Management of Cognitive Communication Difficulties in Dementia: A Cross Sectional Survey of Speech and Language Therapists

Abstract

Background: Cognitive communication difficulties are a characteristic feature of dementia. Speech and language therapists (SLTs) have an important role in managing cognitive communication difficulties associated with dementia. Yet there is a lack of information about the clinical practice of SLTs in dementia care in Ireland and this affects the development and delivery of comprehensive services for people with dementia. The purpose of this study was to survey SLTs working in dementia services in Ireland to review current practice, and to gain insight into their perspectives on service provision in the context of the Irish Dementia Strategy. Methods: A cross sectional survey design was used to review the current practice of SLTs working in dementia services in Ireland. Purposive snowball sampling was used to recruit participants across the Republic of Ireland. The survey comprised 21 questions using various question formats, seeking information on SLT respondent demographics, current practice in the management of cognitive communication disorders in dementia, involvement in research, the levels of satisfaction with existing services for people with dementia and familiarity with the Irish National Dementia Strategy (INDS). Descriptive statistic and thematic analysis were used to organise and analyse the data. Results: Eighty-nine SLTs completed the survey. The most frequently expressed concern across the survey was that dysphagia management takes priority over cognitive communication disorders with 61% (n=89) of respondents spending less than 25% of their clinical time working with communication disorders. There is a low rate of referral for communication interventions and typically people are referred in the advanced stages of dementia. SLTs reported regularly providing specific communication training for families and health care staff to support communication access for the person with dementia. Although the majority of respondents (89%, 59/65) are familiar with the INDS, 40% said they were “not at all confident” and 45% were only “slightly confident” that they could meet the recommendations outlined in the strategy. Specific key recommendations were identified; increased focus on the management of communication disorders, increased MDT working, improved understanding by other health care professionals of the SLT role in dementia care, as well as improved staffing levels including specialty posts. Conclusions: This is the first Irish survey to date of SLT management of cognitive communication difficulties in people with dementia. These results reflect the range of barriers facing SLTs in clinical practice. While the majority of SLTs provide dysphagia services, this survey identifies areas for service development to specifically manage communication difficulties experienced by people with dementia.