Assessing and managing concurrent hearing, vision and cognitive impairments in older people: an international perspective from healthcare professionals

Age Ageing. 2019 Jul 1;48(4):580-587. doi: 10.1093/ageing/afy183.


Background: there is a significant gap in the understanding, assessment and management of people with dementia and concurrent hearing and vision impairments.

Objective: from the perspective of professionals in dementia, hearing and vision care, we aimed to: (1) explore the perceptions of gaps in assessment and service provision in ageing-related hearing, vision and cognitive impairment; (2) consider potential solutions regarding this overlap and (3) ascertain the attitudes, awareness and practice, with a view to implementing change.

Methods: our two-part investigation with hearing, vision, and dementia care professionals involved: (1) an in-depth, interdisciplinary, international Expert Reference Group (ERG; n = 17) and (2) a wide-scale knowledge, attitudes and practice survey (n = 653). The ERG involved consensus discussions around prototypic clinical vignettes drawn from a memory centre, an audiology clinic, and an optometry clinic, analysed using an applied content approach.

Results: the ERG revealed several gaps in assessment and service provision, including a lack of validated assessment tools for concurrent impairments, poor interdisciplinary communication and care pathways, and a lack of evidence-based interventions. Consensus centred on the need for flexible, individualised, patient-centred solutions, using an interdisciplinary approach. The survey data validated these findings, highlighting the need for clear guidelines for assessing and managing concurrent impairments.

Conclusions: this is the first international study exploring professionals' views of the assessment and care of individuals with age-related hearing, vision and hearing impairment. The findings will inform the adaptation of assessments, the development of supportive interventions, and the new provision of services.

Keywords: cognitive impairment; dementia; expert reference group; hearing; older people; vision.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cognitive Dysfunction / diagnosis*
  • Cognitive Dysfunction / therapy*
  • Consensus
  • Dementia / diagnosis
  • Dementia / therapy
  • Health Care Surveys
  • Health Knowledge, Attitudes, Practice
  • Hearing Loss / diagnosis*
  • Hearing Loss / therapy*
  • Humans
  • Interdisciplinary Communication
  • Internationality
  • Memory Disorders / diagnosis
  • Memory Disorders / therapy
  • Vision Disorders / diagnosis*
  • Vision Disorders / therapy*