COVID-19 | GUIDE #4 What you can do about undetected DSI

Caring for someone over 70? You need to read this!

About Our Guides

Our Hi-VisUK information and guidance series is designed to help those supporting or caring for an older person with Dual Sensory Impairment (DSI) during this COVID-19 emergency, social distancing and socially isolating.

Undetected DSI

It is possible that the older person you care for has undetected DSI. Our guides and our online learning help you to spot those signs quickly and communicate safely whilst ensuring their DSI is on their AIS record.

Who are they for?

The guides are for the family, friends, neighbours, carers and care organisations, professionals, social care and health care providers of the person with DSI.

What do they include?

Each individual guide aims to help you quickly understand the impacts of DSI and extra challenges caused by the COVID-19 emergency to keep them and you safe and still have effective communication. Our guides cover everyday situations and related challenges facing a DSI person and those who need to see them during the COVID-19 outbreak.

Guide #4

Guide #4 is about undetected DSI amongst older people and the huge challenge they face to access COVID-19 information and advice. This guide shows you what DSI indicators to look for, to help you identify people struggling undetected and unsupported with DSI. Use our Guide #4 with our ID Toolkit and its’ “what to do next” advice.

Is English your second language?

Each guide is available as a webpage and a downloadable PDF. Using the webpage version means you can use the translate button (at the top centre of each webpage) to choose the language you prefer.

British Sign Language (BSL) users can access the BSL video version further down this webpage or click on this link:


Following the COVID-19 health and safety guidance is vitally important not just to keep you safe and well but to also ensure you can continue helping others. Face masks (PPE) may make it more difficult for them to understand you. Our guides include ideas about this.

Undetected DSI and what you can do

Undetected and unsupported Dual Sensory Impairment in an older person is one of our most pressing concerns as they could be struggling to understand and follow the current government safety guidance, without the crucial help and advice they need.

Tens of thousands have already read and downloaded our ID Toolkit. COVID-19 & DSI Guide #4 helps you use our ID toolkit with confidence. It is from our online course Understanding DSI – try it, it’s free:

Some DSI indicators are common, some vary with location. Others are specific to the person’s experience of DSI, based on the level of their hearing loss; type of sight loss; mental and physical health; mobility and reasoning abilities.

The way DSI impacts on a person can also depend on: the time of day, the light, how much background noise and the visual ‘distraction’ in a setting e.g. bright, bold patterned walls, large windows/mirrors, lots of people, clutter, or how safe and comfortable they feel there.

Any combination of these factors can greatly reduce the quality and ease of conversation, the ability to properly pick-up important information. COVID-19 guidance significantly adds to the communication challenge for both of you.

In older people DSI can sometimes be confused and impacted by other conditions, for example dementia, Parkinsonism, perhaps after a stroke or depression. Or a combination of conditions such as DSI and dementia.

Professionals, if not properly trained and experienced in identifying and understanding DSI, seriously risk underestimating the impact it is has on an older person.

In these challenging COVID-19 times it is even more important that DSI is detected. To do this everyone needs to understand DSI, what it looks like and how to communicate safely whilst staying safe – wearing face masks and social distancing.


DSI Indicators:

  • Do they wear a hearing aid and glasses?
  • Do they fail to respond to sounds from behind or out of sight?
  • Do they miss callers – at the door/doorbell, telephone or alarms?
  • Do they have the TV or radio turned up really loud?
  • Do they sit very close to the TV or watch it from a strange angle?
  • Do they ask you to repeat and / or give wrong or surprising answers?
  • Are the lights in their home on or off at ‘wrong’ times of the day?
  • Are there piles of unopened mail?
  • Are there any signs of reading material/a marked absence of reading?
  • Is there out of date food in the fridge or a lot of the same foods?
  • Is their home or garden looking uncared for?
  • Have they stopped communicating with friends and family?
  • Are they depressed or angry and/or frustrated?
  • Is their appearance a cause for concern?
  • Are there obvious hygiene issues?
  • Are there any unexplained injuries, scalds, bumps or falls?


All of the previous DSI indicators plus:

  • Is there any mention of sensory loss in their care plan?
  • Are there issues taking medication, missing medication?
  • Do they hog the conversation or don’t wait until the other person has finished?
  • Have they NOT noticed you approaching even when they are looking at you?
  • Do they seem to be disorientated and have difficulty getting to their room or elsewhere where they have been to before?
  • Do they sit quietly in a corner and avoid socialising with others or seem to avoid joining in with activity groups?
  • Do they get up or wander around at unusual times (day or night)?
  • Do they shout when they should be speaking softly and vice versa?
  • Do they ask for help when shaving or putting on make-up?
  • Have they left their food uneaten?
  • Have they asked for a drink and then appeared to ignore it?



All of the previous DSI indicators plus:

  • Is there any mention of sensory loss in their patient record (Accessible Information Standard)?
  • Do staff know how the patient prefers to communicate with people (Accessible Information Standard)?
  • Are they able to hear their name when called by the nurse or doctor ?
  • Are they able to see their name when it comes up on the LED display in the clinic or surgery?
  • Are they disorientated and unable to follow signs or directions?
  • Are they able to easily follow the conversation with the doctor, nurse or reception staff? Ask specific questions to establish that they have understood you. Do not accept a smile, a nod or shake of the head as proof that they have
  • Have they missed previous appointments?

Think you know someone struggling with both their vision and hearing?

If, on reading our 4th Guide, you think you might know someone with undetected DSI, look at our ID Tool with its “what to do next” advice and consider how this can help you to help them.

You can find our ID Toolkit here: Download PDF

We are here to help – If you need any help or advice from us please contact

Learn about DSI: Don’t forget to try our free unique awareness course online, its quick and is packed with free resources:

Learn more online – it’s free

Thanks to the support of the National Lottery Community Fund we are able to provide free, practical online learning to help you get the COVID-19 message across and support someone with DSI.


Download Guide #4

COVID-19 and Dual Sensory Loss Guides in British Sign Language

Our Hi-Vis UK COVID-19 & DSI guides 1 to 4 are also available on video in British Sign Language (BSL). Each video is also subtitled in English.

There is no sound on these videos. Note: Guide 3 is divided into 8 sections/8 separate BSL videos.