January/February 2023

Therapy: The Importance of Integrating Speech Therapy for Older Adults
By Avivit Ben-Aharon, MSEd, MA, CCC-SLP
Today’s Geriatric Medicine
Vol. 16 No. 1 P. 8

The link between medical conditions and communication impairments is widely recognized. It affects older adults and continues to challenge both patients and geriatricians. Americans 65 and older often require extensive speech therapy services resulting from the progression of illnesses such as Alzheimer’s/dementia, Parkinson’s disease, and stroke/aphasia, as well as speech disorders related to traumatic brain injury (TBI) following falls. Too often, the appearance or development of these and other maladies results in hospitalizations and may require speech therapy to address the onset of communication disabilities.

Geriatricians are all too familiar with communication disorders associated with diseases and conditions described below. What they may not be aware of is the availability and value of virtual speech therapy, now made possible through the acceptance and adaptation of telehealth services among patients and providers.

Virtual primary care and behavioral health are now mainstream and are beginning to be utilized more extensively by older adults. What’s so encouraging is the growing adoption of virtual speech therapy to support the multitude of older patients who find it more convenient, safe, and practical to access care from the comfort of home.

The following outlines communication issues that can be addressed through virtual speech therapy.

Alzheimer’s disease/dementia: In the early stages, individuals have difficulties recalling words or being able to express or share what they would like to say. There’s often a loss of verbal fluency; individuals may stutter, halt, or find it difficult to finish sentences. During moderate to severe stages, symptoms are very noticeable as people may struggle to form simple sentences or understand conversations. Slurring, stammering, repetition, and use of incorrect words or phrases are common. In the final stages, individuals may lose the ability to express coherent thoughts and frequently repeat phrases they hear from others.

Parkinson’s disease: Individuals might slur words, mumble, or trail off at the end of a sentence. Most people talk slowly, but some speak rapidly, even stuttering or stammering. Parkinson’s motor symptoms, such as decreased facial expression, slowness, and stooped posture, may add to speech problems.

Stroke/aphasia: Someone who has had a stroke may be left with aphasia, which is the inability to produce or to comprehend language (or both). Approximately one-third of stroke survivors have aphasia.

TBI resulting from falls: TBI causes damage to the brain that can result in speech, language, and thinking problems. One out of four older adults will fall each year in the United States, and about 36 million falls are reported among older adults each year.

The Impact of Communications Disorders on Health Outcomes and Interpersonal Relationships
Left untreated, communication disorders can become highly problematic to patients and families.

Older adults with communications disabilities experience poorer health and worse health care outcomes, with communication impairments categorized as a “high predictor” for increased loneliness and depression, according to a 2019 study.

These and other researchers are finding that communication impairment is a “significant” independent predictor for social relationships, including the number of friends in a social network, the frequency of social participation, and a sense of social efficacy—confidence in a person’s ability to initiate and maintain relationships.

Quality social relationships boost wellbeing for people older than 60, concluded one study, indicating relationships with family, friends, and coworkers make people happy and healthier. Unfortunately, impaired speech significantly interrupts these relationships and contributes to social isolation. Studies have linked social isolation to the same mortality levels as smoking and obesity (about 30%), with older adults especially at risk.

Finally, those who experience these difficulties are often unable to communicate with or fully understand their caregivers or physicians. This may contribute to physical problems, lack of compliance with treatment or adherence to therapy, and issues associated with deteriorating health, which could lead to hospital admissions or even readmissions as a result.

Treating those communications impairments for individuals with dementia or even mild cognitive impairment is the role of speech pathologists who help older patients to return to their social networks. A speech therapist can also evaluate the effects of the natural aging process of the throat that can make speech more difficult. Additionally, they can determine if these challenges can be slowed.

How Speech Therapy Helps Geriatric Professionals Help Their Patients
It’s vital to meet patients where they are on their disease trajectory—even patients with dementia who become aggressive and vocal, even yelling, are attempting to communicate. As part of the care team, a speech therapist can help decipher the intent of such patient behavior.

Geriatric specialists help manage the bigger picture of their patients’ quality of life and all the associated factors that affect good living. Speech therapy offers several benefits towards that end.

1: Speech therapy can help improve independence for older adults: Residential communities know that speech therapy evaluations offer proactive benefits for older adults. Speech therapy isn’t just for older patients who may have difficulty speaking. Treatment aids in improving not only language but also swallowing and cognition functions. A speech pathologist helps educate individuals and their families to distinguish between typical and atypical speech and cognition changes that occur with aging. A speech therapist also can advise if language disorders are due to cognitive or speech causes.

Something that all care providers should be on-guard for is the overacceptance of cognitive and physical decline. There can be an “overgeneralized belief” that cognitive deficits that degrade daily function, safety, independence, and general quality of life are a normal and untreatable part of aging. However, a longstanding study indicates that medication and participation in physical activity, behavioral modifications, and participation in speech-language therapy help slow the progression of dementia-related diseases.

2: Speech therapy is a critical element of geriatric treatment for COVID-19, including long COVID: With the latest strain, a widely reported impact of long COVID—symptoms that last four weeks or more—is “brain fog.” The term refers to difficulty concentrating and is associated with the COVID infection. The prevalence of symptoms is now widely recognized by attending physicians. Other commonly reported symptoms that a speech therapist can treat include hoarseness, vocal strain, and communication difficulties, including reading, writing, and recalling words, in addition to speech. Speech therapists deploy several strategies to treat long COVID patients, such as spaced retrieval, script training, life participation goals, melodic intonation therapy, semantic feature analysis treatment, and word retrieval cueing treatments.

3: Older adults are increasingly more comfortable using technology to access virtual speech therapy: According to a recent Pew Research Center study, the adoption of technology by Americans in the oldest age group has grown “markedly” over the past decade. For example, the number of people aged 65 and older who own a tablet computer has grown about 40% since 2010. About 60% of the cohort own a smartphone. A 2017 Pew study determined that 67% of Americans 65 and older use the internet. While roughly 27% of Americans older than 65 are not online, researchers have found that older adults will change their behavior to adopt new technologies if they find them useful. Older patients may use virtual speech therapy for several reasons:

• There’s no travel required to a brick-and-mortar rehab site.

• Older patients with speech difficulties don’t have to navigate receptionists and other patients in waiting areas to see their therapists.

• At-home therapy over a computer, tablet, or smartphone is also safer because there’s no exposure to diseases such as COVID.

• Older patients also prefer not to spend their fixed income on transportation costs, such as fuel or a taxi.

• Finally, if need be, such patients often have adult children or another caregiver available to assist them with virtual speech therapy.

4: Speech-language changes demonstrates promise to help geriatric clinicians detect the early onset of cognitive impairment, including Alzheimer’s disease: Speech therapists do not merely treat individuals with Alzheimer’s or dementia diagnoses. Recent research suggests they also can find indications of these disorders, although a medical doctor must make a diagnosis.

For example, a recent proof-of-concept study published in Frontiers confirmed that changes in speech patterns are “crucial” for the early detection of Alzheimer’s disease. A 2019 Journal of Alzheimer’s Disease study confirms that continuous linguistic analysis and modeling are linked to the disease’s presence. And a 2021 study in Frontiers in Psychology also concluded that automatic speech analysis is a promising tool for diagnosing mild cognitive impairment and Alzheimer’s disease. As this research advances, it seems likely that speech indicators will become yet another tool in the care toolbox.

Geriatrician Providers and Speech Therapists Want What’s Best for Their Patients
Everyone, including older Americans, needs to have a voice. Speech connects us with others and is the basic building block of socialization and good health. It’s also associated with serious health problems.

For example, 75% to 90% of people who develop Parkinson’s disease will develop speech difficulties. The condition degrades nerves and muscles that control speech. Because Parkinson’s disease is often indicated by a change in the quality of the voice, an inability for fluid speech and forming clear and distinctive sounds can present as a first symptom.

A speech evaluation for such patients, as well as for Alzheimer’s disease and dementia patients, is an essential diagnostic to decide on the best treatment management plan to help patients delay severe onsets of such incurable diseases. As geriatrician practitioners can attest, such patients are keen to maintain their quality of life.

Likewise, a recently published study of nearly 4,500 patients with a median age of 76 years found that 90% of patients involved in stroke after-care were diagnosed with speech impairment and swallowing disorders. Better stroke treatment has resulted in improved survival rates—especially for patients younger than 50 in one study. This younger cohort has a survival rate of 57%, compared with just 9% for patients 70 or older.

In general, maintaining speech functions is critical for practical and social reasons. Good speech is necessary for an older adult to maintain and improve personal safety, health, and good quality of life to allow independent living and healthy socialization. Older adults are living longer and surviving many common illnesses. Speech therapy is a proven and powerful tool to help geriatric caregivers give their patients the best quality of life possible.

— Avivit Ben-Aharon, MSEd, MA, CCC-SLP is the founder, CEO, and clinical director at Great Speech, Inc, a virtual speech therapy company founded in 2014. She trailblazed nationwide virtual access to speech therapy.