SENSE-Cog Asia: A Feasibility Study of a Hearing Intervention to Improve Outcomes in People With Dementia

• Published in: Frontiers in neurology Vol. 12; p. 654143
• Main Authors: Sheikh, Saima, Tofique, Sehrish, Zehra, Nosheen, Amjad, Rabia, Rasheed, Maham, Usman, Maria, Lal, Shanker, Hooper, Emma, Miah, Jahanara, Husain, Nusrat, Jafri, Hussain, Chaudhry, Nasim, Leroi, Iracema
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 14-06-2021
• Subjects: acceptability; dementia; feasibility; hearing impairment; LMICs; Neurology; tolerability
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2021.654143

Background:
There are few evidence-based non-pharmacological interventions adapted for people with dementia (PwD) in lower- and middle-income countries (LMIC). Thus, there is value in culturally adapting existing interventions from other settings. One such intervention for PwD involves hearing rehabilitation, which may improve dementia-related outcomes.
Objective:
To culturally adapt and evaluate the feasibility and acceptability of a multi-faceted hearing support intervention to enhance quality of life in PwD for a LMIC setting, Pakistan.
Design:
This was a study in three phases: (1) training and capacity building to deliver the study, including Patient and Public Involvement (PPI); (2) cultural adaptation of the intervention; and (3) delivery of a single-group feasibility study with a pre-test post-test design.
Setting:
Home-based intervention, in two cities of Pakistan.
Participants:
Adults aged ≥ 60 with mild-moderate dementia and uncorrected or partially corrected hearing impairment, and their study partners (
n
= 14).
Intervention:
An adapted hearing support intervention (HSI) comprising a full assessment of hearing function, fitting of hearing aids, and home-based support from a “hearing support practitioner.”
Outcomes:
Ratings of the feasibility of the study procedures, and acceptability/tolerability of the adapted intervention were ascertained through questionnaires, participant diaries, therapist logbooks and semi-structured interviews. A signal of effectiveness of the intervention was also explored using a battery of dementia-related outcome measures.
Results:
Following cultural adaptation and capacity building for study conduct and delivery, we successfully implemented all intervention components in most participants, which were well-received and enacted by participant dyads. Acceptability (i.e., understanding, motivation, sense of achievement) and tolerability (i.e., effort, fatigue) ratings and safety of the intervention were within
a priori
target ranges. Recruitment and retention targets required improvement, due to the COVID-19 pandemic outbreak, as well as the lack of a clear clinical diagnostic pathway for dementia in both sites. Areas for future modification were clearly identified, including: the assessment/delivery logistics circuit; procedures for arranging visits; communication among referring clinicians and the study team.
Conclusion:
This is the first study in a LMIC of sensory enhancement to improve dementia outcomes. Positive feasibility, acceptability and tolerability findings suggest that a full-scale effectiveness trial, with certain modifications is warranted.