A Research Scientist in Biomedical Engineering in Azerbaijan has published a review of communication issues in old age, including discussions of speech-language interventions for their management. The purpose of the paper is to give a sense of the nature and scope of the various communication problems whose incidence increases with aging processes, and to discuss where interventions are indicated, how they may be provided, and with what benefits. This article updates a chapter on aging and communication in the 1984 book Language Disorders in Adults (Audrey Holland, Ed., College Hill Press), written from the perspective of the speech-language pathologist. This author provides the complementary perspective of a bioengineer.
Effective communication is, of course, crucial to health maintenance. In addition to normal aging processes that produce declines in cognitive, sensory, and physical abilities, pathologies tend to increase as individuals age, often producing chronic conditions that require ongoing monitoring and active management. Elderly persons require receptive and expressive communication capabilities to acquire and use medical direction that can evolve over time. Any cerebral injury or insult that hinders medical communication is thus problematic.
Brain damage can occur either suddenly & catastrophically, or slowly & progressively. Examples of the former include strokes, closed head injury, penetrating head wounds, and medical procedures that may cause cerebral lesions resulting in aphasia and related disorders (e.g., dysarthria, apraxia of speech, dysphagia). Huseyn notes recent trends towards multidisciplinary approaches to aphasia rehabilitation, incorporating not only traditional restorative therapy, but compensatory methods, AAC, stimulative speech cueing, and developing support networks for families and communities. Included also is a section on communicative deficits from right hemisphere brain damage, which impairs abilities to infer the communicative intent of figurative speech.
Serious speech-language-communication problems also occur due to progressive degenerative diseases such as Alzheimer’s. Huseyn considers the dementias generally as ‘the most devasting brain disease in middle-aged and elderly people’, owing to an increasing incidence in developing countries such as his own. Progressive pathologies with communication implications include – in addition to Alzheimer’s Type dementia – Primary Progressive Aphasia (PPA), Amyotrophic Lateral Sclerosis (ALS, “Lou Gehrig’s Disease”), Multiple Sclerosis (MS), Pick’s disease, Frontotemporal dementias, and Parkinsonism. Huseyn notes that strategies for amelioration of communication deficits vary by condition and individual, that progression cannot be halted but only slowed, and that best practices include complementary strategies that are best implemented starting as early as possible following diagnosis. They include, for example, informing family and friends about expected disease progression, exploring alternative and augmentative communication options, organizing specialized group therapy sessions where possible, and supporting communication partners.
Comparison of this article with the chapter in Holland’s 1984 book shows that most developments and improvements in the intervening 37 years have come primarily in the establishment and validation of specialized programs and/or technologies for management, rather than in cures. Huseyn mentions the Lee Silverman Method as an effective voice strengthening approach from this period. The work done on specialized computer offerings and the introduction of on-line Virtual Connections represent such newer introductions for persons with aphasia. Huseyn concludes by reiterating the importance of family and community support when addressing the needs of communication-challenged elderly persons.
For further reading: Elcin Huseyn. 2021.
Neurologically Based Communication Problems and Language and Speech Therapy in Old Age. International Trends in Science and Technology, May 2021 Conference, 10 pp.