and sight loss in dementia Thursday 13 December 2018 14:00 15:00 - - PowerPoint PPT Presentation

Webinar: Introduction to hearing and sight loss in dementia

Thursday 13 December 2018 14:00 – 15:00

Enabling health and social care improvement

Agenda

Enabling health and social care improvement

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

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What best describes your role?

Enabling health and social care improvement

Manager AHP Link Worker Medic Nurse Other

Enabling health and social care improvement

Agnes Houston Churchill Fellow June Neil Training and Development Manger RNIB Barbara Sharp Practice Consultant Alzheimer Scotland

Sight Loss and Dementia

Agnes Houston June Neil, RNIB Barbara Sharp, Alzheimer Scotland

Life Experiences and coping Physical Psychological health Neurological changes Environment The person you are

Spirituality

Dementia – a unique, changing experience

Keeping Well, Prevention and Finding out its Dementia Living Well with Dementia Living Well with increasing help and support End of Life and Dying Well

• 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

acuity

• Reduced contrast

sensitivity

• Altered depth

perception

• Difficulty detecting

colours, locating things

• Misidentifications
• Misperceptions
• Visual complexity,

shadows and glare all cause difficulties

• Shrinking peripheral

vision

• Difficulties with

recognition

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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

Enabling health and social care improvement

Questions

Enabling health and social care improvement

Denise Rennex Audiologist NHS Lothian

Deafness and Dementia

Denise Rennex NHS Lothian Audiology

Deafness

Many forms of deafness

– most common is acquired hearing loss affecting the inner ear

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

• Increases with severity of

hearing loss

Deafness

Some Deaf people use British Sign Language (BSL) to communicate

Specialist dementia information and support available

• n the

British Deaf Association website https://bda.org.uk/ dementia/

Most people communicate using speech

Deaf people sometimes use

• ther means of

communication such as lipreading Check preferred method of communication!

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

• f a sentence
• visual information
• language skills

Communication

People adjust by

– using top-down processing but tiring! – Behavioural – eg ask for repetition – Only about 1/3 use aids

Hearing loss affects

Communication

– Social isolation, loneliness, depression, quality of life, tiredness due to listening effort

Awareness of environment

– Environmental cues – Alerts such as doorbells and alarms

Effects of dementia

• Top-down processing much

more difficult - tiring

• Less able to ask for help

Communication problems

• Processing of sounds

impaired

– Bottom-up

• Can’t understand fast

speech or speech in background noise

– Top-down

• Reduced noise tolerance

– Noise is a significant stressor » Life Changes Trust leaflet

Poorer signal and less able to compensate and adapt

Useful tools!

• Is it dementia or is it hearing loss (or

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/

Try a personal listener

‘Can they hear?’

Effects of dementia

Some types of dementia affect language use early Also – Less able to use and 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

• ther 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
• ld and set to test less

than 4 years old

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How to help...

Use that hearing well! – Provide meaningful auditory stimulation – social, environmental, music BUT – With adaptations to take account of deafness

Training

– Deaf awareness – communication tactics – Noise awareness

• Free noise meter apps on smartphones

What to aim for!

• The Goldilocks level of

auditory stimulation!

Not too little Not too much

Just the right kind for every individual

Resources and References

• Livingston et al (2017) Dementia prevention, intervention and care. The Lancet, 390 (10113) 2673-

2734

• British Deaf Association. Transforming the Deaf dementia experience. https://bda.org.uk/dementia/
• The Ear Foundation (2014). The Real Cost of Adult Hearing Loss.

https://www.earfoundation.org.uk/research/adult-strategy-reports/the-real-cost-of-adult-hearing- loss-2014

• Personal listeners – available from Action on Hearing Loss, Connevans, PC Werth, Sarabec
• NES: Deaf Awareness module - LearnPRO
• Life Changes Trust. Dementia and Sensory Challenges.

https://www.lifechangestrust.org.uk/sites/default/files/leaflet.pdf

• SCIE. Dementia-friendly environments: noise levels. https://www.scie.org.uk/dementia/supporting-

people-with-dementia/dementia-friendly-environments/noise.asp

Resources and References

• Hearing Aid use and troubleshooting. Short videos on Youtube channel search ‘C2Hear’ . Hearing aid

maintenance and troubleshooting on www.edinburgh.gov.uk – search for ‘Hearing Aids’ and follow link to videos on ‘Maintain your hearing aids’

Enabling health and social care improvement

Questions

Enabling health and social care improvement

website: ihub.scot/improvement- programmes/focus-on-dementia/ email: lynn.flannigan@nhs.net; julie.miller20@nhs.net; jane.millar2@nhs.net twitter: @Focusondementia

http://www.knowledge.scot.nhs.uk/supportingpeople dementia/resources.aspx

Thank you