1
Q
How to make food safe and palatable for the very elderly:
A
- Increase moisture content with sauces, custards etc - easier to form bolus.
- Soft foods (Avoid dry or crunchy food, ie flaky pastry, corn, meat).
- Hot/cold drinks/food
- finger foods (easier than cutlery)
- No mixed textures - need to have enough control to hold soupy bit in the mouth while chewing the meat and harder bits, which requires good control, so make everything one texture.
- Strong flavours, as taste is reduced in elderly.
2
Q
Communication Predicament of Aging model:
A
- Encounter with older person
- recognition of old age cues
- stereotyped expectations
- modified speech behaviour (‘elderspeak’)
- a) reinforcement of age stereotyped behaviours b) constrained opportunities for communication (ie hostility, communication shut down)
- a) Lessened psychological activity and social interaction b) Loss of personal control and self esteem
- Negative changes in old age cues
back to 1. encounter …(giving off even more old age cues -> downward spiral)
3
Q
Communication enhancement model:
A
- Encounter with older person
- Recognition of cues on an individual basis
- modified communication to accommodate individual needs (or not, if no special needs)
- Individual assessment for multi-focused interventions
- empowerment of client and provider
- a) increased effectiveness and satistfaction of provider
b) optimised health well-being and competence of elder - maximized communication skills and opportunities.
and back to 1. encounter with older person (who feels good about themselves and competent…)
4
Q
How does language change as people become elderly?
A
- declines in both comprehension and production.
- 6 cognitive aging models of language processing
- 3 categories of language
1. phonology and orthography
2. Semantics
3. Syntax
5
Q
What happens with phonology and orthography in aging?
A
PERCEPTION: 1. Decline in sensory processes: - visual and auditory acuity 2. Decline in cognition/processing: -speech in noise -speech rates PRODUCTION: 1. Decline in word retrieval 2. Decline in spelling
6
Q
What happens with semantics in aging?
A
PERCEPTION: **Area of STRENGTH until very old age** -Slower processing of speech -better vocab (education) PRODUCTION: -Decreased density of ideas in discourse - More off-topic speech -maybe communication goals are different -> rich story telling
7
Q
What happens with syntax in aging?
A
PERCEPTION:
- declines for text with greater sytactic complexity
- ?working memory declines
PRODUCTION:
-Decline in syntactic complexity in spoken and written language (fewer left-branching sentences)
8
Q
Some challenges with diagnosing communication/swallowing difficulties in elders:
A
- Increased age = increased complexity *multiple medical conditions more likely.
- medication can affect communication and swallowing.
- Can be difficult to tell if swallowing changes are normal ages, or whether there is an underlying pathalogical process.
9
Q
Factors which impact on speech and swallowing changes in old age:
A
- Tooth loss
- Tissue and muscular changes in jaw, tongue, salivary glands and throat.
- Decreased salivery glands -> reduced taste sensation -> a) decreased appitite b) more difficulty masticating c) more time taken to eat d) change in food choices -> nutritional impact.
- Decreased saliva can make articulation more difficult (speech)
10
Q
What imact to respiration changes in aging have on speech, swallowing and voice?
A
- chest wall complience and elasticity, decrease elastic recoil of lungs
- reduced lung and airway function due to environmental exposures
- -> reduced ease of respiration affects both speech, voice and swallowing.
11
Q
Cognitive Model of aging 1 - Resource theory:
A
Premise: Human capactiy for processing information is limited
- > Difficulty percieving a word affects subsequent mental operations such as how well it is remembered
- > Difficult perceptual operations use more resources and this drains resources from subsequent cognitive operations, including language and memory processes.
12
Q
Cognitive Model of aging 2 - General Slowing theory
A
- > age-related declines in cognitive performance are caused by slowing of component processes (phonology, morphology, syntax, semantics, pragmatics)
- > some cognitive operations may be executed too slowly for their successful competion in the available time or their completion may spill over depeting the time available for succeesive operations.
- > cause increase in speech comprehension errors
- > slowing impairs functionsrequiring simultaneous availablity of information because information from early processes may have decayed by the time intormation from later processes is produced.
13
Q
Cognitive Model of aging 3 - Inhibition deficit theory
A
- > aging weakens inhibitory processes that regulate attention and the contents of working memory
- > older adults’ conversations are more likely to go off topic
14
Q
Cognitive Model of aging 4 - Working memory theories
A
- Storage and processing functions
- Older adults suffer reductions in working memory capacity and this contains ability to comprehend and produce complex semantic content and complex syntax
- Working memory is limited by capacity rather than overall processing efficiency of the language system
15
Q
Cognitive Model of aging 5 - Transmission deficit theory
A
- Connections are strengthened by recent and frequent use, but are weakened by ageing
- Causes general processing deficits
- Linked to the atrophy of white matter (brain)
16
Q
Cognitive Model of aging 6 - Degraded signal theory
A
- Age-related declines in sensory and perceptual processes create incomplete erroneous input
- Older adults select incorrect words or none at all
17
Q
Some age-related swallowing differences:
A
- Increased swallow durations and some (mild) delays in initiation (that do not necessarily impact on function overall)
- Interactions between respiration and swallow
- Changes in appetite
- These issues may become more problematic when the person is unwell - decompensation
18
Q
Changes in swallowing during aging -> anticipatory (before pre-oral)
A
¯ sense of smell
¯ sense of taste
¯ perception of thirst (men)
¯ regulation of fluid intake (men)
19
Q
Changes in swallowing during aging -> pre-oral and oral phases:
A
¬ number of chewing strokes ¬ time to complete oral phase ¬ retention post swallow ¯ tongue driving force (necessary to propel the bolus into the oropharynx) ¯ suction pressure during straw drinking
20
Q
Changes in swallowing during aging -> Pharyngeal stage:
A
-Delay in triggering the swallowing reflex
¬ pharyngeal transit time (women); possibly higher pharyngeal contraction amplitudes
¬ pharyngeal residue post-swallow
¬ penetration no increase in aspiration
more than one swallow needed to clear the bolus
¯ laryngeal excursion reserve (men)
¯ laryngeal and pharyngeal sensation
21
Q
Changes in swallowing during aging -> Oesophageal phase:
A
¯ oesophageal transit speed
¯ oesophgeal clearance efficiency
¯ amplitude of the oesophageal pressure wave, but no change to duration (time) and velocity (speed) of the pressure wave.
22
Q
Evidence based practice (EBP) involves integrating and utilising the best available evidence from empirical research, clinical expertise, client values and preferences, as well as knowledge of context-specific factors to make decisions about the care and management of individual clients.
STRENGTHS?
A
- Uses multiple sources to draw best practice from
- Provides reasoning behind therapy choices (basis for clinical judgement)
- Finds better therapy approaches
- Removing therapy approaches that don’t work
- Learning from mistakes
- Legal protection
- Best clinical practice
- Best utilisation of resources
- Includes client values (demonstrates CRP)
23
Q
Evidence based practice (EBP) involves integrating and utilising the best available evidence from empirical research, clinical expertise, client values and preferences, as well as knowledge of context-specific factors to make decisions about the care and management of individual clients.
WEAKNESSES?
A
- What constitutes as evidence?
- Limitations to samples in research
- Need to make clinical judgement still
- Requires clinician to be proficient in literature research
- Time consuming process that may be restricted by environmental factors
- Client perspective/clinical expertise is often overlooked in favour of scientific evidence
- Some evidence on what works could work because of the clinician themselves, not the therapy approach
24
Q
Family centred practice involves “Helping families to identify concerns, priorities, and resources for their child [or family member] and including them as integral members of the intervention team”
STRENGTHS?
A
- Families know their family best and want the best for them
- Families are different and unique
- Optimal family functioning occurs within a supportive family framework and community context
- Parents hold expert knowledge of their children
25
Family centred practice involves “Helping families to identify concerns, priorities, and resources for their child [or family member] and including them as integral members of the intervention team”
WEAKNESSES?
- Family is not always included at the implementation level of decision making
- Willingness of family to support client
- Familial understanding of treatment (importance of adherence, importance of practice, specifics of how to support/when to support)
- Family level of knowledge (linked to above)
26
Culturally Responsive Practice.
| STRENGTHS?
- Helps to avoid communication breakdowns
- Reduces over and under diagnosis
- Those who feel culturally respected are more likely to continue treatment/seek services
- Can provide a link to other services that client is unaware of (link to IPP)
27
Culturally Responsive Practice
| WEAKNESSES?
- Involves more time to build relationships and develop understanding of other cultures
- Most current assessment methods are made for monolingual clients
- Lack of culturally appropriate resources available to SLPs
- Lack of valid standardised tests
28
Interprofessional Practice (IPP) is a collaborative practice which occurs when healthcare providers work with people from within their own profession, with people outside their profession and with patients and their families. Three variants;
Multidisciplinary teams
- Comprise individuals from different professions conducting discipline-specific tasks.
- Share the same client with the same health conditions, which they're each helping with
- Group effort is not required to meet specific goals - usually don't meet to discuss client
Interdisciplinary teams
- Comprise individuals from different professions who recognise their interdependence and aim to integrate their delivery of services.
- Intervention they provide is directed towards group-defined goals
- Meet to discuss common goals.
Transdisciplinary teams
- Comprise individuals from different professions who may each conduct an initial assessment and develop intervention strategies
- Implementation of these strategies is assigned to one team member while other team members (professionals) provide ongoing consultation and support.
- Outside entry level scope
- Common in rural areas/when not all professions are available
29
```
Interprofessional Practice (IPP) is a collaborative practice which occurs when healthcare providers work with people from within their own profession, with people outside their profession and with patients and their families. Three variants;
STRENGHTS?
```
- Ideal for treatment of severe disabilities
- Isolated planning can lead to detriment to client, therefore, IPP benefits the client
- Potential solution to healthcare shortage
30
```
Interprofessional Practice (IPP) is a collaborative practice which occurs when healthcare providers work with people from within their own profession, with people outside their profession and with patients and their families. Three variants;
WEAKNESSES?
```
- Requires effort, time and forming of relationship
- Can be difficult to match schedules of multiple disciplines
- Organisational culture can be a barrier to implementation (may need policy/service change
- Requires advocacy to implement
31
In what ways do the models of Evidence-Based Practice (EBP), Family-Centred Practice (FCP), Culturally Responsive Practice (CRP) and Interprofessional Practice/Collaborative Practice (IPP) offer you the opportunities to engage with the environmental factors that impact on communication and/or swallowing?
IPP:
IPP
**Products and technology:
-Professions can work as a team to discuss products and technology that can be used to benefit more than one area saving client money
-Use of IPP may identify how use of product may be beneficial in one environment and detrimental in another; i.e. tablet can’t be used at school due to damage.
**Natural environment and human made changes to the environment
-Can make sure changes to environment are suitable for all areas of clients care needs.
**Support and relationships
-Use of IPP can help link clients to professions they may not have been aware of.
Attitudes
?
Services, systems and policies
?
32
In what ways do the models of Evidence-Based Practice (EBP), Family-Centred Practice (FCP), Culturally Responsive Practice (CRP) and Interprofessional Practice/Collaborative Practice (IPP) offer you the opportunities to engage with the environmental factors that impact on communication and/or swallowing?
FCP?
FCP
* *Products and technology
- Family can help support client to make purchase of products/technology as well as support their usage.
* *Natural environment and human made changes to the environment
- Changes to home environment will affect the family as a whole, and this will need to be considered. -Similarly, family may need to support the client in navigating the changes
* *Support and relationships
- Main source of ongoing support for client, long after services have been provided.
* *Attitudes
- The attitude of family to treatment and intervention, especially where family needs to help provide the intervention methods and help practice is important.
* *Services, systems and policies
- Family may need to help the client advocate for changes to service, systems and policies, and may notice before speech pathologists and others elements that need to change.
33
In what ways do the models of Evidence-Based Practice (EBP), Family-Centred Practice (FCP), Culturally Responsive Practice (CRP) and Interprofessional Practice/Collaborative Practice (IPP) offer you the opportunities to engage with the environmental factors that impact on communication and/or swallowing?
CRP?
CRP
Overarching theme that culture needs to be considered in regard to all the below points for respectful practice
**Products and technology
-Some cultures or religions may restrict access to certain products; i.e. Some religions with technology.
**Natural environment and human made changes to the environment
-Some changes to the environment will not be appropriate based on culture
**Support and relationships
-Some cultures view medical issues as stemming from other areas and may not prioritise plans and goals from speech pathologists.
**Attitudes
-Similar to above point
**Services, systems and policies
-Need to advocate for all services, systems and policies to consider CRP, with inclusion markers, availability of communication options, and policies that help identify where there may be cultural factors to consider; i.e. policy to ask on forms if someone identifies as Aboriginal or Torres Strait Islander, religion, English as a second language, culture identified with, etc.
34
In what ways do the models of Evidence-Based Practice (EBP), Family-Centred Practice (FCP), Culturally Responsive Practice (CRP) and Interprofessional Practice/Collaborative Practice (IPP) offer you the opportunities to engage with the environmental factors that impact on communication and/or swallowing?
EBP?
Overarching theme of using EBP to justify decisions on how to make changes on all of the below.
* *Products and technology
- Research and discuss with other collegues on whether products/technology chosen is best suited to client type and outcomes or if there is something better, and if it fits with client values.
* *Natural environment and human made changes to the environment
- Is the change the best option there is; are there other better options. Does it fit with client values?
* *Support and relationships
- Need to know how best to gain support for clients, and best way for those with relationships to provide support.
* *Attitudes
- Need to know how best to change attitudes, and EBP can provide a sound basis to help explain decision making and provide proof for why something works.
* *Services, systems and policies
- EBP can help advocate for changes to the above aspects; by looking into how changes have benefited or harmed in implementation in other places can help guide whether to make changes.
35
Communities of Practice
| ie SP student cohort
Communities of Practice (CoP) are groups of volunteer participants that have an ongoing interaction around a shared concern (1). CoPs provide an environment in which professionals can share their practice experiences, develop and discuss areas of interests and build a sense of community
36
Describe the process of professional socialisation
Professional socialisation refers to the acculturation process (through entry education, reflection, professional development and engagement in professional work interactions) by which individuals develop both the expected capabilities of the profession and a sense of professional identity and responsibility.
- Entry education
- Reflection
- Professional development
- Engagement in professional work interactions.
37
Some age-related changes to swallowing:
* Increased oral transit times.
* Lower initiation of swallowing (ie at level of valleculae)
* reduced production o saliva
38
Aging and swallow
Ageing varies from person to person, however, in general most people notice some deterioration with age. Medical conditions, such as Parkinson's Disease, can impact swallowing and when unwell decompensation can detrimentally effect swallowing. Muscle strength, lung elasticity and sensory perception usually decline with age. These things can result in tooth loss as gums weaken, tongue has less force and larynx, pharynx and oesophagus perform peristalsis less efficiently. Time taken is also increased as getting breath to swallow is harder. Taste is reduced with less saliva and reduced senses of smell and taste. It becomes more difficult to deal with mixed textures and distractions during meals. Malnutrition, dehydration and aspiration need to be monitored by looking for weight loss, dry lips and mouth, wet voice, and lung infections.
