Developing a multi-domain hearing and vision intervention for people with dementia in long-term care

Background: There is a high rate of unrecognised hearing and vision loss in people with dementia (PwD), particularly in long-term care (LTC) settings. This can worsen cognitive and functional decline, contribute to neuropsychiatric challenges, and increase health resource utilisation. This paper describes the modelling and development of a multi-faceted sensory health support intervention for people with dementia in LTC, co-designed with patient and public involvement (PPI) members. Methods: A draft sensory support intervention (SSI) for LTC was co-developed in an iterative manner through collaboration with interdisciplinary health experts, LTC professionals and researchers. In stage 1, we developed the outline of an intervention by, (1) extending an already evaluated home-based SSI conducted with individuals with mild-moderate dementia and hearing and/or vision loss living at home, (2) using evidence from a recent systematic survey of hearing rehabilitation for interventions for PwD in LTC; and (3) adapting a theoretical framework for the intervention, the Sensory-Cognitive Model of Place. In stage 2, qualitative feedback from professionals and PPI members on the draft intervention and intelligence regarding existing sensory healthcare training approaches were combined to produce a multi-component SSI-RC ready for field testing in a single LTC facility in stage 3. Based on the feedback from this phase, final design modifications were implemented, and the final SSI-RC prepared for pilot-feasibility trialling. Results: The SSI-RC was developed to comprise the following tiered intervention components: (1) Person with dementia level - personalised sensory health status check and record development, sensory assessment, device fitting, and adherence support; (2) Staff level – awareness training of care staff and sensory champions; (3) Environmental level – auditing and addressing sensory environments within the LTC facilities; and (4) Organisational level – mapping existing sensory care provision by community-based providers. Conclusion: We have successfully developed, and field tested a multi-tiered sensory support intervention suitable for trialling in LTC facilities in a cluster randomised pilot trial. Clinical Trial Registration: ISRCTN, ISRCTN14462472. Registered 24 February 2022, https://doi.org/10.1186/ISRCTN14462472