Work-Package 3: Intervention

Intervening to improve sensory function could be a means by which the lives of people living with dementia (PwD) may be improved. Despite this, very few studies have tried to improve outcomes in dementia by supporting sensory function. However, straightforward correction of hearing and vision impairments in the context of more serious cognitive deficits such as dementia is unlikely to succeed. This is due to the added complexity of concurrent deficits as well as the low rate of access to vision and hearing services in older adults.  Clearly, a more comprehensive approach to improving outcomes in PwD and sensory impairment is required. A possible solution to this issue is to provide added ‘sensory support’ to PwD who live at home. Thus, the goal of Work Package 3 is to develop a ‘sensory support intervention’ that can be trialled in PwD who have hearing and/or vision problems to improve their quality of life. To do this, we undertook a series of studies to gather the components and method of implementation of such an intervention. The studies were part of a process of ‘intervention mapping’ in which we did the following:
• scoping the gaps in understanding, awareness and service provision for the hearing and/or vision impairment care needs of PwD by means of a systematic literature review and Expert Reference Group;
• investigating the specific support care needs through stakeholder surveys, focus groups, semi-structured interviews and an Expert Reference Group, leading to a prototype sensory support package;
• refining the prototype intervention by additional input from stakeholders using focus groups and semi-structured interviews; and
• field testing the draft intervention using an open-labelled, non-randomised feasibility study to develop the final intervention and implementation methods ready for full scale definitive trialling.

Within this Work Package (WP), our work to date as also included formation of the SENSE-Cog ‘Trial Development Team’ to develop the study protocol, training materials, and Standard Operating Procedures for the full-scale, multi-centred randomised controlled trial (RCT) of the newly developed ‘sensory support intervention’ that is due to start in January 2018. This work also entailed developing the role of the ‘sensory support therapist’ (a new type of professional), training materials and treatment manual for this role. A ‘prototype’ therapist and senior therapist joined the team to take this work forward in preparation for the RCT. The protocol and RCT materials have now being submitted for ethical and other approvals.

Results and potential impact

This is the most comprehensive programme to address the crucial issue of the growing number of people in the European Union (EU) with comorbid dementia, hearing and vision impairment. Taking place in several EU countries, it has used a range of research methods to integrate different levels of evidence to address a key EU societal objective – improving mental-well in elderly people. At this point, the WP3 intervention development programme represents the logical development and modelling of a complex intervention to fulfil an unmet need. It is based on a theoretical framework and has formed the basis of the upcoming full scale SENSE-Cog efficacy trial. We have now determined: (1) the causal assumptions about mechanisms of change through which the intervention may work and created a logic model; (2) the method to assess participants’ level of hearing and vision impairment and range of functional needs in a home-based setting; (3) how the intervention will be tailored to the specific needs of the participant; (4) what the individual components (e.g. modules) of intervention will be; and (5) how the intervention will be implemented (e.g. duration, frequency and delivery of each component); and (7) how the intervention will work in the context of different EU settings.