JCPSLP Vol 17 No 2 2015_web

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Aged care
JCPSLP Volume 17, Number 2 2015 75
Ronelle
Hewetson (top),
Petrea Cornwell
(centre) and
Susannah
Davern
THIS ARTICLE
HAS BEEN
PEER-
REVIEWED
KEYWORDS
AGED CARE
CLINICAL
EDUCATION
DEMENTIA
increasing, there is also a reported increase in the levels
of medical complexity and frailty of older people (AIHW,
2012). With advancing age, a higher incidence of chronic
diseases and complexities associated with medical co-
morbidities emerges. In particular, the increasing prevalence
of dementia, the greatest cause of disability for Australians
over 65 years, will increase demand for complex care
services (AIHW, 2012).
Australia’s growing number of older people has been
identified as an important consideration in recruitment of
the future health workforce (Speech Pathology Australia
[SPA], 2005) to ensure availability of allied health staff with
the interest and skills to management of the needs of an
older and more medically complex population. Speech
pathologists will require specific skills to manage the
communication and swallowing issues associated with
this population, who will likely form a large proportion of
clinical caseloads. Up to 95% of older people experience
change in their communication ability that occurs as part
of the normal ageing process or as a result of acute and
chronic conditions (e.g., stroke, Parkinson’s disease, adult
acquired hearing impairment) with the potential to reduce
communication-based activities and negatively affect quality
of life (American Speech-Language-Hearing Association
(ASHA), 1988; Kiely & Simon, 2000). Furthermore, service
provision to adults with cognitive-communication disorders
secondary to dementia has for several years been identified
as a fast-growing clinical area for speech pathologists (SPA,
2012). Dysphagia management is another key area, with up
to 55% of hospitalised people over 70 years (Cabre, Serra-
Prat, Palomera, Almirall, & Pallares, 2010), 60% of people in
residential care facilities, and 84% of people with dementia
(Horner, Alberts, Dawson, & Cook, 1994) experiencing
swallowing problems that can lead to compromised health
and nutritional status (Lin, Wu, Chen, Wang, & Chen, 2002).
To ensure appropriate and sufficient service provision for
older people across a range of contexts, speech pathology
students require clinical placements that will help them
to develop confidence and interest in working with this
population. Previous research suggests a trend of students
in medical and other allied health disciplines viewing
work with older people as less desirable (Burg, Waddell,
Doty, Horne, Weilgas, & Davidson, 2001; Courtney, Tong
& Walsh, 2000) than other population groups. Studies
examining possible reasons for this trend found that gaining
theoretical knowledge about ageing alone is not sufficient
to positively influence attitudes about working with older
adults; rather, experiences during clinical practicum and
Australia’s demographic future and need for
allied health staff equipped to provide
services to growing numbers of older people
with complex care needs have been
documented. Student interest in working with
older people has been explored in a number
of health care professions, but not in the field
of speech pathology. This study investigated
speech pathology students’ attitudes toward
older people; knowledge and confidence in
clinical skills related to communication and
swallowing disorders in older people; as well
as interest in future employment that
specialises in service provision to older
people. Seventy-four participants completed
an on-line survey and a geriatric attitude
scale prior to a clinical placement in an adult
service, with 52 completing a post-placement
survey. Results indicated that students had
positive attitudes about older people and that
a clinical placement in an adult service
increased their knowledge and confidence in
clinical skills. Despite positive attitudes about
older people, a preference for working with
younger adults emerged. Implications for
future training of speech pathologists are
discussed and the need identified for
research into factors that influence career
interest.
Health care provision to growing numbers of older
Australians, those aged 65 and older, has been
described as one of the most important medical
and economic challenges facing Australia (Productivity
Commission, 2013). Health expenditure for older people,
who comprised 14% of the population in 2012, has
reached four times what is required for those younger
than 65 (Australian Institute of Health and Welfare [AIHW],
2012). People aged over 85 years, who are considered
the major users of health care and aged-care services,
comprise the greatest population growth demographic
(AIHW, 2012). Not only are the numbers of older people
requiring residential, hospital-based, and in-home services
The future of speech
pathology in aged care
Students’ confidence and interest in working
with older people
Ronelle Hewetson, Petrea Cornwell, Susannah Davern, Anne E. Hill, and Lucy Hunter