SENSE-Cog European Research Project
Age-related hearing loss, vision impairment and the onset of dementia can have a devastating combined impact on those affected. This is the focus of a European research project called SENSE-Cog. It aims to promote health for eyes, ears and the mind. The project is led by the University of Manchester.
Some 70% of adults in Europe aged over 65 have problems with their vision or hearing. In addition around two-thirds of over-65s suffer from depression or dementia. Both can be mediated with improved sight and hearing even though they are very different. The multiple effects of two or three impairments are much greater than the individual conditions. SENSE-Cog looks to improve understanding of this combined impact on patients. They hope that new tools and improved support in the home and treating the conditions in unison will improve the lives of patients. In addition, this could result in better use health and social-care budgets throughout Europe.
The four-year project receives financial support from the EU’s Framework Programme for Research and Innovation, Horizon 2020.
HeAL 2018 – SENSE-Cog Hearing Research Summary
At the beginning of June, Alan Hopkirk, Clinical Director at The Invisible Hearing Clinic attended HEAL 2018 – the bi-annual hearing conference at Lake Como in Italy. The SENSE-Cog project was of particular interest.
The SENSE-Cog Intervention Field Trial
In one study, a new home-based intervention took place involving 24 participants with dementia and their carers. The venues were Bordeaux, Manchester and Nicosia. This included an investigation of the sensory loss as well as the supply of hearing or visual aids. Extra support in the home via trained sensory support staff was also provided. Suggestions were given regarding improved communication, changes to the environment and referrals for further support.
Participants and their carers completed a set of qualitative questions before and two weeks after the intervention. This helped to evaluate the outcomes of the field trial.
For this vulnerable group and their carers, the attendance of the sensory support therapist was of great benefit. Home treatment resulted in improved compliance and treatment. Furthermore, the study stressed the importance of the provision of updates regarding the sensory impairment together with training in the use of corrective devices and communication skills.
Impaired Hearing and Dementia
For Dr Piers Dawes, Senior Lecturer in Audiology and Sense-Cog researcher, the possibility of preventing the onset of dementia by treating impaired hearing is intriguing. He notes that all the studies on the subject are correlational and therefore prevent the establishment of a direct causal link between impaired hearing and dementia. He does, however, suggest that the process may work the other way round too. This is covered in an article entitled Hearing Impairment and Dementia penned for BSHAA’s magazine BSHAA People.
Hearing Affects Cognition
Dr Dawes notes that there are various ways in which hearing impairment can affect cognition. An increased “listening effort” may reduce the available brain capacity for other tasks (Rabbit 1968 Hearing and IQ). A further possibility is that a long-term hearing problem may cause a permanent reduction in the cognitive function. Finally, and perhaps most plausibly, problem hearing may lead to social isolation and depression according to Dr Dawes and his colleagues, which may, in turn, lead to poor cognitive performance and an increased risk of dementia.
Cognition Affects Hearing
On the flip side, because hearing is a cognitively taxing activity it could be that cognition affects hearing. Dr Dawes explains that whilst someone may appear to have impaired hearing, in fact, their difficulties result from cognitive problems. Hearing is a complex process that relies on sustained focus on relevant sounds whilst filtering out irrelevant noise. Added to this, is the need to keep updating information and referencing the stored information in our memories to make sense of what we have heard.
As we age and become hard of hearing, we might use more of our cognitive function to process sound. Executive functions require increased effort. Someone of advanced years and poor mobility may lose focus on their motor skills as they are distracted by a conversation and fall as a result. Appropriate hearing devices can help. The wearer is more able to focus on other functions because the listening effort is less.
Reducing Listening Effort
A traditional hearing test won’t necessarily pick up problems with cognition. A patient may be able to concentrate on the sounds generated during a hearing test for a few minutes and produce acceptable and therefore misleading results. However, this is quite different from the environmental factors that are in play during our everyday lives. The burden of sustained listening and concentration can be huge however and those with impaired hearing are at the mercy of many external factors. A loud television, a busy room, multiple conversations happening at once or the proximity and the facing direction of someone talking can all increase the listening effort required.
How Relatives and Carers Can Help Reduce Listening Effort
The role of friends, relatives and carers is vital in helping motivating someone with impaired hearing. It is easier to focus on speech if background noise is reduced or eliminated. Careful pronunciation and articulation of words can also help the hard of hearing as can thoughtful positioning of seating where speakers are clearly visible. In this way, those with impaired hearing will benefit from a reduced listening effort and therefore be more inclined to participate in social intercourse and adopt strategies for improved hearing. This might include actually using their state-of-the-art hearing devices!
The Biopsychosocial Model in Relation to Hearing Impairment
The Biopsychosocial Model of health first put forward by Engel in 1977 suggests that behaviours, thoughts and feelings can impact the physical state. He challenged a long-held belief that only the biological elements of health and disease are worthy of investigation. For him, psychological and social factors can impact our biological function as well as our health and illness.
If we look to apply this to hearing impairment, then the biomedical model might rely on the dispensing of hearing aids as a catch-all solution whereas the biopsychosocial model looks at many more environmental factors. In a care home setting, for example, structured care plans could act as bespoke interventions which could complement the use of hearing aids and accessories. Replacing commodity-based solutions with a more holistic approach may result in improved interactions between staff, residents and hearing professionals. Staff will be empowered to work more effectively towards improved interactions with their patients or residents. This won’t however necessarily result in extra work.
We appear to have underestimated the impact of impaired hearing on mental health. An earlier intervention and treatment of hearing loss could reduce the cost and physical impact of dementia. In addition, a bespoke person-centred approach to hearing care, that includes a wider-reaching assessment of a patient’s needs and underlying conditions might see better results.