The risk that a Veteran will experience concurrent visual and hearing impairments increases with age. Research indicates that as many as 20% of Americans over the age of 70 now experience this dual sensory loss (DSL), up to about 1.9 million people. DSL poses serious problems for people with this diagnosis. Visually impaired people experience difficulties interacting with their environment, but often use their hearing as a way of compensating. Hearing impaired people experience barriers to communication and often use their vision to overcome these obstacles. Those with DSL, therefore, struggle with both managing their environment and communicating with others while lacking some of the compensatory options available to those with a single sensory disability. It is not surprising that adults with DSL often report frustration, few social activities and depression. While providers such as optometrists and audiologists can provide many valuable services to help restore some of the capabilities impeded by sensory loss, studies show functional and psychosocial difficulties often linger, especially with DSL's combined impacts on vision and hearing. We propose a two year pilot study, conducted by the VA National Center for Rehabilitative Auditory Research (NCRAR) in Portland, Oregon, with expert consultation from the VA Center of Excellence for Aging Veterans with Vision Loss (CAVVL) in Atlanta, Georgia and the Helen Keller National Center for Deaf-Blind Youth and Adults (HKNC) in New York. The purpose of this pilot study is to design and conduct a preliminary evaluation of self management groups intended to provide structured education and opportunities for mutual sharing by outpatient military Veterans with DSL. We will carefully investigate the feasibility of our research methodology, intending that, if successful, our methods be used for a full clinical trial to examine the efficacy of DSL self management groups as value added services, useful beyond what Veterans with DSL derive from standard care offered by VA blind/low vision and audiology services. Our national research team will collaborate to produce a working draft of the project manual, containing the self management group curriculum and guidelines for critical logistical procedures for ensuring effective transportation and communication for participants with vision and hearing limitations. Twenty four Veterans with DSL over age 55, of both genders and from varied ethnic origins will be enrolled at the research site in Portland, Oregon. These Veterans will be screened to establish whether their vision, hearing or adaptive technology have deteriorated since last entries in the VA electronic medical record, and if indicated, updated services will be provided by local VA clinics. When clinical rehabilitation is up to date Veterans will be randomly assigned to participate either immediately, or after a wait list period, in self management groups (DSL groups) that meet for six weekly sessions of two hours duration. All Veterans will take baseline questionnaires before beginning DSL group participation to assess their functional and psychosocial adaptation to DSL, and post- tests after DSL group participation. The DSL groups will employ a variety of accomodations to ensure that all Veterans participate fully, with curriculum drawn from the current evidence base on the successful use of self management groups for adults with disabilities and other chronic health issues. The research team will refine the DSL group curriculum and the project procedures throughout the two year period of the project. If our results show the groups have promise and our methodology is effective, we will have a completed Curriculum and Technical Manual and established outcome measures and procedures for conducting a rigorous follow up randomized clinical trial to establish whether this approach will be useful to VA providers nationwide for assisting Veterans with DSL in improving their quality of life.
Project Narrative: Data show up to 350,000 Veterans now have both hearing and vision loss (Dual Sensory Loss, DSL) and population trends suggest 3.5 to 14 million Americans could have DSL by 2030. Adults with DSL have reported depression, poor mental and social well-being and few social activities. VA thus determined Veterans with DSL are a priority population, with research needed to establish best practices for serving their needs. This pilot study draws from literature on the effective use of self management groups for people with chronic health issues, including sensory loss, which utilize structured education and sharing with peers. The pilot study will develop and implement a self management group tailored for the first time to the specific needs of outpatient Veterans with DSL, and examine the feasibility of research methods adapted to this challenging population. Results will guide the conduct of a followup randomized clinical trial that could provide VA with an evidence base and curriculum/technical manual for improving services to Veterans with DSL.
