March/April 2011 Issue

Communication Partners for Older Adults By Deborah Crabbs MacDonald, MS, CCC-SLP Social Work Today Vol. 11 No. 2 P. 14

For an older adult whose communication skills are compromised by disease or trauma, a communication partner offers a vital connection to verbal expression.

Humans are social creatures. While that’s not news, it’s important not to overlook that fact while working with an older adult who has an acquired communication disorder. Most of us are fortunate enough to have multiple means of expression and reception available to us—speaking and listening, reading, writing, gestures, and facial expressions. We communicate daily via e-mail, telephone, and various continually growing means of transmitting information. In each case, communication doesn’t occur without at least one sender and one receiver.

Becoming a patient due to a new medical diagnosis presents numerous challenges that vary according to the condition and its severity. All elders deserve to receive clearly presented information, so that they can actively engage in decision making. Despite varying differences in learning style and capacity to understand all the pertinent details, older adults have the right to ask questions to understand options and likely outcomes. Emotions that are triggered by the experience of a serious illness often interfere with an individual’s ability to comprehend and evaluate information. When the disease or event involves the impairment of an elder’s ability to communicate, there is further interference with treatment and recovery.

In the event that normal communication is interrupted by illness, disease, or trauma, treatment ideally involves at least one familiar communication partner in addition to the patient. A communication partner is just what the term implies: one who is on the opposite end of the sender-receiver connection. In a best-case scenario, this partnership begins at the entry point to the healthcare system, whether it’s in a physician’s office, hospital emergency department, or an individual’s home.

The ideal communication partner knows the individual well. Familiarity with the elder’s personality, educational background, health history, language background (primary language/additional language), and cultural background is valuable when it comes to assessing the level of functioning following the onset of a communication disorder. Information about an elder’s communication style—preference for interaction with individuals or groups, degree of daily use of reading and writing, sense of humor, and sophistication of vocabulary and language usage—are valuable.

Partnering for Progress

An older adult who experiences aphasia (impairment of language understanding and usage) as a result of an insult to the brain may face the greatest communication challenges when compared with other communication impairments. The difficulty with communication may simply involve poor word retrieval or range to an almost total inability to speak recognizable words. Individuals with aphasia may experience extreme difficulty comprehending verbal or written language. To an uneducated observer, they may seem to speak a foreign language. Due to their difficulty putting words together to express thoughts, older adults with aphasia often believe others perceive that they lack intelligence.

Initially, it’s essential to provide aphasic elders with a means for expressing basic needs such as being hungry or the need to use the bathroom. Some individuals develop this independently through speech or gestures. Others require a speaker to present options to which they can respond “yes” or “no.” Those with severe verbalization impairments may require a picture board that allows them to point at images to indicate their needs.

As an older adult’s medical condition stabilizes or changes, communication requires modifications. The course of treatment often involves being transferred from an acute care setting to a rehabilitation setting and/or a skilled nursing facility. In addition to the experience of tremendous loss that accompanies the illness, the adjustment to each new setting, with its different culture, environment, and staff, can be unsettling.

Facing such challenges as though surrounded by speakers of a foreign language, older adults benefit from the assistance of a communication partner who can educate staff about the individual’s cultural background and how it affects personal attitudes toward healthcare. The partner can take time to explain a procedure—a few times, if necessary—so the individual feels more comfortable about it. Because the partner is familiar with the elder’s life prior to the onset of aphasia, the partner can explain to staff a longtime disdain for oatmeal, accounting for the individual’s limited breakfast intake. A skillful partner may think of stories or activities that could effect a positive mood change. Although these tactics may seem obvious, or even trivial, for an elder whose sending and receiving circuits are blocked, they become essential considerations.

Involving a partner who is a spouse, friend, or family member in communication training offers several advantages. Treatment objectives that target the successful exchange of information can be measured as a clinician observes the elder and the partner communicating with one another, providing an assessment of communication in its most functional sense. For example, an older adult is shown a photograph of a fictional Thanksgiving dinner, unseen by the partner. He or she is asked to describe it for the partner using any means necessary (speaking, gesturing, drawing, etc). As the partner guesses what is depicted, the individual responds, adjusting as necessary until the message has been successfully transmitted.

Since the clinician (speech-language pathologist) has the advantage of knowing what is pictured, he or she is able to coach the patient on what information should be communicated to the partner. The clinician may also coach the partner regarding the most helpful strategies to elicit useful information from the patient. Such strategies can be carried over into various settings outside the treatment clinic. In addition to its usefulness in preparation for real situations, this scenario can be enjoyable for everyone involved.