Every individual’s development is different and usually a reflection of the world around them. Such environmental, cultural and biological factors influence this development. Like many other countries, Australia has an ageing population (ABS, 2016). This global phenomenon means increased life expectancy and provides a positive indicator of improving health for older people (Moyle, Parker & Bramble, 2014). Although each individual’s timeframe of development varies, there are normal changes that occur as the result of ageing (Worrall & Hickson, 2003, page 8). This is known as healthy ageing. The ageing process alone can affect multiple aspects of communication, such as hearing, language, spoken discourse, speech and voice. (Worrall & Hickson, 2003, page 8). This paper will discuss the communication changes in health ageing and effective communication with older people.
Communication changes in healthy ageing:
Age- related hearing loss
Age-related hearing loss, known as presbycusis, is the most common sensory deficit in the elderly (Huang & Tang, 2010). Although many adults do maintain good hearing, severity of presbycusis can vary, with 45% of adults between 48 and 92 years having some degree of hearing loss, further impairing communication (Cruickshanks et al, 1998). Age-related hearing loss occurs most often in and affects equally both ears (NIDCD, 2016). The loss associated with presbycusis is usually greater for high-pitched sounds and because the loss is gradual, you may not realize that your ability to hear has declined (NIDCD, 2016). There are many causes of age-related hearing loss. The most common cause is it arises from changes in the inner ear as we age. These changes are due to the cochlear hair cells and auditory nerve fibres, whether that’s loss of them or reduced responsiveness (Huang & Tang, 2010). The prevalence of hearing loss increases greatly with age, with a higher prevalence of hearing loss in men (Cruickshanks et al, 1998). This greater risk of hearing loss may be due to greater noise exposure in occupational settings and sex differences in other risk factors (Cruickshanks et al, 1998). No matter the cause of the age-related hearing loss, the impact it has, is unequivocal. Hearing loss has a detrimental effect on an individual’s quality of life, impacting the ability to receive information, affecting quality of care and socialization. Its unequivocal impact may result in confusion, depression and withdrawal (Backhaus, 2011).
Language
Older adults report the inability to produce a well known word, word retrieval, to be one of their most annoying cognitive problems (Burke & Shafto, n.d.). Although people of all ages suffer from this, the type of error becomes more frequent with age. This decline is significant, as many other language abilities remain moderately well maintained. For example, it is generally agreed that lexical storage is resistant to age-related change, however, retrieval processes may be affected (Park et al, 2001). Therefore, it is the encoding and retrieval that is the problem and not their ability to store information, or their semantic memory. It is proposed that retrieval processes are affected due to the fact that older adults are less effective at inhibiting irrelevant information in working memory, than young adults (Park et al, 2001). Therefore, the working memory is filled with “mental clutter”, meaning attention is more difficult to maintain and more vulnerable to distraction (Park et al, 2001). As the retrieval processes are less effective, the appearance of strategies such as circumlocution, pauses and fillers occur. As a decline in word retrieval, causes disfluencies in speech and frustration in the individual, this can further cause an individual to withdraw from social interaction as they may be embarrassed with their competency.
Voice
Voice symptoms in the elderly are frequent and often underdiagnosed (Vaca et al, 2015). Aging of the larynx and its associated voice changes are a notable concern for many older adults (Carey, 2012). A number of anatomical changes of the larynx occur. These changes relate to the thickness and density of vocal fold layers and to the discolouration of tissue (Carey, 2012). These anatomical changes result in further changes to the way an older adults voice may sound. The most prevalent symptoms are vocal fatigue, hoarseness, difficulty in voice projection and coughing. As well as increased secretion in the airways and decreased vocal intensity. It is believed that these changes explain the qualitative characteristics of the aged voice (Vaca et al, 2015). The disorder relating to the aging voice is determined “presbyphonia”. Presbyphonia includes morphological changes in the coverage mucosa, muscle and cartilage (Pessin et al, 2014). Presbyphonia has been well documented and literature suggests that older adults suffer negative quality of life changes as a result of voice problems (Carey, 2012). Clearly, negative voice changes would have a functional impact on the elderly as people depend on their voices every day to communicate their wants and needs. It is an individual’s way of expressing their feelings. If a person begins to experience difficulties with their voice, frustration can occur as they struggle to communicate these needs.
Effective communication with older people
Regardless of the results of healthy ageing, communication is critical to an individual’s wellbeing. Older residents need the ability to communicate their needs and understand what is being said to them. Older residents who can communicate effectively maximize their quality of life through increase in independence, the connection felt with their significant others and their enhanced sense of self (Backhaus, 2011). It is through receiving quality care, regardless of the long term care setting in which the older person resides, that they can successfully achieve all this. In order to receive quality care and the ability to communicate successfully, professional caregivers must be able to incorporate affective care and do this both efficiently and effectively (Backhaus, 2011).
Storlie (2015), talks about principles for person-centred communication specifically with older adults. One of the main principles is to treat each older adult with respect, displaying genuine care and concern. One way to demonstrate caring is by listening mindfully. By committing full attention to an older client and listening with the intent to understand, you are conducting active listening which is grounded in effective communication (Arnold & Boggs, 2015). Another of Storlie’s (2015) principles is to utilize the appropriate clinical skills in order to to identify and constructively address the concerns, problems and needs of the older adult.
An important component of Storlie’s (2015) principles of person-centred communication is to avoid elderspeak. Elderspeak is said to be a form of speech that is sometimes used with older adults and can make them feel as though they are being patronized and can further result in unintended negative health outcomes (Lombardi et al, 2014). The elements of elder speak includes slow speech rate, simple vocabulary and grammar, as well as repetition (Corwin, 2017). All these characteristics imply incompetence on the part of the listener (Backhaus, 2011). Although non intentional, evidently due to these characteristics, elderspeak actually sounds like ‘babytalk’ (Corwin, 2017). People working in long-term care facilities are more likely to be prone to using elderspeak because they frequently interact with vulnerable older adults who require assistance with every day tasks and living (Lombardi et al, 2014). As majority of older adults find this form of speech patronizing, elderspeak has been found to trigger negative self-assessments of competence in communication and therefore increases dependency (Corwin, 2017). Alongside dependency, is the greater concern of the association with social isolation and cognitive decline (Corwin, 2017). In order to inhibit a person’s use of elderspeak, that said person must strive to recognise any personal, age-based stereotypes and attitudes and work to overcome them (Storlie, 2015). Therefore, by avoiding elderspeak we are eliminating the negative affects it can have on both the social and psychological health of older adults. This will increase the likelihood of positive interactions and therefore more effective communication and improvement of quality of care.
Some older adults are also candidates for assistive listening devices and communication technologies. Therefore, it is necessary that older residents have access to appropriate communication aids but also that caregivers support and incorporate their use (Backhaus, 2011). Caregivers need to understand the importance of using such aids, in order to achieve successful communication for these adults (Backhaus, 2011).
Conclusion
The health of adults is affected by the ageing process; however, these developments follow no specific timeline. Healthy ageing affects communication in terms of hearing, language and voice. These developments may have negative impacts on an individual’s quality of life, and is why effective communication between caregivers, significant others and most importantly the older person, is vital. Through working with respect, mindfulness and attention to the needs of the older adult this will improve cognition, as well as social and psychological status. This improvement encourages older adults to communicate to their potential and helps others see them as viable communication partners, eliminating negative stereotypes.