JCPSLP Vol 17 No 2 2015_web

Aged care

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

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. H ealth 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

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

KEYWORDS AGED CARE CLINICAL EDUCATION DEMENTIA

THIS ARTICLE HAS BEEN PEER- REVIEWED

Ronelle Hewetson (top), Petrea Cornwell (centre) and Susannah Davern

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JCPSLP Volume 17, Number 2 2015

www.speechpathologyaustralia.org.au