Speech Pathologist

The Speech Pathologist's (SP) role in working with an older adult receiving palliative care at the end of life is the assessment, management and support for communication and swallowing difficulties that can arise. The approach is led by the individual’s symptoms with respect to communication, cognition and swallowing and their sense of what is important to them to co-create realistic goals and expectations across the end-of-life period.

Key points

The SP liaises within the interprofessional care team to promote best outcomes. SPs who work with older adults receiving palliative care at the end of life may contribute to care planning via:

• assessment of communication
• cognition and swallowing function to determine relevant management strategies and therapy needs / interventions.

When assessing therapy needs and appropriate therapeutic interventions , a broad range of tools may be used depending on the context, important to note these are not palliative care specific. In addition to routine assessment, a practitioner might also use

-  Quality of life measures (e.g. SWAL-QOL or SWAL-CARE)

The results of communication and swallow assessment will guide methods of treatment and care, such as:

• Optimising the older individual’s ability to eat and drink in the safest, most comfortable way and to participate in mealtimes
• Educating the individual, their carers and family on safe swallowing techniques, recommendations and possible trajectory with regard to ability to swallow and oral intake
• Educating and collaborating with the individual and their family to support their ability to make informed choices and ensure a documented care plan when eating / drinking with acknowledged risk and advising on risk and benefits of feeding modes in cases of dysphagia (see Resources section of Toolkit)
• May work with a pharmacist to provide assessment information to inform medication administration routes
  • The new SHPA Don't Rush to Crush Handbook available for aged care settings can be purchased via the Resources page in the toolkit
• Helping to optimise the older individual’s ability to communicate, particularly to support their ability to participate in end of life decision making, communicate choices, needs and emotional states and maintain social and emotional closeness and relationships with family and friends, including through the use of augmentitave and alternative communication
• Providing education and advice to communication partners (family, carers, health team etc) with regards to communication, cognition and swallowing function, and how to best support communication as a communication partner
• Cognitive stimulation to improve or maintain communication function in people living with moderate to severe dementi
• Assessing and supporting strategies to manage oral care and hygiene including excessive saliva production (drooling) and dry mouth (teaching the family on how to assist with this).