Bulbar-onset ALS patients with cognitive impairments and neuronal loss in the anterior cingulate gyrus subsequently developed more profound neuropsychological dysfunction whereas both language and speech capabilities remained relatively preserved. Of note, the absence of bulbar signs did not predict an absence of cognitive decline.

Good communicat ion is an essential compo nent of optimal delivery of health care and health pr omot ion effort s. In t his article, we address t he communicat ion predicament faced by older adults when their opportunities for optimal care are limited by inappropriate communication with formal care providers. We then introduce the Communication Enhancement Model which promotes health in old age by stressing recognition of individualized cues, modification of communication to suit individual needs and situations, appro priate assess-ment o f the healt h/social problems, and empowerment of bot h eiders and providers. Applications of the Communication Enhancement Model are discussed for two high-risk groups (elders from ethnocultural communities and elders with dementia) to show how it can functio n as a guide for t he development and evaluation of educational interventions with health and social professionals working with elders. ______________Good communication is important in achieving health across one's lifespan. Moreover, it is central in the delivery of health care and in health promotion efforts of formal care providers. In this ar ticle, we initially address the co mmunication pr edicament which limits the opportunities of older adults to optimize their health. We then present a communication enhancement model to promote health in old age, and we elaborate on the role of formal care providers fro m various professional disciplines (referred to here as providers) in participating in this health-promoting co mmunication pr ocess. Finally, we use two case st udies to highlight the application of this model for elders who are especially vulnerable to the communication predicament we describe. COMMUNICATION PREDICAMENT OF ELDERLY PEOPLEIn late life, o lder adu lts fr equ ent ly expe rience changes which t hreaten t heir communication skills [1][2][3]. Hearing and vision impairments, slower processing of information, and memory difficulties affect many otherwise healthy elders, while neurological, depressive, and physical illnesses as well as medications, can also influence communication. Moreover, reduced contacts with relatives and friends may limit the opport unity to exercise conversational skills for a number of older adults.At the time in their lives when older adults need an especially suppo rtive and stimulating interpersonal environment, many individuals experience a communication pre dicament. This pr edicament arises when o lder adu lts, expe riencing c hanges in t heir individual skills, have to overcome extra barriers imposed by their conversational partners [4,

ObjectivesThe objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada.MethodsCross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments.ResultsThe rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group.ConclusionsThe presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.

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.

Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD.