Speech pathologists working with older people

Due to increased life expectancy and low fertility rates, Australia is getting older. By 2050, there will be 36 million Australians and 1.8 million will be aged 85 and over. Along with this growth, the number of older Australians experiencing communication and swallowing problems will rise.

As people age their speech, language, memory, voice and swallowing changes naturally. It is also more likely that older people will acquire a communication or swallowing disorder as they are at higher risk of stroke or developing a condition such as dementia and Parkinson’s disease.

Speech pathologists are experts in the assessment and management of communication and swallowing disorders. They work with older Australians to help promote independence, participation and quality of life.

Communication Problems
Communication is a basic human right that is essential for participation in society. Many older Australians live with a communication disorder that impacts on their ability to maintain relationships, express their
wants and needs and participate in social conversation and community life.  Communication problems experienced by older adults may be caused by neurological disorders such as stroke, Parkinson’s disease and dementia.

Stroke is Australia’s second biggest killer and a leading cause of communication impairment in older adults. Following stroke, one in three people will experience a communication disability (aphasia) caused by damage to the language centres of the brain. Today, more than 80,000 people live with aphasia in Australia, experiencing difficulty talking, understanding, reading and/or writing. Research estimates that up to 89% of people with Parkinson’s disease have a speech or voice disorder.

Communication problems are common in residential aged care settings, with 95% of residents living with at least one communication disorder. Communication problems associated with hearing loss and dementia are very common. Older people are at risk of voice disorders (dysphonia), with more than half of older adults with voice problems finding it negatively impacts on their quality of life.  This can lead to social withdrawal, anxiety, depression and other mental health issues.

Swallowing Problems
Swallowing disorders (dysphagia) may affect as much as 22% of people aged 50 and over. This figure increases to 50% of people living in residential aged care facilities.  While minor changes in the way people
swallow is a normal part of the ageing process, conditions such as stroke, Parkinson’s disease and dementia can also cause swallowing difficulties.  Dysphagia is common after stroke with around 60% of stroke survivors experiencing trouble swallowing. This increases the risk of pneumonia and aspiration (food or drink entering the lungs). Long-term difficulties affect around one in four stroke survivors.  It is estimated that 50% of older adults living with dementia in residential aged care facilities experience dysphagia.  Swallowing disorders have a nutritional, emotional and social impact for the person and their family. If dysphagia is left untreated or not managed properly it may result in chest infection, malnutrition and dehydration, weight loss, and in serious cases, death. 

Signs of swallowing difficulties include coughing when swallowing, a wet or gurgly voice during or after eating or drinking, extra time or effort needed to chew or swallow, recurring chest infections, or unexplained weight loss.  Swallowing disorders should be treated by an interprofessional team, including timely assessment and management by a speech pathologist. A speech pathologist will conduct a careful and  comprehensive assessment of an individual’s swallowing ability and safety. Treatment strategies and exercises are tailored to an individual’s swallowing needs and based on the cause and type of swallowing problem. This may include teaching strategies to swallow safely or changing a person’s diet to make sure they can swallow safely and comfortably.

Hearing impairment is the most common communication disability experienced by older adults. Most people over the age of 65 will experience measurable hearing loss and have some vision impairment.

How can speech pathology help?
Speech pathologists work with people of all ages, regardless of where they live or their level of disability. Speech pathologists work with older Australians to improve their communication and swallowing abilities to increase independence, their participation in society and quality of life. Speech pathology services may include assessment, individual and group therapy, counseling and education of clients, family and staff. Advice regarding dietary changes and swallowing strategies and advocacy for older adults with communication and swallowing difficulties.

Speech pathologists also ensure that healthcare information and communication environments are accessible for older adults to promote inclusion and participation in life.  Speech pathologists can recommend
communication technology and assistive or augmentative communication devices to ensure that older adults are able to communicate. 

For more information on swallowing difficulties, please see the fact sheet “Swallowing”.  For more information on communication problems following stroke, please see the fact sheet “Communication difficulties
following stroke”.

Communication difficulties are a common symptom of dementia and can emerge during the early stages of disease. Symptoms can include difficulty finding words, losing train of thought, forgetting recently heard
information, repeating themselves and repeating the same question over again. Communication difficulties are very distressing for both the person and their family.

Tips for Communicating with older adults
• Understand the person’s communication strengths and weaknesses. Go slowly and allow extra time – particularly for more complex discussions.
• Sit face to face and communicate at eye level 
• Hold conversations in a quiet, comfortable environment. Ensure good lighting and minimise visual and auditory distractions
• Check that sensory aids are working, in place and turned on (e.g. hearing aids, glasses)
• Speak clearly and stick to one topic at a time
• Repeat, summarise and/or write down important points or pieces of information. Simplify instructions or use pictures and gestures to illustrate your message
• Provide the opportunity for the person to ask questions or seek clarification
• Watch carefully for non-verbal cues during conversation and caregiving tasks
• Acknowledge and respond to communication breakdown or frustration
• Make signs, brochures and forms accessible for people with vision and communication difficulties
• Use greetings and touch appropriately to connect and ensure the person is relaxed and comfortable
• Involve older adults with communication difficulties in supported conversation and decisions about their care and activities
• Draw upon the person’s life history, former interests and familiar topics to support and stimulate conversation
• Find time to communicate and connect on a regular basis