Barriers to health information and health services in COVID-19 for older adults with combined vision and hearing loss

Purpose : Older adults with combined vision and hearing loss (dual sensory loss/DSL) are often sidelined in vision and hearing research, and evidence suggests that they are at a high risk of cognitive impairment, functional decline, social isolation, falls, depression, and mortality. These consequences get exacerbated during the COVID-19 pandemic due to physical distancing restrictions on mobility and social interactions. Around one million older adults in Canada experience DSL;yet, there is very limited evidence in the Canadian context that could inform pandemic preparedness for this population. Hence, the present study identifies and describes the barriers to health information and health services access for older adults with DSL during the COVID-19 pandemic. Methods : We conducted semi-structured qualitative interviews with 11 communitydwelling older adults with DSL (age 62-85 years;7 female) in Montreal between September and December 2020. Diverse remote communication modes and accessible formats were used to obtain consent and interview participants. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo software and analyzed using a thematic analysis approach. Results : Findings indicate that the central barriers to healthcare information and access are linked to communication breakdown between older adults with DSL and healthcare providers, in addition to the presentation of information through inaccessible formats. Furthermore, healthcare staff rarely have the additional time available that is necessary to interact with the DSL clientele or have the necessary training to accommodate their communication needs. In terms of barriers to accessibility, participants reported that they have difficulty following the 2-meter distance requirements and coloured lines painted on the floor to ensure physical distancing in the healthcare setting. Conclusions : Our results highlight that the pandemic heightened the risk for older adults with DSL because of the systemic and physical barriers to healthcare access for this population. There is a dire need for training of healthcare professionals to accommodate the communication and accessibility needs of older adults living with DSL. Healthcare administrators and policymakers should consider the distinct accessibility and communication needs of this vulnerable population in order to help them age well.