Janis McDonald discusses how deafscotland is using World Alzheimer’s Awareness Month to highlight the established link between dementia and hearing loss
It’s in our collective interest to commit to more research to better understand the challenges we face. Additionally, we need to capitalise on the existing knowledge base, so that we can create and plan services that manage dementia differently.
In 2017, the Lancet Commission on Dementia Prevention reported that 35% of dementia could be potentially prevented by modifying 9 risk factors. The three most common were poor early school education, hearing loss in mid-life (age 45-65) and smoking. Although these findings were updated in July 2020 when a new Lancet Commission study added a further three, making a total of 12, the three most common risk factors remain the same.
Realising that a life-long perspective is needed to address dementia rather than thinking of it as something that only happens later in life, offers a huge window for positive interventions by individuals and government. However, we need informed conversation to move practice along, both within and across the public service.
Our recent report summaries research, funded by the Life Changes Trust and carried out by us, in partnership with Queen Margaret University. This research was aimed at providing prevalence rates for hearing loss and dementia to help with the planning of health and social care.
By drawing on research and data, we believe the medical and social sectors can combine to deliver creative and rights-based solutions that can support people living with dementia. For example, by improving attainment at school, the promotion of BSL, improving communication techniques and enabling greater hearing aid use to help prevent cognitive decline and improve the quality of life for older adults.
However, too often audiology services are not treated as a priority. During lockdown, deafscotland was contacted by people from various parts of Scotland who complained their local services were closed because they were considered non-essential. Also, we were told that hearing aid repairs were impossible, and batteries could not be sourced despite needing to be replaced on a weekly basis. Audiology services are a key part of the ‘whole person’ approach to physical and mental health.
During the research process, various issues were highlighted. There was an absence of statistics on the prevalence of hearing loss as these figures were not captured at GP level. This lack of recording meant that it was impossible to obtain figures for those with hearing loss and dementia. The report’s authors compensated by developing a complex statistical analysis of current figures and were able to provide regional prevalence estimates for those with hearing loss and dementia, projecting these figures into future decades. As a result of this research, Scotland now has some indication of the likely pressure on related services which enables future local planning. The report gives a prevalence rate for each of the 32 local authorities so please check out your area. For example, researchers found that the highest prevalence rate can be found in Dundee City with 11.02% and the lowest in North Ayrshire with 5.03% so there are marked variations requiring a nuanced response.
Listening to audiology staff, the pressures within the system are clear, but some big issues are avoidable. It was pointed out that staff need to be told in advance that a patient has dementia, so a longer appointment is made. Training in care homes was also identified as key but viewed as ‘problematic and difficult to maintain due to high staff turn over’. Unsurprisingly, staff acknowledge more work is needed with the families of patients so they know about hearing loss and are given training on procedures regarding using and maintaining hearing aids. This fits well with deafscotland’s “Communication For ALL” campaign.
The current research landscape on hearing loss and dementia is vibrant so we can expect to know much more in the near future. What we do with this knowledge is the real challenge in Scotland. The impact of lockdown also needs to be factored in as social isolation, may speed up the pace of cognitive decline and dementia in older adults. We know enough now to plan services better and a national plan with local roll out is a sensible approach
Alzheimer Scotland believes there are about 90,000 people with dementia in Scotland and around 3,000 of these people will be under the age of 65. There is significant underreporting so we know the figures are higher. deafscotland is clear each is an individual with a family, friends and social circle. To help them all, it is time the well established link between hearing loss and dementia is explicitly acknowledged and moved from the margins to the mainstream so that it can influence governmental policy and funding decisions.
Janis McDonald is chief officer of deafscotland