by Faerella Boczko, MS, CCC-SLP
Disorders of speech and communication that affect the elderly population may result from stroke, cancer, disease of the larynx, Parkinson’s Disease, or other neurological disorders. They vary widely and include difficulty speaking and understanding verbal and/or written information. In many cases, the effects of speech impairments may be overwhelming and frustrating for the patient and caregiver.
A patient should be evaluated by a Speech Language Pathologist, licensed by New York State and one who holds the Certificate of Clinical Competence (CCC), issued by The American Speech Language Hearing Association. Speech Language Pathologists are specialists in communication and its disorders. They are professionally educated to evaluate and treat persons with speech and communication impairments.
Frequently Asked Questions:
What are the types of speech disorders?
The disorders of speech and communication which most frequently affect the elderly are:
Aphasia: Aphasia is caused by brain damage, resulting most often from a stroke or direct injury of the head. It is a condition in which a person has difficulty expressing thoughts and understanding what is said or written by others.
Dysarthria: Dysarthria is the result of incoordination or weakness of the speech mechanism. Speech may be slurred or difficult to understand. Parkinson’s, multiple sclerosis, as well as strokes, can cause dysarthria.
Voice problems: Surgical removal of the larynx (voice box) due to cancer and other forms of disease may result in complete or partial loss of the voice. Voice is a problem when loudness, quality or pitch are inadequate for communication.
Other communication disorders: Cognitive disorders result in progressive loss of mental functions of the brain. These may include memory, language, problem-solving/reasoning, attention/concentration, and organization-of-thought processes. These functional disorders may result in decreased ability to concentrate.
How do I pay for speech disorder treatment?
Major health care plans may provide for a Speech Language Pathologist (SLP) to evaluate and treat impairments or loss of speech, language or swallowing. Medicare does include coverage for treatment of SLP disorders. In non-public insurance plans, look for terms such as “speech pathology” or “speech therapy”, “other rehabilitation services” or “other medically necessary services or therapies”. These services should include:
- A speech language assessment
- Provision of necessary rehabilitation speech language pathology services for speech, or language resulting from illness, disease, injury, congenital and /or developmental conditions
- Dysphagia (swallowing disorder) assessment and treatment. Read about our Swallowing/Dysphagia Center to learn more about caring for this condition.
Re-assure the patient. Give the patient extra time to respond and to communicate. Encourage the patient to relax before attempting to communicate.
- Speak slowly. Use short phrases. Emphasize key words. Keep messages short and simple.
- Ask one question at a time. Ask questions that can be answered by “yes” or “no”, or questions that give a finite number of choices.
- Give simple, one step directions. If the message is not understood, try again at another time.
- Remember that the goal is communication of information and not perfect speech.
- Clarify the patient’s message when needed.
- Make sure background noise is kept to a minimum when communicating (turn off the T.V. and radio). Eliminate distractions.
- Use gestures when needed. Point to objects when necessary.
- Repeat information as needed. Repeat it in a different way. Use different types of words. Try writing or drawing.
- Provide encouragement. Do not correct. If you don’t comprehend the message, say “almost” or “I’m sorry that I didn’t understand”.
- Tell the patient that you will return to the topic later.
- Look for facial expressions and attempt to guess within a category.
- Let the patient know that what he/she is attempting to communicate to you is important but that you are unable to understand at that time and that you will attempt to get the message at a later time.
- Provide orientation. Use a memory book or journal and read it frequently. Use pictures and/ or simple sentences and speak in a calm voice.
- Follow a routine-perform the same tasks in the same order daily.
- Use signs and labels; provide many visual cues that can easily be seen.
- Give one step instructions (e.g. “put on your socks” and then “put on your shoes”)
- Provide two choices when asking questions.
- Validate the patients feelings.
About the Author:
Faerella Boczko, MS, CCC-SLP, is the Director of Speech Language Pathology at The Jewish Home and Hospital, Bronx Division. She has been with the Home for over 25 years. She has been awarded and served as principal investigator to two research grants. Ms. Boczko has published research articles and presented at numerous professional society meetings, including Annual Conventions of ASHA (American Speech Hearing Association), GSA (Gerontological Society of America), and DRS (Dysphagia Research Society). She is the co-author of Communication Outcome Measures of Functional Independence:The Comfi Scale and a chapter entitiled “The Breakfast Club and Related Programs” in Aspects of Aging: For Clinicians by Clinicians. She has 27 years of experience in the field of Speech Language Pathology and has done research in swallowing disorders in the adult population.
American Speech Language Hearing Association
10801 Rockville Pike
Rockville , MD 20852
New York State Speech Language Hearing Association
146 Washington Avenue
Albany, New York 12210
Fax: (518) 472-8177