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BMJ Open. 2019 Sep 8;9(9):e027803. doi: 10.1136/bmjopen-2018-027803.

Agreement on the use of sensory screening techniques by nurses for older adults with cognitive impairment in long-term care: a mixed-methods consensus approach.

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School of Optometry, Université de Montréal, Montreal, Quebec, Canada
Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain, Montreal, Quebec, Canada.
School of Optometry, Université de Montréal, Montreal, Quebec, Canada.
Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.



Based on two scoping reviews and two environmental scans, this study aimed at reaching consensus on the most suitable sensory screening tools for use by nurses working in long-term care homes, for the purpose of developing and validating a toolkit.


A mixed-methods consensus study was conducted through two rounds of virtual electronic suitability rankings, followed by one online discussion group to resolve remaining disagreements.


A 12-member convenience panel of specialists from three countries with expertise in sensory and cognitive ageing provided the ranking data, of whom four participated in the online discussion.


As part of a larger mixed-methods project, the consensus was used to rank 22 vision and 20 hearing screening tests for suitability, based on 10 categories from the Quebec User Evaluation of Satisfaction with Assistive Technology questionnaire. Panellists were asked to score each test by category, and their responses were converted to z-scores, pooled and ranked. Outliers in assessment distribution were then returned to the individual team members to adjust scoring towards consensus.


In order of ranking, the top 4 vision screening tests were hand motion, counting fingers, confrontation visual fields and the HOT-V chart, whereas the top 4 hearing screening tests were the Hearing Handicap Inventory for the Elderly, the Whisper Test, the Measure of Severity of Hearing Loss and the Hyperacusis Questionnaire, respectively.


The final selection of vision screening tests relied on observable visual behaviours, such as visibility of tasks within the central or peripheral visual field, whereas three of the four hearing tests relied on subjective report. Next, feasibility will be tested by nurses using these tools in a long-term care setting with persons with various levels of cognitive impairment.


hearing loss; long-term care; nursing; sensory screening; vision loss

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