Hearing, Cognition, And Social Isolation In Older Adults: A Pluralist Approach

Abstract

This thesis examined the role of social isolation in older adults living with hearing loss and Dementia. A pluralist approach was used to investigate these associations at both a population and individual level. A systematic review and meta-analysis investigated whether social isolation was a mediator between hearing loss and later cognitive impairment or onset of Dementia. The review's findings supported an association between hearing loss and later cognitive impairment, but social isolation was not identified as a mediator. The results led to epidemiological analyses of hearing threshold and later cognitive score and hearing threshold and later social isolation score using the Hertfordshire Ageing Study. No statistically significant or clinically significant associations were observed in the multiple linear regression analyses, highlighting the need for more specific measures of social isolation to be used in population-level data. Substantial planning and engagement work was conducted at four care homes to adequately prepare for ethnographic work, which involved an environmental audit, interviews, and qualitative analysis using Grounded Theory. The ethnographic work aimed to explore the mechanisms that contribute to the experience of social isolation and give voice to the resident, staff, and visitor perspective. The model demonstrated internal and external barriers to communication and how this contributed to sustained social isolation within residential care settings. Residents needed to frequently engage in meaningful conversation and interactions with their peers and staff to feel connected to one another and retain social identity. Their ability to communicate and for care staff to listen through disordered language was the deciding factor in experiencing social isolation. A person's level of hearing impairment was almost irrelevant. The combined work highlights the complexities of social isolation in older adults. A pluralist approach allowed for novel insight into the mechanisms contributing to and maintaining social isolation.