Screening for hearing, visual and dual sensory impairment in older adults using behavioural cues: A validation study

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Abstract

Objective

This study investigated the psychometric properties of the Severe Dual Sensory Loss screening tool, a tool designed to help nurses and care assistants to identify hearing, visual and dual sensory impairment in older adults.

Design

Construct validity of the Severe Dual Sensory Loss screening tool was evaluated using Crohnbach's alpha and factor analysis. Interrater reliability was calculated using Kappa statistics. To evaluate the predictive validity, sensitivity and specificity were calculated by comparison with the criterion standard assessment for hearing and vision. The criterion used for hearing impairment was a hearing loss of ≥40 decibel measured by pure-tone audiometry, and the criterion for visual impairment was a visual acuity of ≤0.3 diopter or a visual field of ≤0.3°. Feasibility was evaluated by the time needed to fill in the screening tool and the clarity of the instruction and items. Prevalence of dual sensory impairment was calculated.

Results

A total of 56 older adults receiving aged care and 12 of their nurses and care assistants participated in the study. Crohnbach's alpha was 0.81 for the hearing subscale and 0.84 for the visual subscale. Factor analysis showed two constructs for hearing and two for vision. Kappa was 0.71 for the hearing subscale and 0.74 for the visual subscale. The predictive validity showed a sensitivity of 0.71 and a specificity of 0.72 for the hearing subscale; and a sensitivity of 0.69 and a specificity of 0.78 for the visual subscale. The optimum cut-off point for each subscale was score 1. The nurses and care assistants reported that the Severe Dual Sensory Loss screening tool was easy to use. The prevalence of hearing and vision impairment was 55% and 29%, respectively, and that of dual sensory impairment was 20%.

Conclusions

The Severe Dual Sensory Loss screening tool was compared with the criterion standards for hearing and visual impairment and was found a valid and reliable tool, enabling nurses and care assistants to identify hearing, visual and dual sensory impairment among older adults.

Section snippets

Background

Sensory impairment is widespread among older adults; however the consequences for daily life are often overlooked. The percentage of hearing and visual impairment in the group aged 80 and older was found to be 78% and 31% respectively; 25% of them suffered a dual sensory impairment (DSI), i.e. the combination of a hearing and a visual impairment. The highest percentages were found among older adults living in residential care settings (Vaal et al., 2007). Although age-related sensory impairment

Translation of the SDSL screening tool

The original Norwegian authors produced both a Norwegian and an English version of their SDSL screening tool. With their permission, the English version was translated into Dutch by the researchers (authors LR and SZ) and back-translated into English by an independent native English speaker who was blinded to the original questionnaire (Sperber, 2004). Both English-language versions were subsequently compared and problem items were revised by a committee consisting of the researchers (authors

Participants

A total of 83 older adults who met the age criterion were invited to participate in the study. Written consent was obtained from 60 individuals, no consent was obtained by legal guardians. Four older adults had missing data because they were hospitalized (n = 2) or had moved to a nursing home elsewhere (n = 2). Among the remaining 56 older adults, 22 lived in a residential setting, 34 lived at home, of whom 20 visited a social day centre and 14 visited a day centre with rehabilitation services. Age

Discussion

We found that the SDSL screening tool is a valid, reliable, and easy-to-administer tool to identify sensory impairment among older adults. Moderate to good sensitivity and specificity were found for the hearing and visual subscales. The internal consistency of the items was strong and the interrater reliability of the tool was substantial. Factor analysis identified two domains in the hearing subscale (social environment and individual environment) and two domains in the vision subscale (daily

Conclusions

In healthcare, the impact of hearing and visual impairment is underestimated and the mutual negative influence on cognitive functioning and depressive behaviour neglected. Older adults need social and environmental support in addition to medical treatment and technical device use. Nurses and care assistants have a key role in recognizing behaviours and in maximizing communication and functional opportunities. The SDSL screening tool is developed for use by nurses and care assistants to identify

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