Webinar: Introduction to hearing and sight loss in dementia Thursday 13 December 2018 14:00 – 15:00 Enabling health and social care improvement
Agenda Time Item Lead 14:00 Welcome Lynn Flannigan 14:05 Webinar tips and who's who Jane Millar 14:10 Sight loss and dementia Agnes Houston MBE, Churchill Fellow Barbara Sharp, Practice Consultant, Alzheimer Scotland June Neil, Training and Development Manger, RNIB Deafness and Dementia Denise Rennex, Audiologist, NHS Lothian 15:00 Close Enabling health and social care improvement
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Where are you? Click on the arrow and drag it onto the map Enabling health and social care improvement
What best describes your role? Manager AHP Other Link Worker Nurse Medic Enabling health and social care improvement
Agnes Houston Churchill Fellow June Neil Barbara Sharp Training and Practice Consultant Development Manger Alzheimer Scotland RNIB Enabling health and social care improvement
Sight Loss and Dementia Agnes Houston June Neil, RNIB Barbara Sharp, Alzheimer Scotland
The person you are Environment Life Experiences Neurological and Spirituality changes coping Physical Psychological health
Dementia – a unique, changing experience Keeping Well, Living Well Prevention Living Well with End of Life and with increasing and Dying Finding out Dementia help and Well its support Dementia
• Different types of dementia will affect vision in different ways • Seeing – perceiving – visuo-perceptual difficulties • Influence of other conditions, senses, expectations, memories and thoughts
Sight Loss and Dementia • Age related changes • Eye condition • Other health conditions • Some medications • Dementia itself
Impact of dementia • Reduced visual • Misidentifications acuity • Misperceptions • Reduced contrast • Visual complexity, sensitivity shadows and glare • Altered depth all cause difficulties perception • Shrinking peripheral • Difficulty detecting vision colours, locating • Difficulties with things recognition 13
Sight loss and dementia – a significant issue • 250, 000 people living with sight loss and dementia • Sight loss may be ‘hidden’ • Incidences of sight loss increase with age • 50% of sight loss is preventable
What can you do? • Be aware, anticipate, adapt (approach and environment) • Access eye care • 4’s C for glasses • Aids • The golden rule ‘keep everything in its place’
Useful Resources • Dementia and sight loss leaflet • Questions to ask at the sight test • Tips on promoting eyecare, communication and the environment • Effective practice notes Technology and Falls
Resources and references • Alzheimer Scotland www.alzscot.org Dementia and sight loss leflet https://www.alzscot.org/assets/0002/5404/APDF- COU091605_Update_Sight_loss_dementia_leaflet.pdf • Posterior Cortical Atrophy • https://www.alzscot.org/information_and_resources/information_sheet/ 3536_posterior_cortical_atrophy • Anne Macdonald of the Scottish Dementia Working Group talking about her diagnosis of PCA https://www.youtube.com/watch?v=hd2ZVwvXZRAn • Alzheimer Society Sight, Perception and Hallucinations in Dementia https://www.alzheimers.org.uk/sites/default/files/2018- 10/527LP%20Sight%2C%20perception%20and%20hallucinations.pdf • Alzheimer's Society Learning Disabilities and Dementia www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=1 03
Resources and references • Bowen, M., Edgar, D.F., Hancock, B., Haque, S., Shah, R., Buchanan, S., Iliffe, S., Maskell, S., Pickett, J., Taylor, J.P. and O’Leary, N., 2016. The Prevalence of Visual Impairment in People with Dementia (the PrOVIDe study): a cross-sectional study of people aged 60 – 89 years with dementia and qualitative exploration of individual, carer and professional perspectives • Dementia and Sensory Challenges https://www.lifechangestrust.org.uk/sites/default/files/Leaflet.pdf • Emerson, E. and Robertson, J. (2011). The estimated prevalence of visual impairment among people with learning disabilities in the UK. Learning Disabilities Observatory report for RNIB and SeeAbility • RNIB/Alzheimer Scotland guidance for ECLO’s https://www.rnib.org.uk/eyeclinicstaffguidance • Maurer, K. and Prvulovic, D., 2004. Paintings of an artist with Alzheimer’s disease: visuoconstructural deficits during dementia. Journal of neural transmission , 111 (3), pp.235-245.
June Neil: Training and Development Manager (Older People Complex Needs) UK Adult Social Care Practice and Development Team June.Neil@rnib.org.uk 0141 648 8510 07776 348 698
Dr. Barbara Sharp Policy and Practice Consultant Alzheimer Scotland bsharp@alzscot.org Phone: 07584 673967 www.alzscot.org
Questions Enabling health and social care improvement
Denise Rennex Audiologist NHS Lothian Enabling health and social care improvement
Deafness and Dementia Denise Rennex NHS Lothian Audiology
Deafness Very common as people age – 70% over people over the age of 70 years Association between hearing loss and dementia - Mild hearing loss 1.9x higher risk Many forms of deafness - Increases with severity of hearing loss – most common is acquired hearing loss affecting the inner ear
Deafness Most people communicate Some Deaf people use British using speech Sign Language (BSL) to communicate Deaf people sometimes use other means of Specialist dementia communication such as information and lipreading support available on the British Deaf Association website Check preferred method of communication! https://bda.org.uk/ dementia/
Deafness Effect of acquired hearing loss • Typically, age-related hearing loss affects the ‘speech banana’ from right to left • Soft, high- pitched consonants ‘f’ ‘s’ ‘th’ go first “ I can hear people speak but I can’t make out what they are saying”
Listening Hearing is simple but listening is complex Sounds are processed – ‘bottom up’ signal from 2 ears integrated and sent to the brain - identify ‘what’ and ‘where’ ‘top down’ from brain to ears - ‘tune in’ what want to hear and ‘tune out’ unwanted sounds
Listening Listening to speech is complex and also needs - attention - auditory memory - remember the beginning and middle of a sentence - visual information - language skills
Communication Hearing loss affects People adjust by Communication – Social isolation, loneliness, – using top-down processing depression, quality of life, but tiring! tiredness due to listening – Behavioural – eg ask for effort repetition Awareness of environment – Only about 1/3 use aids – Environmental cues – Alerts such as doorbells and alarms
Effects of dementia • Processing of sounds impaired • Top-down processing much – Bottom-up more difficult - tiring • Can’t understand fast • Less able to ask for help speech or speech in background noise – Top-down • Reduced noise tolerance – Noise is a significant stressor » Life Changes Trust leaflet Poorer signal and less Communication able to compensate problems and adapt
Useful tools! • Is it dementia or is it hearing loss (or Try a personal listener both)? – Overlap of symptoms • Depression • Social withdrawal • Lack of response There are now smartphone apps available to aid communication. For a list see https://www.hearinglink.org/living/loops- equipment/useful-apps-for-hearing-loss/ ‘Can they hear?’
Effects of dementia Also Some types of dementia – Less able to use and affect language use early maintain aids • Function as earplug – Less able to manage tinnitus (in 10 – 17% of people - perception of sound that is not there)
How to help... Practical help – Check Communication needs – Ear wax removal (treatable) – Hearing test (every 3 years) • Should be checked during diagnosis! – Support access and use of hearing aids or other technology including sensory support services • 5 C’s for hearing aids
The 5 C's for hearing aids! • Correct – belong to the person and in the correct ear • Charged – correct batteries giving power • Clean – not blocked with wax • Comfortable – fitting well, hearing well • Current – less than 5 y old and set to test less than 4 years old 34
How to help... Use that hearing well! Training – Provide meaningful auditory – Deaf awareness – communication tactics stimulation – social, environmental, music – Noise awareness • Free noise meter apps on smartphones BUT – With adaptations to take account of deafness
What to aim for! • The Goldilocks level of auditory stimulation! Not too little Just the right kind for every individual Not too much
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