Communication
Older adults can have difficulties with communicating clearly due to various age-related changes or diseases that affect their ability to produce speech, to hear speech or to see someone communicating with them, or to read written words.
When people have difficulty producing words due to aphasia or a motor apraxia, or difficulty producing clear speech due to dysarthria or hearing difficulties, this can significantly affect their quality of life. There are no-tech, low-tech, and high-tech assistive devices that can help individuals communicate by supplementing their current speech ability, replacing their difficulty in communicating verbally, or compensating for their sensory loss (vision or hearing). Devices that compensate for speech are called augmentative and alternative communication devices (Case Example 21-2).
CASE EXAMPLE 21-2Augmentative Communication
Harold is a 70-year-old man who was diagnosed with a cerebrovascular accident (CVA) 1 year ago that resulted in significant declines in independence in self-care and mobility, and severe expressive aphasia. In the past year, he has improved in his functional ability in self-care activities and mobility but has not seen many improvements in his ability to speak so that others can understand him.
Harold is getting increasingly frustrated when trying to communicate his needs to others. His wife has asked for assistance in providing her husband with a means to communicate. After evaluation, it was determined that Harold had the ability to type and spell and was cognitively intact. Because of these characteristics, he was deemed a good candidate for a speech-generating augmentative and alternative communication (ACS) device. With a device that he can use to either spell out his needs or point to words to create sentences to indicate his needs, Harold will be able to communicate effectively with his family and friends.
Unaided speech options include the use of gestures, body language, and sign language, which enable the individual to get his or her meaning across without the use of devices. Low-tech options include writing on a tablet; pointing to items on a picture, phrase, letter, or word board; or choosing a word or phrase from a booklet that contains words and phrases most commonly used by the individual. It is important if the older adult has difficulty communicating that the occupational therapist consult with a speech and language pathologist to include the most appropriate communication words and symbols for that person’s current capabilities. The speech and language pathologist would determine the words/pictures that are used for a low-tech communication board, and the occupational therapist would determine the access means to the device. There are a variety of ways that a person can access a communication device. The person conveying the message can use his or her finger or an alternative pointing device (e.g., a head pointer or laser pointer) to point to choices on the board. The individual could also use eye gaze to indicate his or her choice as the partner in the conversation watches where the individual’s eyes are looking to determine the individual’s choice.
Functional communication can also become difficult for older adults if they experience a loss of hearing or vision that is not corrected through traditional compensation devices such as glasses/contacts and hearing aids. Referrals to appropriate professionals (optometrists, ophthalmologists, or audiologists) are needed to find the best device or adaptation possible to maximize a person’s functional communication in light of any sensory impairment. Hearing aids are expensive and unaffordable for many older adults because they are not currently a covered benefit for Medicare recipients. Not being able to hear what is going on around you is always frustrating, but older adults and their families can become extremely frustrated when hearing aids are purchased out of pocket and they do not totally compensate for a hearing loss and the older adult ends up not using them.
Other devices to compensate for a hearing impairment are adaptive alerting mechanisms such as alarm clocks that shake a bed, light-activated doorbells and warning systems, and telephone systems with extra-loud volume control. Most television sets that have been purchased in the last 10 years have settings to activate closed captions on television programs to allow someone with a hearing limitation to understand the content of programs by reading the closed captioning on the screen.
When you are communicating with people who have sensory impairments (visual or auditory), it is important to communicate in quiet environments with sufficient ambient lighting, while also reducing glare on the eyes of the older adult. Seating the client where the glare is to his or her back, rather than in the client’s eyes, can dramatically improve the client’s ability to pick up nonverbal cues and to use limited lip reading. (See chapter 10 for additional suggestions on dealing with low vision.)
Problems with communication due to vision loss may be compensated through enlarged print, colored overlays, brighter light, magnification (handheld magnifying glasses or increased magnification on a computer screen), and text-to-speech programs (simple programs are built into most computer operating systems, but much more sophisticated programs are also available commercially). These compensations are discussed in the following high-technology section of this chapter. Please refer to the websites in Box 21-1 for examples of available programs.