The communication environments of severely aphasic individuals living in long-term care facilities

Aphasia has a significant negative impact on an individual's ability to communicate in his or her daily living environment. When this environment offers limited communication opportunities, as is generally believed to be the case in long-term care facilities such as nursing homes, aphasic individuals may suffer doubly. These individuals have to deal not only with limited communication abilities, but they also have few avenues to use spared abilities. This investigation characterized the communication environments of three severely aphasic nursing home residents by determining their interactants (i.e., people with whom they interacted), where interactions took place, what information content was communicated in these interactions, and why this communication occurred. Data collection relied on direct observation of the aphasic individuals in their daily living environments and semi-structured interviews with their interactants. Findings revealed that all three aphasic individuals interacted with a wide variety of people, from those one would expect, such as nurses, to those who are not so obvious, such as hairdressers and maintenance staff members. The majority of communication occurred with Certified Nursing Assistants (CNAs). With respect to communication locations, most communication occurred either in the aphasic individuals' own rooms, in their dining rooms, or in the hallways of their nursing homes. Communication content was categorized as either Social Communication, Activities of Daily Living (ADL) Communication, Medical and Physical Well-being Communication, and Facility Survival Skills Communication. For all three aphasic individuals, Social Communication and ADL Communication were the primary topic areas. To answer the question of why communication occurred, interactions were characterized as either instrumental (task-based) or affective (socially-based). The aphasic individuals varied in the ratios of these two types of communication. Possible contributing factors to the different profiles included the length of time each individual had to adapt to both the sequelae of his or her stroke and his or her nursing home environs, as well as individual personality characteristics. Clinical implications from the findings are suggested