Screening for hearing,visual and dual sensory impairment in older adults using behavioural cues: A validation study

ObjectiveThis study investigated the psychometric properties of the Severe Dual Sensory Loss screening tool, a tool designed to help nurses and care assistants to identify hearing, visual and dual sensory impairment in older adults.DesignConstruct validity of the Severe Dual Sensory Loss screening tool was evaluated using Crohnbach's alpha and factor analysis. Interrater reliability was calculated using Kappa statistics. To evaluate the predictive validity, sensitivity and specificity were calculated by comparison with the criterion standard assessment for hearing and vision. The criterion used for hearing impairment was a hearing loss of ≥40 decibel measured by pure-tone audiometry, and the criterion for visual impairment was a visual acuity of ≤0.3 diopter or a visual field of ≤0.3°. Feasibility was evaluated by the time needed to fill in the screening tool and the clarity of the instruction and items. Prevalence of dual sensory impairment was calculated.ResultsA total of 56 older adults receiving aged care and 12 of their nurses and care assistants participated in the study. Crohnbach's alpha was 0.81 for the hearing subscale and 0.84 for the visual subscale. Factor analysis showed two constructs for hearing and two for vision. Kappa was 0.71 for the hearing subscale and 0.74 for the visual subscale. The predictive validity showed a sensitivity of 0.71 and a specificity of 0.72 for the hearing subscale; and a sensitivity of 0.69 and a specificity of 0.78 for the visual subscale. The optimum cut-off point for each subscale was score 1. The nurses and care assistants reported that the Severe Dual Sensory Loss screening tool was easy to use. The prevalence of hearing and vision impairment was 55% and 29%, respectively, and that of dual sensory impairment was 20%.ConclusionsThe Severe Dual Sensory Loss screening tool was compared with the criterion standards for hearing and visual impairment and was found a valid and reliable tool, enabling nurses and care assistants to identify hearing, visual and dual sensory impairment among older adults.     

Gerontological nursing. 1: Challenges nursing older people in acute care

This article, the first in a series of five, will briefly trace the emergence of gerontological nursing and highlight some of the tensions that currently exist in the context of acute care environments. The next two articles will consider the prospects and challenges for nurses working with older people in community and nursing home environments, while the fourth article uses hearing impairment across a range of care contexts as a case study to summarize the ways in which the nursing contribution to the health needs of older people could be significantly improved. The series will conclude with an article drawing together the challenges that gerontological nursing faces in the new millennium.     

Audiology and hearing impairment: improving the quality of care.

Hearing impairment can hinder nurses' and carers' ability to provide high quality care. In this article, the author provides basic information on audiology and hearing aids to help nurses and carers communicate more effectively with people with a hearing impairment.     

Expanding speech pathology services for older people with hearing impairment

Hearing impairment is the most common communication disability in the older population, yet few speech pathologists provide a service to this group. The aim of this paper is to present a rationale and describe a new role for speech pathologists working with older people who have hearing impairment, both those living in the community and those in aged care. The major issues for this population are the high prevalence of hearing impairment, the fact that the majority of older people do not seek audiological interventions, and the serious impact of the impairment on communication and on the quality of life of older people and their families. It is recommended here that speech pathologists expand their current roles with this population and consider interventions that optimize the communication of older people with hearing impairment and their frequent conversational partners (using programs such as Active Communication Education (ACE) described here), as well as taking greater responsibility for hearing issues in aged care facilities and promoting interventions that enhance the communicative environment for older people with a hearing impairment in an aged care facility.     

The ICF and third-party disability: Its application to spouses of older people with hearing impairment

Purpose.?Third-party disability is defined as the disability of family members due to the health condition of their significant other and was identified as a direction for future development by the World Health Organization in 2001. The aim of this article is to identify the International Classification of Functioning, Disability and Health (ICF) domains and categories that describe third-party disability of spouses of older people with hearing impairment.

Method.?Ten spouses of older people with hearing impairment participated in individual semi-structured in-depth interviews. Themes identified by participants were linked according to ICF instructions to deliver a set of ICF category codes relevant to the study of third-party disability in spouses of older people with hearing impairment.

Results.?A total of 18 themes and 50 sub-themes emerged from analysis of the interviews. The majority of these themes were able to be linked to the ICF, with the majority linking to codes in the activities and participation component. A number of contextual factors also emerged in the interviews that impacted on the spouses' third-party disability. Difficulties arose when attempting to link themes to the body function component.

Conclusions.?The ICF appears to be a useful tool in describing the effects of hearing impairment on the significant other; however, further research is necessary to clarify the applicability of some codes to third-party disability, especially the relevance of body functions to third-party disability.     

The ICF and third-party disability: Its application to spouses of older people with hearing impairment

Abstract

Purpose. Third-party disability is defined as the disability of family members due to the health condition of their significant other and was identified as a direction for future development by the World Health Organization in 2001. The aim of this article is to identify the International Classification of Functioning, Disability and Health (ICF) domains and categories that describe third-party disability of spouses of older people with hearing impairment.

Method. Ten spouses of older people with hearing impairment participated in individual semi-structured in-depth interviews. Themes identified by participants were linked according to ICF instructions to deliver a set of ICF category codes relevant to the study of third-party disability in spouses of older people with hearing impairment.

Results. A total of 18 themes and 50 sub-themes emerged from analysis of the interviews. The majority of these themes were able to be linked to the ICF, with the majority linking to codes in the activities and participation component. A number of contextual factors also emerged in the interviews that impacted on the spouses’ third-party disability. Difficulties arose when attempting to link themes to the body function component.

Conclusions. The ICF appears to be a useful tool in describing the effects of hearing impairment on the significant other; however, further research is necessary to clarify the applicability of some codes to third-party disability, especially the relevance of body functions to third-party disability.     

Hearing impairment: significant but underassessed in primary care settings

In this study, 91 older adults with hearing impairment were interviewed and asked whether their primary care providers had ever inquired about or initiated screening for hearing loss. A total of 85% indicated there had been no physician inquiry, and additional data demonstrated that the rate of inquiry was unrelated to either objective or subjective levels of hearing loss. In addition, interview narratives revealed that hearing impairment was sometimes dismissed by primary care providers, with detrimental consequences for both the individuals with hearing impairment and their communication partners. Nurses could positively influence the initiation of treatment for hearing loss by incorporating screening techniques into their assessment routines.     

Caring for older adults with hearing loss

This article discusses hearing impairment and the frequency with which it occurs in older adults. Anatomy and physiology of the ear are examined. Categories of hearing loss, causes, assessment and management are explored, including hearing aids, auditory implants and approaches to communication with hearing-impaired patients.     

Auditory sensory/perceptual alteration: suggested revision of defining characteristics

This correlational study of acutely ill geriatric patients examined (1) if psychosocial dysfunctioning is associated with hearing impairment, as popularly believed; (2) the utility of using psychosocial changes as cues for making the nursing diagnosis sensory/perceptual alterations: auditory; and (3) an alternative model of defining characteristics for predicting auditory perception using variables that have been reported in the literature as being associated with hearing loss but, to date, are not part of the approved diagnostic category. A random sample (n = 226) was drawn from daily admission lists of English-speaking patients 65 years of age or older, admitted to nonintensive care units of a medical center hospital. The major defining characteristics for sensory/perceptual alterations were operationalized as seven variables: depression, cognitive function, social contact with children, social contact with other relatives, social contact with friends, subject-reported hearing ability, and subject-reported overall health status. Auditory sensory perception was operationalized as number of tones heard on audiometric examination. Findings indicate that assessing psychosocial functions does not provide nurses with helpful cues for making the auditory alteration diagnosis. Rather results suggest that nurses can make a more accurate diagnosis merely by knowing the patient's age, self-rating of hearing, and checking ear canals for impacted cerumen.     

Auditory Sensory/Perceptual Alteration: Suggested Revision of Defining Characteristics

This correlational study of acutely ill geriatric patients examined (1) if psychosocial dysfunctioning is associated with hearing impairment, as popularly believed; (2) the utility of using psychosocial changes as cues for making the nursing diagnosis sensory/perceptual alterations: auditory; and (3) an alternative model of defining characteristics for predicting auditory perception using variables that have been reported in the literature as being associated with hearing loss but, to date, are not part of the approved diagnostic category. A random sample (n = 226) was drawn from daily admission lists of English-speaking patients 65 years of age or older, admitted to nonintensive care units of a medical center hospital. The major defining characteristics for sensory/perceptual alterations were operationalized as seven variables: depression, cognitive function, social contact with children, social contact with other relatives, social contact with friends, subject-reported hearing ability, and subject-reported overall health status. Auditory sensory perception was operationalized as number of tones heard on audiometric examination. Findings indicate that assessing psychosocial functions does not provide nurses with helpful cues for making the auditory alteration diagnosis. Rather results suggest that nurses can make a more accurate diagnosis merely by knowing the patient's age, self-rating of hearing, and checking ear canals for impacted cerumen.     

Gerontological nursing. 4: Age-related hearing explored

In the previous three articles in this series (Vol 9(1): 39-42; Vol 9(2): 103-6; Vol 9(3): 157-60), nurses have been challenged to reconsider their approach towards the care of older people. To facilitate this it is helpful to provide specific examples of how expert practice might be achieved. Using one of the most prevalent but neglected problems of old age, hearing disability, the authors describe how nurses can contribute to the health of older people and maximize the therapeutic component within gerontological nursing.     

Healing ourselves, healing others: third in a series

A review of the literature (Part 1 in this series) revealed the power and pitfalls of being female and being a healer. A qualitative study of medical-surgical nurses (Part 2) gave a glimpse of the satisfaction, frustration, and confusion nurses experience as healers. In particular, participants did not engage in regular self-care behaviors and did not articulate ways to create healing environments that would support nurses as well as patients. In this third and final article, implications and recommendations beyond the study will be shared. Education, clinical practice, leadership, and research are aspects of professional nursing that may benefit from these interpretations.     

Older people with dementia in acute settings

This article suggests that screening and assessing for dementia can be incorporated into nurses' roles, as can a range of strategies to address some of the common challenges that nurses face when working with older people with cognitive impairment in acute settings.     

Vision and hearing impairments and their associations with falling and loss of instrumental activities in daily living in acute hospitalized older persons in five Nordic hospitals

Background:  Many older people believe sensory problems are inevitably, a part of growing old, and avoid assessment and help. Such problems are often also overlooked by health professionals. The aim of this study was to find the prevalence of hearing and vision impairment and their associations with loss of instrumental activities in daily living (IADL) and risk of falling in patients aged 75 years or older, admitted to a medical ward in an acute hospital in each of the five Nordic countries.
Method:  The Minimum Data Set for Acute Care was used for data collection in 770 patients. Premorbid data, admission data and history of falls over 3 months were obtained on admission by interview and observation. Hearing impairment was present if the patient required a quiet setting to be able to hear normal speech. Vision impairment was defined as unable to read regular print in a newspaper.
Results:  Bivariate and logistic regression analyses were performed. Forty-eight per cent of the patients had a hearing impairment, 32.3% had vision impairment and 20.1% had both. Hearing impairment was associated with falling but not in the logistic regression model. Hearing and vision impairment were associated with loss of IADL but only combined impairment was independently.
Conclusion:  Hearing and vision impairments were frequent among older patients in the medical wards. Falling was associated with hearing loss and IADL loss with hearing, vision and combined impairments. Sensory loss was also associated with fear of falling. It is recommended routinely to screen sensory functions in older patients in a medical setting. Intervention studies are needed to determine whether improvements in hearing and vision can prevent falls and further loss of function in this patient population.     

Grounded theory in nursing research: Part 1--Methodology

The epistemological underpinnings of grounded theory make it valuable in the study of nursing, which is premised on an interpersonal process between nurses and clients. Further, it is a useful style of research when there is little prior information about a topic. In this article (Part 1), Terence McCann and Eileen Clark outline the key features of this methodology. In the follow-up article (Part 2, McCann and Clark 2003a), a critique is provided of grounded theory and the two main approaches to this methodology. In the final article in the series (Part 3, McCann and Clark 2003b), the authors illustrate how grounded theory can be applied to nursing research with examples from McCann's Australian study (McCann and Baker 2001) of how community mental health nurses promote wellness with clients who are experiencing an early episode of psychotic illness.     

From Frustration to Red Fury: A Description of Work-Related Anger in Male Registered Nurses

This article is Part II of a three part article. Part I described work-related anger experiences of female registered nurses, and in this article findings from a companion study of male RNs are presented. In phenomenological interviews, male nurses described their work environment as hostile, causing them to be on the defensive and less productive. Sources of anger included attacks from physicians, coworkers, and managers; lack of assistance and support from peers; and differential treatment based on gender. The men stated they were called upon for physical tasks rather than for their nursing knowledge. Severed relationships and feelings of guilt, powerlessness, isolation, humiliation, and incompetence were concomitant with, or consequences of, anger. Part III provides recommendations for channeling anger constructively.     

Role transition from caregiver to case manager, part 1

This two-part article explores the process of role transition as it pertains to nurses moving from roles of caregivers to roles of case managers. Part 1 of the article presents a theoretical model that demonstrates the interplay of significant factors in the process of role transition and discusses how this model can be used to examine nurses experience of this transition. Part 2 presents findings from a qualitative study involving interview and focus group data contributed by nurses who have made the transition from caregiver to case manager. Data point to specific tensions experienced by these nurses, which are associated with time-task orientation, interactions and relationships, business culture and objectives, and self-image and professional identity. Recommendations for preparing and supporting nurses through this role are also offered.     

Home visiting programme for older people with health problems: process evaluation

AIM: This paper is a report of a process evaluation of the content, patient compliance and participant experiences of a home visiting programme for older people with self-reported health problems. BACKGROUND: Systematic home visits by nurses to older people are a public health strategy to improve their functional abilities and prevent institutionalization. Evidence of the usefulness of these visits is conflicting, partly due to a lack of information on the intervention process in these programmes. METHOD: One hundred and sixty people (aged 70-84 years) participated in the programme and were visited eight times during an 18-month period (February 2003-October 2004) by experienced home nurses. The nurses recorded key elements of each visit on standard forms: topics discussed, interventions regarding health problems and risks, and compliance with these interventions. Participants' and nurses' opinions on the visits were obtained through interviews at the end of the programme. FINDINGS: Nearly 80% of the group received the complete programme. Problems were detected in nearly all visits, mainly regarding social and psychological functioning, circulatory and musculoskeletal problems, and vision or hearing impairment. On average, ten problems and 11 interventions were recorded per participant. Nearly 40% of interventions related to referrals, 45% to advice and 17% consisted of information-giving. The compliance rate was 65% for referrals and 58% for advice. Both nurses and participants were positive about the programme. CONCLUSION: A health visiting programme, performed by home nurses, is feasible and appreciated by frail elders. The latter seem to be a relevant target population in view of the many and varied problems detected.