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

Abstract

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.

The 2022 symposium on dementia and brain aging in low‐ and middle‐income countries: Highlights on research, diagnosis, care, and impact

“…However, study recruitment, timely hearing aid delivery, procedures for arranging home visits, and communication between referring clinicians and the study team were identified as areas in need of improvement. 70 …”

“…Preliminary findings from Pakistan demonstrated positive feasibility, acceptability, and tolerability of the intervention by study participants. However, study recruitment, timely hearing aid delivery, procedures for arranging home visits, and communication between referring clinicians and the study team were identified as areas in need of improvement 70 …”

Equity and balance in applied dementia research: A charter of conduct and checklist for global collaborations

“…The 'Balanced Partnership for Dementia Research Checklist' (Table 3), when applied to two ongoing dementia studies with LMIC-HIC collaborations 35,36 revealed scores of 18 out of a total score of 27 (66% of the total score) and 16 out of a total score of 22 (5 'not applicable' items, thus the total score was lower; 72% of the total score), respectively, where a higher score is better. The higher percentage score attained by the Brazil-France study reflects a greater maturity of the collaboration achieved over time and greater awareness of the recommendations outlined in our Charter of Conduct.…”

“…To test the utility of the checklist, we applied it to two existing LMIC‐HIC dementia research collaborations, the SENSE‐Cog Asia project, 35 which is adapting a sensory support intervention for people with dementia in three South Asian countries (Bangladesh, India and Pakistan) in collaboration with UK investigators, and a data‐mining collaborative study on Theory of Mind in Alzheimer disease, conducted between colleagues in Brazil and France 36 …”