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Title: Fostering Communication in CommunityBased Groups for Senior Citizens: Developing Graduate Students K


1
Fostering Communication in Community-Based Groups
for Senior Citizens Developing Graduate
Students Knowledge and Skills
  • American Speech Language Hearing Association 2008
    Convention
  • Chicago
  • Assistant Professor Christine Kosky, PhD CCC- SLP
  • Communication Disorders
  • Mercy College
  • Dobbs Ferry, New York

2
Learning Outcomes
  • Describe the effects of normal aging on
    communication skills
  • Identify the clinical skills that are needed to
    communicate effectively with senior citizens
  • Identify activities that promote group
    communication with senior citizens in
    community-based centers.

3
Demographic Information
  • In the United States, the number of people over
    85 years, who are most in need of help, will
    reach at least seven million in 2020 and double
    again when the baby boomers reach 85 years of age
    2040 (National Institute of Aging, 1997)
  • Worral Hickson (2003) page 6

4
  • It is currently estimated in the United States
    that 19 of the overall speech-language pathology
    caseload and 33 of the overall audiology
    caseload are older people
  • Worral Hickson,
    (2003)

5
  • there will be an increasing number of older
    population requiring audiology and
    speech-language pathology services, and the
    majority of these clients will be living alone.
  • By 2050, these caseloads are expected to
    increase to 39 and 59 respectively
  • Worrell Hickson
    (1991)

6
KASA Standards Targeted
  • Standard 111 B Demonstrate knowledge of the
    basic human communication processes including
    their biological, neurological, acoustic,
    psychological, developmental, linguistic and
    cultural bases.
  • Standard 111 C Demonstrate knowledge of
    articulation and phonological disorders,
    receptive and expressive language disorders,
    cognitive and social aspects of communication and
    later language development, voice and resonance
    disorders, neurogenic disorders of speech, and
    acquired receptive and expressive language
    disorders.
  • Standard III-F Demonstrate knowledge of
    processes used in research and the integration of
    research principles into evidence-based clinical
    practice.
  • Standard 1V B Possess skill in oral and
    written or other forms of communication
    sufficient for entry into professional practice.

7
Normal Aging
  • understanding normal aging is a pre requisite
    to clinical work with, as well, as research of,
    cognitively impaired elders. Such knowledge is
    necessary to analytically separate the effects of
    disease from those of aging, individual life
    history, and environment.
  • Ryan
    (1991)

8
Effects of Normal Aging
  • Age related impairments of the
  • Auditory and vocal systems
  • Word retrieval impairments,
  • Language comprehension (including a decrease in
    literacy skills)
  • Conversational discourse skills

9
  • Changes in the Auditory System
  • a reduction in speech perception ability in
    adverse or difficult listening conditions

10
Changes in Laryngeal Function
  • Reduced fundamental frequency for females,
    increased fundamental frequency for males,
    decreased vowel time, diminished vocal intensity,
    increased jitter, shimmer, and vocal tremor, and
    increased hoarseness
  • Worrall Hickson
    (2003)

11
Word Retrieval Impairment
  • Lesser (1987) described the stages of word
    retrieval impairment as semantic lexicon,
    phonological lexicon, phonological lexicon,
    phonological assembly, phonetic planning, and
    articulation

12
Linguistic Impairments in Conversational Discourse
  • - decreased efficiency, increased ambiguity,
    increased degree of topic maintenance, decreased
    cohesion, decreased rate, increased number of
    words per clause, overall increase in words
  • Garcia Orange
    (1996)

13
Successful Aging
  • Successful aging is defined as maintaining
    physical health, avoiding disease, sustaining
    good cognitive function, and having engagement
    with other people and productive activities
  • Rave Kahn, (1998)

14
  • Activities, such as socializing helps senior
    citizens feel competent and improves their
    self-esteem. Social networks include
  • Neighbors
  • Family
  • Volunteer/Social organizations

  • Heller (1993)

15
  • Social relationships influence both health and
    well-being throughout the lifespan with effects
    for multiple dimensions of health
  • Attix Welsh-Bohmer, (2005)

16
Prevention
  • According to Kastenbaum (1987) a prevention
    activity is a form of environmental modification
    to reduce levels of loneliness and to increase
    social usefulness, while at the same time
    providing help to maintain and improve older
    adult coping abilities
  • Prevention activities can be
  • Group therapy (Community centered)
  • Family centered
  • Heller,
    1993

17
Communicative Benefits of Group Therapy
  • Communication helps to increase
  • Word retrieval rate
  • Comprehension of complex messages/discourse
  • Efficiency of expression during discourse
  • Helps to provide appropriate respiratory support
    for speech
  • More precise articulation
  • Appropriate
  • Topic maintenance
  • Rate of speech
  • Number of words per utterances
  • Pitch
  • Vocal quality

18
  • Groups are
  • Valuable for interaction
  • People listen, talk, laugh, meet new people and
    can be motivated to maintain their communication
  • Reminiscence has been found to be a significant
    factor in successful aging and the enhancement of
    quality of life in older people
  • Reminiscence is a process involving people
    recollecting, reflecting on and recreating
    events, feelings, incidents, happenings, either
    individually or collectively
  • Worrall
    Hickson (2003)

19
Cognitive Benefits of Group Therapy
  • Psychological support
  • Generalization of communication skills
  • Helps individuals cope with feelings of
    loneliness, depression, and hopelessness
  • Sense of worth belonging
  • Support acceptance
  • Establishing expected level of performance
  • Consistent communication with peers
  • Reverse cognitive decline

  • Zarit Zarit (2002)

20
ASHA The Role of Speech-Language Pathologists
(SLPs)
  • the provision of speech, language, and hearing
    services to older people is critical to the
    maintenance of quality of life
  • ASHA, 1988
    p.84

21
Student Learning Outcomes
  • Demonstrate group leadership skills
  • Utilize appropriate opening and closing of a
    group/communication activity session
  • Provide appropriate choices of materials/topics
    that of interest to the group
  • Demonstrate familiarity with the reading material
    by researching the topic before the group
    activity

22
  • Give appropriate responses to participants
    questions about the written material/topic
  • Recognize the appropriate time(s) to change a
    topic
  • Facilitate topic change smoothly
  • Request record participants topic choices for
    the next session

23
  • Recognize participants nonverbal and verbal
    communication
  • Recognize a participants desire to communicate
  • Reproduce a participants contribution so that
    other participants can hear the message
  • Utilize appropriate prosody when communicating
    with the participants
  • Utilize appropriate fluency and prosody when
    reading aloud

24
  • Rephrase a participants contribution so that
    other participants can comprehend the message
  • Utilize appropriate communication models and/or
    prompts to facilitate communication in the group
  • Demonstrate appropriate collaborate skills with
    other (student) clinicians and professionals/staff
    at centers for senior citizens

25
  • Demonstrate appropriate listening skills
  • Demonstrate empathy and sensitivity
  • Create appropriate communication goals for
    individual members of the group
  • Collect appropriate data
  • Demonstrate appropriate writing and editing of
    session plans and SOAP notes
  • Accept an individuals right to join or not join
    in a communication activity

26
  • Accept an individuals opinion
  • Demonstrate understanding that each participant
    is a unique individual
  • Demonstrate ease and confidence when engaged in
    conversation with senior citizens
  • Demonstrate critical thinking and reflection
    skills during weekly supervisory conferences
  • Demonstrate understanding of the nature of a
    professional relationship

27
Communication Activities/Discussion Groups
  • Three locations in Lower Westchester County,
    New York
  • Two Discussion groups (a) Village-based center
    with a nutrition program
  • (b) independent living facility
  • Communication activities Village-based club
    for senior citizens

28
Method
  • Group Discussions
  • Self- selected
  • Participants are primarily women
  • Participants choose discussion topics
  • Small group discussion (6 8 participants) in a
    center and a large group discussion (20
    participants) in another center
  • Student clinicians take turns leading the group
    and facilitating communication

29
Learning Outcomes Group Communication
  • Group dynamics
  • Participative listening
  • Opening closing a session

30
Reflection
  • At first the seniors took a little bit of
    coaxing to join the discussion group. Once the
    participants and clinicians introduced
    themselves, and the article was read,
    conversation flowed easily

31
Reflection
  • The discussions taught me how to firmly take
    command of a group scenario all the while
    respecting each persons turn to speak, thoughts
    and opinions. I learned a great deal by listening
    to the input that each individual had to share on
    any topic and I shared my thoughts and feelings
    with them as well

32
Reflection
  • The student clinicians learned to collaborate
    for this group therapy and improved their
    abilities to work together, manage time, share
    interests, and express concerns

33
Data Collection
  • Clinicians developed a data collection form
    to track individual participants communication
    skills
  • Alteri, L., Burch, A., Carnevale, J.,
    Unterberger, B., and Kosky, C

34
Reflection
  • We as (student) clinicians decided to monitor
    each of the participants abilities to
    demonstrate a particular skill. The skills we
    focused on were topic maintenance, listening,
    yielding to others, eye contact, initiating, and
    interrupting.

35
  • Communication Activities
  • Variety of communication activities that
    involve both student clinicians and participants.
    E.g.,
  • - Guest speakers nutrition, local history
  • - Flower arranging, house plants
  • - Cross word puzzles and word games
  • - Recipes cooking demonstrations
  • Students working with Club organizers

36
Masters Project
  • Attitudes of Senior Citizens and Their
    Comfort Level in Various Communication
    Activities
  • Graduate Students Maggie Hales Odasia
    Mallory

37
Research Questions
  • Are communication activities designed for
    community-based senior citizens beneficial?
  • What are community-based senior citizens self
    perceptions concerning their own communication?

38
Methods
  • Led and facilitated a discussion group in a
    village center for senior citizens and
    facilitated communication activities in a club
    for senior citizens in another village
  • Developed a questionnaire that was trialed
    revised based on a small group of participants
    feedback

39
Questionnaire
  • 3 point scale (1 agree, 2 neither agree or
    disagree, 3 disagree)
  • Asked participants 11 questions regarding their
    attitudes and comfort level with their
    communication skills
  • Supplemental questions for participants to check
    off pertaining to
  • - Age, living conditions, level of education,
    past working experience, interests, communication
    partners reasons for attending the group

40
Initial Results
  • Unable to compare scores from the two centers due
    to difference in group size at each of the sites
  • Independent T-tests were to analyze the data
  • Significant correlation between comfort with
    communication and hearing level
  • Moderate correlation between the total number of
    communication partners the quantity of
    communication topics

41
Reflection
  • when I thought about a field like
    speech-language pathology and the senior citizen
    population I automatically thought about the
    senior population already presenting with some
    type of speech, language, or swallowing disorder,
    as a result of stroke, illness, injury of the
    aging process. However, after spending afternoons
    with this lively, active, and opinionated bunch
    of seniors, I not only acquired a different
    outlook on the seniors that attended the center,
    but is also gave me a sense of empathy when
    dealing with future clients from the senior
    citizens population.

42
Reflection
  • My experience working with senior citizens
    at the ______Center was life changing Ive
    gained wisdom and knowledge from each one of the
    senior citizens. I do love my grandmother dearly
    and this experience has made me recognize the
    significance of our knowledge.

43
References
  • American Speech Language Hearing Association
    Healthy people 2010 Health objectives for the
    nation and roles of speech language pathologists,
    and speech language scientists
  • Attix, D.K. Walsh Bohmer, K.A. (2005)
    Geriatric neuropsychology assessment
    intervention New York Guildford Press
  • Garcia Orange (1996) in Worral, L.E. Hickson,
    L.M. (2003) Communication Disability in Aging
    From prevention to intervention Thompson Delmar
  • Graham, M.S. Avent, J., (2004) A discipline
    wide approach to group treatment Topics in
    Language Disorders, 24, (3), 225 238
  • Heller, K. (1993) Prevention activities for older
    adults Social structures personal competencies
    that maintain useful roles Journal of Counseling
    Development (92) 124 130

44
  • Hickson, L.M. Worrall, L.E. (2003)
    Communication Disability in Aging New York Delmar
    Learning
  • Lesser (1997) in Worral, L.E. Hickson, L.M.
    (2003) Communication Disability in Aging From
    prevention to intervention Thompson Delmar
  • Ryan, E.B. Normal Aging and Language in Dementia
    and Communication (1991) Ed. Lubinski, R. BC
    Decker
  • Shipley, K.G. Roseberry_McKibbin, C. (2006)
    Interviewing and Counseling in Communicative
    Disorders Pro Ed
  • Worral, L.E. Hickson, L.M. (2003) Communication
    Disability in Aging From prevention to
    intervention Thompson Delmar
  • Zarit Zarit (2002) Mental disorders in older
    adults Fundamentals of assessment treatment
    Guildford
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