Late Starts, Lifelong Voices – Speech pathology access for older, non-speaking individuals
Often when we think about speech pathology, we picture children learning to talk or maybe adults recovering from stroke. What’s usually overlooked are the older individuals who might not have accessed communication support before – those who have lived most of their lives non-speaking, relying on gestures, facial expressions, or the understanding of those closest to them.
In recent years, and more apparent with NDIS access, these individuals now have some level of communication support. These older individuals are now being introduced to Augmentative and Alternative Communication (AAC) options. And every single time, I’m reminded that it’s never too late to find your voice.
Starting Late Doesn’t Mean Missing Out
For many older adults, AAC and speech pathology weren’t options when they were younger. Technology wasn’t there, awareness was limited, and, in some cases, societal attitudes did not prioritise communication support for non-speaking individuals.
Now, as service becomes more accessible and inclusive, with AAC being more widely recognised, more people are exploring communication for the first time.
Working with older individuals means adjusting our expectations and redefining the “goals”. The focus isn’t necessarily on “developing speech” or “playing catch up” on missed milestones. The focus is about creating meaningful, achievable and relevant communication opportunities in the here and now.
This might mean building a personalised communication system to be able to express choices, share memories or connect socially with others. This might range from creating a personalised communication book, photo-based system or implementing a high-tech AAC communication device. The goals are practical and personal.
Exploring What Works: Low-Tech, High-Tech or a Combination
“Will it be too complex?”
Sometimes wondering whether introducing something new for an older adult can be utilised effectively, which is a fair concern. Sometimes it might not be, and sometimes it’s exactly what it could be.
Some adults can be quick to adapt to tablet-based AAC systems. Some adults might prefer low-tech options – laminated boards, photo books or a written word. Some might be capable of using a combination.
What matters most isn’t which system we choose – it’s that the system is customised to fit the person, their environment and their support network.
Being Flexible
Empowering the person to choose what communication tool works for them based on the context of the interaction, the environment and their relationship with their communication partner/s (Porter, 2018).
Adaptation, Not Limitation
Older adults can learn new AAC systems. But success depends on how we approach it. We need to teach at a comfortable pace, build in repetition, and make the content meaningful to them. When someone can make a simple choice of what they want to eat, comment on their daily routine, express ‘yes’ or ‘no’; their motivation increases.
It’s also about supporting the people around them – family, carers, support staff – so communication doesn’t just happen during intervention sessions, but in the flow of everyday life.
It’s not about building on expressing sentences or teaching complex vocabulary per se. The focus is on empowerment, autonomy and participation. All very purposeful to the individual. Supporting older, non-speaking individual reminds us that communication is a lifelong journey.
About the author
Virginia is the Speech Pathology Clinical Excellence Lead at KEO Care. Her speech pathology journey started off in private practice before moving into specific clinical areas of autism spectrum disorder and intellectual disability. She has worked with individuals across the lifespan from young paediatrics to adults in all areas of communication. Her previous role prior to KEO Care was in a multidisciplinary hospital setting providing speech pathology input in the areas of mental health and intellectual disability combined.
