of this process. METHODS: All patients with MCI attending a tertiary referral memory service referred for audiology review were contacted. A patient survey was delivered over the phone. Outpatient letters and the memory clinic database were reviewed. RESULTS: Twenty patients with MCI were included in the survey. Eight (8/20, 40%) had self-reported hearing loss. Upon formal audiological assessment seventeen (17/20, 85%) had objective evidence of hearing loss; nine (9/17, 52.9%) with mild-moderate and eight (8/17, 47%) with moderate-severe hearing loss. Only six patients (6/20, 30%) recalled having the rationale behind having a hearing test as part of their memory work-up explained to them. However, the majority (15/20, 75%) felt a hearing test was an important part of their memory assessment. Just seven patients overall (7/20, 35%) identified a link between hearing-loss and cognition. All patients who provided feedback on the service itself made positive comments, although (4/20, 20%) felt they did not get adequate information about the results. CONCLUSIONS: A significant proportion of people with MCI had de-novo evidence of hearing impairment upon assessment. Patients are satisfied with incorporating audiological evaluation into a memory clinic assessment, however clear communication around indication, recommendations, and follow-up ensuring compliance is required.

Nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital: A qualitative descriptive study.

OBJECTIVE: To explore nurses' experiences of caring for persons with dementia experiencing responsive behaviours in an acute hospital. BACKGROUND: Caring for persons with dementia who have an acute medical illness and are experiencing responsive behaviours in acute hospitals can be challenging for nurses. While existing research has explored the experiences of nurses in providing dementia care in this setting, there is limited knowledge about the specific care experiences of nurses when working to meet the needs of persons with dementia who experience responsive behaviours alongside an admitting diagnosis. METHOD: A qualitative descriptive design was implemented. Semi-structured interviews were carried out with nine nurses working in medical and surgical wards. A thematic analysis approach was used to analyse the data. Ethical approval to conduct the study was received from the writers' university. RESULTS: Three themes were found: (a) challenges encountered, (b) a person-centred response and (c) dementia preparedness. Key findings about challenges encountered by nurses included: the acute hospital environment; increased need for enhanced knowledge; and emotional challenges. Person-centred responses such as working in partnership with others and reminiscence were identified as strategies to address the challenges. Finally, nurses identified particular interventions that were supportive to them in enhancing their preparedness to meet the needs of persons with dementia who experience responsive behaviours. CONCLUSIONS: Persons with dementia who are acutely unwell and are experiencing responsive behaviours, within acute hospitals, have specific and individualised care needs. Nurses working in these settings must therefore be supported in developing competence in managing these frequently complex clinical cases, while also providing person-centred care. IMPLICATION FOR PRACTICE: Nurses' narratives demonstrate that they continue to experience challenges in the presence of responsive behaviours. There is a consequent need for dementia-specific education on person-centred ways to address responsive behaviours within acute hospital settings.