Walter Wittich, School of Optometry, Université de Montréal
Katherine S. McGilton
In a sample of Ontario home-care recipients with sensory and/or cognitive impairments, just over 21% were living with sensory impairment only; this number was reduced to 4.4% in long-term care, indicating the vast proportion were living with comorbid sensory and cognitive decline. Recent analyses indicated that there is a trend over time for an increase in the number of long-term care residents living with vision, hearing, or combined vision and hearing impairment, with those over the age of 85 making up the largest proportion.
Sensory-cognitive aging is a multi-factorial process that depends on a vast network of interacting variables, resulting in the heterogeneity we observe when working with older adults. The complexities are especially apparent in the long-term care setting because residents’ levels of functioning can be very low and depend (by definition) on the care-relationships with others. Relatedly, the ability to communicate effectively and efficiently contributes greatly to the experiences of being a long-term care home resident, but also influences the experiences of long-term care home staff. Communication abilities, strategies and accommodations to sensory and cognitive impairment(s) often are not optimal, especially at times when work priorities dictate how much time can be allocated for staff to engage with, or among, residents, versus delivering essential services in notoriously under-staffed environments. These challenges are complicated further by the high prevalence of dementia among long-term care residents. Not surprisingly, the effects of sensory impairments can be interpreted as signs of dementia. For example, residents may be unresponsive because they cannot hear or see that someone has entered their room and is talking to them. Residents may appear forgetful because they cannot find an item (that they cannot see) or because they ask for repetition of information (that they did not hear).
This portrait forms the backdrop of our symposium on sensory health and its importance to communication and social interaction in long-term care homes. The presenters combine inter-professional perspectives (nursing, audiology, low vision therapy, speech-language pathology, gerontology, occupational therapy) in examining topics related to the quality of interactions between residents and the individuals who care for them. The session highlights the importance of relationship building, review clinical experiences of sensory care in long-term care homes, focus on specific evidence-based communication strategies, demonstrate the benefits of a person-centered communication intervention, and review the importance of comorbidities, specifically related to combined vision and hearing impairments.
Presenter #1, Katherine S. McGilton
Relationship-building within long-term care homes: The importance of knowing the residents’ sensory status.
Authors: McGilton, K.S., Höbler, F., Wittich, W., Pichora-Fuller, M.K.
Relationship-centred care has emerged as a crucial underlying principle for the delivery of quality care in long-term care homes. A key component of resident-centred care is the ability of staff to engage with residents in a way that allow them to understand the resident’s specific needs. However, a majority of residents living in long-term care homes are living with dementia, a syndrome characterized by cognitive communication difficulties. These problems have profound implications for effective staff-resident interactions in care facilities and, thus, relationship-centred care. When residents cannot express their needs or cannot understand others, not only does communication fail because information is not exchanged, but the frustration and agitation that can frequently be felt and expressed by residents may also compromise the quality of their care. Compounding these communication difficulties is the high prevalence of sensory impairments among residents living with dementia in long-term care homes. Sensory impairments contribute to a greater risk of falls, depression, and difficulties performing activities of daily living. This presentation discusses some key lessons learned by our team in the quest to find tools suitable for use by nursing staff to screen for hearing and vision impairments in residents with dementia.
Presenter #2, Marilyn Reed
40 years of hearing service provision in long-term care homes: What have we learned?
Residents in long-term care homes are dependent on others for their care and quality of life. Their ability to hear and communicate with staff, other residents and family members affects the quality of their relationships and health outcomes. While communication is key to meaningful social engagement and healthy aging, hearing loss is so prevalent among residents in long-term care that it is frequently disregarded as a normal part of aging that must be accepted rather than managed. The attitudes, awareness, knowledge and skills of caregivers with respect to hearing loss and its management must be addressed along with residents’ hearing challenges in order to ensure successful communication.
This presentation discusses some key experiences and lessons learned by an audiologist over more than 40 years of providing hearing services to residents in long-term care settings. Topics include models of service provision and modes of delivery, successes and failures in staff training and making the environment more communication accessible for residents with hearing loss. Recommendations for modifications to practice that help to ensure successful outcomes with hearing rehabilitation will be shared, along with tips for mitigating the impact of additional communication challenges presented by pandemic restrictions.
Presenter #3, JB Orange
Communication issues for residents with dementia and sensory impairments in long-term care homes: Considerations for family care providers and formal care givers
There is a high prevalence of dementia and other neurodegenerative conditions among residents in long-term care homes. Data also show a high prevalence of age- and pathology-related hearing, vision and dual hearing-vision sensory impairments in long-term care homes. The presence of language, speech-production, memory, executive function and single and dual sensory modality problems among residents in long-term care homes contribute to enormous difficulties in communication for residents and their family and formal care providers. Barriers to communication, particularly for residents in long-term care homes, create walls to interaction and inclusion, and are associated with increased levels of depression, stigmatization, isolation, marginalization, disenfranchisement and lower quality of life, among other negative outcomes. There are, however, emerging bodies of empirical evidence showing communication- and language-based strategies for residents in long-term care homes with dementia and associated single and dual sensory impairments enhance social connectedness and optimize message transmission. The presentation focuses on current, evidence-informed findings on effective communication- and language-based strategies for residents of long-term care homes who exhibit dementia and who also may suffer single or dual hearing-vision sensory losses. The session also addresses the crucial links among personhood, enhanced communication and conceptualizing communication as shared partnerships in human relations.
Presenter #4, Marie Savundranayagam
The impact of Be EPIC on person-centered communication among frontline staff in long-term care homes
This study assessed the impact of Be EPIC, a person-centered communication intervention for personal support workers caring for persons living with dementia. Be EPIC focuses on the [E]nvironment, using [P]erson-centered communication, client relationships ([I] matter too), and incorporating the [C]lient’s abilities, life history and preferences during routine care. Video-recorded conversations between personal support workers and simulated persons living with dementia assessed Be EPIC’s impact on an intervention group (n=16) versus a wait-list control group (n=23). Outcome measures included the proportions of person-centered communication utterances (recognition, negotiation, facilitation, validation) and the proportions of missed opportunities for person-centered communication. A two-way mixed ANOVA showed a significant group by time interaction for person-centered communication. Simple main effects analysis showed a significant increase in the proportion of person-centered communication utterances among Be EPIC participants compared to the control group. Similarly, there was a significant group by time interaction for missed opportunities for person-centered communication. Simple main effects analysis showed a significant decrease in the proportion of missed opportunities for person-centered communication among Be EPIC participants compared to the control group. Findings show that Be EPIC enhanced person-centered communication, which is essential for optimizing quality of care.
Presenter #5, Atul Jaiswal
Effects of combined vision and hearing impairment on communication and social interaction in long-term care homes
Age-related combined hearing and vision impairments (dual sensory impairment/DSI), is an understudied public health problem. Around one million Canadians experience DSI, of which a large number reside in long-term care homes. Residents with DSI experience challenges in access to information, communication, mobility, social interaction, and functioning. They are at a high risk of cognitive impairment, social isolation, falls, and other comorbidities, which, in turn, are associated with high healthcare utilization. Communication challenges between older residents with DSI and long-term care home staff impede the care delivery and its outcomes in long-term care homes. This situation becomes even more challenging when an older adult with DSI in long-term care homes needs medical care due to co-morbidities. Evidence is emerging globally highlighting the need for training of healthcare professionals on DSI-specific communication and social interaction to enhance care experience for long-term care home residents with DSI and their service providers. This presentation discusses the synthesis of evidence on DSI in long-term care homes globally and then situates the findings in the Canadian context to present the implications for clinical practice, policies, and future research. Topics include strategies on DSI-specific communication and social interaction, and recommendations for long-term care homes.