Acquired Combined Vision and Hearing Loss: Awareness and Perceptions of Australian Aged Care Workers

Abstract

Introduction: Understanding the attitudes, competency, and awareness of those supporting older people who have an acquired combined vision and hearing loss is an important endeavor for this population. It can help guide aged care policy makers, leaders, and managers in the allocation of resources and training. This Australian study investigated the awareness and perceptions of aged care workers on supporting older adults with acquired combined vision and hearing loss. Methods: Twenty-four participants who were employed in aged care services participated in semistructured interviews that were thematically analyzed. The interviews explored the participants’ awareness of this disability, identification within their service, adaptation strategies, and their access to relevant information. Results: Several themes emerged, including lack of identification and recording of acquired combined vision and hearing loss in this population, lack of awareness of this disability, and lack of available information or training to support aged care workers within their care setting. Discussion: Aged care workers have little understanding of the prevalence of acquired combined vision and hearing loss in an older population. Care plans are key documents for individuals, which outline their needs and any sensory losses; however, this information is not well recorded. Aged care workers have little awareness of how to effectively support this population. When encountering an individual with an acquired combined vision and hearing loss, however, an aged care worker will develop strategies to support the individual. Individuals with this acquired dual-sensory loss, as well as dementia, pose a significant challenge to aged care workers, and dementia is often the primary focus of intervention. Implications for Practitioners: It appears that older individuals living in aged care settings who have acquired combined vision and hearing loss are not adequately identified, nor are aged care workers adequately trained to support individuals with this unique disability.

Keywords

deafblind dual-sensory loss aged care

A common physiological change during ageing is the deterioration of vision and hearing (Farley et al., 2011). These sensory impairments can often be managed well with corrective lenses and hearing aids or devices. However, for many individuals, corrective devices are not adequate to maintain functional levels of sight and hearing. The vast majority of older people with combined vision and hearing loss have acquired their sensory loss as a result of ageing (Simcock & Wittich, 2019). Some individuals however, were born with either a hearing or vision impairment and acquired the other impairment over time, while others were born with both impairments. Combined vision and hearing loss is a specific disability (Centre for Welfare and Social Issues, 2016), where an individual is unable to compensate for the loss in one sense by using the other sense (Guthrie et al., 2018). Some professionals and researchers working in the sensory impairment field regard having a visual acuity of 20/60 or less and a hearing loss in the better ear of 35 decibels or less is sufficient to classify an individual as having a dual-sensory disability (Fellinger et al., 2009). Whereas others believe that being classified with a specific disability of both vision and hearing should not be defined solely by medical assessment but should also be supplemented by a functional evaluation (Dammeyer, 2010). This lack of definitional agreement is reflected in the research literature. A review of studies examining the effect of age-related combined vision and hearing loss reported inconsistencies in their assessment criteria, with some studies using self-rating methods, others using observations from a third party, while others used audiometric and visual assessments (Tiwana et al., 2016).

In addition to the lack of agreement regarding assessment criteria, is the lack of an agreed term to describe the impairment. Combined vision and hearing impairment, dual-sensory impairment, dual-sensory loss, and deafblind are all terms that are used to describe combined vision and hearing loss. The term deafblind is generally accepted by those working in the field of visual impairment as the standard term describing all levels of impairment, regardless of when the sensory impairment occurred, which impairment occurred first, or the age of the person, while acquired deafblindness is the term used specifically for people whose vision and hearing losses have developed later in life (Wittich et al., 2013). However, within the Australian aged care sector in which this study occurred, there is a lack of awareness and understanding of the term deafblind. The term acquired combined vision and hearing loss was, therefore, used throughout the research reported on in this article to facilitate discussion of the disability with clients, aged care staff members, and professionals working in other fields. Table 1 outlines terms that are used to describe combined vision and hearing loss and subtle differences in meaning.

Table 1.
Combined Vision and Hearing Loss Terminology.

Terminology Explanation

Dual-sensory impairment According to Wittich et al. (2013), some researchers prefer this terminology as it more accurately describes the sensory losses, however this term implies that the dual-sensory impairment is vision and hearing and can be misleading. In Australian Deaf Culture, impairment is a limiting word and people who are deaf and sign language users resist this label. “Impairment” is often substituted to “loss” to describe the condition to ensure cultural sensitivity to this population (Aussie Deaf Kids, 2021).

Dual-sensory loss A term often used in the literature (Wittich et al., 2013). In Australia it is a more culturally sensitive term where “impairment” has been replaced by “loss,” for reasons outlined above.

Deafblind Is generally accepted by those working in the field as the standard term describing all levels of impairment, regardless of when the sensory impairment occurred, which impairment occurred first, or the age of the person (Wittich et al., 2013).

Congenitally deafblind A term used to describe those born with vision and hearing loss or having developed both prior to age two (Munroe, in Dalby et al., 2009).

Acquired deafblind The term used specifically for people whose vision and hearing losses have developed later in life (Wittich et al., 2013).

Acquired combined vision and hearing loss Often used interchangeably with acquired deafblindness, this term describes the acquisition of both a vision and hearing loss after the development of language (approximately 2 years old). Individuals may have a congenital vision or hearing loss and develop a loss in the other sense, or they may have normal vision and hearing and develop losses in both (Dalby et al., 2009).

Given the fact that Australia is experiencing population ageing, like many other countries around the world, the prevalence of acquired combined vision and hearing loss is expected to increase. According to the Australian Institute of Health and Welfare (2016), the proportion of people with chronic vision disorders changes from 10% of children between 0 and 14 years, to 93% of those aged 55 years and over. The proportion of those with disorders of hearing increases from 3% of children between 0 and 14 years, to 49% in those aged 75 years and older. In relation to the prevalence of combined vision and hearing loss, an Australian study with a sample of 1,972 reported a prevalence of 6% in people over the age of 55 years, that increased to 27% in those aged over 80 years (Schneider et al., 2012).

An acquired combined vision and hearing loss may lead to significant impacts upon an individual's communication, mobility, mental health, and independence (Brennan et al., 2006; Capella-McDonnall, 2005; Crews & Campbell, 2004; Grue et al., 2009; Tay et al., 2006). These effects may lead to an individual receiving home care services or admission to a residential aged care facility or nursing home. In Australia, all aged care services are funded by the Australian Government according to the assessed level of need. It will, therefore, become increasingly important that aged care employees in all assessment, care, support, rehabilitation, or management roles, have the tools, skills, and systems to identify and adequately support this population.

There is little research that has focused on older people with acquired combined vision and hearing loss (Simcock & Wittich, 2019; Tiwana et al., 2016). This dearth of information is concerning given the reported prevalence of combined vision and hearing loss in the older population. Andrusjak et al. (2020) conducted a review of the literature from 1985 to 2018 relating to primary research into the identification of vision and hearing loss in long-term residential aged care and the management of these losses. The authors found six barriers to effective practice within the 51 articles included in their review: “… lack of knowledge in care home staff members, poor management of assistive aids, unsuitable environment, lack of connection with optometrists and audiologists, underuse of effective screening tools, and the added complexity of supporting those with dementia” (Andrusjak et al., 2020, p.e155). A follow-up survey of 400 care home staff members conducted in the United Kingdom further confirmed the outcomes of the review, with participants reporting that: they were mostly not confident in ear and eye care, less than half used vision or hearing screening tools, assistive devices were not available for those with vision and hearing loss, and audiological services were not regularly accessed (Andrusjak et al., 2021). Although these studies focused on singular sensory loss, these results are relevant to this study, due to the lack of data in the acquired combined vision and hearing loss area.

The comorbidity with dementia is one barrier that was identified by Andrusjak et al. (2020) as being a considerable challenge when working with older people with a sensory loss. As with a decline in the senses, there is also an increase in the prevalence of cognitive impairment with ageing: an estimated 60–80% of individuals in long-term care settings have dementia (Gaugler, et al., 2016). To compound the situation, O’Malley (2013) reported that the prevalence of a sensory loss is even higher in those with a cognitive impairment, such as dementia. Studies have reported the challenges of screening for sensory impairments in older adults with dementia are due to communication difficulties of the individual, lack of validated tools that accommodate dementia symptoms, lack of equipment, and lack of skills of those conducting the screening (Campos et al., 2019; Hobler et al., 2018). The purpose of this study was to explore the awareness and perceptions of aged care workers on supporting older adults with acquired combined vision and hearing loss within an Australian context.

Methods

Ethics

The Human Research Ethics Committee at Curtin University approved this study (Project Number: HRE2016-0218). Written informed consent was obtained from all participants prior to data collection.

Design

This was a qualitative study design using semistructured interviews.

Recruitment

This study employed convenience sampling to recruit participants who were working in residential or community aged care in Western Australia between 2016 and 2017. Participants could be employed in any position, including as a nurse, allied health professional, domestic assistant or manager. Twelve aged care provider organizations were sent a letter, information sheet, and consent form outlining the study and seeking management approval and support to recruit employees. Once management approval was obtained and information disseminated to their employees, interested employees directly contacted the research team to participate in interviews.

Data Collection Process

All interviews were conducted face-to-face, at a participant's home or place or work, by the lead researcher or paid research assistant. No other individuals were present during the interview. Interview times ranged between 25 to 50 minutes. Demographic information collected related to their age, role in their organization, number of years in their current role, number of years working in aged care, and highest level of education.

A semistructured interview schedule that was developed for the study was used to elicit information about the participants’ awareness of, experiences with, and ability to support individuals with acquired combined vision and hearing impairments (see Table 2).

Table 2.
Interview Schedule.

• Tell me about working with people with sensory impairments.
• Tell me about working with people with combined vision and hearing loss.
• Can you tell me about one or two residents in particular that you work with who have a combined vision and hearing impairment?
• Tell me about the training and skills you have in working with people with combined vision and hearing impairment.
• Tell me about resources available for people with combined vision and hearing impairment.
• What about resources available for staff working with people with combined vision and hearing impairments? What is available?
• Is there anything else you think we should know about working in aged care settings with people with combined vision and hearing impairments?

Research Funding

This study was funded by the Australian Government Department of Health “Aged Care Service Improvement Healthy Ageing” grant. The study was a component of a larger project to develop and validate a screening tool to identify and support individuals with an age-related acquired combined vision and hearing loss.

Research Bias

There was no bias within the research team as outcomes were not predetermined from the grant or any research agenda and the research team was not working for any of the participating aged care organizations.

Data Analysis

Descriptive statistics in SPSS (Version 25) were used to analyze the demographic data. The interviews were audio recorded, transcribed verbatim, checked for errors, then analyzed thematically. Transcripts were not returned to the participant for comment. Thematic analysis is a method that is frequently used in qualitative studies (Braun & Clarke, 2006) and Nvivo software was utilized to support the thematic analysis process, with participant comments coded to a node (major theme) or subnode (minor theme). Commonalities emerged across all participant interviews into themes. Interviews were coded in batches of six and, when no new themes were identified, interviewing was ceased, since this point was considered saturation. Saturation was achieved after 24 interviews.

To establish trustworthiness of the thematic analysis in line with Lincoln and Guba's standards for reliability and validity in qualitative research, a strict protocol was followed (Lincoln & Guba, 1985). The initial coding was carried out by two researchers independently of one another. All coding was then individually reviewed and refined by both researchers. The researchers then compared results of the two sets of analyses, and discrepancies were resolved by returning to the data to obtain consensus.

Results

Twenty-four participants were interviewed, 20 (83.3%) were female. The average age was 43 (SD 14.6) years, with ages ranging from 20 to 67 years. The average amount of time that participants had been working within any aged care setting was 10.2 (SD 7.4) years, ranging between 2 and 27 years. The mean length of time in their role at the time of interview was 5.3 (SD 4.2) years. In terms of highest level of education of the participants: one had not completed high school; two had completed high school; nine had received vocational training, and three had a diploma; six had a bachelor degree; and three had postgraduate qualifications. Participant roles included: six were managers or team leaders, three were allied health professionals, four were allied health assistants, two were registered nurses, eight were nursing assistants or personal care assistants, and one was a domestic assistant. Participants predominately worked in residential aged care, with 18 (75%) working only in this setting. Three participants (12.5%) worked in both residential and community (i.e. home care) settings and three (12.5%) worked in a regional assessment service assessing individuals to determine their aged care service needs and to refer them to appropriate community care services.

Three key themes emerged from the data: (1) identification and recording, (2) awareness of impact and prevalence, and (3) competency. Subthemes included: a systemic lack of identification of individuals with acquired combined vision and hearing loss, care plans being an important source of information about the person, lack of understanding of what acquired combined vision and hearing loss is, apprehension about working with people with an acquired combined vision and hearing impairment, perceived lack of skills to adequately support people with this dual-sensory loss, adaptations or strategies to support individuals with acquired combined vision and hearing loss, the challenges of working with individuals with both dementia and sensory impairments, and limited training opportunities to develop competency. A conceptual thematic map shown in Figure 1 illustrates these results.

Figure 1.
Thematic map conceptualizing aged care workers awareness and perception of acquired combined vision and hearing loss.

Identification and Recording

The identification and recording theme groups comments related to aged care workers not being aware of individuals they support having a combined vision and hearing loss and this information not being readily available in the facility or organization's records.

Lack of Identification

Participants were generally not aware of having supported, or whether they were currently supporting, individuals with an acquired combined vision and hearing loss.
Interviewer, “Have you got any residents who have got both a vision and hearing impairment?” Respondent, “Oh, both. Not really at the moment.” (Personal care assistant, aged 26 years)

We very rarely see people with dual sensory loss. (Facility manager, aged 53 years)

Never had someone with both. (Registered nurse, aged 53 years)

Care Plans as Important Sources of Information

Participants reported that the quality of the care plan is essential in knowing if the individual had a sensory (or other) loss and what strategies to use when supporting them.
You should read their care plan, and then you’ve got an idea if there's a hearing or an eyesight problem. (Personal care assistant, aged 57 years)

If they have a major hearing or vision impairment then it's also on that front page. (Personal care assistant, aged 26 years)

Awareness of Impact and Prevalence

The awareness of impact and prevalence theme groups comments related to aged care workers’ lack of understanding of what a combined vision and hearing loss is, the impact of this unique disability, and being unaware of any prevalence rates.

Some participants thought a combined vision and hearing loss involved no hearing or vision at all.
I guess I was probably seeing dual sensory loss as being almost can't see anything, can't hear anything. (Service manager, aged 54 years)

… [I]t's obviously a range of perhaps poor vision and mild hearing loss. … [W]e wouldn't necessarily be seeing them as having a dual-sensory loss in that classification. (Registered nurse, aged 53 years)

Others thought that when an individual was able to use their impaired vision or hearing to interact in a functional way, they would not be classified as having a combined vision and hearing loss, “… obviously both senses have deteriorated but one sense is still strong enough to work quite well” (personal care assistant, aged 26 years).

Competency

This theme groups comments related to aged care workers’ lack of competency (including apprehension and skills), as well as any effective interventions when supporting individuals who have a combined vision and hearing loss.

Apprehension

Participants were apprehensive about how to effectively support those with an acquired combined vision and hearing loss.
I think I was probably thinking dual-sensory loss sounds “oooohhh,” it must be really, really complex. (Service manager, aged 54 years)

I don't really know what I’d do in that circumstance. (Personal care assistant, aged 20 years)

That would be very challenging. (Ward supervisor, aged 64 years)

Perceived Lack of Skills

Participants perceived they did not have sufficient skills or knowledge to adequately support individuals with sensory impairment, especially those with combined vision and hearing loss.
I don't really know what I’d do. (Personal care assistant, aged 20 years)

I’d probably just talk to the OT [occupational therapist]. … Um, I’d probably kind of hand ball that to her. (Facility manager, aged 53 years)

Adaptation and Strategies

Some of the participants were able to provide examples of adaptations and strategies they had implemented for individuals with sensory impairments, including those with acquired combined vision and hearing loss. Some adaptations appeared to support socialization between the participant and the individual with combined vision and hearing loss, as well as with others within the residential or home environment.
Always make sure you’re looking at them and they’re looking at you. Talking slowly, not talking behind their back, that sort of thing. Always checking their hearing aids, as well. Make sure they’re working. Ask them once they’re in, are they working. That sort of thing. (Registered nurse, aged 53 years)

And you’ve got to get very close to her so you can have a conversation with her. And you also let the other people know around her. Let the other residents know that she can't really hear what you are saying so they don't get offended when she doesn't answer you back. (Occupational therapy assistant, aged 30 years)

Other adaptations described were aimed at enhancing the environment of those with an acquired combined vision and hearing loss to increase independence.
We had to put a big shiny ball outside her bedroom, so she knew which one it was. (Clinical manager, aged 58 years)

You set up the room, in a manner, and it stays set up in that manner. We don't change things around so that they know where things are in their room. (Personal care assistant, aged 55 years)

Acquired Combined Vision and Hearing Loss With Dementia

Some participants commented that, due to many of the individuals having a diagnosis of dementia, it became the primary focus of their support, rather than any sensory impairment. Participants reported that an individual with a single or dual-sensory loss and dementia presented a greater challenge to support than an individual without a cognitive impairment.
…[S]he was deaf in that age-related deafness way, but her blindness was very significant. But what made it difficult for her was that she also had dementia to the point where she would um … have hallucinations. … So, it was a bit, you know, really quite hard to manage in terms of keeping her calm and feeling safe, because you kind of have to shout to her, “It's okay.” (Facility manager, aged 53 years)

…[W]e come up against the problem that they can probably still read something in large print, but not necessarily understand what it means. (Clinical manager, aged 58 years)

…[Y]ou make sure they get their hearing aids in and wearing them properly, batteries changed, go through all the whole rigmarole of looking after them [hearing aids], which is very hard in a dementia wing, ‘cause um … residents take them out and they lose them. You know, you find them in funny places and so, it's really challenging, especially with [certain] behaviors. People in here that have had hearing aids usually end up not wearing them, due to their behaviors.” (Ward supervisor, aged 64 years)

Limited Training Opportunities

Many participants reported having limited ongoing training opportunities in all aspects of their employment. Some participants reported that they had received education on sensory impairment while undertaking their vocational or tertiary qualifications prior to working in aged care. Other participants commented that they had not received any training on how to support an individual with sensory loss.
Sometimes we have specific talks on hearing or sensory loss. Not that often, but occasionally. (Registered nurse, aged 53 years)

…[A] hearing mob came last year for whoever wanted to do or if you had the time to, so I couldn't make it cause I was on the floor [providing direct care]. (Occupational therapy assistant, aged 30 years)

Discussion

The purpose of this study was to explore the awareness and perceptions of aged care workers on supporting older adults with acquired combined vision and hearing loss within an Australian context. The research presented here is an initial study intended to be part of a larger project designed to develop and validate a screening tool to identify and support individuals with age-related acquired combined vision and hearing loss. It appears, from the results presented here, that aged care staff members are unaware that many of the individuals they support are likely to have an acquired combined vision and hearing loss. Particularly given that Yamada et al. (2014) estimated that 34% of aged care residents have a combined vision and hearing loss and Schneider et al. (2012) reported a 27% prevalence of combined vision and hearing loss in individuals over the age of 80 years in an Australian sample. With the average amount of time spent working in the aged care sector for participants being 10.2 years, it is highly probable that participants had encountered someone with this dual-sensory loss.

Identification and Documentation

In aged care, a care plan is an essential document that describes the needs of, and support required for, an individual. Many participants referred to care plans as being the source for identifying whether an individual had an acquired combined vision and hearing loss. In Australia, when an individual initially accesses aged care services, they are assessed to determine if they need aged care and what level of funding is required to provide the appropriate levels of support. As noted by Jee et al. (2005), although this assessment includes questions to the individual about their ability to see and hear, it does not include any actual testing of vision and hearing function. Without this assessment information, it may be challenging for aged care workers to have an awareness of the individual's functional vision and hearing and how to effectively support them. This lack of information could potentially be the reason why many participants were unaware of whether any of the individuals they support had an acquired combined vision and hearing loss.

In Australia, as with other developed countries, aged care organizations are transitioning to electronic records. Within this study, one participant reported that their organization had moved all their care plans online. As Dullard and Saunders (2016) found, even when an individual has had assessments of vision and hearing, this information is often not documented in their individual file. They reported that only 50% of the 20 electronic medical records of individuals with known combined vision and hearing loss had this impairment recorded. For front line aged care staff members to effectively support this population, it is essential that this information is documented and brought to their attention.

Lack of Training

Given the many negative outcomes that are associated with acquired combined vision and hearing loss, it is somewhat surprising that aged care staff members are not specifically trained in strategies to overcome some of these negative effects. Impacts include reduced ability to communicate and socialize, difficulties with activities of daily living, reduced mobility, increased depression, and reduced concentration and memory (Brennan et al., 2006; Capella-McDonnall, 2005; Crews & Campbell, 2004; Gopinath et al., 2012; Lin et al., 2004; Tay et al., 2006).

Supporting Those With Dementia

Many participants described the additional challenges associated with individuals having both a combined vision and hearing loss and dementia. These descriptions are reflected in several publications that reviewed aged care workers’ perceptions of supporting individuals with sensory loss and dementia (Andrusjak et al., 2020; Campos et al., 2019; Hobler et al., 2018). Participants in this current study reported focusing on the dementia symptoms, rather than any sensory impairment, when interacting with an individual. This result is similarly reported by Hobler et al. (2018), where nurses working in long-term aged care did not feel confident or skilled to manage the vision or hearing impairments of individuals with dementia.

Using Assistive Devices

In the current study, several participants identified difficulties in having individuals with dementia wear their corrective lenses and hearing aids, with some individuals removing or losing these assistive devices. This difficulty was also reported by Andrusjak et al. (2020). If damaged or lost, repairing or replacing corrective lenses and hearing aids can be a significant added expense for families. The cost and effort of maintaining and using corrective lenses and hearing aids, however, must be considered important in the context of enhancing an individual's sight and hearing to maximize their opportunity for engagement with others. Assistive technology for individuals with acquired combined vision and hearing loss was not widely discussed by participants, apart from corrective lenses and hearing aids, however, technology can support an individual in many aspects of their life. Wittich et al. (2021) commented that many devices are specifically designed for vision loss or hearing loss and recommends devices that target both hearing and vision deficits concurrently, such as with volume controls that have buttons that are large.

Adapting Practices to Meet Individual Needs

A positive finding of this investigation was that some participants, despite not having received specific training, were able to provide adaptations and strategies to better support those with acquired combined vision and hearing loss. Some interviewees described using a common sense approach to communicating, such as getting close, speaking louder, and using tactile cues. Others modified environments to help the older person remain as independent as possible, such as placing a shiny ball outside an individual's door, so they could identify their room, or using large-print signs. Social isolation is a considerable concern for individuals who have a combined vision and hearing loss (Hersh, 2013; Jaiswal et al., 2018). In a study aimed at helping this population increase their social participation, no increase was found in the social participation of the 89 program participants as a result of the intervention (Roets-Merken et al., 2018), demonstrating this is a particularly complex challenge to overcome.

Challenges Supporting This Population

The lack of effect of the intervention used in the Roets-Merken et al. (2018) study highlights the significant challenges in supporting this cohort. Wittich et al. (2016), report that repetitive instruction is a simple but effective strategy to improving the performance of a simple task performed by individuals with low vision using assistive hearing devices. While adjustment to face-to-face communication is a key strategy when interacting with an individual with a combined vision and hearing loss, technology can also be useful. Saunders and Echt (2007) presented a range of technology strategies to support older adults with combined vision and hearing impairment. They commented that combined vision and hearing loss “poses challenges for rehabilitation in which assistive technology relies on the use of the unimpaired senses” (p. 252). As such, they suggested hearing aids that have larger batteries may be more practical for someone with a vision impairment who may have difficulty changing small batteries, leading to frustration and abandonment. Other devices such as an amplified telephone with raised buttons and contrasting numbers, or vibrating alarm clocks and doorbells were suggested.

Limitations

A limitation of this study may be that participants were only sampled from Western Australia and the results are not transferrable to other jurisdictions, where education and training related to acquired combined vision and hearing loss in aged care may be different. The study, however, did reach saturation, and it is the first investigation into the awareness and perceptions of aged care workers of this unique disability.

Further Research Opportunities

Given the reported prevalence of combined vision and hearing loss in the older population, there is opportunity to conduct research in this area to enable improved support to this cohort. Topics to explore could include: how combined vision and hearing loss is conceptualized, the identification of possible barriers in providing effective care to this population, identification of strategies to address the difficulties experienced by aged care workers, and the impact of other disabilities on care.

The aged care staff members interviewed had limited understanding of what combined vision and hearing loss is and how many people it affects. They expressed apprehension about how to effectively support these individuals and did not know where to seek support or information about this unique disability. Specific information about an individual's sensory functioning and how to best support them should be available to aged care workers, with care plans a key document in achieving this. Greater education, resources, and training are required in the aged care setting regarding supporting individuals living with an acquired combined vision and hearing loss.

Implications for Practice

Aged care workers appeared apprehensive about supporting individuals with acquired combined vision and hearing loss and had little understanding of the impact of this dual-sensory disability, even though the literature presents high prevalence rates in aged care settings. Further education to raise awareness of this unique disability and how to effectively support this group should be incorporated into aged care worker induction and training programs. Identification of acquired combined vision and hearing loss is the first important step to adequately supporting this population. If an individual's sensory functioning were routinely assessed when entering a long-term aged care facility or receiving home care services, this information would support the individualized care of each person, in terms of communication, environment, and equipment, which would lead to a better quality of life for these individuals.

Terminology	Explanation
Dual-sensory impairment	According to Wittich et al. (2013), some researchers prefer this terminology as it more accurately describes the sensory losses, however this term implies that the dual-sensory impairment is vision and hearing and can be misleading. In Australian Deaf Culture, impairment is a limiting word and people who are deaf and sign language users resist this label. “Impairment” is often substituted to “loss” to describe the condition to ensure cultural sensitivity to this population (Aussie Deaf Kids, 2021).
Dual-sensory loss	A term often used in the literature (Wittich et al., 2013). In Australia it is a more culturally sensitive term where “impairment” has been replaced by “loss,” for reasons outlined above.
Deafblind	Is generally accepted by those working in the field as the standard term describing all levels of impairment, regardless of when the sensory impairment occurred, which impairment occurred first, or the age of the person (Wittich et al., 2013).
Congenitally deafblind	A term used to describe those born with vision and hearing loss or having developed both prior to age two (Munroe, in Dalby et al., 2009).
Acquired deafblind	The term used specifically for people whose vision and hearing losses have developed later in life (Wittich et al., 2013).
Acquired combined vision and hearing loss	Often used interchangeably with acquired deafblindness, this term describes the acquisition of both a vision and hearing loss after the development of language (approximately 2 years old). Individuals may have a congenital vision or hearing loss and develop a loss in the other sense, or they may have normal vision and hearing and develop losses in both (Dalby et al., 2009).

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Australian Government Department of Health “Aged Care Service Improvement Healthy Ageing” and Dr Elissa Burton’s time was supported by a National Health and Medical Research Council Investigator grant.

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