Improving your interactions with older people with communication difficulties

25 speech path HC

This week is Speech Pathology Week, a perfect time to consider how you interact with older people who may face communication barriers. 

During the process of ageing, health issues can have a significant impact on communication abilities, or the act or process of using words, sounds, signs, or behaviours to express ideas, thoughts, feelings to someone else.

Communication impairments include difficulty with speaking and understanding as well as difficulty reading and writing.

This is often difficult for the individual and their carers, family and friends who are trying to understand them. And it can also be a challenge for aged care workers providing care to older people who may be experiencing communication difficulties.

“Communication is a two-way street”, said Kym Torresi, Senior Aged Care Advisor at Speech Pathology Australia, noting both the speaker and hearer both play a role in how effective a conversation is. 

Common communication problems

Some of the most typical communication problems you may find in older people include hearing loss, reduced vision, stuttering, weakened facial muscles, swallowing issues, and an inability to write. 

The health problems that can interfere with regular communication range from physical issues like hearing loss to neurological problems that affect the brain and muscles.

Some communication problems are temporary and reversible such as those brought on by medicines, infections, or depression.

Other communication problems are caused by structural or neurological damage from strokes, brain lesions (such as tumours), and diseases such as Alzheimer’s and Parkinson’s disease. 

Or, some older people may have difficulties understanding regional and ethnic accents, as well as dry mouth or poorly fitting dentures which can affect clarity of speech.

Things to remember when assisting an older person with communication difficulties

Ms Torresi said when interacting with an older person with communication difficulties, you must always respect them as a person and an adult by being mindful of tone and to not over exaggerate what you are saying. 

“Not everyone who has difficulties with their communication has problems with their cognitive skills, which is often an assumption people made.”

Ms Torresi noted aged care workers should try and ask the person what form of communication works best for them, if they already have any communication aids, and if they want their family involved to assist in the communication exchange. 

“Listen for the content and meaning instead of correcting for accuracy because when someone with communication difficulties feels rushed to get their message out, it increases the chances that they will have more trouble,” Ms Torresi said. 

“We know that that sort of anxiety and stress heightens communication difficulties, it can lead to communication breakdown and lengthens the time spent trying to get the message across.

“Pay attention to your non-verbal cues like facial expressions, tone of voice and gestures to help supplement what you are saying to someone with communication difficulties. 

“Check back in and repeat back to be sure you’ve understood what the person was trying to convey.” 

Alternative communication methods

A speech pathologist can look at what supports an older person with communication difficulties may need to be able to live as independently as they can, often working with the families and care staff to create different communication methods like cue cards, poster images, or electronic communication devices – such as mobile phone apps. 

These aids allow people with communication difficulties to maintain a level of personal autonomy they may not otherwise have.

Ms Torresi said it is integral for carers and the surrounding support network to encourage the person to try different communication methods out.

“Often care staff feel it’s much easier for them to do things instead… and yes, it is for them,” she said.

“But if the person has a picture card that says ‘can I have a cappuccino please?’ it means they can go up and order independently. 

“It seems like a small thing for the carer, but it’s often a massive thing for an older person to get that chance back for a little bit of independence and autonomy in their life at a time when they’re often having a lot of things done for them.”

Other communication aids can include a life-story book, which is something carers can refer to to understand how to best care for the older person with communication difficulties.

A life-story book is compiled of the person’s background information, what they did in their life, what hobbies they enjoyed and any care preferences they may have so that any treating aged care staff can care for them correctly, and be armed with topics they can engage in to encourage communication. 

Aged care workers can play a role in ensuring an older person with communication difficulties remains connected with their support network and other relationships they may have by helping explain the nature of the person’s communication issues, and the best way is to communicate with them.

Ms Torresi said it is quite common for the friendships of older people with communication difficulties to dissolve because there is fear surrounding communicating with them.

“It is important to try and help the broader social network to understand the older person with communication issues and that they’re okay with you repeating yourself or asking them to repeat themselves if you didn’t understand them the first time.”

Quick tips to enhance communication 

What you can do depends on what the primary problem is, what is causing it, and how severe the problem is. Depending on the cause, the solutions will be different. Many people have more than one communication problem, and everyone is unique. 

Health professionals may suggest communication aids such as hearing aids, speech and language therapy, and non-verbal communication strategies.

But outside of these communication aids, there are some things aged care workers can do while engaging with an older person with communication difficulties to facilitate the most effective communication possible. Such as: 

  • Reduce background noise by turning off television or radios 
  • Try and ensure you and the older person are in a well-lit and quiet environment
  • Allow the older person extra time to respond and don’t interrupt
  • Watch for nonverbal cues
  • Attempt to communicate with the older person when they are most alert, not when they are tired or disengaged
  • Ensure the older person is upright, equip with their visual (glasses) or hearing aids, and can make direct eye contact
  • Avoid overly complex sentences with open-ended questions and use simplified conversation
  • Attempt to communicate about familiar topics to the older person
  • Use writing, pictures, and gestures to supplement spoken language to inform the older person of important information
  • Be patient
  • Take breaks when needed
  • Ask specific questions (“Are we talking about dinner?”), use different phrasing (“Tell me in a different way”), ask follow-up questions to confirm or clarify, and repeat important messages to ensure you understand what the older person is communicating
  • Encourage exercises to improve speech with the help of a speech pathologist

Aged care workers should refer the older person with communication difficulties to specialists like a speech pathologist if they recognise more specific help would be beneficial. 

For more information about speech pathology, visit Speech Pathology Australia

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