Adult Audiology —
Training activity: 7

Details

Manage care delivery for patients with the following intellectual disabilities or cognitive impairments, using appropriate modifications management techniques:

• Normal age-related cognitive decline
• 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
• Safeguarding
• Issues of capacity, consent, and best-interest decisions
• Effective communication and counselling
• NHS Accessible Information Standard
• Scope of practice
• Onward referrals
• Patient experience
• Referral information
• Range of management techniques
• Effects of peripheral and central decline in the auditory pathways
• Environmental modifications at home
• Setting of appropriate expectations
• Methods of hearing aid verification
• Hearing aid fitting considerations
• Hearing aid compression ratios and speeds
• Aided detection/recognition measures
• Alternative listening devices
• Home visits
• Formatting of written/pictorial information

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 principles of managing audiological care for individuals with different cognitive impairments?
• Consider reviewing information on technological options or adaptations for those with additional needs.
• What communication and counselling strategies are most effective?
• Discuss with your training officer specific management approaches used in your department.
• What challenges do you anticipate in ensuring effective care delivery and adherence to management plans for these patients?
• Think about the role of carers and significant others. What do you already know about managing hearing loss in the context of cognitive impairment?
• Consider potential difficulties in patient recall and understanding and how you might address them.
• Think about the importance of providing clear and accessible information and involving carers in the management process.
• Think about what multidisciplinary teams and pathways may exist locally for these patient groups.

In action

• How are you modifying your standard management techniques (e.g., hearing aid fitting, counselling) to suit the patient’s cognitive abilities? What specific adjustments are you making to device selection, fitting procedures, and counselling strategies?
• What decisions are you making regarding the involvement of caregivers, the simplicity of instructions, the frequency of follow-up, and the use of memory aids?
• How are you communicating management plans and device usage to the patient and their support network in a clear and understandable way?
• How effective are your modified management techniques in improving the patient’s hearing and quality of life?
• What challenges are you encountering in ensuring the patient can use and maintain their hearing devices or adhere to the management plan?
• What can you learn from the patient’s and caregivers’ feedback on the practicality and effectiveness of the modified management plan?
• Are there alternative management approaches or technologies you could explore if the current plan is not successful?
• What additional resources or support services might be beneficial for the patient and their caregivers?
• Are you ensuring that the management plan respects the patient’s autonomy and cognitive limitations while promoting their well-being?

On action

• Describe the key modifications you made to the standard care delivery approach. What specific management techniques did you employ to accommodate the patient’s cognitive profile? How did these techniques impact the patient’s understanding, engagement, and adherence to the management plan? What role did carers or significant others play in the management process?
• What effective management strategies did you discover for patients with different types and levels of cognitive impairment? Were there any unexpected difficulties or successes in implementing modified management techniques? What did you learn from these? How did your real-time adaptations influence the effectiveness of the care delivery? How does this experience relate to promoting independence and quality of life for individuals with cognitive challenges?
• What areas for continued development in managing the care of patients with cognitive impairments have been identified? How will you apply the insights gained to future care delivery for this patient group? What specific actions will you take to further develop your skills and knowledge in this area? What resources or support would enhance your ability to provide optimal care?

Beyond action

• Considering different strategies you’ve employed to manage care delivery for patients with cognitive impairments, which modifications have yielded the most positive outcomes in your experience?
• How have these experiences highlighted the importance of tailored management plans and the need for flexibility in service delivery for these individuals?
• Can you identify specific management techniques you’ve learned in this DTA that you now apply, in a modified form, to other patients with communication or processing difficulties?
• How has your understanding of the support networks and resources available for individuals with cognitive impairments and their families developed through this activity?
• What future training or professional development will you pursue to further refine your skills in managing the care of patients with intellectual disabilities or cognitive impairments?
• Can you think of any multidisciplinary teams or pathways that could benefit these patients but do not currently exist locally? How would you initiate action to set these up?

Relevant learning outcomes

#	Outcome
# 2	Outcome Apply shared decision-making to develop an individualised management plan and counselling for adults with hearing loss and other auditory difficulties, taking into account differing cultural and social attitudes to hearing care.
# 3	Outcome Evaluate individual patient outcomes and safely manage a range of routine and complex hearing losses.
# 4	Outcome Practice within their own personal and professional scope, identifying where onward referral is appropriate.