The ORCHARD study

ORCHARD - Managing dementia with hearing loss in care homes

ORCHARD stands for ‘optimising hearing-related communication for care home residents with dementia’. The study, which ran from 1st April 2017 to 30th September 2018, looked at the problems that many residents in care homes have with hearing loss, dementia and often both conditions.

Managing dementia with hearing loss in care homes is complex. Hearing tests can be difficult to perform. Care homes are often noisy, making communication harder for someone with poor hearing. Residents and care staff often have different backgrounds, sometimes neither speaks English as their first language. Hearing aids are often supplied, but problems can arise in using them. Staff may lack skills and knowledge about hearing, and therefore feel that it is unimportant whether the aid is being worn or not. Hearing aids go missing, which can upset relatives.

This topic had been neglected by research with little sound evidence about the best ways to improve hearing-related communication in this population. ORCHARD used a research methodology known as realist synthesis to address the questions of what works, how, why, to what extent, for whom and in what circumstances, to manage hearing loss in people with dementia in care homes. This included working with professionals, including audiologists, and with care home staff, and with members of the public.

The main findings were that five main themes contributed towards good practice in the management of dementia and hearing impairment. These were: leadership promoting positive regard and empathy through person-centred care; communication training for staff; ‘knowing the person’ and relationship building for responsive awareness of residents’ hearing needs; maintaining and monitoring hearing communication through care planning; and managing noise in the care home environment. These were linked by an overarching realisation that staff could provide good care if they felt they had permission to do so.

The results of ORCHARD have been published in the journal BMC Medicine and summarised in our infographic (download below).

pdfORCHARD study infographic

We were also pleased to run an arts competition in partnership with City Arts Nottingham, which led to the creation of Silent Orchestra, an interactive sound and visual experience for people living with dementia. Watch the video below for more information.

Research funding(s): Funded by the National Institute of Health Research

Lead researcher(s): Tom Dening, Professor of Dementia Research

Research team:

ORCHARD had a strong multi-disciplinary team, with a wide range of expertise.

  • Professor Tom Dening - Professor of Dementia Research, expertise in old age psychiatry
  • Dr Melanie Ferguson - Honorary Associate Professor, consultant clinical scientist audiology
  • Dr Geoff Wong - GP and expert in the realist synthesis approach
  • Stevie Vanhegan - Patient and Public Representative, lead for patient and public Involvement
  • Dr Dawn-Marie Walker - Associate Professor, expertise in qualitative research methods
  • Dr Brian Crosbie - Research Fellow, sociology of health and illness, and qualitative research