Sarah White highlights the role of primary care healthcare professionals in identifying and supporting people with dual sensory loss

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1 Dual sensory loss is a growing problem

There are an estimated 250,000 people aged over 70 years with dual sensory loss in the UK, a figure that is set to rise to almost half a million by 2030.1 One in 20 patients over the age of 75 years is likely to have moderate or severe hearing and sight loss; the combination of the two—commonly known as dual sensory loss or deafblindness—can have a serious impact on an individual’s ability to access information and advice on health and wellbeing; other impacts are discussed below. 2

2 Consider the impact on the individual

The impact dual sensory loss has on a person will vary according to the cause, age of onset, and the skills a person has in using their residual sight and hearing. Living independently may be difficult, or even impossible, without receiving some level of support.3

Dual sensory loss can affect many areas of life; for example, it can make healthy eating difficult, as shopping and cooking can become a challenge to do safely. Individuals may struggle to communicate with others and become isolated from friends and family; they may find it hard to read, watch television, or listen to the radio to keep their minds active; or they may not feel safe to go outside, making exercise difficult.

Communicating with healthcare professionals and accessing services is challenging for a person with dual sensory loss, and if they are no longer confident to leave the house on their own they may delay visiting their GP about a health complaint until it is more established.

People with dual sensory loss are likely to have a range of other health conditions. Research has found that those aged 55–84 years are more than twice as likely to have Alzheimer’s disease or another form of dementia if they have a loss of hearing or vision.4

While 69% of individuals with dual sensory loss have two or more additional long-term conditions, only 64% feel confident in managing their own health. Medicines management is also a concern for many people with dual sensory loss and is illustrated by the case study in Box 1, below.

Older people with dual sensory loss are also at increased risk of stroke, arthritis, heart disease, hypertension, falls, and depression. 2,4 Lack of services for people with dual sensory loss has been found to impact on mental health; research by Sense found that 75% of those not in receipt of social care reported problems in their lives including mental health and communication.5 Social engagement is also key; a recent study of care home residents with dual sensory loss found that those with dual sensory impairment who were not socially engaged experienced faster rates of cognitive decline.6

Box 1: Case study—medicines management in a patient with dual sensory loss

Mary, a 76-year-old female with dual sensory loss, visited her GP. The GP gave her a prescription but did not speak very clearly during the consultation so Mary was not entirely sure what the prescription was for. When she went to the pharmacy to collect her prescription there was a lot of background noise so she struggled to hear the instructions from the pharmacists regarding when to take her medication. By the time she got home she had forgotten what the pharmacist had said and could not read the patient information leaflet as the font was too small. She didn’t start the medication for fear of getting it wrong and instead waited for her son to visit so he could read the instructions for her.

4 Identify dual sensory loss in patients

As many older people with dual sensory loss attribute their difficulties to just one more effect of old age, it is essential that we, as healthcare providers, endeavour to identify and support those who walk through our doors. This is true for every member of the primary care team who has contact with the patient at some point in their journey, from receptionists to practice nurses and GPs. Primary care is often the first and most regular point of contact and so it provides an ideal opportunity to identify dual sensory loss in patients; signs and symptoms suggesting dual sensory loss are listed in Box 2, below.

Some older patients may not recognise that they have a problem with their hearing or their sight. Sensory loss may be gradual and people may adapt their behaviour in response to sensory changes, sometimes without realising. Too often individuals and their families think of sensory loss as an inevitable part of ageing only to be expected at their age and do not look for help. Make an effort to identify dual sensory loss in patients and, with their permission, refer them to social services for an assessment as it can lead to improvements in their physical and mental health.

Box 2: Signs and symptoms that suggest dual sensory loss2

Patients with dual sensory loss may:

  • not respond when they are sent written information
  • have to be told several times that it is their turn to see a doctor
  • give answers that don’t relate to the question they were asked
  • nod and smile but their body language tells you they have not understood
  • walk slowly or with less confidence or bump into things
  • read in an unusual way, e.g. holding the paper close to their face
  • ask you to repeat what you have said, or complain that you are mumbling
  • not recognise staff they have met often
  • prefer to talk to staff they have met before because familiar voices are easier to understand
  • find it difficult to find their way to the right room
  • not come to the surgery at all because it is too difficult.

5 Effective communication is key

Work with patients to find the best way to support them with communication and attending appointments. When communicating with a patient with dual sensory loss:2

  • make sure you have the person’s attention before you start
  • good lighting is important. Don’t have the light behind you—for example, don’t sit with the window behind you
  • speak clearly
  • speak a little more slowly than usual but keep the natural rhythm
  • speak a little louder, but don’t shout as this will distort your lip patterns
  • keep your face visible. Don’t cover your mouth with your hand, or speak while looking down
  • take your time. Pauses will allow the person to work out what you said before you start the next sentence
  • repeat phrases if needed. If this doesn’t work, try re-phrasing the whole sentence—some words are easier to lipread than others
  • make the subject clear from the start
  • use short sentences
  • be aware that if the person is smiling and nodding it doesn’t necessarily mean they have understood.

6 Ensure services are accessible

There are many low-cost changes that can help people with sensory impairments access primary care services more easily, including: 2

  • ensuring all areas are well lit
  • utilising colour contrast paints between banister rails, door frames, and walls
  • using large lettering with colour contrasted backgrounds for signs and door labels
  • keeping all floors and walkways clear of obstructions
  • installing a loop system in reception and making sure it is used
  • announcing appointments via a visual display, as well as having names called
  • training staff to ensure they are aware of procedures for booking and assisting patients to appointments, e.g. patient guiding, utilising a text phone, receiving a text relay call.

7 Specialist equipment can help

Even if a patient’s underlying sensory loss cannot be treated, there is a range of equipment available designed to assist with everyday living.7 Equipment such as magnifiers and listening aids can make the most of remaining senses, and items such as vibrating pager doorbells, telephones fitted with a loop, and text phones, can help maintain independence around the home.

Your local sensory team, based within the local authority, can provide an assessment and equipment if required. It is also possible for individuals to purchase assistive equipment from online resource stores at:

For further advice and support on equipment and technology see www.sense.org.uk/content/technologysense

8 Arrange for patient support

Support for people with dual sensory loss is available through social services. There is a statutory requirement for social services to identify deafblind people in their area and offer them a specialist assessment. 8 Even people who cannot get free services are entitled to an assessment and advice about where to get the right support. Most social services have a sensory team, usually with a deafblind specialist worker.

Some people will need extra support to get to the surgery and make best use of their appointment. Some will also need support with communication and accessing information during their time at the surgery. This support can be provided by a Communicator Guide—a support worker who is trained to act as the eyes and ears of the person they are supporting, helping them to get around safely, access information, communicate, and be as independent as possible.2,9

9 Support carers and family too

Friends and families of those with dual sensory loss may need information and advice on how best to provide support. Inform them of the support that is available if the issue arises, or direct them to the Sense Enjoy Life booklet10, which aims to help families understand what an older person is going through, how they can be helped, and where they can go for support.

10 Refer patients on appropriately

If you identify a patient with dual sensory loss who needs additional support:

  • ensure that they have had a recent assessment of their hearing and vision—refer to your local audiology, ophthalmology, or optometry service if needed
  • consider referring them to your local Sensory Team (situated within your local authority) for a specialist assessment. 8

For further information and advice, contact specialist organisations such as Sense, RNIB, Action on Hearing Loss, or Deafblind UK.

References

  1. Emerson E, Robertson J. Estimating the number of people with co-occurring vision and hearing impairments in the UK. Lancaster: Centre for Disability Research, 2010.
  2. Sense. It all adds up—a guide for healthcare staff on supporting patients with a dual sensory loss.Sense, 2015. Available at: www.sense.org.uk/sites/default/files/it_all_ads_up.pdf (accessed 2 June 2015).
  3. Sense website. Introduction to deafblindness.http://www.sense.org.uk/content/introduction-deafblindness (accessed 2 June 2015).
  4. Davies, S. Annual report of the chief medical officer, surveillance volume, 2012: on the state of the public’s health. London: DH, 2014. Available at: www.gulbenkian.org.uk/files/27-05-14-CEL-Alone-in-the-crowd%20-%20loneliness%20 and%20diversity.pdf (accessed 2 June 2015).
  5. Calouste Gulbenkian Foundation. Alone in the crowd: loneliness and diversity. Calouste Gulbenkian Foundation, 2014. Available at:www.gulbenkian.org.uk/files/27-05-14-CELAlone-in-the-crowd%20-%20loneliness%20and%20diversity.pdf (accessed 9 June 2015).
  6. Yamada Y, Denkinger M, Onder G et al. Dual sensory impairment and cognitive decline: the results from the shelter study. J Gerontol A Biol Sci Med Sci. doi: 10.1093/gerona/glv036 (Epub ahead of print, April 2015).
  7. Sense website. Everyday-living aids. www.sense.org.uk/content/everyday-living-aids (accessed 2 June 2015).
  8. Department of Health. Care and support for deafblind children and adults policy guidance.DH, December 2014. Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/388198/Care_and_Support_for_Deafblind_Children_and_ Adults_Policy_Guidance_12_12_14_FINAL.pdf. pdf (accessed 2 June 2015).
  9. Sense website. Communicator guides. www.sense.org.uk/content/communicator-guides (accessed 2 June 2015).
  10. Sense website. Enjoy life. www.sense.org.uk/content/enjoy-life (accessed 2 June 2015).