Adult Audiology —
Training activity: 6

Details

Adapt or modify a routine assessment for patients with intellectual disabilities or cognitive impairments, including those with:

• Normal age-related cognitive decline
• Mild cognitive impairment (MCI)
• Dementia
• Learning disability

Type

Developmental training activity (DTA)

Evidence requirements

Evidence the activity has been undertaken by the trainee​.

Reflection on the activity at one or more time points after the event including learning from the activity and/or areas of the trainees practice for development.

An action plan to implement learning and/or to address skills or knowledge gaps identified.

Considerations

• Principles of patient-centred care
• Issues of capacity and informed consent
• Local, national, and international guidelines and standards
• Range of intellectual or cognitive impairment
• Patient centred care and support Effective communication and counselling
• Patient experience
• Modifications to the clinical environment and case history
• Modifications to audiometry presentation, approach, and patient responses
• Other diagnostic tests, including: speech testing, diagnostic otoacoustic emissions and acoustic reflex thresholds

Reflective practice guidance

The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.

Before action

• What are the key considerations when assessing individuals with different types and levels of cognitive impairment?
• Consider reviewing information and national guidelines on patient-centred care for those with dementia, learning disabilities, and MCI.
• What alternative assessment techniques or modifications to standard tests might be appropriate?
• Discuss with your training officer specific strategies used in your department.
• What are the potential challenges you foresee in adapting routine assessments for these patients?
• Think about how you will maintain their engagement and understanding.
• What do you already know about cognitive impairments and how they might affect the assessment process?
• Consider potential difficulties in obtaining subjective responses and how you might address them.
• Think about the importance of clear and simple communication during the assessment.
• What other healthcare professionals could you need to collaborate with to ensure more effective assessment and management for these patients?
• Think about how you may need to engage with and involve family, friends, or care-givers in the appointment with these patient groups.

In action

• How are you adapting the routine assessment procedures to suit the cognitive abilities of the patient? What specific modifications are you making to test instructions, response methods, and the overall structure of the assessment?
• What decisions are you making regarding the use of visual aids, simplified language, repetition, and breaks during the assessment?
• How are you interacting with the patient and any accompanying caregivers to ensure a comfortable and successful assessment?
• How successful are your adaptations in obtaining meaningful information about the patient’s hearing?
• What challenges are you facing in maintaining the patient’s attention and cooperation throughout the assessment?
• What can you learn from the patient’s responses (verbal and non-verbal) and their level of engagement with the adapted assessment?
• Are there other adaptive strategies you could try if the patient is struggling with the current modifications?
• What information from the patient’s history or caregivers could further inform your approach to the assessment?
• Are you working within your level of competence in assessing patients with intellectual disabilities or cognitive impairments, and when might it be appropriate to seek further guidance?

On action

• Summarise the key adaptations or modifications you implemented during the routine assessment. What specific cognitive or intellectual challenges did the patient(s) present? Which adaptation techniques proved most effective or ineffective in obtaining reliable assessment data? How did you adjust your communication style and the pace of the assessment?
• What new strategies or techniques did you learn for assessing patients with intellectual disabilities or cognitive impairments? Were there any surprising aspects or unexpected outcomes during the adapted assessments? What did you learn from these? How did your ‘in-the-moment’ adjustments impact the assessment process and the patient’s engagement? How does this experience align with best practices for assessing individuals with cognitive challenges?
• What areas for further development in assessing this patient population have you identified? How will you incorporate the lessons learned into your future practice when assessing patients with cognitive impairments? What specific next steps will you take to improve your skills and knowledge in this area? What resources or support would be valuable for your continued learning?

Beyond action

• Reflecting on various instances of adapting assessments for patients with cognitive impairments, what adjustments have you found to be consistently effective? Are there any approaches you have refined or discarded?
• How have these experiences increased your awareness of the communication and cognitive challenges faced by these patient groups and influenced your general communication style in audiology appointments?
• In what ways has your learning from this DTA informed your understanding of how cognitive status can impact the reliability and interpretation of audiological test results in other patient groups?
• How has your understanding of appropriate questioning techniques and the involvement of carers or support individuals evolved through these experiences?
• What future steps will you take to deepen your knowledge and skills in assessing individuals with intellectual disabilities or cognitive impairments?

Relevant learning outcomes

#	Outcome
# 1	Outcome Use a range of tests to safely assess the extent and nature of auditory problems in adults, including those with complex aetiologies, complex audiological configurations and comorbidities.