By Rachel Hirsch

As people age, changes may occur in their memory, speech, language and swallowing. Older adults may experience difficulty with cognition, communication or swallowing due to neurological events or changes.

Memory Loss/Cognitive Decline

Cleaning, cooking, shopping, grooming, dressing, medication, and money management are all activities of daily living. They are all things we do daily without much thought. However, what happens when activities of day-to-day living start to become difficult to complete? What happens when sequencing tasks becomes problematic because a loved one presents with memory loss? It can be challenging to detect a cognitive decline or memory loss in our loved ones, especially when our interactions are limited to scripted conversations or brief phone calls. It’s crucial to be observant of changes in their behavior, mood and ability to perform routine tasks. Memory loss and cognitive decline can manifest in various ways, and it’s important to be aware of potential signs that may indicate these conditions.

Signs of Memory Loss/Cognitive Decline

Increased Forgetfulness: Progressive forgetfulness is often one of the earliest signs of a cognitive decline. This may include forgetting recent conversations, repeatedly asking the same questions, or forgetting important dates, appointments or events.

Repetition: Repeating oneself, telling the same stories or asking the same questions frequently.

Impaired Task Performance: Difficulties in completing tasks or activities of daily living can emerge. This can be seen in an avid cook leaving out ingredients, forgetting steps in a familiar recipe, or struggling with basic household chores.

Financial Management Challenges: Cognitive decline can affect an individual’s ability to manage finances. Forgetting to pay bills, misplacing important documents or making errors in financial transactions can be warning signs.

Neglected Living Environment: Cognitive decline may lead to deterioration in personal care and an unkempt living environment. Forgetting to do laundry, change clothes or maintain cleanliness can become more pronounced.

Medication Errors: Memory loss can result in mistakes with medication management. This may involve forgetting to take prescribed drugs or result in incorrect doses.

Language Impairments

As adults age they may experience difficulty understanding spoken language or written text, as well as difficulty with word retrieval. The inability to understand spoken language is known as a receptive language impairment. Individuals with such a deficiency have difficulty grasping the meaning behind spoken words. They may struggle to understand and interpret verbal instructions, follow conversations or comprehend complex sentence structures. Simple tasks like answering questions or engaging in social interactions can become overwhelming, leading to frustration and isolation.

An additional language challenge is word-finding difficulty, often referred to as the “tip-of-the-tongue” phenomenon. This manifests as momentary lapses in recalling familiar words or struggling to find the precise terms to express thoughts.

Signs of a Language Impairment

Requiring repetition in conversations.

Slow processing or response time.

Inability to name common objects. Individuals may struggle to find the appropriate words to label or describe familiar items.

Difficulty following directives. If a loved one requires physical assistance and starts struggling to understand instructions to stand, sit or move their limbs, it suggests challenges in comprehending and executing verbal directives.

Swallowing Deficits

Across cultures, food plays a significant role in fostering connections and providing comfort. It becomes a source of solace when someone is unwell, as we prepare or bring their favorite dishes to lift their spirits. However, imagine the distress of not being able to consume your cherished food or beverage with ease. Every sip and bite can trigger coughing and choking. Picture attending a dinner party or holiday gathering where eating or drinking becomes a challenge. It is not uncommon for families to dismiss these difficulties, saying, “It’s normal; he always coughs when he eats.” However, it is crucial to recognize that dysphagia, a condition characterized by swallowing difficulty, can impact both adults and the elderly population. Left untreated, it can lead to weight loss, choking incidences, aspiration pneumonia or hospitalization.

Signs of Swallowing Deficits

Weight loss

Holding solids or liquids in one’s mouth

Inability to swallow

Constant throat clearing during meals

Coughing on food and/or liquids immediately after swallowing

Wet or hoarse vocal quality after swallowing

Recurring pneumonia

Choking episodes

The difficulties mentioned above can arise as a result of various neurological events.

These challenges can be attributed to various conditions, including undetected mini strokes (TIA), strokes (CVA), head injuries, brain tumors, cancer, seizures, and degenerative diseases such as dementia, Parkinson’s disease or multiple sclerosis.

Medical speech-language pathologists specialize in working with individuals impacted by neurological events. Their expertise lies in diagnosing communication, cognition and swallowing difficulties, and developing personalized treatment plans. Through comprehensive assessments, they identify specific impairments and tailor interventions to improve functional abilities.

Rachel Hirsch, MA, CCC-SLP, is an experienced medical speech language pathologist specializing in working with the adult and geriatric population in New Jersey. With over 10 years of experience, she offers evaluations and treatment services in the convenience of patients’ homes. Part of her therapy approach is to educate and include family and caregivers in the therapeutic process. She can be reached at [email protected] or (917) 589-4836.