Understanding the impact of aphasia on the everyday communication of older people is central to the provision of speech pathology services within gerontological health-care. Research questions grew from recognition of the importance of communication in the lives of older people and of the need for evaluation of the consequences of aphasia following stroke. Communication networks and skills change with age and thus, study of aphasia in ageing needed to reflect communication in social situations pertinent to this population. Increased understanding of the impact of aphasia was realised by asking "What communication takes place in the daily lives of older people?"
The research had two inter-related phases. The primary aim of the first phase was to describe and compare the everyday communication of older people with aphasia and healthy older people who were living in the community. Naturalistic inquiry was the
methodology of choice for exploring the daily communication of 15 older people with chronic aphasia and a matched group of 15 healthy older people. Participant observation and information from structured diaries provided data on the typical daily communication of participants. Field notes from 240 hours of observation were coded.
Quantitative and qualitative methods combined to reveal a multi-layered analysis of everyday communication. Conversations were the most common communication activities of both groups. Older people with aphasia engaged in similar communication activities to healthy older people although differences were evident in the frequency of communication activities and also in the time spent in conversations during the observation period. A greater proportion of healthy older people engaged in story telling, reading and writing, making comments and using the telephone. For the older people with aphasia, more episodes of unsuccessful
communication and of listening and watching television were recorded. Older people with aphasia had fewer communication partners and the majority of communication occurred at home. The communication domains of community-based older people were revealed as family, friendship, leisure, domestic life and community services. Themes within the observed everyday communication included establishing and engaging in communication, planning and negotiating, participation in leisure and daily activities, formal communication exchanges and the experience of incomplete communication. Hence this study not only showed the complexity of natural communication, but also that there were qualitative and quantitative differences in the everyday communication of aphasic and non-aphasic older people.
A secondary aim of this first study was to investigate the content validity of the American Speech-Language Hearing Association Functional Assessment of Communication Skills for Adults
(ASHA FACS)(Frattali, Thompson, Holland, Wohl, & Ferketic, 1995) for older Australians. After each hour of observation, the researcher checked which items of the ASHA FACS had been observed. Items were generally relevant to older Australians living in the community, although the interactional function of communication was not well represented.
It is consistent with a social-model approach that research and practice emphasise the perspectives of the person with aphasia. The second phase of the research explored the insider perspective of the impact of aphasia on social communication through case studies of three older people with aphasia. Data from a Social Network of Aphasia Profile (Code, 2001), qualitative interviewing, and stimulated recall of conversations with two regular communication partners were analysed. Older participants described factors that affect social affiliation and satisfaction in conversation. The concept of connectedness was
identified, together with the role of humour and story telling in furthering interactions. The role of phatic communion in lubricating social communication was revealed as relevant to establishing and maintaining social relationships.
Clinical implications of this research are a renewed focus on the personal, relational and contextual factors that influence the everyday communication of the older person. Findings indicate that dimensions of satisfaction and enjoyment in social communication should be featured in outcome measures. Lessons learned hold relevance for programmes for older people with aphasia and their communication partners, including addressing, in therapy, the interactional function of communication.
Qualitative methods provided for rich and systematic investigation of the impact of aphasia on social communication, including the use of active reflexivity by the researcher. Findings point to interventions that address
authentic communication issues for the person living with aphasia in older age. The ultimate goal of achieving successful ageing with aphasia has been highlighted.