Introduction: Hearing, vision, and cognitive impairment commonly co-occur in older people. However, the rate of recognition and appropriate management of combined hearing and vision impairment in people with dementia impairment is low. The aim of this work was to codevelop internationally relevant, multidisciplinary practice recommendations for professionals involved in the diagnosis, care, and management of older people with these concurrent conditions. Methods: We applied consensus methods with professional and lay expert stakeholders, using an adapted version of the World Health Organization Handbook for Guideline Development. The development involved 4 phases and included: (1) collating existing evidence, (2) filling the gaps in evidence, (3) prioritising evidence, and (4) refining the final list of recommendations. Each phase encompassed various methodologies including a review of existing guidelines within the 3 clinical domains, systematic reviews, qualitative studies, a clinical professional consortium, surveys, and consensus meetings with interdisciplinary domain experts. Results: The task force evaluated an initial list of 26 recommendations, ranking them in the order of priority. A consensus was reached on 15 recommendations, which are classified into 6 domains of “awareness and knowledge,” “recognition and detection,” “evaluation,” “management,” “support,” and “services and policies.” Pragmatic options for implementation for each domain were then developed. Conclusion: This is the first set of international, interdisciplinary practice recommendations that will guide the development of multidisciplinary services and policy to improve the lives of people with dementia and hearing and vision impairment.

Hearing and vision impairments increase in prevalence with increasing age and are among the most common comorbid conditions in people living with dementia (PwD) and other age-related cognitive impairment [1]. The added burden of poor sensory function in an individual with dementia exacerbates the impact of dementia on a range of outcomes, including cognitive and functional ability, behavioural disturbances, quality of life (QoL), overall level of independence, and mortality [2, 3]. In parallel, the presence of dementia has a deleterious effect on the ability to support people with sensory impairment as PwD may not be able to report their sensory impairment, or it may be overlooked by care providers [4, 5]. The impact on care partners (any person involved in the care of PwD) is also significant, and social isolation, depression, care burden, and relationship stress increase with concurrent sensory and cognitive problems in the care recipient [6, 7].

Hearing and vision interventions are relatively inexpensive, effective, and acceptable for PwD; thus, addressing sensory impairments in PwD represents a potentially cost-effective and acceptable opportunity to improve outcomes for PwD and their care partners [7] and may be relevant to people in all socio-economic spheres. Both dementia and sensory impairment (hearing, vision, or dual sensory loss) require timely and accurate detection and assessment to ensure the most appropriate care and management. Neuropsychological screening and assessment of cognition often relies on good hearing and/or vision functioning [8]. Similarly, cognitive impairment may hinder the accurate assessment of sensory impairment. Older people, and particularly PwD, have a low rate of access to vision and hearing services [8, 9]. For those who do access hearing and vision services, the uptake and adherence with corrective devices, such as hearing aids or spectacles, may be low [10] and have not been studied in individuals with both vision and hearing impairment [11]. Thus, a more holistic approach to adapting assessments and optimising sensory function in PwD is warranted [12].

The Need for Practice Recommendations

National or international care standards for the effective detection, assessment, treatment, and management of concurrent hearing (and/or), vision, and cognitive impairment are presently not widely available to our knowledge. Hearing, vision, and dementia care professionals have historically worked independently, and therefore, there is limited sharing of information of relevance to clinical care across these healthcare disciplines [12, 13]. Existing guidance for dementia care (i.e., the National Institute for Clinical Excellence, UK [14], and the Alzheimer’s Association, Chicago, IL, USA [15]) offers general statements regarding the evaluation of other morbidities including sensory impairments but contains no specific recommendations on how evaluations should be conducted nor how management of sensory impairments should be undertaken or supported. Recently, the World Health Organization (WHO) guideline for the integrated care of older people in the community [16] recommended the maintenance of sensory health as a means to preserve physical and mental capacity. This recommendation reinforces the need for more specific guidance on hearing and vision impairment in PwD.

Recently, studies exploring knowledge, attitudes, and practices regarding the detection and management of combined hearing and/or vision impairment in PwD (HVD) in different international settings have revealed that professionals are aware of the potential comorbidity of sensory and cognitive impairments but are less confident in identifying and managing concurrent sensory and cognitive impairments [12, 13, 17]. For example, in a 3-nation European study of the support care needs of 98 PwD and their care partners, evidence emerged that multidisciplinary, individualised care was lacking and was desired [7]. In-depth interviews revealed that critical areas of concern for PwD and their care partners were the impact of sensory impairment on dementia-related behavioural and psychological changes, as well as loneliness, social isolation, and care partner burden and strain. Thus, significant gaps remain in the following:

  • the knowledge of professionals working across the fields of hearing, vision, and dementia care with respect to the complementary areas [13];

  • the detection and diagnosis of concurrent hearing and vision impairment in PwD, and the detection of cognitive impairment in people with hearing and vision impairment [12, 18, 19];

  • timely and appropriate interventions to improve hearing and vision in PwD, which may impact other outcomes, such as QoL and care partner burden [19, 20].

Scope of the Practice Recommendations

Our objective was to provide the first set of practice recommendations for the detection, evaluation, management, and support of people living with HVD, as well as outlining steps for implementation. The practice recommendations are directed at clinicians and other professionals involved in the diagnosis, general care, management, and support of people living with HVD. The aim was to foster the highest quality care to enable people to live well with combined sensory and cognitive impairments. Addressing the issue of concurrent HVD offers an opportunity to improve outcomes for PwD, including QoL and, potentially, alter the trajectory of cognitive decline [21, 22]. The recommendations are not discipline-specific or exhaustive. Moreover, they do not provide advice or guidelines regarding the specific diagnostic procedures that should be undertaken by dementia, vision, or hearing professionals. The task force plans to revisit the evidence informing these recommendations in 2 years from the time of publication.

Approach

An initial rapid review of the literature undertaken by J.L. and I.L., revealed a scarcity of peer-reviewed published information, rendering a rigorous systematic review unfeasible. Thus, the task force adopted core elements of the WHO Handbook for Guideline Development and derived evidence to support the recommendations from recent studies pertinent to specific recommendations. Where published evidence was lacking, we relied on various methods for elicitation of expert knowledge, such as workshops and consultation [23, 24]. Since the topic area is novel and multidisciplinary, and evidence is still emerging, it was important to adopt this approach, which does not rely on a single class of evidence alone.

International Hearing, Vision, and Cognition Practice Recommendations Task Force

The task force was an international panel of 16 hearing, vision, and dementia professionals, outlined in Table 1. Members were from Australia, Canada, the USA, Cyprus, Ireland, and the UK. The initial discussions for this project arose from an invited keynote address on the topic of sensory-cognitive health (The Brucker Lecture, delivered by I.L.) at the American Congress of Rehabilitation Medicine’s 95th Annual Conference in Dallas, TX, USA, October 2018. Following this, task force members were self-appointed or nominated by colleagues in the field for their expertise and links to professional bodies in one or more of the 3 fields. Members were recruited between November 2018 and June 2019.

Table 1.

Professional roles of task force and consortium members

 Professional roles of task force and consortium members
 Professional roles of task force and consortium members

Principles Underlying the Recommendations

At the outset, the task force agreed on a set of guiding principles to underpin the recommendations. A key focus was the promotion of a person-centred approach that was pragmatic and internationally relevant. We considered various contextual levels (including professional care pathways), geographies, policies, and socio-economic factors. Accordingly, key principles underlying the recommendations were to: (1) be inclusive of people living with sensory impairment and dementia, their care partners, and professional stakeholders; (2) promote equity and mutual respect across the 3 fields; and (3) be pragmatic, implementable, and resource sparing.

Steps in Developing the Recommendations

We have outlined our stepwise approach in Figure 1. In brief, this involved 4 phases: (I) collating existing evidence; (II) filling the gaps in evidence; (III) prioritising the evidence, and (IV) refining the final list of recommendations.

Fig. 1.

Steps to developing recommendations. PPI, patient and public involvement.

Fig. 1.

Steps to developing recommendations. PPI, patient and public involvement.

Close modal

In phase I, we undertook scoping reviews of the extant literature and evidence regarding: (a) existing clinical guidelines in the 3 fields (hearing, vision, and dementia) to ascertain whether or not they refer to the dual or triple morbidity, (b) interventions to support hearing and vision impairment for PwD, (c) assessment of hearing and vision impairment in PwD, and (d) cognitive evaluation tools in PwD with hearing and/or vision impairment. The initial rapid review of this area highlighted a paucity of information, and thus, the search strategy was broadened to encompass all study designs and explore the breadth and depth of the evidence. We specified computer searches of electronic databases as well as hand-searching reference lists and identification of additional articles of interest by task force members. We did not include strict inclusion and exclusion criteria, except for practical reasons; only articles in English language were included. The existing clinical guidelines were identified through repositories such as the Guidelines International Network, CPG InfoBase: Clinical Practice Guidelines, and a search on PubMed. Search terms in PubMed for the literature (b–d) included dementia AND (sight OR vision OR hearing OR deaf) AND (intervention OR management OR rehabilitation OR assessment OR evaluation). For each article, 2 members of the task force graded the methodological quality of each study according to study design and risk of bias. Any differences in scores were resolved by discussion by the 2 graders and the lead researcher. Study design was reported descriptively according to the Oxford 2011 Levels of Evidence criteria [25]; and, if appropriate, the quality of intervention studies was assessed using Downs and Black’s checklist for randomised and non-randomised studies [26].

We then summarised and synthesised the findings from the literature to ascertain gaps in knowledge and generate a list of potential recommendations that broadly fell into one or more of the following 6 domains: awareness and knowledge, recognition and detection, evaluation, management, support, and services and policies. In phase II, we conducted a professional stakeholders’ consultation in the UK, held in Manchester on April 5, 2019, as a half-day event. We recruited 41 additional professionals, all of whom had experience in the diagnosis, management, and care of people living with impairment in one or more of the 3 fields (see Table 1). Following an initial didactic session on each of the 3 topics (dementia, hearing, and vision impairment), participants were divided into breakout groups to undertake facilitated discussions. The groups comprised 6–8 professionals as well as a member of the European SENSE-Cog research programme (www.sense-cog.eu; professionals, academics, and researchers), who facilitated each group by guiding the discussion and capturing feedback using field notes. We purposefully balanced the make-up of the groups a priori to include a mix of expertise, gender, and years of experience to ensure a range of views and perspectives. Within the groups, delegates were asked to express their views on a series of questions related to detection, evaluation, and management of HVC impairment in older people across different settings (home, clinic, and care home). Brief prototype case studies were used to prompt discussion and elicit feedback. The facilitator kept the participants on topic with guided questions and probed suggestions made by the group to achieve depth and clarity. Following the breakout sessions, the participants reconvened for a shared plenary discussion, led by an academic geriatric psychiatrist (I.L.), at which the facilitators fed back the discussion findings from each of the groups. This enabled group themes and differences to be highlighted and discussed and further summary points to be elicited and captured.

In this phase, we also consulted with lay stakeholders to ensure robust “patient and public involvement” (PPI) input. PPI is acknowledged as an important part of guideline development as it recognises that patients are experts by experience of their health conditions [27, 28]. We presented the 6 domains as areas of importance and asked for recommendations from 4 PPI focus groups in the UK (n = 5), Cyprus (n = 4), Greece (n = 6), and France (n = 6). All PPI members were experienced in providing feedback to clinical researchers regarding the assessment and management of PwD with hearing and/or vision problems. (A full description of the PPI methodology can be found in online suppl. material 1; for all online suppl. material, see www.karger.com/doi/10.1159/000515892.) Feedback was captured from all groups using field notes and added to the draft list of recommendations originating from phase I to create 26 recommendations across the 6 domains.

In phase III, we created 2 online surveys for a “prioritisation” exercise, which members of the task force (n = 16) completed. The methodology for both surveys was adapted from a robust decision-making method developed by the Child Health and Nutrition Research Initiative [29]. For the first survey (phase III a), we presented an initial draft list of 26 headline recommendations. These were generated by group-specific outputs from phases I and II according to the 6 domains. We asked respondents to rate each recommendation from the draft list as: (1) “yes,” (0) “no,” (0.5) “I do not know,” or “unsure,” for each of 4 scoring criteria. The criteria were: (a) potential for the recommendation to reduce the burden of dementia on those involved (i.e., people with dementia, care partners, and the society as a whole); (b) potential for the recommendation to be translated into practical impacts; (c) potential for the recommendation to achieve its stated outcome within a reasonable period of time; and (d) potential for the recommendation to be delivered an equitable way (considering socio-economic and demographic factors, particularly gender, education level, and geography). This led to the generation of intermediate scores calculated for each recommendation as the sum of scores divided by the number of scorers for each of the 4 scoring criteria. An overall score was then obtained for each recommendation by calculating the mean of the 4 intermediate scores, yielding a score with a possible range of 0–1. As 0.5 was the score given to responses “I don’t know or unsure” and 1 was the score given to “yes,” it was decided to be a priority recommendation, and thus, to be considered for further inclusion, it must have an overall score of ≥0.80.

For survey 2 (phase III b), each reference, recommendation, and idea generated in phases I and II were collated as “options,” duplications were removed and further explored against the 15 headline practice recommendations. This time, 3 criteria were chosen: (a) this option supports implementation of the recommendation; (b) this option has the opportunity to be delivered in an equitable way (considering socio-economic and demographic factors); and (c) this option can be delivered in a timely manner. Once more, the task force rated each option as: (1) “yes,” (0) “no,” (0.5) “I do not know,” or “unsure.” Again, for each option, there was an intermediate score for the 3 criteria, which was summed and averaged to yield overall scores.

For phase IV, the task force was then split into 6 working groups, each assigned a domain with the responsibility to discuss options for implementation of their respective domain from the prioritisation output, as well as further literature pertinent to that specific domain. Where gaps were identified and information was lacking, consensus meetings by all task force members enabled pragmatic solutions for implementation based on clinical and academic judgement. All members of the task force then critically appraised the final manuscript before submission.

The output of phases I to III (a) in the form of draft recommendations, along with supporting evidence and the metrics, is collated in Tables 1-6 of online suppl. material 2. Overall scores from survey 1 ranged from 0.66 to 0.92. The task force critically evaluated the recommendations. Recommendations which yielded an overall score of <0.80 was interpreted as making the item a low priority and thus was discarded (n = 10). Wording of the recommendations was further refined for readability, clarity, and succinctness, leaving 15 headline practice recommendations.

Table 2.

Practice recommendations for domain 1 “awareness and knowledge” with steps to implement the recommendation [53‒55]

 Practice recommendations for domain 1 “awareness and knowledge” with steps to implement the recommendation [53‒55]
 Practice recommendations for domain 1 “awareness and knowledge” with steps to implement the recommendation [53‒55]
Table 3.

Practice recommendations for domain 2 “recognition and detection” with steps to implement the recommendation [4, 40, 42, 56‒59]

 Practice recommendations for domain 2 “recognition and detection” with steps to implement the recommendation [4, 40, 42, 56‒59]
 Practice recommendations for domain 2 “recognition and detection” with steps to implement the recommendation [4, 40, 42, 56‒59]
Table 4.

Practice recommendations for domain 3 “evaluation” with steps to implement the recommendation [19, 47, 58, 60‒68]

 Practice recommendations for domain 3 “evaluation” with steps to implement the recommendation [19, 47, 58, 60‒68]
 Practice recommendations for domain 3 “evaluation” with steps to implement the recommendation [19, 47, 58, 60‒68]
Table 5.

Practice recommendations for domain 4 “management” with steps to implement the recommendation

 Practice recommendations for domain 4 “management” with steps to implement the recommendation
 Practice recommendations for domain 4 “management” with steps to implement the recommendation
Table 6.

Practice recommendations for domain 5 “support” with steps to implement the recommendation [38, 55, 69, 70]

 Practice recommendations for domain 5 “support” with steps to implement the recommendation [38, 55, 69, 70]
 Practice recommendations for domain 5 “support” with steps to implement the recommendation [38, 55, 69, 70]

Overall scores from survey 2 (phase III b) ranged from 0.60 to 1.00. Again, options with overall scores under 0.80 were considered as low priority and thus were discarded (n = 58), leaving n = 83 “priorities” to be considered for implementation by the task force working groups in phase IV. The output from all phases is described below, according to domain and as steps to implement the headline recommendations (Tables 2-7). For transparency of idea/item generation, each is referenced with the published research or policy article. Where published evidence was lacking, “PC/PPI” describes where gaps were filled by professional consortia and/or PPI groups and “TF” if this came from the authors’ task force consensus meetings.

Table 7.

Practice recommendations for domain 6 “services and policies” with steps to implement the recommendation

 Practice recommendations for domain 6 “services and policies” with steps to implement the recommendation
 Practice recommendations for domain 6 “services and policies” with steps to implement the recommendation

Domain 1: Awareness and Knowledge of the Links among HVD

To effectively recognise, manage, and support HVD, it is imperative that professionals and the public are aware of the implications of comorbid sensory and cognitive impairments in terms of prevalence, impact, identification, and treatment. Knowledge of the contribution of comorbid sensory impairments is not consistent among dementia professionals, while knowledge of the functional aspects of dementia is low among hearing and vision professionals [13, 30]. Similarly, educating the public about dementia risk factors, such as sensory loss, is emerging as a good strategy to prevent or delay cases [31], and promoting good sensory health encourages active ageing in older adults with dementia [32]. PwD and their care partners may not realise communication or mobility limitations can be exacerbated by sensory impairments, and instead attribute such symptoms to dementia syndrome.

Two practice recommendations have been included for domain 1, aimed at increasing awareness of professionals, PwD, and caregivers to ensure individuals receive a timely diagnosis and treatment. These are outlined in Table 2, with suggestions to implement each recommendation.

Domain 2: Recognition and Detection of Hearing and Vision Impairment in People Living with Dementia

Hearing and vision impairments are common in PwD, with prevalence of hearing/vision impairment among those with cognitive impairment higher than that in the general population, whereas in the general population, approximately one-third of all adults older than 65 years have hearing loss [33] and 23% have vision loss [34]; one study reported 94% of attendees at a memory clinic had a hearing impairment, while 32.5% of people with dementia in a national sample had significant visual impairment [19, 20].

Hearing and vision impairments are under-recognised and under-treated in the general population and are particularly under-recognised among people with cognitive impairment [9, 35, 36]. Under-recognition of concurrent HVD is problematic for many reasons. Firstly, hearing/vision impairments may confound the results of cognitive assessments, which typically rely on good hearing/vision [37]. A person with unrecognised hearing/vision impairment may be incorrectly identified as having a cognitive impairment or may have the severity of cognitive impairment overestimated due to not being able to hear or see the test items.

Additionally, sensory impairments may reduce social engagement and QoL in PwD and increase dependency, behavioural and psychological symptoms, and rate of cognitive decline [38]. Sensory deprivation is associated with boredom and is classified as one of the most common unmet needs for PwD in care settings [39], where residents with sensory loss and dementia frequently have higher levels of inappropriate behaviours. Early sensory remediation may be preventative and has been shown to improve depression and neuropsychiatric symptoms in PwD [40, 41]. It is therefore imperative that hearing and vision impairments are recognised and detected among people with cognitive impairment and dementia [42].

Two practice recommendations have been included for domain 2, intended to identify hearing and vision loss in PwD with the aim to avoid the negative consequences associated with unrecognised HVD. These are outlined in Table 3, with suggestions to implement each recommendation.

Domain 3: Evaluation (i.e., Specialist Assessment) of HVD

Most standard cognitive evaluations rely on items that require good hearing and vision, and inversely, evaluation of vision and hearing functioning depends on relatively intact cognitive functioning [43, 44]. Although highly prevalent, professionals and technicians administering cognitive assessments often do not identify or account for deficits in vision or hearing, and providers of vision and hearing services may not have adequate training or experience in evaluating individuals with cognitive impairments [13]. Therefore, to obtain valid assessment results, those carrying out the assessments need to take an individual’s sensory-cognitive health status into consideration.

Three practice recommendations, as outlined in Table 4, ensure other disciplines are considered when undertaking assessments. Some are general considerations for evaluating all hearing, vision, and cognitive impairments, with examples for how to adapt to the needs of specific services. More detailed advice regarding specific adaptations of assessments is beyond the scope of these recommendations.

Domain 4: Management of Hearing, Vision, and Cognitive Impairment

A key theme that emerged from the evidence review and PPI groups is that for PwD, “diagnostic overshadowing” may occur, such that the focus for health and care management becomes the dementia, with other conditions or issues being missed, given lower priority, or ignored entirely. In addition, professionals providing care and health services to PwD may believe that due to dementia, there will be little that they can do to help an individual manage the hearing/vision condition. Care and health professionals involved in the overall care planning of PwD may lack specific knowledge about HVD and guidance on how to manage HVD impairments within the context of their specialism.

By providing recommendations for managing HVD, it is hoped that professionals and care partners will be enabled to better support PwD in managing their health and social care needs, maintaining their independence, and participating in activities of daily life. As outlined in Table 5, three practice recommendations have been included for domain 4 with suggestions to implement and promote person-centred and informed management approaches for HVD and their care partners.

Domain 5: Support for HVD (“Living Well with Dual or Triple Impairment”)

PwD who are living with hearing and vision impairment are at risk of reduced QoL and increased social isolation [38, 45]. They may find that their world “shrinks,” and they withdraw into themselves as they experience increased difficulty in communicating and engaging with the world around them. In order to support these individuals to live well, a multifaceted approach is warranted [7]. For example, many PwD and their care partners may not be aware of social inclusion opportunities that would meet their sensory needs. Equally, it is important that professionals and care partners offering treatment and care be trained to adapt their approaches and various environments to optimise the abilities of the individual with sensory and cognitive impairment. With the aim to promote safety, independence, and opportunities for social inclusion, 3 practice recommendations have been developed for domain 5 outlined in Table 6.

Domain 6: Services and Policies for People with HVC Impairment

Expansion of clinical competence in supporting HVD, as well as implementation and maintenance of change in health service provision over time, is only possible if developed in partnership with policy change. Traditionally, the fields of hearing, vision, and dementia care have been considered separately; however, recent health and social care trends for older adults indicate that sensory-cognitive ageing may transform from a multidisciplinary field (coming together of multiple separate health professions) to an interdisciplinary (several professions beginning to overlap), or even an emerging transdisciplinary field (several professions fusing to create an innovative and holistic care perspective). Only such a merged perspective can inform all care professionals involved and potentially open new pathways for research, treatment, and care provision. One example of this approach is the concept of frailty, where multiple changes in health status are considered in parallel, including changes in sensory and cognitive health [46].

At the policy level, few examples currently exist where inter- or transdisciplinary factors in HVD are acknowledged and/or incorporated. However, documents like the guidelines presented by the College of Optometrists in the UK on “Examining patients with dementia or other acquired cognitive impairment” [47] serve as guiding examples in bringing together professionals and their expertise in HVD. Ideally, these and other pioneering efforts to promote the importance of structuring and integrating HVD care (e.g., [48]) can then lead to the development and implementation of service delivery models that can appropriately accommodate the needs of persons with sensory-cognitive impairments.

Two practice recommendations have been included for the policy level. These are outlined in Table 7, with suggestions to implement each recommendation.

Hearing and vision impairments commonly co-occur in PwD; however, their detection, diagnosis, and management represent an unmet need for older people with cognitive impairment or dementia. Based on the currently available health sciences literature, as well as the views of PwD and their care providers, this document presents the current consensus recommendations across 6 domains. Our approach, recommending a person-centred, multidisciplinary path seeking to improve clinical and social care for HVD, is the first set of practice recommendations, which we hope will initiate an international exchange of ideas to move the development and refinement of care for this vulnerable population forward. We hope they will support all professionals working across health and social care to consider how they can adjust practice to better meet the needs of those living with combined sensory loss and dementia within the context in which they work.

The guidance presented here is only useful if it is accessible to the professionals and researchers for whom it has been designed. The task force, an interdisciplinary consortium of clinical and academic professionals, and the lay stakeholders with lived experience, who contributed to the development of the guidance, will support dissemination of the guidance to relevant groups, internationally. This will be supported by the national and international professional associations and institutions endorsing the work (outlined in acknowledgements) as well as snowballing by members of the wider sensory-cognitive community. This will include posting on partners’ Websites and linking with social media networks.

Although steps have been taken to ensure robust methodology and transparency regarding the development of these recommendations, there are some limitations. The main constraint is the lack of published literature across the 6 domains, rendering the level of evidence for the recommendations rather low. As this is the first set of recommendations for sensory-cognitive health, the practice recommendations rely heavily on expert professional opinion and the perspectives of those with lived experience, rather than substantive quantitative evidence. For example, the effects of hearing and vision impairment on QoL in PwD were excluded from a recent meta-analysis due to the lack of high-level evidence [49]. From our work with lay expert groups and professionals working in dementia care, we believe there is in fact a strong link between sensory loss and QoL in PwD and hope this gap in published evidence will be addressed by the findings from the ongoing large-scale randomised controlled trial in 5 countries, which is addressing the impact of hearing and vision rehabilitation on QoL in dementia [50]. As the field of sensory-health grows and the literature base emerges, future iterations of these recommendations will include higher level evidence to allow for systematically reviewing the literature and the production of more scientifically robust practice recommendations.

Further to this, methodological limitations from this study include the potential for selection bias by only including the literature published in English language and the threshold for which evidence was included during the prioritisation exercises (phase III). The task force chose an arbitrary, but pragmatic, cut-off point (of 0.80) for the generation of final practice recommendations which may have meant some examples and ideas were discarded.

In future iterations of this guidance, we may consider the topic of dementia prevention through sensory health, an area of emerging importance and growing evidence base [51]. In our preliminary guidance here, we purposefully omitted this area and focussed instead on the sensory health on individuals already living with dementia. However, as more evidence regarding the impact of hearing and/or vision remediation on prevention of dementia materialises, recommendations regarding prevention can be addressed.

The recommendations outlined here are intentionally broad, pragmatic and aimed at professionals working directly with individuals with sensory-cognitive challenges. As such, they will be relevant to the global health community. While we acknowledge that the task force, professional consortium, and lay stakeholder input have largely been generated from high-income countries, which may bias the recommendations towards better-resourced health and social care systems, evidence emerging from low- and middle-income countries, does appear to align with the recommendations we have made here [52]. Moreover, task force members span international boundaries and have the potential to activate global networks such as through the Global Brain Health Institute (GBHI; www.gbhi.org) whose aim is to work to decrease the burden of dementia globally. Further to this, the broad and pragmatic nature of the recommendations permits relevance across all socio-economic groups as they are low cost and relevant across different health systems and services. These recommendations are not intended to replace the many examples of specific dementia guidance that already exist. Instead, they are to be used in conjunction with the existing guidance to galvanise and empower professionals to focus their expertise on this vital area to fill the gap in practice. This guidance is preliminary and forms the foundation for future iterations as the transdisciplinary field of sensory-cognitive health in older adults develops and more robust evidence emerges. In the meantime, it can serve as a driver to improve services, rectify existing institutionalised dualism in which cognitive and sensory health are often disconnected and, ultimately, to better support PwD as well as sensory impairment.

The authors would like to thank people with lived, or caring, experience of dementia and sensory impairment for their invaluable input into this project, including the SENSE-Cog programme’s (www.sense-cog.eu) Research User Groups in Athens, Greece; Manchester, UK; Nice, France; Nicosia, Cyprus, and their PPI coordinators, Maria Alexaki and Maria Passa (Greece), Jahanara Miah (UK), Valeria Manera (France), and Anna Pavlina Charalambous (Cyprus). We also gratefully acknowledge support from the following international organisations: Deafblind International; International Society for Low Vision Research & Rehabilitation; and national organisations: Canadian Consortium on Neurodegeneration in Aging (Canada); Deafness Support Network (UK); Ordre des Optometristes du Quebec (Canada); Royal College of Psychiatrists (UK); and the College of Optometrists (UK).

Ethical approval was not required for this study as it involved groups of professionals and members of the public acting as specialist advisors providing knowledge and expertise based on their professional or lived experience of the health conditions and as such are exempt according to the UK Policy Framework for Health and Social Care Research.

The authors have no conflicts of interest to declare.

J. Littlejohn is funded by Deafness Support Network (www.dsnonline.co.uk), DSN fellowship 2018–2022. I. Leroi’s contribution to this work was supported in part by the European Union’s Horizon 2020 research and innovation program (grant agreement No. 668648) for the SENSE-Cog Project (www.sense-cog.eu).

All the authors were involved in task force consensus meetings and development of the practice recommendations. J.L. and I.L. created the first draft of the recommendations, and all task force members critically revised them. All the authors had responsibility for revising and approving the final manuscript.

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