Department of Rehabilitation Medicine, University of Washington, Seattle, Washington.
Department of Speech and Hearing Sciences, University of Washington, Seattle, Washington.
Semin Speech Lang. 2022 Jun;43(3):176-197. doi: 10.1055/s-0042-1749618. Epub 2022 Jul 20.
People with communication disorders face barriers to accessing safe and respectful healthcare. These barriers result in increased healthcare complications and inefficiencies, both of which contribute to increased healthcare costs. One obstacle to advocating for accommodations that could improve healthcare for this population is the absence of cost effectiveness studies of such accommodations specifically, as well as a paucity of data defining the needs of this population in general. The purpose of this study was to explore how people with communication and swallowing difficulties are characterized in the National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries aged 65 and older, and how they manage their healthcare. Cross-sectional data from the NHATS rounds 5 to 9 (2015-2019) resulted in 8,038 unique respondents, 3,243 of who reported speech, memory, hearing, and/or swallowing difficulties. More than 90% of respondents with communication difficulties reported having a regular doctor. Less than 60% of respondents with communication difficulties had a family member or caregiver go to medical appointments with them, and around 70% of that subset of participants received help from that caregiver with communication during appointments. Fewer than 15% of respondents with communication difficulties used the internet for healthcare communication or information. Less than 5% of respondents across all communication difficulty categories had received rehabilitation services for communication in the year prior to their survey responses. While the information gleaned from NHATS points to likely gaps between the needs people with communication disorders may have for safe and accessible healthcare, and the support available, future research is needed to improve and clarify how communication disorders are defined and characterized in large-scale surveys to generate more interpretable data. These stronger empirical foundations are needed to support cost-effectiveness analyses to advocate for better communication accessibility of healthcare settings.
患有沟通障碍的人在获得安全和尊重的医疗保健方面面临障碍。这些障碍导致医疗保健并发症和效率低下增加，这两者都导致医疗保健成本增加。倡导改善这一人群医疗保健的住宿条件的一个障碍是缺乏针对这些住宿条件的成本效益研究，以及缺乏一般定义这一人群需求的数据。本研究的目的是探讨在全国健康老龄化趋势研究（NHATS）中，有沟通和吞咽困难的人是如何被描述的，这是一项对 65 岁及以上的医疗保险受益人的全国代表性调查，以及他们如何管理自己的医疗保健。NHATS 第 5 至 9 轮（2015-2019 年）的横断面数据导致了 8038 个独特的受访者，其中 3243 人报告有言语、记忆、听力和/或吞咽困难。超过 90%有沟通困难的受访者报告有固定的医生。不到 60%有沟通困难的受访者有家庭成员或照顾者陪他们去看医生，大约 70%的参与者在看医生时从照顾者那里得到了沟通上的帮助。不到 15%有沟通困难的受访者使用互联网进行医疗保健沟通或信息。不到 5%的受访者在所有沟通困难类别中，在接受调查之前的一年里接受过沟通方面的康复服务。虽然从 NHATS 中收集到的信息表明，有沟通障碍的人可能对安全和可及的医疗保健有需求，但目前提供的支持可能存在差距，但需要进一步的研究来改善和澄清如何在大规模调查中定义和描述沟通障碍，以产生更具可解释性的数据。需要这些更强有力的实证基础来支持成本效益分析，倡导改善医疗保健环境的沟通可及性。
