Background: Speech pathologists infrequently address the quality of aphasic people's lives in a direct manner in rehabilitation, most likely due to the difficulty in grasping the role of communication in quality of life (QOL). Despite considerable research into aphasic language impairments and communication disabilities, there is no clear evidence how aphasia impacts on clients' QOL. This paper reports on a comprehensive evaluation of 30 people with mild to moderate aphasia to determine which aspects of communication predict their QOL. A conceptual model of the relationship between communication and QOL was devised, using the disablement framework of the International Classification of Impairment, Activity and Participation Beta-2 Draft (ICIDH-2) (World Health Organisation, 1998). Communication was conceptualised as language impairment, functional communication ability and activity, and social participation. QOL included both health-related QOL (HRQOL) and psychological well-being concepts. Aims: The aim of this study was to investigate how measures of impairment, activity and participation, and measures of QOL related to each other for people with aphasia, for the purpose of: (1) determining which specific communication assessments were most predictive of their QOL; and (2) determining whether HRQOL or psychological well-being was represented more in relationships, thus indicating a focus for QOL in aphasia. Methods & Procedures: Thirty people aged 57-88 years (mean = 70.7yrs) with predominantly mild to moderate chronic aphasia (mean WAB AQ = 74.4, range 21.9-5.8; mean TPO = 41 mths, range 10-108 mths) participated in this study. In total, 13 standardised and specifically designed measures evaluated the different concepts of the model. Maximal multiple regression analysis illustrated which communication measures were most predictive of participants' HRQOL and psychological well-being. Outcomes & Results: Overall, aphasic people's communication predicted their psychological well-being and social health (a subscale of HRQOL). Specifically, the findings demonstrated that functional communication ability, and language functioning to a lesser degree, were implicated in QOL, providing evidence for particular speech pathology interventions in addressing clients' QOL. Finally, emotional health powerfully influenced the relationships among variables, and physiological/physical health was a determinant of social participation.

To examine associations between audiological and non-audiological factors and successful hearing aid use in older adults. In a retrospective study, audiological factors, attitudinal beliefs (as derived from the health belief model), client demographics, psychological factors, and age-related factors were evaluated. Participants included 160 individuals, 60 years or older, with unilateral or bilateral hearing impairment (HI), fitted with hearing aids for the first time in the previous two years. Participants were assigned to either an unsuccessful hearing aid owner group (n=75) or a successful hearing aid owner group (n=85) based on their self-reported hearing aid use and benefit. A multivariate, binomial logistic regression model indicated five factors associated with group membership: participants who had greater support from significant others; more difficulties with hearing and communication in everyday life before getting hearing aids; more positive attitudes to hearing aids; coupled with greater perceived self-efficacy for advanced handling of hearing aids; or who were receiving more gain from their devices; were more likely to be successful hearing aid owners. These findings highlight the importance of addressing non-audiological factors in order to assist older adults achieve success with hearing aids.

Purpose: The language changes experienced by a person with aphasia following a stroke often have sudden and longlasting negative impact on friendships. Friendship relationships are core to social engagement, quality of life, and emotional well-being. The aims of this study were to describe everyday communication with friends for older people with and without aphasia and to examine the nature of actual friendship conversations involving a person with aphasia. Method: This naturalistic inquiry drew data from two phases of research: a participant observation study of 30 older Australians, 15 of whom had aphasia following a stroke, and a collective case study using stimulated recall to examine friendship conversations involving an older person with aphasia. Results: People with aphasia communicated with fewer friends and had smaller social networks. “Friendship” was a core domain of communication for older people and participation in leisure and educational activities was focal in everyday communication with friends. Case study data of conversations between three older people with aphasia and their friends illuminated features of “time,” the role of humour, and friends having shared interests. Conclusion: Aphasia has been found to impact on friendships. A need exists for research and intervention programs to address communication with friends for older people with aphasia.

Objective: The purpose of this review paper was to identify factors that influence older adults’ decisions to seek help for hearing impairment and to adopt hearing aids. Design: A literature search of abstracts within peer-reviewed journal articles published in English between 1990 and 2010 was conducted in online bibliographic databases using the keywords: hearing; impair* or loss; seek* or candidate* or applicant* or acquir*; and hearing aid* or help or advice. Results: Twenty-two articles that were directly relevant to this topic were included in this review. Conclusions: The evidence suggests that individuals are more likely to seek help for hearing impairment and/or adopt hearing aids if they: (1) have a moderate to severe hearing impairment and self-reported hearing-related activity limitations or participation restrictions; (2) are older; (3) perceive their hearing as poor; (4) consider there to be more benefits than barriers to amplification; and (5) perceive their significant other/s as supportive of hearing rehabilitation. A barrier to help-seeking for hearing impairment and hearing aid adoption appears to be general practitioners’ management of age-related hearing impairment.

(2003). Candidature for and delivery of audiological services: special needs of older people. International Journal of Audiology: Vol. 42, No. sup2, pp. 92-101.

People with aphasia need communicatively accessible written health information. Healthcare providers require knowledge of how to develop printed education materials (PEMs) in formats that people with aphasia prefer and can read. This study aimed to explore formatting characteristics considered to be barriers and facilitators to reading PEMs. Semi-structured in-depth interviews were conducted with 40 adults with aphasia who were selected using maximum variation sampling across aphasia severity, reading ability, and time post-stroke. Participants were shown stroke and aphasia PEMs obtained from the recruiting stroke services, asked to rank them from most liked to least liked, and comment on factors that made the PEMs easier and harder to read. The majority of participants ranked the aphasia friendly stroke (56.4%, n = 22) and aphasia (87.2%, n = 34) PEMs as most liked. Forty-five facilitator and 46 barrier codes were identified using qualitative content analysis and grouped into two categories; (1) content characteristics and (2) design characteristics. Findings support many of the recommendations found within the literature for developing best practice PEMs and accessible information for other patient groups. Routine consideration of the facilitators and barriers identified will contribute to making written information more accessible to people with aphasia.