WEBVTT
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Hello and welcome to Age Compass, where we're navigating aging and dementia together.
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Today we have a very special guest.
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Uh, it's a friend of mine.
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She is a speech pathologist, and she never ceases to intrigue me about her patience and her cases and her insights.
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So, welcome, Sophie.
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Thank you.
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Glad to be here.
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Very excited to be here.
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Oh, I'm very grateful you're on the show.
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It's very cool.
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Um I want to educate people about what a speech pathologist is actually all about.
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Because when my mum was referred to a speech pathologist after having a diagnosis of dementia, I was quite confused because I thought, well, she doesn't have a stutter.
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What does she need a speech pathologist for?
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So please let me know that I'm not the only one that ever thought that.
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Absolutely not.
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And if you can see me right now, I'm enthusiastically nodding as um DJ speaking because we get that all the time.
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And even before I started studying speech pathology, my mum suggested it as a career, and I was not interested because I thought it was stuttering in Lisps.
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That's all I thought it was, um, until I went to a uni open day.
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So it's much more than that.
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Um, and I might go into a little bit of what we do, kind of the two main areas, um, which is communication and swallowing.
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And they're kind of the two main areas it breaks down to.
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Communication, we're looking at everything and anything across the whole lifespan from kids to adults.
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It might be someone's ability to understand, express themselves, um, their voice quality as well.
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Um, if you know they don't have a very strong voice, or it might be breathy or hoarse.
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Um, we also do the stuttering and lists, that's that's included.
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Um, and speech sounds.
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So that's kind of your ability to articulate yourself and be and understand the sounds and produce them correctly.
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Um, and then I suppose the other part is swallowing, where our main goal is we're not dietitians, um, which we often get confused for as well.
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Our role is to make sure that mealtimes are safe and enjoyable for a person.
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So safety is kind of our main focus, that all the food and drink is going down as it should.
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That's incredible.
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I honestly, until I got mum involved with one, I honestly had no idea.
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And it's one of those things that I feel more of us should have a better understanding about what it actually involves.
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So thank you for explaining that.
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Because my mum was referred, she had dysphagia.
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Um, and again, we're always dealing with big words in this world.
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Um, now, overall, is that a very common part of your work?
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And could you explain what that is?
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Yeah, so dysphagia is basically disordered swallowing.
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So something's wrong with the swallow, and it can be any range of things from chewing or you know, even the steps before you put it in your mouth, being able to get it in your mouth effectively, all the way to the actual kind of swallow reflex itself.
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Um, dysphagia is a very common one that I see.
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I work with um adults in the community, um, particularly adults over 65, but it can happen to any age depending on any diagnosis, or you don't have to have a diagnosis either.
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So we see a lot of people with any progressive neurological disease like Parkinson's or motor neurone disease is a big topic at the moment, um, Huntington's disease, yeah, anything kind of within that realm.
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Um, also people that have had brain injuries, whether acquired or traumatic brain injuries, um, also people with diagnosis of um an intellectual disability or sometimes autism spectrum disorder as well.
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So there's a very large range of people we see.
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Um, and some people we we don't know why there's no diagnosis, but they're just having difficulty swallowing.
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So for me, working particularly in that age group 65 and above, I see a lot of people with swallowing difficulties.
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Um, and just to put into a bit of perspective the swallow and how complex it is, you use about 50 sets of muscles to swallow.
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Oh wow, I still didn't even know that.
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So you're looking at like a hundred different muscles to actually complete a swallow process.
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Oh my god.
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Um, and you have five cranial nerves involved in the swelling process, um, and you're swallowing about 500 to 700 times a day.
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So it's a very big part of our life, but it's also quite a complex part.
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I reckon we take that for granted.
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We definitely do, we definitely do.
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Um, so that's just to put in perspective how easily that if you had damage to one of your cranial nerves, say through a stroke or or through dementia or changes to the brain, um, or you had any changes to that, those muscles that control swallowing.
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I often give people the example of, you know, when we think about physios coming in later in life and you use lose some of your muscle strength, things like that, swallowing is all muscles as well.
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So that can be affected.
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Oh wow.
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That's so amazing to explain it that way.
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Yeah, because there is natural changes that happen to the swallow with age in the strength of our chew, things like that.
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Um, often we have less dentition or may have dentures, um, which can also impact strength, even though they are teeth and they are generally a full set of teeth, it does reduce your um strength of your chew quite significantly.
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So there's all little changes like that that can happen that can affect someone's ability to eat and drink safely.
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Um, and so dysphagia being a disordered swallow, um, a stroke can cause those changes, like when you have um changes to your muscles after a stroke and your ability to move your legs and arms, it happens the same with your swallow as well, or it can again for everyone.
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Something that I would never have thought of.
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There's so much more that is unseen.
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And that's I guess what you deal with, all that unseen kind of anatomy.
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Yeah.
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Yeah, absolutely.
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Um on that, are there any signs that we could look for for people at home or people we care about that might suggest something might be starting to impact their swallowing?
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For sure.
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And I think it's one that it is good to know the signs and symptoms because obviously when you go into a doctor's surgery and you're seeing your GP, you're not often, I can't even think of a circumstance where they might watch you eat or drink.
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So often those things are not flagged.
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You know, it's something, not something that they can look at in the session and be like, oh, yeah, you're probably having difficulty with this.
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Like, let's get a speech pathologist in.
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So it really comes back to knowing that something has changed and being able to report that and kind of get that process rolling.
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Um, so some of the signs are the most common one is probably coughing during eating or drinking.
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And that can be during or maybe after the meal.
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You have a bit of coughing episodes.
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It can be quite, you know, full-on sometimes.
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It can be almost kind of to that point of choking, or it could be a choking incident where you do have that full blockage of an airway and it's silent and they're quite terrifying.
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Um, but yeah, it can just be those little throat clears as well, where you're just going like kind of throughout the meal.
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But ah, so and that would happen during a meal.
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So we'd notice someone doing that a bit more often during a meal, and that might be a bit of a red flag.
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Yeah, yeah, during or after.
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So it can kind of happen anywhere along that spectrum, kind of within the meal time setting.
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Okay.
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Um, another one is wet voice, which once you hear it, you'll know it.
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Um but I always kind of describe it, it sounds like someone's gargling water when they speak.
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So you kind of hear a real wet quality to their voice.
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So if I was speaking like this all the time, and then I had a dramatic change to my voice, and you would hear this like gurgliness as I talk, that's a sign that things are probably not going down all the way.
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They're kind of getting a bit stuck halfway, and that can cause a bit of a problem.
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Um, also reduced intake.
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If someone has changes to their appetite or they're not eating their full meals, or um they're declining some meals, it's always good to think about maybe getting us in to have a look at whether their ability to enjoy a meal and eat safely is impacting that.
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Because one of the things that I see every day is the impact of fatigue on mealtimes.
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And like I said, like you're swallowing so often, and I think we take for granted how fatiguing a meal time can be.
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You're using that many sets of muscles, you're having to concentrate on the food, you're doing a lot of chewing, it can be really exhausting.
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Wow.
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In a million years, I would never have put that together.
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And I mean, I've seen a lot of people as well, and even now I've learned that.
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Wow.
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Yeah, so that's I I think one of the biggest things that we see, and particularly um for quite a range of people, you know, as as you get older, you might start to have naps in the afternoon is quite common.
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Um, and say if they have lunch directly before that nap, so they're starting to get a bit tired and they're eating just beforehand, sometimes they can have a more trouble in that specific meal.
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The rest of the meals are absolutely fine, but in that one specifically, they have a bit more difficulty.
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Or sometimes we see I saw a lady the other day that, you know, she had kind of stopped eating dinner.
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She didn't have much of an appetite, she reported for it, but it was more so that she was choosing really soft things to eat.
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So she was eating basically like, you know, a soup or you know, a bit of like banana, so very easy things to kind of eat because she didn't have the energy by the end of the day to eat a full meal.
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That is really something very interesting to look out for.
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Very yeah, to be aware of.
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Yeah, and that's where we work in conjunction with dietitians a lot because the dietitians might come and they're like, okay, you're not meeting your nutritional needs, um, but we we can't figure out why that is.
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So they might get us in to see if we can find any gaps in the person's ability to eat or drink safely and enjoyably.
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And it's something you mentioned earlier.
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It's interesting when you said that meals should be pleasurable.
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And I think that thing, if it becomes an effort, it's like anything, if it becomes an effort, then it is less pleasurable.
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But I hadn't thought of that in the in the thought of meal type.
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Absolutely.
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Very interesting.
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And because there's also that aspect of someone has to prepare the meal first, and even preparing a meal can be exhausting.
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This is true.
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So you've made it, you've I don't know what you're eating, but you you've chopped up all your bits for your salad and you're standing for a long time, and that can be exhausting.
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And then by the time you actually go to eat it, you're depleted and ble depleted of energy.
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So yeah, it can be really difficult.
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That is that is something that I have just learned.
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Like, that's significant, that's very cool to know.
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Yeah.
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Um, now you've said that you're working with older adults, and I know in your career you've worked with both children and older adults, and you've confessed to me that you do prefer older adults.
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I do.
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Could you give us some insight into why?
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Yeah.
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So my first job, I was working in what was classed as a rural health area in Australia.
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Um, and so we were the only speech pathology clinic for quite a long way.
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So we were servicing um kids and adults in the community in a hospital setting in the local hospital we would go to, um, also in aged care homes, kind of right across the board in a range of different settings.
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Um, and I did love working with kids as well during that time.
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Um, we're allowed to have preferences.
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We're allowed to have preferences, but I enjoyed both.
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I enjoyed both.
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Um, but I definitely did fall in love with working with older adults.
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And I think the thing that initially drew me in was just having the chats and the connection.
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I loved the chats and the connection.
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Um, and you know, I would see people in aged care homes where would go in and, you know, that might be the only visitor they have that day, and just having those chats and being able to sit for a while and probably spend a bit too much time that we weren't supposed to, uh, you know, making a cup of tea and learning a bit about their story and having those discussions.
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I that would that was kind of what immediately drew me in.
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Um, but I think more so nowadays, I love the the functional goals that we have with our old older adults.
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Um, and a lot of it is, you know, we'll go in to see people and they've always loved reading and now they're struggling to read, whether because of their eyesight or language difficulties or you know, dementia and memory, it could be a range of things, and being able to see if there are ways that we can help that person to engage in that hobby.
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Wow.
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So, like it's it's really functional, and and we're talking to them about what they want to achieve and what's important to them, and really learning about, you know, what how they get enjoyment in in life and making sure that we can have like get that person access to those things, which I really love.
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Yeah, and that's the thing.
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I I I admit I'm similar to you.
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I enjoy finding someone's story.
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Everyone, every older adult has some sort of incredible advice or story that they've got that they don't really ever share with anyone.
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So I I definitely agree with agree with you there.
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Yeah.
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Um, so a thing that really surprised me when dealing with mom and a speech pathologist was how much of a difference speech pathology can make for someone living in dementia and their family.
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Can you explain what that looks like in practice?
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Absolutely.
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This is an area I'm really passionate about.
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I think that as a profession, you know, speech pathologists, we're often known for being a little bit shorter on um having staff around.
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And, you know, where we are, we do have professional shortages, but I think more and more we're around and we have a role in working with people with dementia.
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And I don't think it's fully seen yet in the community, also by the medical community, um, the role that we can have.
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Um but I always get excited when someone's kind of found their way to us um and books that assessment, and then we can chat all about all the things that we can help and do with.
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And I think to put it in perspective first, we often look at kind of two types of therapy or or input that we can have.
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And one is being rehabilitative and one is compensatory.
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And often we'll go into people and they've been told, you know, you've been given a diagnosis of dementia, depending on what what type of dementia, and they are told, you know, you're going to lose your communication.
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And then that's kind of the end of it.
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And we go in and we're already on the back foot because they're like, well, there's nothing you can do for me.
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Like, there's I've been told there's nothing you can do.
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And the thing is, we're not trying to fix, you know, we're not trying to mend, we're not trying to repair so that nothing happens, you know.
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Unfortunately, we don't have that magic wand.
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I wish we did, but that's not our aim for you.
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But we can work with you in a compensatory approach.
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So looking at strategies to make life that little bit easier, to try and maintain your communication for as long as possible, and looking at workarounds for whatever's difficult, see if there's a way that we can work around it with your language that you do have and the capacity that you do have.
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Um, so I think that's a a good thing to keep in mind initially, is that we're not coming in promising to fix everything.
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It's to work with you and with the family to find ways to make things that little bit easier.
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And that is something I notice working with um older adults, particularly in aged care homes, is I notice once communication starts declining, then that withdrawal happens.
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And just knowing that there's a way to essentially, would you say, help preserve as much as possible?
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Yeah, and I I think that's kind of our goal at the moment.
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And look, we don't have endless amounts of research, unfortunately, at the moment.
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I wish we did.
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Um, but that's definitely kind of our goal.
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And, you know, sometimes we go in to see people that are quite isolated already, you know, even prior to the diagnosis, and they're not talking to people very often.
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Yes.
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And if you're not, it's the same with the body and all the other skills.
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If you don't use it, you lose it.
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Yes.
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So sometimes we go into those settings, and our first thing is looking for ways to increase their language day to day.
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So it can be as simple as, you know, I see a lot of people that watch the chase and all those quiz shows in the afternoon, one after the other.
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And we're like, you know, answer the questions, say them out loud.
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Like that's an easy first one to do, you know, even commentating on what you're doing day to day.
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If you're cooking a meal, pretend you're on a cooking show and explain it.
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So it's using like simple ways to get that language in a little bit more day-to-day.
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Um, and we can give like sheets and you know, explicit like practice on your word finding, your word retrieval, all of those strategies.
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But it can be as simple as just incorporating it into little things that you do day to day.
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So it's not adding on anything extra, not having to sit down and do homework, but it's just creating a bit of a communication-friendly environment.
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Yeah, they're just little daily micro habits.
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Commentate what I'm doing.
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Exactly.
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Have a chat to yourself.
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Just ignore the looks from people.
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Exactly.
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There's nothing wrong with having a chat with yourself.
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Um, so that's definitely a thing that we do.
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Um, and I think another thing that we do a lot of is communication partner training because it can be so confronting for families as the communication partner with the person that's having difficulties to see that communication change.
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Yes.
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And it's so difficult to understand sometimes what it's changed, like how it's changing and why it's changing.
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And how can I communicate with this person?
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Because the ways that we've used our whole lives are not working.
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And you know, sometimes we go into situations where people are quite quite stressed with just, you know, they can't talk to their loved one anymore as they normally would.
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Um, so we look at ways that we can create that communication for both people and make it easier for both people.
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So both the communication partner teaching them strategies, but also making it easier on the person with uh dementia as well, because you know, there it's communication can be so overwhelming.
00:18:33.359 --> 00:18:34.319
Yes, no, I agree.
00:18:34.400 --> 00:18:43.039
And it's also so much, it's so essential, it's so much part of a relationship, a care relationship, a family relationship, whatever it may be.
00:18:43.440 --> 00:18:48.720
You know, it's just so important and I think uh uh taken for granted, as we were saying earlier.
00:18:48.960 --> 00:18:49.519
Absolutely.
00:18:49.759 --> 00:18:52.880
Um, okay, well, this is a good place to take a break.
00:18:53.039 --> 00:18:59.039
So we'll be back with a part two to hear the rest of the advice and learning that we have from Sophie.
00:18:59.359 --> 00:19:00.640
Thank you very much, Sophie.
00:00:00.880 --> 00:00:05.519
Hello and welcome to Age Compass, where we're navigating aging and dementia together.
00:00:05.759 --> 00:00:08.320
Today we have a very special guest.
00:00:08.400 --> 00:00:09.519
Uh, it's a friend of mine.
00:00:09.599 --> 00:00:17.839
She is a speech pathologist, and she never ceases to intrigue me about her patience and her cases and her insights.
00:00:18.079 --> 00:00:19.679
So, welcome, Sophie.
00:00:20.079 --> 00:00:20.559
Thank you.
00:00:20.800 --> 00:00:21.440
Glad to be here.
00:00:21.600 --> 00:00:22.640
Very excited to be here.
00:00:22.879 --> 00:00:24.480
Oh, I'm very grateful you're on the show.
00:00:24.559 --> 00:00:25.600
It's very cool.
00:00:25.920 --> 00:00:33.119
Um I want to educate people about what a speech pathologist is actually all about.
00:00:33.679 --> 00:00:45.600
Because when my mum was referred to a speech pathologist after having a diagnosis of dementia, I was quite confused because I thought, well, she doesn't have a stutter.
00:00:45.679 --> 00:00:47.840
What does she need a speech pathologist for?
00:00:48.000 --> 00:00:51.679
So please let me know that I'm not the only one that ever thought that.
00:00:51.920 --> 00:00:52.560
Absolutely not.
00:00:52.719 --> 00:01:00.000
And if you can see me right now, I'm enthusiastically nodding as um DJ speaking because we get that all the time.
00:01:00.079 --> 00:01:08.239
And even before I started studying speech pathology, my mum suggested it as a career, and I was not interested because I thought it was stuttering in Lisps.
00:01:08.400 --> 00:01:11.680
That's all I thought it was, um, until I went to a uni open day.
00:01:11.760 --> 00:01:13.200
So it's much more than that.
00:01:13.359 --> 00:01:20.560
Um, and I might go into a little bit of what we do, kind of the two main areas, um, which is communication and swallowing.
00:01:20.640 --> 00:01:23.200
And they're kind of the two main areas it breaks down to.
00:01:23.439 --> 00:01:28.480
Communication, we're looking at everything and anything across the whole lifespan from kids to adults.
00:01:28.640 --> 00:01:35.200
It might be someone's ability to understand, express themselves, um, their voice quality as well.
00:01:35.359 --> 00:01:40.159
Um, if you know they don't have a very strong voice, or it might be breathy or hoarse.
00:01:40.319 --> 00:01:44.159
Um, we also do the stuttering and lists, that's that's included.
00:01:44.319 --> 00:01:45.599
Um, and speech sounds.
00:01:45.680 --> 00:01:51.920
So that's kind of your ability to articulate yourself and be and understand the sounds and produce them correctly.
00:01:52.079 --> 00:02:00.239
Um, and then I suppose the other part is swallowing, where our main goal is we're not dietitians, um, which we often get confused for as well.
00:02:00.400 --> 00:02:05.040
Our role is to make sure that mealtimes are safe and enjoyable for a person.
00:02:05.200 --> 00:02:10.000
So safety is kind of our main focus, that all the food and drink is going down as it should.
00:02:10.240 --> 00:02:10.960
That's incredible.
00:02:11.120 --> 00:02:15.919
I honestly, until I got mum involved with one, I honestly had no idea.
00:02:16.080 --> 00:02:22.560
And it's one of those things that I feel more of us should have a better understanding about what it actually involves.
00:02:22.800 --> 00:02:24.800
So thank you for explaining that.
00:02:25.120 --> 00:02:29.199
Because my mum was referred, she had dysphagia.
00:02:29.439 --> 00:02:33.280
Um, and again, we're always dealing with big words in this world.
00:02:33.520 --> 00:02:37.680
Um, now, overall, is that a very common part of your work?
00:02:37.759 --> 00:02:39.520
And could you explain what that is?
00:02:39.840 --> 00:02:43.759
Yeah, so dysphagia is basically disordered swallowing.
00:02:43.919 --> 00:02:58.479
So something's wrong with the swallow, and it can be any range of things from chewing or you know, even the steps before you put it in your mouth, being able to get it in your mouth effectively, all the way to the actual kind of swallow reflex itself.
00:02:58.719 --> 00:03:02.560
Um, dysphagia is a very common one that I see.
00:03:02.719 --> 00:03:13.680
I work with um adults in the community, um, particularly adults over 65, but it can happen to any age depending on any diagnosis, or you don't have to have a diagnosis either.
00:03:13.840 --> 00:03:28.400
So we see a lot of people with any progressive neurological disease like Parkinson's or motor neurone disease is a big topic at the moment, um, Huntington's disease, yeah, anything kind of within that realm.
00:03:28.560 --> 00:03:41.840
Um, also people that have had brain injuries, whether acquired or traumatic brain injuries, um, also people with diagnosis of um an intellectual disability or sometimes autism spectrum disorder as well.
00:03:41.919 --> 00:03:44.719
So there's a very large range of people we see.
00:03:44.800 --> 00:03:50.560
Um, and some people we we don't know why there's no diagnosis, but they're just having difficulty swallowing.
00:03:50.719 --> 00:03:58.240
So for me, working particularly in that age group 65 and above, I see a lot of people with swallowing difficulties.
00:03:58.479 --> 00:04:07.439
Um, and just to put into a bit of perspective the swallow and how complex it is, you use about 50 sets of muscles to swallow.
00:04:07.759 --> 00:04:09.199
Oh wow, I still didn't even know that.
00:04:09.520 --> 00:04:13.680
So you're looking at like a hundred different muscles to actually complete a swallow process.
00:04:13.840 --> 00:04:14.639
Oh my god.
00:04:14.800 --> 00:04:22.480
Um, and you have five cranial nerves involved in the swelling process, um, and you're swallowing about 500 to 700 times a day.
00:04:22.639 --> 00:04:25.759
So it's a very big part of our life, but it's also quite a complex part.
00:04:26.000 --> 00:04:27.279
I reckon we take that for granted.
00:04:27.759 --> 00:04:29.519
We definitely do, we definitely do.
00:04:29.680 --> 00:04:45.519
Um, so that's just to put in perspective how easily that if you had damage to one of your cranial nerves, say through a stroke or or through dementia or changes to the brain, um, or you had any changes to that, those muscles that control swallowing.
00:04:45.680 --> 00:04:56.639
I often give people the example of, you know, when we think about physios coming in later in life and you use lose some of your muscle strength, things like that, swallowing is all muscles as well.
00:04:56.720 --> 00:04:58.000
So that can be affected.
00:04:58.240 --> 00:04:58.879
Oh wow.
00:04:59.279 --> 00:05:00.959
That's so amazing to explain it that way.
00:05:01.120 --> 00:05:06.959
Yeah, because there is natural changes that happen to the swallow with age in the strength of our chew, things like that.
00:05:07.120 --> 00:05:22.319
Um, often we have less dentition or may have dentures, um, which can also impact strength, even though they are teeth and they are generally a full set of teeth, it does reduce your um strength of your chew quite significantly.
00:05:22.639 --> 00:05:29.439
So there's all little changes like that that can happen that can affect someone's ability to eat and drink safely.
00:05:29.920 --> 00:05:47.360
Um, and so dysphagia being a disordered swallow, um, a stroke can cause those changes, like when you have um changes to your muscles after a stroke and your ability to move your legs and arms, it happens the same with your swallow as well, or it can again for everyone.
00:05:47.839 --> 00:05:49.759
Something that I would never have thought of.
00:05:50.079 --> 00:05:51.839
There's so much more that is unseen.
00:05:52.319 --> 00:05:55.759
And that's I guess what you deal with, all that unseen kind of anatomy.
00:05:55.920 --> 00:05:56.079
Yeah.
00:05:56.319 --> 00:05:57.279
Yeah, absolutely.
00:05:58.000 --> 00:06:10.240
Um on that, are there any signs that we could look for for people at home or people we care about that might suggest something might be starting to impact their swallowing?
00:06:10.399 --> 00:06:10.800
For sure.
00:06:10.959 --> 00:06:25.120
And I think it's one that it is good to know the signs and symptoms because obviously when you go into a doctor's surgery and you're seeing your GP, you're not often, I can't even think of a circumstance where they might watch you eat or drink.
00:06:25.279 --> 00:06:27.680
So often those things are not flagged.
00:06:27.839 --> 00:06:33.199
You know, it's something, not something that they can look at in the session and be like, oh, yeah, you're probably having difficulty with this.
00:06:33.279 --> 00:06:35.199
Like, let's get a speech pathologist in.
00:06:35.360 --> 00:06:42.720
So it really comes back to knowing that something has changed and being able to report that and kind of get that process rolling.
00:06:42.959 --> 00:06:48.560
Um, so some of the signs are the most common one is probably coughing during eating or drinking.
00:06:48.639 --> 00:06:51.360
And that can be during or maybe after the meal.
00:06:51.600 --> 00:06:53.680
You have a bit of coughing episodes.
00:06:53.839 --> 00:06:57.120
It can be quite, you know, full-on sometimes.
00:06:57.199 --> 00:07:06.000
It can be almost kind of to that point of choking, or it could be a choking incident where you do have that full blockage of an airway and it's silent and they're quite terrifying.
00:07:06.160 --> 00:07:12.879
Um, but yeah, it can just be those little throat clears as well, where you're just going like kind of throughout the meal.
00:07:12.959 --> 00:07:15.519
But ah, so and that would happen during a meal.
00:07:15.600 --> 00:07:20.240
So we'd notice someone doing that a bit more often during a meal, and that might be a bit of a red flag.
00:07:20.480 --> 00:07:22.079
Yeah, yeah, during or after.
00:07:22.319 --> 00:07:26.639
So it can kind of happen anywhere along that spectrum, kind of within the meal time setting.
00:07:26.879 --> 00:07:27.199
Okay.
00:07:27.600 --> 00:07:32.319
Um, another one is wet voice, which once you hear it, you'll know it.
00:07:32.639 --> 00:07:37.839
Um but I always kind of describe it, it sounds like someone's gargling water when they speak.
00:07:38.000 --> 00:07:41.279
So you kind of hear a real wet quality to their voice.
00:07:41.519 --> 00:07:52.079
So if I was speaking like this all the time, and then I had a dramatic change to my voice, and you would hear this like gurgliness as I talk, that's a sign that things are probably not going down all the way.
00:07:52.240 --> 00:07:56.160
They're kind of getting a bit stuck halfway, and that can cause a bit of a problem.
00:07:56.720 --> 00:07:59.759
Um, also reduced intake.
00:07:59.920 --> 00:08:16.160
If someone has changes to their appetite or they're not eating their full meals, or um they're declining some meals, it's always good to think about maybe getting us in to have a look at whether their ability to enjoy a meal and eat safely is impacting that.
00:08:16.240 --> 00:08:22.000
Because one of the things that I see every day is the impact of fatigue on mealtimes.
00:08:22.319 --> 00:08:29.439
And like I said, like you're swallowing so often, and I think we take for granted how fatiguing a meal time can be.
00:08:29.600 --> 00:08:36.320
You're using that many sets of muscles, you're having to concentrate on the food, you're doing a lot of chewing, it can be really exhausting.
00:08:36.559 --> 00:08:37.039
Wow.
00:08:37.440 --> 00:08:40.080
In a million years, I would never have put that together.
00:08:40.240 --> 00:08:44.559
And I mean, I've seen a lot of people as well, and even now I've learned that.
00:08:44.879 --> 00:08:45.200
Wow.
00:08:45.440 --> 00:08:56.399
Yeah, so that's I I think one of the biggest things that we see, and particularly um for quite a range of people, you know, as as you get older, you might start to have naps in the afternoon is quite common.
00:08:56.559 --> 00:09:06.960
Um, and say if they have lunch directly before that nap, so they're starting to get a bit tired and they're eating just beforehand, sometimes they can have a more trouble in that specific meal.
00:09:07.039 --> 00:09:12.080
The rest of the meals are absolutely fine, but in that one specifically, they have a bit more difficulty.
00:09:12.320 --> 00:09:18.240
Or sometimes we see I saw a lady the other day that, you know, she had kind of stopped eating dinner.
00:09:18.320 --> 00:09:25.039
She didn't have much of an appetite, she reported for it, but it was more so that she was choosing really soft things to eat.
00:09:25.120 --> 00:09:37.519
So she was eating basically like, you know, a soup or you know, a bit of like banana, so very easy things to kind of eat because she didn't have the energy by the end of the day to eat a full meal.
00:09:37.759 --> 00:09:40.320
That is really something very interesting to look out for.
00:09:40.960 --> 00:09:42.320
Very yeah, to be aware of.
00:09:42.559 --> 00:09:54.720
Yeah, and that's where we work in conjunction with dietitians a lot because the dietitians might come and they're like, okay, you're not meeting your nutritional needs, um, but we we can't figure out why that is.
00:09:54.799 --> 00:10:01.759
So they might get us in to see if we can find any gaps in the person's ability to eat or drink safely and enjoyably.
00:10:02.080 --> 00:10:03.840
And it's something you mentioned earlier.
00:10:04.000 --> 00:10:08.159
It's interesting when you said that meals should be pleasurable.
00:10:08.480 --> 00:10:14.639
And I think that thing, if it becomes an effort, it's like anything, if it becomes an effort, then it is less pleasurable.
00:10:14.720 --> 00:10:18.879
But I hadn't thought of that in the in the thought of meal type.
00:10:19.039 --> 00:10:19.360
Absolutely.
00:10:19.679 --> 00:10:20.240
Very interesting.
00:10:20.480 --> 00:10:25.919
And because there's also that aspect of someone has to prepare the meal first, and even preparing a meal can be exhausting.
00:10:26.080 --> 00:10:26.480
This is true.
00:10:26.720 --> 00:10:34.799
So you've made it, you've I don't know what you're eating, but you you've chopped up all your bits for your salad and you're standing for a long time, and that can be exhausting.
00:10:34.960 --> 00:10:40.000
And then by the time you actually go to eat it, you're depleted and ble depleted of energy.
00:10:40.240 --> 00:10:41.759
So yeah, it can be really difficult.
00:10:42.159 --> 00:10:45.039
That is that is something that I have just learned.
00:10:45.120 --> 00:10:47.440
Like, that's significant, that's very cool to know.
00:10:47.600 --> 00:10:48.240
Yeah.
00:10:48.720 --> 00:11:02.080
Um, now you've said that you're working with older adults, and I know in your career you've worked with both children and older adults, and you've confessed to me that you do prefer older adults.
00:11:02.399 --> 00:11:02.960
I do.
00:11:03.279 --> 00:11:06.399
Could you give us some insight into why?
00:11:06.720 --> 00:11:07.200
Yeah.
00:11:07.440 --> 00:11:14.080
So my first job, I was working in what was classed as a rural health area in Australia.
00:11:14.240 --> 00:11:18.879
Um, and so we were the only speech pathology clinic for quite a long way.
00:11:19.039 --> 00:11:32.240
So we were servicing um kids and adults in the community in a hospital setting in the local hospital we would go to, um, also in aged care homes, kind of right across the board in a range of different settings.
00:11:32.399 --> 00:11:35.840
Um, and I did love working with kids as well during that time.
00:11:37.200 --> 00:11:38.799
Um, we're allowed to have preferences.
00:11:39.120 --> 00:11:41.200
We're allowed to have preferences, but I enjoyed both.
00:11:41.279 --> 00:11:42.159
I enjoyed both.
00:11:42.320 --> 00:11:46.000
Um, but I definitely did fall in love with working with older adults.
00:11:46.080 --> 00:11:51.600
And I think the thing that initially drew me in was just having the chats and the connection.
00:11:51.759 --> 00:11:53.679
I loved the chats and the connection.
00:11:53.919 --> 00:12:12.000
Um, and you know, I would see people in aged care homes where would go in and, you know, that might be the only visitor they have that day, and just having those chats and being able to sit for a while and probably spend a bit too much time that we weren't supposed to, uh, you know, making a cup of tea and learning a bit about their story and having those discussions.
00:12:12.080 --> 00:12:15.360
I that would that was kind of what immediately drew me in.
00:12:15.519 --> 00:12:23.759
Um, but I think more so nowadays, I love the the functional goals that we have with our old older adults.
00:12:23.919 --> 00:12:45.360
Um, and a lot of it is, you know, we'll go in to see people and they've always loved reading and now they're struggling to read, whether because of their eyesight or language difficulties or you know, dementia and memory, it could be a range of things, and being able to see if there are ways that we can help that person to engage in that hobby.
00:12:45.600 --> 00:12:46.000
Wow.
00:12:46.159 --> 00:13:03.759
So, like it's it's really functional, and and we're talking to them about what they want to achieve and what's important to them, and really learning about, you know, what how they get enjoyment in in life and making sure that we can have like get that person access to those things, which I really love.
00:13:04.000 --> 00:13:05.039
Yeah, and that's the thing.
00:13:05.200 --> 00:13:07.120
I I I admit I'm similar to you.
00:13:07.279 --> 00:13:09.440
I enjoy finding someone's story.
00:13:09.600 --> 00:13:17.279
Everyone, every older adult has some sort of incredible advice or story that they've got that they don't really ever share with anyone.
00:13:17.440 --> 00:13:20.639
So I I definitely agree with agree with you there.
00:13:20.799 --> 00:13:21.440
Yeah.
00:13:22.879 --> 00:13:36.080
Um, so a thing that really surprised me when dealing with mom and a speech pathologist was how much of a difference speech pathology can make for someone living in dementia and their family.
00:13:36.559 --> 00:13:40.000
Can you explain what that looks like in practice?
00:13:40.240 --> 00:13:40.720
Absolutely.
00:13:40.879 --> 00:13:42.639
This is an area I'm really passionate about.
00:13:42.720 --> 00:13:52.000
I think that as a profession, you know, speech pathologists, we're often known for being a little bit shorter on um having staff around.
00:13:52.080 --> 00:14:01.279
And, you know, where we are, we do have professional shortages, but I think more and more we're around and we have a role in working with people with dementia.
00:14:01.360 --> 00:14:07.360
And I don't think it's fully seen yet in the community, also by the medical community, um, the role that we can have.
00:14:07.519 --> 00:14:18.000
Um but I always get excited when someone's kind of found their way to us um and books that assessment, and then we can chat all about all the things that we can help and do with.
00:14:18.240 --> 00:14:26.320
And I think to put it in perspective first, we often look at kind of two types of therapy or or input that we can have.
00:14:26.480 --> 00:14:31.200
And one is being rehabilitative and one is compensatory.
00:14:31.360 --> 00:14:44.080
And often we'll go into people and they've been told, you know, you've been given a diagnosis of dementia, depending on what what type of dementia, and they are told, you know, you're going to lose your communication.
00:14:44.240 --> 00:14:45.840
And then that's kind of the end of it.
00:14:46.000 --> 00:14:50.159
And we go in and we're already on the back foot because they're like, well, there's nothing you can do for me.
00:14:50.240 --> 00:14:52.960
Like, there's I've been told there's nothing you can do.
00:14:53.279 --> 00:15:01.200
And the thing is, we're not trying to fix, you know, we're not trying to mend, we're not trying to repair so that nothing happens, you know.
00:15:01.360 --> 00:15:03.200
Unfortunately, we don't have that magic wand.
00:15:03.279 --> 00:15:06.559
I wish we did, but that's not our aim for you.
00:15:06.720 --> 00:15:10.559
But we can work with you in a compensatory approach.
00:15:10.799 --> 00:15:26.159
So looking at strategies to make life that little bit easier, to try and maintain your communication for as long as possible, and looking at workarounds for whatever's difficult, see if there's a way that we can work around it with your language that you do have and the capacity that you do have.
00:15:26.320 --> 00:15:33.120
Um, so I think that's a a good thing to keep in mind initially, is that we're not coming in promising to fix everything.
00:15:33.279 --> 00:15:39.919
It's to work with you and with the family to find ways to make things that little bit easier.
00:15:40.240 --> 00:15:51.279
And that is something I notice working with um older adults, particularly in aged care homes, is I notice once communication starts declining, then that withdrawal happens.
00:15:51.840 --> 00:15:57.440
And just knowing that there's a way to essentially, would you say, help preserve as much as possible?
00:15:57.679 --> 00:16:00.159
Yeah, and I I think that's kind of our goal at the moment.
00:16:00.240 --> 00:16:03.919
And look, we don't have endless amounts of research, unfortunately, at the moment.
00:16:04.000 --> 00:16:04.879
I wish we did.
00:16:05.039 --> 00:16:07.600
Um, but that's definitely kind of our goal.
00:16:07.679 --> 00:16:17.200
And, you know, sometimes we go in to see people that are quite isolated already, you know, even prior to the diagnosis, and they're not talking to people very often.
00:16:17.360 --> 00:16:17.600
Yes.
00:16:17.840 --> 00:16:21.200
And if you're not, it's the same with the body and all the other skills.
00:16:21.279 --> 00:16:22.879
If you don't use it, you lose it.
00:16:23.039 --> 00:16:23.600
Yes.
00:16:23.919 --> 00:16:31.200
So sometimes we go into those settings, and our first thing is looking for ways to increase their language day to day.
00:16:31.360 --> 00:16:37.759
So it can be as simple as, you know, I see a lot of people that watch the chase and all those quiz shows in the afternoon, one after the other.
00:16:38.000 --> 00:16:41.039
And we're like, you know, answer the questions, say them out loud.
00:16:41.279 --> 00:16:46.320
Like that's an easy first one to do, you know, even commentating on what you're doing day to day.
00:16:46.399 --> 00:16:49.600
If you're cooking a meal, pretend you're on a cooking show and explain it.
00:16:49.679 --> 00:16:55.360
So it's using like simple ways to get that language in a little bit more day-to-day.
00:16:55.519 --> 00:17:04.640
Um, and we can give like sheets and you know, explicit like practice on your word finding, your word retrieval, all of those strategies.
00:17:04.799 --> 00:17:09.440
But it can be as simple as just incorporating it into little things that you do day to day.
00:17:09.519 --> 00:17:18.000
So it's not adding on anything extra, not having to sit down and do homework, but it's just creating a bit of a communication-friendly environment.
00:17:18.160 --> 00:17:20.160
Yeah, they're just little daily micro habits.
00:17:20.319 --> 00:17:21.599
Commentate what I'm doing.
00:17:21.839 --> 00:17:22.160
Exactly.
00:17:22.319 --> 00:17:23.920
Have a chat to yourself.
00:17:24.400 --> 00:17:26.160
Just ignore the looks from people.
00:17:26.400 --> 00:17:26.799
Exactly.
00:17:26.960 --> 00:17:30.000
There's nothing wrong with having a chat with yourself.
00:17:30.480 --> 00:17:33.039
Um, so that's definitely a thing that we do.
00:17:33.200 --> 00:17:49.119
Um, and I think another thing that we do a lot of is communication partner training because it can be so confronting for families as the communication partner with the person that's having difficulties to see that communication change.
00:17:49.279 --> 00:17:49.680
Yes.
00:17:49.839 --> 00:17:56.640
And it's so difficult to understand sometimes what it's changed, like how it's changing and why it's changing.
00:17:56.880 --> 00:17:59.279
And how can I communicate with this person?
00:17:59.359 --> 00:18:02.720
Because the ways that we've used our whole lives are not working.
00:18:03.039 --> 00:18:14.319
And you know, sometimes we go into situations where people are quite quite stressed with just, you know, they can't talk to their loved one anymore as they normally would.
00:18:14.720 --> 00:18:20.640
Um, so we look at ways that we can create that communication for both people and make it easier for both people.
00:18:20.720 --> 00:18:32.960
So both the communication partner teaching them strategies, but also making it easier on the person with uh dementia as well, because you know, there it's communication can be so overwhelming.
00:18:33.359 --> 00:18:34.319
Yes, no, I agree.
00:18:34.400 --> 00:18:43.039
And it's also so much, it's so essential, it's so much part of a relationship, a care relationship, a family relationship, whatever it may be.
00:18:43.440 --> 00:18:48.720
You know, it's just so important and I think uh uh taken for granted, as we were saying earlier.
00:18:48.960 --> 00:18:49.519
Absolutely.
00:18:49.759 --> 00:18:52.880
Um, okay, well, this is a good place to take a break.
00:18:53.039 --> 00:18:59.039
So we'll be back with a part two to hear the rest of the advice and learning that we have from Sophie.
00:18:59.359 --> 00:19:00.640
Thank you very much, Sophie.
