Priorities for Dementia and Hearing Research (V2) - BSL version

Page 1: Information Sheet and The Survey

1.1. You can complete this survey on your own behalf and complete it again on behalf of someone else (e.g., a relative living with dementia). Required

I am completing the survey from my point of view.

I am completing the survey from someone else’s point of view.

Prefer not to say.

2.2. Reducing the risk of developing dementia and hearing conditions (please give up to 3 suggestions). Optional

3.3. Diagnosing dementia and hearing conditions (please give up to 3 suggestions). Optional

4.4.  Treating or managing dementia and hearing conditions (please give up to 3 suggestions). Optional

5.5. Are there any other issues or concerns about the connection between dementia and hearing that you want research to focus on? Optional

6.6. Hearing: Which category best describes you? (Choose all that apply) Required

I have hearing loss

I am a member of the Deaf community (e.g., I use sign language)

I have tinnitus

I have hyperacusis (sound sensitivity)

I have a vestibular condition (balance problems)

I do not have a hearing condition

Prefer not to say

Other

a.6.a. If you selected Other, please specify:

7.7. Dementia: Which category best describes you? Required

I have been diagnosed with Alzheimer’s disease

I have been diagnosed with vascular dementia

I have been diagnosed with fronto-temporal dementia

I have been diagnosed with Lewy body dementia

I have been diagnosed with mixed dementia

I have been diagnosed with mild cognitive impairment

I have been diagnosed with dementia (type not known)

I have suspected mild cognitive impairment or dementia

I do not have dementia

Prefer not to say

Other

a.7.a. If you selected Other, please specify:

8.8. Occupation: Are/were you any of the following (Choose all that apply): Required

Health professional (e.g. Nurse, audiologist)

Social care professional (e.g. Care home staff, support worker)

Researcher

Prefer not to say

Other

a.8.a. If you selected Other, please specify:

 

 

b.8.b. If you selected health professional, please describe (e.g. audiologist, admiral nurse, geriatrician):

 

 

c.8.c. If you selected social care professional, please describe (e.g. support worker, care home manager, social worker):

9.9. Are/were you a supporter (e.g., relative, informal carer, close friend) of someone living with mild cognitive impairment or dementia? This includes diagnosed or suspected mild cognitive impairment or dementia. Required

Yes

No

Prefer not to say

10.10. Are/were you a supporter (e.g., relative, close friend) of someone living with a hearing condition (e.g., hearing loss, tinnitus)? Required

Yes

No

Prefer not to say

11.11. Which country do you live in? Required

England

Scotland

Wales

Northern Ireland

Prefer not to say

Other

a.11.a. If you selected Other, please specify:

12.12. How would you describe your gender? Required

Man

Woman

Non-Binary

Prefer not to say

I would describe it in another way

a.12.a. If you selected 'I would describe it in another way' you can opt to tell us more here if you wish:

13.13. What is your ethnic group? (Choose one option that best describes you) Required

White

Asian

Mixed / Multiple ethnic groups

Black / African / Caribbean

Prefer not to say

Other ethnic group

a.13.a. If you selected Other, please specify:

14.14. What is your age group? Required

18-29 years

30-39 years

40-49 years

50-59 years

60-69 years

70-79 years

80-89 years

90 years and above

Prefer not to say

15.15. Do you consider you are any of the following (please tick all that apply): Required

Someone with a disability or long-term health condition (not including dementia or a hearing condition).

Someone with a mental health condition (not including dementia).

Someone who lives in a rural or remote area.

Someone from the LGBTQ+ community.

Someone who does not have educational qualifications or has qualifications not recognised in their current country.

Someone who is on a low income (e.g., receiving state pension or minimum wage).

Someone who is/was unhoused or homeless.

Someone who is/was a refugee or asylum seeker.

Someone from a minority or marginalised group (please describe).

None of the above

Prefer not to say

a.15.a. If you selected someone from a minority or marginalised group, you can tell us more here if you wish:

16.16. Email address:

17.17. Postal address (if preferred):

18.18. Telephone (if preferred):

19.19. Name (if preferred):