Normal aging and environmental effects on communication.

This article focuses on the role of communication in the successful adjustments and adaptations to normal aging by elders. It views communication as an essential tool for living safely and independently, for maintaining interests and a sense of purpose, for continuing important social and family relationships, and for exercising active control over quality of life and care. The discussion emphasizes the importance of physical and social environments to elders' communication efforts and suggests that an environmental approach to the communication problems of many elders may be more beneficial than the remediation of specific speech-language skills.

Prevalence of speaking and hearing disabilities among adults with traumatic brain injury from a national household survey.

The purpose of this study is to provide prevalence estimates of the sociodemographic characteristics and extent of speaking and hearing disabilities among a community-based sample of adults (15 years and older) who have survived traumatic brain injury (TBI). This report is based on the Canadian Health and Activity Limitation Survey (1986-87), a national household survey of self-reported disabilities. Results indicate that adults with TBI with speaking or hearing difficulties tend to be male, middle-aged and older, urban dwellers, of relatively low income levels who are limited at work. Over 75% of adults with speaking difficulties report difficulty being understood by people outside their immediate family context. Hearing difficulties rise dramatically from 75% occurring with one communication partner to over 96% occurring with three partners. The mean duration of disabilities is 12.7 years for speaking and 13.5 years for hearing. More than 80% of adults with communicative difficulties have co-occurring disabilities of mobility and agility. Results have specific implications for functional assessment of adults with TBI and service delivery decision-making.

Conversational repair by individuals with dementia of the Alzheimer's type.

Conversational repair was examined in videotaped samples of spontaneous mealtime talk of 6 normal elderly adults, 5 subjects with early stage dementia of the Alzheimer's type (EDAT) and 5 subjects with middle stage DAT (MDAT) with a family member who acted as a conversational partner. The overall percentage of utterances involved in communication breakdown and repair and the specific proportions of utterances related to conversation problems, signals identifying problems, and repairs, were evaluated. Using the normal dyads as a control group, results showed the differential effects of DAT onset and progression on the conversational repair behavior of both subjects with DAT and their conversational partner. The percentage of conversation involved in repair was significantly higher for MDAT versus control and EDAT dyads. Despite the increase of conversational troubles with DAT onset and progression, the difficulties were repaired successfully the majority of the time. Subjects with EDAT produced more requests for repair than did their conversational partners. However, conversational partners of EDAT subjects used more elaboration repairs than did EDAT subjects. The opposite pattern was observed in the MDAT group where subjects with MDAT created and repaired more conversational problems than did their conversational partner. MDAT subjects produced more discourse trouble sources than did EDAT subjects. It was also observed that MDAT subjects and conversational partners frequently used nonspecific terms to signal misunderstandings. The findings have important implications for developing family caregiver communication enhancement strategies that are specific to the clinical stage of DAT.

Hearing health services in nursing homes: perceptions of administrators and audiologists.

A recent survey found that many residents lack adequate audiological services despite a high prevalence of hearing loss. Upgrading hearing health services is one way to dramatically improve quality of life.

Perception of spoken communication by elderly chronically ill patients in an institutional setting.

The purpose of this research was to investigate the perception of elderly and chronically ill patients regarding the spoken communication that occurs in a long-term care institution. Twenty-four patients were given a focused semi-standardized interview to investigate their perception of how much they talked, their communication partners, where they talked, their topics, their desire and enjoyment in talking, factors affecting communication, and suggestions for improving the communication atmosphere in this setting. Results indicate that communication is limited in quantity and scope, though elderly patients desire communicative interaction. The results of the study are explained from two perspectives-how the patients themselves contribute to the limited communication and how institutional life restricts interaction. Implications for the speech pathologist are given.

Strategies for improving productive thinking in the language impaired adult.

The purpose of this article is to discuss a cognitive approach to therapy with a language impaired adult. Two types of productive thinking are explored in this research: concept awareness and problem solving. These are dynamic and creative processes underlying the development and use of cognition and language. This single subject study follows an ABAB design and describes techniques used in therapy and methods for measuring productive thinking in a 66-yr-old moderately language impaired adult. Results indicate a sharp increase in the subject's thought productivity in a variety of contexts. A critical appraisal of reasons for therapy effectiveness are given.

Semantic judgment ability in adult aphasia.

Recent psycholinguistic literature suggests that language usage often involves the ability to make judgments or appraisals about various aspects of language. It was therefore the purpose of the present study to examine the semantic judgment or evaluation abilities of thirty persons with aphasia in comparison to these same behaviors in a group of thirty normal individuals. That is, this study examined subject ability to use knowledge to make comparisons or judgments in reference to specific criteria. Results support the existence of a judgment capacity and indicate that persons with aphasia are impaired in their ability to evaluate semantic material. Therefore, speech pathologists may wish to include semantic judgment tasks in their evaluation procedures and plan therapy directed toward the retrieval of judgment responses.

Communication therapy for the young adult.

Speech clinicians are often frustrated in their assessment and therapeutic management of a young adult with speech and language problems. Procedures for children with language disorders and aphasic adults are often inadequate for the adult who has communication impairments that cannot be attributed to aphasia. This case study presents an account of a 29-year-old woman who had cognitive, linguistic, and pragmatic difficulties. Both diagnosis and therapy were based on recent innovations in the areas of cognition, linguistics, and interpersonal relations. Results indicated that therapy was successful when the client was responsible for therapy activities, when therapy combined tutorial as well as experimential sessions, and when each session focused on the development of cognitive, linguistic, and interpersonal domains. Specific examples of diagnostic and therapeutic activities are presented as well as the rationale underlying the approach to therapy.

Why so little interest in whether or not old people talk: a review of recent research on verbal communication among the elderly.

This paper is concerned with the spoken communication of chronically ill and aging residents of long term care institutions. Social gerontologists and speech pathologists have investigated areas related to spoken communication, however, there has been almost no investigation of communication from the patients' and staff perspective. Spoken communication is a vital component of social interaction and psychological well being and underlies such concepts as isolation, integration, and adjustment, and is a fertile area for investigation and analysis.

Optimal conditions for assaying human lactate dehydrogenase by the lactate-to-pyruvate reaction: Arrhenium relationships for lactate dehydrogenase isoenzymes 1 and 5.

Optimal reaction conditions to sassay human lactate dehydrogenase (lactate-to-pyruvate) were established for isoenzymes 1 and 5 at 25, 30, and 37 degrees C in diethanolamine and 2-amino-2-methyl-1,3-propanediol. Different substrate concentrations are required at each temperature. The conditions permit measurement of lactate dehydrogenase 1 and 5 with the lowest substrate concentrations that allow for the highest equal sustainable efficiency in measuring both isoenzymes. About 95% of each isoenzyme activity is measured if the assay is performed within the first minute after the reaction is initiated even for activities as high as triple the upper limit of normal. The Arrhenius relationship is different for each isoenzyme, but results obtained for each at one temperature can be compared with results at another temperature by use of simple conversion equations. Assays at 25 and 30 degrees C are more economical and less variable than assays at 37 degrees C.

Interconverting measurements of human lactate dehydrogenase activities in three buffers.

The lactate-to-pyruvate reaction for serum lactate dehydrogenase (LD) is most frequently assayed in one of three buffers, pyrophosphate (PPi), tris(hydroxymethyl)amino-methane (Tris), or 2-amino-2-methyl-1-propanol (AMP). We described interconverting results for serum samples and for highly purified LD isoenzymes I (dissolved in one of these matrixes) assayed in these buffers under optimized reaction conditions. The equation for converting results obtained for sera in Tris (x) to those in PPi(y) (both at 30 degrees C) is y = 0.74x+10 (n = 98). Since AMP is used extensively in Technicon procedures, we determined the LD activity of sera with an SMA 12/60, at 37 degrees C. The equation for convering these AMP results to results obtained in PPi at 30 degrees C is y = 0.45x-16 (n = 90). Very different equations were obtained with highly purified LD isoenzyme I maintained in two different matrixes and with both isoenzymes assayed in the same matrix. The matrix in which LD is dissolved and the proportion of various LD isoenzymes affect the magnitude of difference in observed LD activity under various conditions. Therefore, in clinical laboratories that use more than one analytical method or when conversion equations are used in the comparison of interlaboratory results, it is important to define the LD source, isoenzyme content, and the matrix, as well as the reaction conditions, and to use many samples with a wide range of activities when determining the conversion equations. For any changes in reagent source, substrate concentration, or alteration in procedure, a new normal range and new conversion equations should be determined.

A search for the best buffer to use in assaying human lactate dehydrogenase with the lactate-to-pyruvate reaction.

Highly purified human lactate dehydrogenases I and V were assayed in 17 different buffers, at a variety of reaction pH's. Diethanolamine and 2-amino-2-methyl-1,3-propanediol provided the best measurements of the enzyme, assayed lactate-to-pyruvate. However, the commercial preparation of 2-amino-2-methyl-1,3-propanediol contained insoluble matter and was relatively expensive. All of the four buffers nowmost commonly used were found to present difficulties. Glycine and pyrophosphate were inhibotory tolactate dehydrogenase activity with increasing buffer concentration. 2-Amino-2-methyl-1-propanol had three major disadvantages: it is chemically unstable during reagent preparation; activity is dependent on buffer concentration; and the pH optima for isoenzymes I and V are vastly different. The pKa of tris(hydroxymethyl)aminomethane is 8.0 at 30 degrees C, whereas to measure total activity the reaction pH should be greater than 8.5; thus tris(hydroxymethyl)aminomethane has limited buffering capacity at the reaction pH.