SIG 15 Perspectives Vol. 20, No. 3, September 2015

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Ethical Challenges: Less About Moral Wrongdoing and More About Communication Breakdown

“My patient refuses thickened liquids, should I discharge them from my caseload?” A version of this question appears at least weekly on the American Speech-Language-Hearing Association's Community pages. People talk of respecting the patient's right to be non-compliant with speech-language pathology recommendations. We challenge use of the word “respect” and calling a patient “non-compliant” in the same sentence: does use of the latter term preclude the former? In this article we will share our reflections on why we are interested in these so called “ethical challenges” from a personal case level to what our professional duty requires of us. Our proposal is that the problems that we encounter are less to do with ethical or moral puzzles and usually due to inadequate communication. We will outline resources that clinicians may use to support their work from what seems to be a straightforward case to those that are mired in complexity. And we will tackle fears and facts regarding litigation and the law.

Cognitive Dysphagia and Effectively Managing The Five Systems

In order for a person to swallow safely and effectively, five bodily systems must work in coordination. Dysphagia occurs when there is a breakdown in one or more of these systems: neurological (NeuroDys), cognitive (CogDys), muscular (MuscDys), respiratory (RespDys), and gastrointestinal (GIDys). The present perspective discusses cognitive decline preceding or concurrently degrading mechanisms of the swallow. We put forth current evidence supporting the premise that cognitive decline can cause dysphagia, and that dysphagia can cause cognitive decline through the exploration of anatomy, physiology, cellular architecture, basic homeostatic mechanisms, metabolism, and nutrition. Additionally, this perspective distinguishes CogDys from NeuroDys and provides an overview of the remaining systems. These types of dysphagia comprise a bi-directional, constantly evolving relationship in which cognition can affect neurological function, and the reverse can be true. We propose literature-driven conclusions and further discussion into considerations for certified nursing assistants, medical physicians, speech-language pathologists, occupational therapists, & physical therapists in effective dysphagia management.

Erratum

A speech-language pathologist's review of the latest publication from audiologist John M. Burkey of Yale University.

Meeting the Cultural, Therapeutic, and Individual Needs of the Lesbian, Gay, Bisexual or Transgendered Patient

As our population ages, providers will encounter the lesbian, gay, bisexual, and transgender (LGBT) patient possessing varying individual degrees of cultural identity and psycho-social acceptance. In addition to adjusting to the debilitating disease or injury, the patient's spouse/domestic partner, adult children, friend(s), and/or parents can play critical roles in his, her, or hir successful rehabilitation and acute and long-term care. This article documents current trends, resources, and research with the aging LGBT population. In addition, this article identifies the multiple contexts and barriers confronting the LGBT patient and LGBT care provider's quality of life. This article offers care practices designed to the experiences, expectations, and needs of older LGBT patients, including HIV-associated dementia, its stages, and its symptoms as it relates to cognitive, motor, and behavioral domains.

The Relationship Between the Use of Adult Dementia Day Care and Caregiver Quality of Life

Purpose To qualify the use of adult dementia day care services as an appropriate respite opportunity to improve the quality of life of the caregiver. Design and Methods Thirty familial caregivers from the Alzheimer's Association were recruited and divided into three groups based on number of days of use of day care services (non-use, 1–2 day use, and 3–5 day use). Survey data was self-report and measured using scores from the Evaluations Scale of Caregiver's Quality of Life. Quantitative results from the 20-item questionnaire were analyzed with Kruskal-Wallis and Mann Whitney U tests. Results The analysis showed statistically significant difference in the perception of burden for the group using day care 1–2 days per week than those that did not use the service at all. These findings were not seen in the group using the services 3–5 days per week. Implications Results lead toward the use of an adult day care program attended 3–5 days a week, incorporation of a support group with day care services, and the implementation of a structured home program for all participants to reduce caregiver level of burden.

The Impact of Subjective and Objective Hearing Loss on Cognition and Memory in Older Adults

For this exploratory cross-disciplinary study, a speech-language pathologist and an audiologist collaborated to investigate the effects of objective and subjective hearing loss on cognition and memory in 11 older adults without hearing loss (OAs), 6 older adults with unaided hearing loss (HLOAs), and 16 young adults (YAs). All participants received cognitive testing and a complete audiologic evaluation including a subjective questionnaire about perceived hearing difficulty. Memory testing involved listening to or reading aloud a text passage then verbally recalling the information. Key findings revealed that objective hearing loss and subjective hearing loss were correlated and both were associated with a cognitive screening test. Potential clinical implications are discussed and include a need for more cross-professional collaboration in assessing older adults with hearing loss.

Regulatory Review: Speech-Language Pathology and Aural Rehabilitation

Understanding regulatory requirements when providing auditory rehabilitative services to Medicare beneficiaries involves understanding of Medicare guidelines and billing and coding procedures. This paper will serve to provide general outline and provide guidance on resources to allow clinicians to explore regulations specific to their region.