Evaluating the impact of hearing and vision support in home care settings

The intervention is a sensory support program for older adults (65y+) with hearing and/or vision impairment who receive home care services. Participants are (1) older adults with hearing and/or vision impairment who receive home care services, and (2) their informal caregiver (e.g., family or friend). Older adults without an informal caregiver are eligible to participate on their own. The sensory support program is a complex intervention. It will be delivered over 3 months with 4 to 6 sessions (duration 1 to 2 hours) in the participant's home. The intervention will be delivered by a trained sensory therapist who is a qualified allied health professional (e.g., an audiologist or optometrist). The Sensory Therapist completed an online training course developed by the research team which took 16 hours. As well they receive 2 days of face-to-face training by the research team one month prior to first participant enrolment. The program provides sensory support to older adults with cognition ranging from normal to moderately severe dementia. . The complete intervention comprises eight components: 1) Identifying sensory needs through a structured interview with the Sensory Therapist to develop their Personalised Sensory Plan, 2) Optimising vision/hearing impairment if required with updated hearing aids and/or spectacles (with Hearing Aids supplied by Starkey Hearing and/or $250 reimbursement towards new spectacles), and by organising appointment with community-based audiologist and/or optometrists and liaising with home care providers to organise transportation to the audiologist/optometrist, 3) Continuous training in correct use of sensory devices will be provided by the Sensory Therapist at each visit. They will provide the older adult and their informal caregiver information on the correct useage, wearing times, handling, maintenance, cleaning and storage of devices with knowledge tested by Hearing Aid Skills and Knowledge Test (HASK) and Glasses Skills and Knowledge Test (GLASK), 4) Home based functional assessment and goal setting: The Sensory Therapist will conduct a home based functional assessment via a structured interview, Using this information and the older adult's Personalised Sensory Plan, the Sensory Therapist will engage in a goal setting exercise with the older adult to determine what they would like to achieve out of the program. 5) Communication training provided by Sensory Therapist to both the older adult and their informal caregiver. Strategies on how to communicate in different settings and scenarios will be explored and discussed, 6) Referral to health and social services: Based on the functional assessments and goals set in component 4, the Sensory Therapist may refer the older adults to health or social care services in the community (e.g., psychological services, low vision services, geriatric psychiatry services, falls clinic, etc.) if required or desired. 7) Fostering social inclusion: In line with the participants' goals set in component 4, the Sensory Therapist will provide information and guidance on opportunities to develop the older adult's hobbies and interests or attend local social groups. 8) Environmental modifications and assistive devices : Based on the functional assessment and goals set in component 4, the Sensory Therapist may arrange and support the use of environmental modifications (e.g., lighting, increasing contrast) or assistive devices (e.g., Personal Amplifying devices, low vision devices, etc.,) to create an environment that supports the sensory needs of the older adult. Each intervention component will be tailored to meet the participant's individual needs dependent on their cognitive ability, hearing and/or vision impairment, current knowledge and skills, access to services, and environmental factors. The sensory support program resources are housed on a Learning Management System (Canvas Instructure). Participants will be enrolled as students in Canvas so that they can access and review the materials and resources at their leisure. Materials housed on Canvas comprise bespoke resources developed for the study as well as resources sourced from organisations. Bespoke resources: Personalised Sensory Plan Questionnaire, Functional Assessment Questionnaire. Educational topics include: Correct usage of hearing/vision devices, One on one communication, Group communication, Written communication, Hearing and Vision Advocacy agencies, Healthy Ageing Advocacy agencies, Hobby/Activity Decision Aid, Audio Description & Subtitling, Modifying the Auditory Environment, Modifying the Visual Environment, Lighting, Modifying the Environment for People with Dementia, Assistive Technologies, Other organisations: Bangor Goal Setting Inventory, Starkey Hearing (Videos – How to Guides for Hearing Aid Use), University of Nottingham (M2Hear Videos), SENSE-Cog Hearing Aids Skills & Knowledge Assessment (HASK), SENSE-Cog Glasses Skills & Knowledge Assessment (GLASK). Strategies to assess adherence to the intervention: Adherence to intervention will check in various ways.(1) hearing aid and glasses correct useage will be assessed at each visit using the HASK and GLASK, (2) both the home care recipient and their informal caregivers will complete a logbook at the end of each visit. This will record the component(s) completed at that visit, any homework or practice they need to complete before next visit. In addition, they will rate the component on its feasibility, acceptability, and appropriateness in the logbooks, (3) the Sensory Therapist will complete a logbook for each visit documenting components completed, duration of visit, and any barriers and enablers to delivering the component, (4) the Sensory Therapist will complete a study logbook each week documenting, number of visits per day, costs incurred, and mileage, The informal caregivers are included in this study to provide support to the older adults with hearing/vision impairment throughout the intervention. This includes attending the sessions with the sensory therapists whenever possible to learn about correct useage of devices and communication strategies, accompanying the older adults to visits to the audiologist/optometrist or other health or social care professionals or services, and helping the older adult to facilitate engagement in social activities as needed.