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Tuesday, December 5, 2023

Feature Q&A – senior aged care advisor at Speech Pathology Australia, Kym Torresi

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Speech Pathology Australia (SPA) is the national peak body for more than 11,000 speech pathologists across the country. Speech pathologists work to support the communication and swallowing needs of people across the lifespan, including the elderly.

SPA provides an online directory to link persons and their carers with a speech pathologist that is appropriate for their individual needs, and they have also recently released new e-learning modules for health and aged care professionals on the topic of elder abuse, a phenomenon which is often correlated with communication difficulties.

Last week was Speech Pathology Week, but the conversation is ongoing about the specific communication difficulties facing elderly people generally, as well as the new compounding challenges of the digital and COVID eras.

Aged Care News journalist Bianca Roberts spoke to Kym Torresi, senior aged care advisor at Speech Pathology Australia, about these issues and more.

Bianca: Hi Kym! So, this year’s Speech Pathology Week theme was ‘communication is everyone’s right’. Can you explain to us the relevance of that theme?

Kym: I guess the message we’re wanting to promote is that being able to communicate — in the sense of being able to be heard and to express yourself, and to get information — is a basic human right for everyone. Being able to communicate is absolutely fundamental to somebody’s quality of life, for them to be able to participate in their day to day activities in a full way. We know it’s really important for people’s ability to maintain relationships and their social connectedness and to be able to remain independent. We know that there’s high rates of social isolation, loneliness and depression with people who are living with communication difficulties, so it’s really important that we look at ways to make sure that we are supporting this group of people.

A common issue face by people with communication difficulties is [them] feeling like they are dismissed, that people will look past them to talk to the person they’re with, even talk about them in front of them to their carer. In the work that we’ve done with these people, they’ve said that they just wanted to be noted as a person. ‘I’m here. Talk to me. You don’t have to look past me and talk to my carer or pretend like I’m not here.’

Torresi says we know that there’s high rates of social isolation, loneliness and depression with people who are living with communication difficulties, so it’s really important that we look at ways to make sure that we are supporting these people.

By ‘expressing yourself’, are you referring to just verbal communication, for example, ‘talking’?

No, in fact as speech pathologists, we work with that whole gamut of communication and it’s more than just speech aligned. So we’re working with how somebody can express themselves and make their needs known, as well as being able to understand what other people might be saying. Our work also extends to helping one understand what they are reading, as well as being able to express themselves in written form. So there are a wide range of different things going on through communication that we’re addressing and difficulties with communication are actually quite common.

Just how common are communication difficulties in Australia?

We know from the ABS (Australian Bureau of Statistics) data that 1.2 million Australians have some form of communication disability, and it’s common for older people to have difficulties that can arise from both natural ageing processes and as a result of disease processes that might be happening. The latter may be a [form of] dementia or stroke or traumatic brain injury or some other progressive neurological condition. It is a common situation faced by a lot of older people. For example, we know that some studies have concluded as high as 95 per cent of older people living in residential aged care have some form of communication difficulty, but it’s also common in older people living in the community who are living with chronic or progressive conditions.

We’re really keen to raise awareness in this area because communication disabilities are often invisible. It’s not necessarily something you can see, and a lot of times people in the community are a little less confident in how they might engage with somebody who’s having difficulty with their speech or communication.

What are the most common forms of communication impairment experienced by the elderly community?

Sometimes some of the most common factors impacting someone’s communication are those hearing difficulties that haven’t been supported in an appropriate way. So, hearing difficulties are certainly one of the most common. It impacts not only the ability of an elderly person to take in information, but it often leads to a subsequent social withdrawal, especially from group situations, which starts to have much wider impacts on their day to day life and quality of life as well.

Some other common difficulties relate to:

  • slurred speech due to a stroke or condition like multiple sclerosis
  • Low volume voice due to a condition like Parkinson’s disease.
  • Difficulty finding the right words, that ‘on the tip of my tongue’ issue
  • The ability to organise words coherently, common in Alzheimers. 

So it’s important to remember that somebody can be talking quite a lot, but they can still have a communication difficulty because their communication isn’t effective— the other persons can’t grab the meaning out of what they’re saying.

Another thing that I’ll just mention, is that as speech pathologists, we also work in the area of reading and writing skills, and often the disease processes that I’ve already mentioned impact those skills, as well. I think that’s an under-recognised impact for people, particularly in terms of their access to information and their ability to get the information they need, and be able to respond to it. So even if you think about how we all get all of our information online by reading things like texts and emails. If we need to complain about a service or provider, we’d probably have to go on to an online forum. All those things, all of those sorts of mechanisms, start to become less accessible to somebody who’s having reading and writing difficulties as well.

Speech pathologists also help with the reading and writing skills often impacted by various disease processes, assisting particularly with receiving and sending texts and emails, for example.

In this current COVID age, have you found that health directions such as mask wearing have added an extra strain to elderly people and their communication?

We’ve probably all experienced that to a certain extent, but it has definitely made communication a lot more difficult for older people. Obviously, people who are a little more hard of hearing are really struggling without the additional visual cues that are obscured because of the masks, because generally speaking it is these non-verbal cues (for example, facial expressions) that this group of people rely on to augment the extraction of meaning from what you are saying to them.

But I think that the wearing of PPE (personal protective equipment) has sort of, in a way, brought more attention to that notion of communication breakdown for us all. Because all the people I’ve worked with are noticing that they’re struggling a lot more to make themselves heard or understood because of the mask wearing,  and commenting “oh gee, this is really difficult. This is really tiring. I feel like not talking at all because it’s so exhausting.’ These are all things that people with communication difficulties face on a day to day basis, so in a way it’s perhaps helping to shine a light on the issue.

The other impact of COVID, in addition to the mask wearing and in particular for older people in residential aged care, has been the lack of or limited access to that family and informal carer support. Often people with communication difficulties are having to rely really heavily on their family as the communication partner to convey information to and from their facility. Lockdown restrictions have meant less access to those family members to do that and to act as their social interaction. So that’s had a big, big impact as well.

We are lucky to have such a robust health system in Australia, but do you find that there are a lot of elderly people slipping through the cracks or not knowing where to begin in in accessing these services?

Absolutely. Oftentimes we’re finding that people with swallowing difficulties may be referred on and are generally accessing services more regularly than older people with those communication difficulties. In terms of what we can do to tackle that, I think the first thing I’d say is greater awareness of those difficulties and capacity to recognise them at a community-wide level. Furthermore, we must challenge some of the general perceptions and stereotypes that are out there.

Oftentimes, there’s a perception that communication difficulty is the same thing as cognitive difficulty. For example, take somebody who is nonverbal and not able to get their words out at all. People often assume that the person, intellectually or cognitively, is not able to think the same way as them. That is not the case, necessarily. They might have certain conditions, such as a stroke that’s affected the muscles that they use for speaking, but they’re able to think just like you. They know what they want to say, and they’re able to understand you, just as readily as you or I, but people might treat them as if they have a cognitive difficulty. And so a lot of the time there is this perception, therefore, that perhaps there’s nothing you can do to help that person. So I think one of the first things is challenging that stereotype, and as part of that, I would say that there’s that need for greater awareness.

Also important is the notion that communication is a two way thing. Communication is not a static thing that just belongs to that one individual, but when we communicate, it’s a two way process and it depends on both people as to how successful that interaction is. It’s a funny thing isn’t it that when somebody has a walking difficulty, we wouldn’t just put a really steep set of stairs in front of them. Instead, we think about ‘OK, what do you need to be able to walk a bit more safely? Maybe you need an aid to help you be safer when you’re walking, and maybe we can do something with the environment to make it easier for you to get up there, like a. ramp.’

We don’t recognise that the same things apply when somebody has a communication difficulty. That’s where having education and training for those communication partners comes in. It’s not just all about what the person does, but it’s also about the communication partner training, and having access to the right sort of aids and supports. Some people might not be able to improve their speech, but given the right sort of aids and resources they can still make their needs and choices known. And so we just encourage people that if they’re looking for further information to contact Speech Pathology Australia.

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