Strategies used during the cognitive evaluation of older adults with dual sensory impairment: a scoping review

Abstract

Background: Dual sensory impairment (DSI), the combination of visual and hearing impairments, is associated with increased risk for age-related cognitive decline and dementia. Administering cognitive tests to individuals with sensory impairment is challenging because most cognitive measures require sufficient hearing and vision. Considering sensory limitations during cognitive test administration is necessary so that the effects of sensory and cognitive abilities on test performance can be differentiated and the validity of test results optimized.
Objective: To review empirical strategies that researchers have employed to accommodate DSI during cognitive testing of older adults.
Methods: Seven databases (MEDLINE, Embase, Web of Science, CINAHL, PsycINFO, Global Health and the Evidence-Based Medicine Reviews databases) were searched for relevant articles integrating the three concepts of cognitive evaluation, aging, and DSI. Given the inclusion criteria, this scoping review included a total of 67 papers.
Results: Twenty-eight studies reported five categories of strategies for cognitive testing of older adult participants with DSI: the assistance of experts, the modification of standardized test scoring procedures, the use of communication strategies, environmental modifications, and the use of cognitive tests without visual and/or auditory items.
Conclusions: The most used strategy reported in the included studies was drawing on the assistance of team members from related fields during the administration and interpretation of cognitive screening measures. Alternative strategies were rarely employed. Future research is needed to explore the knowledge-to-practice gap between research and current clinical practice, and to develop standardized testing strategies.

Plain Language Summary

Administering cognitive tests to individuals living with sensory impairment is a challenging task because both vision and hearing are needed to complete commonly used tests. Still, researchers use these tools when measuring cognition in individuals living with combined vision and hearing loss. We were interested in exploring whether researchers use strategies to compensate for vision and/or hearing impairment during the administration of cognitive tests to their older participants. We reviewed the research literature for studies that evaluated cognition in older adults (65+) living with combined vision and hearing impairment. Of the 67 articles we found, only 27 used strategies to address participants’ vision and hearing difficulties. We grouped these strategies into four categories: the help of experts, the modification of standardized tests’ scoring, the use of cognitive tests without visual and/or auditory items, and the application of communication and environmental strategies. This review shows that even though some researchers made an effort to accommodate their participants with sensory impairments, the strategies they used were not applied in a standardized manner. That is, the strategies vary and are inconsistent from one study to the next. The next step in this research is to develop better ways to test cognition that are the least affected by sensory ability.