Asmita V. Manchha

Background and Objectives: Communication changes in older adults affect independence, social participation, and quality of life. In aged care settings, timely identification of communication support needs and preferences is essential to upholding older people’s rights and ensuring person-centered care, yet communication is not routinely assessed. This scoping review systematically identifies and describes instruments that measure communication support needs and preferences in older adults. Research Design and Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, we searched PubMed, PsycINFO, CINAHL, and Embase alongside gray literature. Titles, abstracts, and full texts were screened against eligibility criteria using Covidence. Data on instrument context, content, and administration were extracted and synthesized using content analysis and the World Health Organization International Classification of Functioning, Disability and Health framework. Results: 26 publications describing 29 instruments were included. Instruments were typically condition-specific (e.g., dementia) or impairment-specific (e.g., hearing loss). Communication preferences and personal factors, such as cultural and linguistic background, were rarely considered, and only one instrument assessed both needs and preferences. While self-report instruments were often intended for completion by the older adult, only one offered a communication-accessible version (e.g., easy read text, larger font, visual aids). Discussion and Implications: No existing instrument adequately measures communication support needs and preferences for use in aged care settings. A condition-agnostic instrument is needed that adopts a holistic, biopsychosocial perspective; accounts for the aged care environment; incorporates multiple perspectives; and is communication-accessible. Developing such a measure is a foundational step toward accurate, consistent, and timely identification of the communication needs of older adults in aged care.

Background: Enrichment activities are essential for enhancing the psychosocial well-being of older adults living in residential aged care homes. There has been increasing interest in using digital technology for enrichment, but the implementation of technology requires careful support and enablement from staff to ensure that residents experience the intended benefits. Objective: This study aimed to understand how care staff facilitate aged care residents’ use of the Tovertafel (“magic table” in Dutch), a technology that projects images onto a tabletop to enable groups of people to play games. The study further aimed to understand the benefits arising from the Tovertafel when facilitated by staff. Methods: We conducted a field study in 1 residential aged care home in Queensland, Australia. The methods included semistructured interviews with the staff and residents about their experiences with the Tovertafel, observations of 4 sessions in which the residents and staff played Tovertafel games, and a diary completed by the staff after Tovertafel sessions. Data were analyzed through reflexive thematic analysis. Results: We developed 3 themes through our analysis. Theme 1 highlights the need for the staff to overcome physical and personal barriers before Tovertafel sessions could take place. These included a lack of a dedicated space for playing Tovertafel games and the residents’ reluctance to attend Tovertafel sessions. Theme 2 highlights how the staff used creative strategies to make Tovertafel sessions successful. These included helping the residents learn how to interact with the games; adapting the activity to suit the capabilities of the residents; sustaining engagement by choosing appropriate games; and using prompts, questions, and storytelling to make the games more engaging. Theme 3 describes the benefits and outcomes that arose from staff-supported enablement of the Tovertafel, including participation in an enjoyable physical activity, socialization, and reminiscence. Conclusions: This study suggests that the Tovertafel provides opportunities for aged care staff to engage in creative play and personalization catering to residents with different capabilities. However, the benefits arising from the Tovertafel are unlikely to be achieved without substantial facilitation from the staff, who play a key role in enabling the participation of the residents. Sustaining the engagement of the residents is important during Tovertafel activities and can lead to beneficial outcomes.

Background and Objectives: Older adults often experience communication changes due to ageing and an increased prevalence of conditions affecting speech, language, cognition, and sensory functions. While individual health conditions and contextual factors (e.g., personal and environmental) are known to influence communication, limited research has examined how these factors interact. Our scoping review summarizes how health conditions, impairments, and contextual factors can interact to influence communication in residential and community aged care settings. Research Design and Methods: Peer-reviewed articles published 2003-2023 were identified through searches of PubMed, PsycINFO, CINAHL, Scopus, and ProQuest. Using the International Classification of Functioning, Disability and Health as a framework, we extracted information about health conditions, impairments to body structures and functions, and personal and environmental factors reported to influence communication. Data were synthesised using thematic analysis. Results: From 75 articles, we identified combinations of health conditions (e.g., dementia), impairments to body functions and structures (e.g., hearing impairment, personal (e.g., language, culture, gender) and environmental factors (e.g., relationships, health services, products/technology), reported to impact communication for older adults in aged care environments. Language and culture, and support and relationships, were both key facilitators and barriers to communication. Discussion and Implications: Older adults may experience complex and diverse communication support needs that result from multiple intersecting factors. Research to date has focused on communication in residential aged care, with few studies exploring community aged care services. Our findings will inform the development of resources for identifying and supporting communication needs of older adults who receive aged care services.

Occupational stigma can negatively impact aged care workers’ (ACWs) mental health. This mixed-methods study investigates whether ACWs who challenge stigmatising discourses, through communication, experience reduced psychological costs of aged care stigma. We screened 184 ACWs’ discursive responses and tested for differences in ACWs’ mental health between those who challenge stigma and those who do not. A discourse approach was further employed to examine recurring language patterns in ‘challenge’ discursive responses. ACWs (n = 95) who discursively challenged stigmatising discourses reported lower internalised occupational stigma and psychological distress than those who did not challenge stigma (n = 89). These workers chose to infuse positive value into negative evaluations about ACWs and aged care work. Overall, findings suggest that ACWs may spontaneously challenge occupational stigma, through their discursive responses, which may proactively protect their mental health. We offer practical implications for challenging stigma, including developing guidelines, training, and language-based interventions.

Background: In aged‐care settings, direct care staff play a crucial role in supporting older people with communication needs. Many direct care staff, however, have unmet skill needs in interpersonal, intercultural, and intergenerational communication. Communication Partner Training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication needs encountered in aged‐care settings. We sought to identify the key features of existing CPT programs to determine their suitability for the Australian aged‐care context.Aims: To identify existing CPT programs relevant to aged‐care settings and to describe their content and format.Methods: A scoping review was conducted in alignment with the Joanna Briggs Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta‐Analyses for Scoping Reviews reporting guidelines. Using a systematic search, we identified peer‐reviewed articles from five electronic databases: PubMed, PsycINFO, Embase, Cochrane and CINAHL. All retrieved articles were screened by title and abstract; 20% were independently screened by a second reviewer. All full‐text articles were independently assessed by two reviewers. Data describing the content and format of identified CPT programs was extracted using the Intervention Taxonomy and an author‐developed tool.Main Contribution: This review highlights critical gaps in existing CPT programs for aged‐care settings. Identified programs were predominantly disorder‐specific (79%), with the vast majority focusing on conditions like dementia or aphasia and failing to address broader communication needs arising from personal, social and environmental factors. Notably, no programs addressed intercultural communication, despite known cultural and linguistic diversity among aged‐care workers and recipients in countries such as Australia. Furthermore, few (9%) included intergenerational communication considerations. Most programs relied on in‐person delivery methods (67%), often led by health professionals (71%), which may be impractical for resource‐constrained and geographically dispersed aged‐care services. Furthermore, reported outcome measures varied (187 across 90 articles), and few evaluated both trainee and client (the ‘dyad’) outcomes. These findings underscore the need for comprehensive, scalable and contextually relevant CPT programs to address the complex communication challenges seen in aged‐care settings.Conclusions: There is a need for a comprehensive CPT program that is fit‐for‐purpose for direct care staff in aged‐care settings. This program should address the multifaceted and intersecting communication support needs of aged‐care recipients, including intercultural and intergenerational communication differences. The program should also incorporate resource‐feasible delivery methods and evaluate dyadic communication outcomes. Closing these gaps is vital to enhancing quality of care and life for older adults in aged‐care settings.WHAT THIS PAPER ADDS: What is already known on the subject: Many older Australians have complex, unmet communication support needs. In aged‐care settings, direct care staff play a crucial role in supporting older people to communicate. Many aged‐care workers, however, have their own unmet skill needs in interpersonal, intercultural and intergenerational communication. Communication partner training (CPT) provides a potential solution. However, it is not known if existing programs address the diverse communication support needs encountered in aged‐care settings. What this paper adds to existing knowledge: Using a scoping review methodology, we identified and described CPT programs for direct support staff who work with older adults. Most CPT programs were disorder‐specific and targeted communication needs in dementia or aphasia. As aged‐care recipients have multifaceted, complex and intersecting communication support needs, these programs may fall short of addressing the training needs of aged‐care workers. The mode of training delivery was predominately in‐person and health professional‐led. Such delivery modes may not support implementation given resource constraints across the Australian aged‐care sector. CPT that can be feasibly implemented in aged‐care settings to address complex and intersecting communication support needs is required. What are the potential or actual clinical implications of this work?: Our analysis highlights the need for comprehensive, disorder‐agnostic CPT tailored for aged‐care staff to address diverse communication support needs. This CPT should consider scalable delivery modes effective across Australia's vast geography and limited trainer availability. It must include outcome measures reflecting the perspectives of communication support partners—older Australians in aged care with communication challenges. To tackle the health, personal and environmental communication barriers in aged care, a fit‐for‐purpose CPT program, co‐designed with key stakeholders, is essential to ensure the training is both feasible and acceptable to meet the unmet needs of intended end‐users.

BACKGROUND Enrichment activities are essential for enhancing the psychosocial well-being of older adults living in residential aged care homes. There has been increasing interest in using digital technology for enrichment, but the implementation of technology requires careful support and enablement from staff to ensure that residents experience the intended benefits. OBJECTIVE This study aimed to understand how care staff facilitate aged care residents’ use of the Tovertafel (“magic table” in Dutch), a technology that projects images onto a tabletop to enable groups of people to play games. The study further aimed to understand the benefits arising from the Tovertafel when facilitated by staff. METHODS We conducted a field study in 1 residential aged care home in Queensland, Australia. The methods included semistructured interviews with the staff and residents about their experiences with the Tovertafel, observations of 4 sessions in which the residents and staff played Tovertafel games, and a diary completed by the staff after Tovertafel sessions. Data were analyzed through reflexive thematic analysis. RESULTS We developed 3 themes through our analysis. Theme 1 highlights the need for the staff to overcome physical and personal barriers before Tovertafel sessions could take place. These included a lack of a dedicated space for playing Tovertafel games and the residents’ reluctance to attend Tovertafel sessions. Theme 2 highlights how the staff used creative strategies to make Tovertafel sessions successful. These included helping the residents learn how to interact with the games; adapting the activity to suit the capabilities of the residents; sustaining engagement by choosing appropriate games; and using prompts, questions, and storytelling to make the games more engaging. Theme 3 describes the benefits and outcomes that arose from staff-supported enablement of the Tovertafel, including participation in an enjoyable physical activity, socialization, and reminiscence. CONCLUSIONS This study suggests that the Tovertafel provides opportunities for aged care staff to engage in creative play and personalization catering to residents with different capabilities. However, the benefits arising from the Tovertafel are unlikely to be achieved without substantial facilitation from the staff, who play a key role in enabling the participation of the residents. Sustaining the engagement of the residents is important during Tovertafel activities and can lead to beneficial outcomes.

Background and Objectives: Stigmatizing discourses surrounding aged care is complex. The stigma associated with people working in aged care is often conflated with negative evaluations about older adults who receive care and/or the institutions and systems that provide these services. This lack of nuance hampers productive dialogue in gerontology required for making sense of the stigmas attached to entities and systems. We propose that an interdisciplinary approach drawing on gerontology, psychology, and linguistics would facilitate a greater understanding of the stigma of aged care. Specifically, a discourse approach underpinned by Stigma Theory and Systemic Functional Linguistics can clarify the different stigmatizing discourses associated with aged-care entities and systems, and inform priorities for interventions targeting each discourse category identified.Research Design and Methods: APPRAISAL, a linguistics framework, was employed to analyze evaluative language in 660 submissions published in the Australian Royal Commission into Aged Care. Through applying predefined language-based criteria, we distinguished between multiple stigmatizing discourses that were interrelated but conceptually distinct in terms of attitude types and targets.Results: Twelve categories of stigmatizing discourses derived from the linguistic analysis established a typology. This typology conceptualized different ways stigma can be meaningfully understood in the aged-care context. By employing this typology, 12 intervention priorities were also identified.Discussion and Implications: This interdisciplinary approach enabled us to examine the diversity and complexity of the social construction of stigma in the public domain. We argue that understanding these linguistic patterns can assist with designing targeted aged-care interventions and policies.

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Negative social evaluations about aged-care work continue to discredit those who perform this type of work. Drawing on ‘dirty work’ literature from the field of management and stigma theory from the field of psychology, this study examines occupational stigma in the context of aged-care work and its relationship with negative outcomes for people who work in aged care. Findings from a path analysis revealed that aged-care workers (n = 185) who ascribe occupational taints and poor occupational conditions with aged-care work perceive aged-care work as being stigmatized, and in turn, are more likely to internalize this stigma. Through this process of perceiving and internalizing occupational stigma, aged-care workers experience greater psychological distress, job dissatisfaction, and turnover intentions. This research fills a void within the gerontology literature regarding the psychological processes underlying how occupational stigma may come to negatively impact this workforce. Findings offer practical implications for policy reform and managerial training.