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Speech pathology and communication as a human right

As we grow older, communication skills can deteriorate – whether as a result of hearing loss, speech fluency or physical health – and an estimated 1.2 million Australians live with a communication disability.

Communication has been forefront of the minds of aged care residents and providers alike during the COVID-19 pandemic and the ability to communicate as a basic human right is often taken for granted.

Speech Pathology Australia believes that those with communication disabilities often suffer in silence as their symptoms are often unseen and out of sight, and this is exacerbated as we age.

Speech pathologist Danica Dalton spoke with Aged Care Insite about communication disabilities and what aged care providers can do to make the lives of residents better.

ACI: What’s the definition of a communication disability?

DD: I think a communication disability is anything that really impairs a person’s opportunity to communicate with others, whether that’s their family, friends, people out in the community, it doesn’t necessarily have to be as a result of a severe medical diagnosis.

It can be something more common like a hearing impairment. So that can be a communication disability, particularly if someone hasn’t received appropriate hearing support, or it can be something more severe that impacts a person’s ability to put together words, find the right way to put speech together, to make those sounds come together.

What effect does ageing have on communication?

We have changes in communication. So, there’s usually a range of comorbidities that are occurring at the same time. You might have a bit of a hearing impairment. There are age-related changes that occur to the voice as well, so they can become quieter, it’s sometimes harder to project.

So you’ve got those considerations, as well as other communication partners who potentially have hearing impairments or other concerns in their ability to attend to information. There could be background noise and the person that is speaking might also have difficulty recalling information to be able to put that in a sentence to convey information, or it may be that they struggled to find some words here and there. So the information that they convey isn’t necessarily concise or precise. They have a difficulty retaining large chunks of information. It might be that the key information you wanted someone to get from your statement might not actually be the information that they retain from what is being told to them.

You obviously deal with a lot of older Australians, what are the general comments they make about life as a result of their inability to communicate?

I think any kind of communication disability is quite difficult to visualise. Unlike a physical disability, a communication disability isn’t necessarily that obvious to someone. We’re moving in a very verbal world and a very big world, so you get mail, you can get it on the phone, even currently, you’ve got lots of telehealth which COVID threw the huge twist in to how we provide services, which is really difficult for some people in the aged care sector.

So in terms of access to the community and completing everyday tasks, it can be quite isolating and become quite difficult when someone has difficulty in accessing reading information or being able to express themselves clearly when they go out to have lunch, it might be too noisy and they have difficulty keeping up with the conversation and finding the right words.

And that can make it difficult for them to have meaningful connections with others. And it can be quite isolating unless someone takes the time and puts in the energy to work with someone who has a communication disability.

I often associate speech pathology with younger people. Do people realise that speech therapy and speech pathology can be effective for older Australians?

I think it depends on who you talk to. I think speech pathology is increasingly being identified in its role within the aged care sector. There’s a different living, the community versus residential aged care in terms of funding and access to speech pathologists, which is something that is being reviewed by the royal commission.

I think particularly with the introduction of My Aged Care and the national standardised assessment form, I think that that’s been really good at being able to identify where the role of the speech pathologist may be in aged care. I think there’s a lot more prompts within that for assessments to really consider someone’s communication and the impact that might have on their everyday life, and the role of the speech pathologist in being able to work with someone, it does take a lot to educate the community around that role.

How much can be done for someone over an advanced stage?

There’s a lot, there are lots of people who are very young 65-year-olds and particularly in the community, you look towards the section of all the way through high level care needs and residential care. There’s a huge range of things that we work on and these are some clinical examples.

A gentleman was diagnosed with Alzheimer’s disease. Part of that involved loss of his language. He also became quite apathetic in his presentation, so he didn’t initiate as much conversation with others as well. And his ability to recall information was reduced.

We worked on a life story book with him so that he could really engage in a meaningful way with someone. Instead of relying on him being able to recall information, the information is there, it can be shared with someone. So it gave him the opportunity to really share part of himself and his identity, identifying that he is still a person despite the fact he does have a diagnosis with dementia, and really looked at what roles that he could still fulfil within his life and included in that was part of communication partner training.

Take someone with Parkinson’s disease. Very early on in a diagnosis we usually do some voice therapy, which has really good evidence behind it. It is rehab to strengthen someone’s voice with the knowledge of an understanding of the neurobiology behind Parkinson’s disease. And then as that progresses, we look at other strategies and supports.

In the community, we have aphasia support groups, for people who are living post stroke chronically with language impairments. Part of that is having an opportunity to link in with people who understand what it’s like to live with a communication impairment.

Last week was speech pathology week. For anyone out there, any older Australian who are reading or any aged care homes who don’t currently use the services of a speech pathologist, what would you say to them?

Speech pathology definitely has a role quite diversely across the aged care sector, and anybody with the right help can learn to communicate with confidence.

I think we have a huge role in terms of behaviour support and creating meaningful experiences across the sector. And that even though someone has been living with a communication disability chronically, it doesn’t necessarily mean that there isn’t anything that we can do to help.

Things progress, things change, evidence changes, technology changes; there’s always new, upcoming things within the sector. So just because someone might have difficulty recalling words or constructing a sentence, or is having difficulty clearly not getting words, it doesn’t mean that that’s their diagnosis and that’s the end. We’re definitely out there to provide strategies and support to build people’s opportunity to communicate with confidence.

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