Abstract
The World Health Organisation’s World Report on Hearing (2021) states that governments should recognise Age-Related Hearing Loss (ARHL) as a public health priority. The Global Burden of Disease study (2019) reports that ARHL is the primary cause of Years Lived with Disability (YLD) for people over the age of 70. By 2050, those living with deafness is set to increase by 50%. Moreover, deafness is the largest modifiable risk factor for dementia (Livingston et al. 2017;2020).
Deafness is highly prevalent in the older adult care home population. Prevalence of visual impairment is also high, as is dual sensory loss. Unsupported deafness increases the risk of depression, social isolation, delirium, hallucinations, falls and poor nutrition. However, signs of deafness are frequently attributed to other causes such as dementia. There are significant inequalities in accessing sensory care and these health disparities need addressed (White et al. 2019).
Recommendations to address barriers include sensory screening and improving staff training. However, previous studies have not considered the wider care home infrastructure and governance of health and social care as barriers to improvement, which limits their impact. Governing bodies exist to scrutinise the delivery of care to ensure needs are met. However, it is not clear if, or how, any of the regulatory bodies scrutinise sensory care specifically.
The Transformative Worldview holds that, ‘research inquiry needs to be intertwined with politics and a political change agenda to confront social oppression at whatever level it occurs…the research contains an agenda for reform that may change the lives of the participants, and the institutions in which individuals work or live’ (Creswell and Creswell, 2018, p.9). Unsupported deafness impedes communication, and communication is both a human right and a critical enabler to realising other human rights. Without systematic and national consideration of residents' sensory needs, human rights will continue to be withheld.
Using a transformative mixed-methods approach, Freedom of Information requests were sent to the Scottish Government and Public Health Scotland for data relating to care home sensory care safeguarding; the mandatory qualification syllabus for all care home staff was searched for evidence of sensory training content; and ten years of Care Inspectorate inspection reports were analysed for evidence of sensory care scrutiny. Finally, online focus groups were conducted with teams of care inspectors to discuss how sensory care is regulated during annual inspections.
Results revealed that while Scotland has a clear regulatory framework for dementia care, sensory care continues to feature low on the hierarchy of needs. Significant improvements are required to meet the aims of the World Health Organisation. The findings of this research are important because the largely unidentified and unsupported status of sensory care in care homes is not unique to Scotland, but represents the global landscape. The Transformative Worldview provides an innovative approach to identifying legislative barriers to safeguarding the sensory care needs of older people. Further action is required to protect the human right to communication in this population and address the inequalities in access to vital sensory care.