Meeting the Needs of Older CLD Clients

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The ¿Qué Tal? column has typically discussed topics related to services to the younger CLD populations. I thought it would be a good idea to mention some general characteristics that pertain to the adult population group, especially those who are included in the 65 and older groups. The ¿Qué Tal? column has typically discussed topics related to services to the younger CLD populations. I thought it would be a good idea to mention some general characteristics that pertain to the adult population group, especially those who are included in the 65 and older groups.

Facts: One in 8 individuals were 65 years or older in 2000, but the proportion will decrease to one in 6 individuals by 2025. By 2050s, the number of older Hispanics, Asian and Pacific Islanders will triple, whereas the number of Blacks and American Indian and Alaska Natives will increase by only 50%. Whites will constitute only slightly more than half (63.5%) of the total groups. Currently, the 65 and older population is only 12% in the United States, compared to 15% in most European countries and as many as 19% in Japan.

Epidemiology: The cause of death is somewhat variable depending on the ethnic group considered. For example, some statistics indicate that the leading cause of death because of stroke is the highest among white populations. compared to any other populations. Cancer seems to be more prevalent for Asian populations and all kinds of accidents seem to be the cause of death appears to be most prevalent among American Indians.

Diabetes and Alzheimer’s disease are common causes among whites, while assaults, diabetes and HIV are more prevalent among the Black populations. Hispanics’ death is most frequently attributed to diabetes and homicide whereas diabetes and pneumonia are the most common causes of death between Asian and Pacific Islanders. American Indians die most likely because of liver cirrhosis or diabetes. However, outcomes depend on results of specific studies and their interpretation. Nevertheless, awareness that there might be differences across and among various cultural and linguistic groups should be in the minds of everyone working with individuals who may have potentially a speech, language or communication disorder.

Role of SLPs:  The table below outlines some commonalities but also differences in working with adult CLD populations compared to younger populations.

Factors and Variables Younger CLD Populations
(Infant to young adult)
Adult and Older CLD Populations
Etiology Most commonly inherent. Most likely acquired.
Identification Use of multiple sources of information. Use of multiple sources of information.
Sources of Information Parents, teachers, and significant others. Spouse, family members, and friends.
Location of Services School, clinic or home Clinic, hospital rehabilitation setting or nursing home.
Process Observations in different contexts, feedback from persons that know the student well, results of performance on specific test items and outcomes of attempted intervention strategies.Collaboration with an interpreter/translator if the SLP cannot communicate with the student. directly. Response to testing materials and feedback from persons that know the patient well.Collaboration with an interpreter/translator if the SLP cannot communicate with the client directly.
Items to Keep in Mind Variables in rearing practices,
Language use by significant others within the family.Second language process and variables.
Life experiences, contact and experiences with each language, as well as prior education and occupations.Language history and current research on recovery of bilinguals who have sustained brain damage.
Tests  “normed” on CLD populations continue to provide a limited view of the client’s performance and potential for improvement. Consider the validity of the test items and how they apply to the particular case.Tests are limiting even if administered in the client’s language- we need to think of what the results mean in real life –for future academic growth and preparation for occupation. Consider the validity of the test items and how they apply to the particular case.Tests are limiting, even if administered in the client’s language we need to think of what the results mean in the individual’s real life performance and satisfaction.
Intervention Focus on strengths and strategies to enable maximal learning. Focus on strengths and strategies to enable returning to pre-morbid skills.

 

Some References:
  • Bonder, B., Martin, L., & Miracle, A. (2002). Culture in clinical care.
    Thorofare, NJ: Slack Incorporated.
  • De Bot, K., & Makari, S. (2005). Language and aging in multilingual contexts. Clevedon, England: Multilingual Matters.
  • Ferketic, M., Frattali, C. ,Holland, A., Thompson, C. & Wohl,  (1995; 2004).Functional assessment of communication  skills for adults. Rockville, MD: ASHA.
  • Paradas, M. Ed. (2001). Manifestations of aphasia symptoms in different languages. Amsterdam: Pergamon In this volume, there are articles on aphasia in languages such as Czech, Farsi, Greek and Hebrew-speaking individuals (monolingual).
  • Paradis, M (2000). Generalizable outcomes of bilingual aphasia research. Folia Phoniatrica et Logopaedica, 52:54-64
  • Paradis, M. (1995). Aspects of bilingual aphasia. New York, N.Y: Elsevier Science Ltd.
  • Pope, C. (2005).Ethnolinguistic variations in communication with elderly persons who have Alzheimer’s disease. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, (12), 3, 14-21.
  • Roberts, P. (2001). Aphasia  assessment and treatment for bilingual and culturally diverse patients. In Chapey, R. (Ed.), Language intervention strategies in aphasia and related neurogenic communication disorders. (pp.208-232). Philadelphia. Lippincott Williams & Wilkins
  • Wallace, G. (1997). Multicultural neurogenics. A clinical resource for speech-language    pathologists providing services to neurologically-impaired adults from culturally and linguistically diverse backgrounds. Tucson, AZ: Communication Skill Builders.

 

Coming up in SEPTEMBER 2006
The Value of Cultivating One’s First Language – A Revisit After 60 Years

As always, I do welcome your comments.

Henriette W. Langdon, Ed.D., F-CCC-SLP
Professor
Communicative Disorders & Sciences
College of Education
San José State University
San José, CA 95192-0079
408-924-4019 voice
408-924-3641 fax

hlangdon@email.sjsu.edu

Gracias – Thank you.

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