2.2 Support in intervention in residential care services for the elderly with intellectual disabilities

Aging is considered a social vulnerability factor that can contribute to increasing situations of greater susceptibility to exclusion and/or discrimination. The professional figure in this area is currently recognized as essential to guarantee adequate care and services for the population of older people with intellectual disabilities, facilitating their integration into the socio-health and educational system.

This aging process in people with intellectual disabilities is beginning to worry the professionals who carry out their activity in this group, especially as regards the physical and behavioral changes that originate among these people from an age that ranges between 45 -50 years and that forces professionals to modify the type of activities and to demand more and better resources from the different administrations to better serve older people with intellectual disabilities who begin an aging process.

Among the problems that professionals may encounter when dealing with people with special needs is their difficulty in communicating, due to their own disabilities, the greatest difficulties occur when using speech and writing. manual as the main form of expression.

In some cases, communication and expression difficulties can cause people with intellectual disabilities to present behavioral changes (irritability, sleep disturbances, loss of appetite, self-aggressiveness and/or heteroaggressiveness…) as a manifestation of pain or physical or psychological discomfort. (for example, due to anxiety over the loss of a loved one…).

That is why it is important that family members and direct care people be aware of these changes to try to get the person the right treatment as soon as possible. It is especially important to monitor alterations and changes in behavior, emotion and communication, as well as declines in reasoning and memory abilities, since they may be indicative of a mental disorder or some type of dementia.

Communication is the process by which two or more people interact with the intention of transmitting or expressing an idea, information, emotion or need, and whose result is mutual understanding, exchange, and even influence on the behavior of the other. In many cases, dependent people, due to their health conditions, see their abilities to carry out optimal communication diminished, so they need adaptations to achieve this mutual exchange that is communication.

On the other hand, we can find people with special difficulties to communicate, due to their own disabilities, and that is why in this section we introduce some guidelines referring to the needs that some people in situations of dependency may have in these situations.

Communication process

The communication process is the set of behaviors that makes human relationships possible. When two or more people exchange a series of messages, we understand that they are interacting socially, communicating through words, gestures, emotional expressions, etc. We say that this communication is effective when the receiver correctly interprets the information given by the sender; that is, capturing the sense with which he had transmitted it.

In the framework of verbal communication we can distinguish:

1. Oral communication or spoken language
whose culmination is language (articulated sounds from which we can emit words and phrases). The acquisition of oral language is determined by the sum of a maturational and imitative process from the stimuli that surround the human being from the moment of his birth and develops to allow him to communicate with others through conversation, attending to a specific situation and depending on the spatio-temporal and socio-cultural contexts. When for any physiological or psychological reason this acquisition does not take place or is lost throughout the life cycle, special communication needs arise.

We can specify language as a “specifically human communicative behavior, which fulfills important functions at a cognitive and social level; that allows man to express his intentions, stabilize them and turn them into regulators of actions, allowing the subject to reach a level of cognitive and behavioral self-regulation that would be impossible to access without this language”.

One of the most common disorders among older people with intellectual disabilities is aphasia.

This word refers to the loss of ability to express oneself or to understand language, leading to communication problems of various kinds. The highly developed capacity for communication in humans is what allows us to establish extensive, full and satisfactory relationships. When this ability deteriorates (as occurs in most dementias), secondarily difficulties appear to guarantee the well-being of both the sick person and those around him.

The language alteration can happen suddenly, as in the case of cerebral vascular accidents, or gradually, as in Alzheimer’s disease. It is important to know that language can be affected in different aspects. Fundamentally, the alterations can be grouped according to whether they are of the expression or reception of language.

Thus, expressive language refers to the ability to speak and be understood. In dementias, it is usually lost gradually: at first, the most characteristic may be the difficulty in finding the right words, while in advanced stages of the disease the person may appear to mumble or mutter, being frankly difficult, even impossible. understand what it says.

On the other hand, receptive language assumes the ability to understand others. In most cases, its alteration is not parallel to the loss of expressive language; that is, a person can understand more than he is able to say or, on the contrary, he can speak quite well, but understand little of what is said. It is very important to take the precaution of never saying things to the sick person that we do not want them to hear or understand, as well as never speaking in their presence as if they were not there.

Furthermore, language impairment is not a good indicator of the degree of loss of other functions. That is, a person with a severe language impairment may be able to function reasonably well in many daily activities.

2. Written communication
Writing is the form of verbal expression created from more complex linguistic codes, such as graphic representation systems: pictograms, ideograms and the alphabetic system (the alphabet of a language), which have been selected by the human being to communicate and that vary according to the societies.

The ability to write (that is, to fix ideas on a material support) is the result of a specific cognitive, linguistic, perceptual and motor acquisition. Written communication offers numerous advantages for the transmission of messages to people with memory problems and patients with cognitive difficulties. For example, through basic materials, such as agendas, diaries, etc., therapeutic intervention is supported and the understanding of complex messages is also facilitated.

In the case of people with special needs, the greatest difficulties arise when using speech and manual writing as the main form of expression. As professionals we must take into account when communicating with any user that it is necessary to follow a series of guidelines or rules that facilitate the establishment of a good communication process and ensure that our interlocutor perfectly understands the meaning of the information that we want to send them, for it:

• The message must be correctly structured.
• The message must be clear and concise, avoiding giving rise to different interpretations.
• We must select the most appropriate time to initiate communication, avoiding situations that may hinder it.
• We must communicate only what we know for sure, avoiding giving false or incomplete messages.
• We must adapt the content and form of the message to the characteristics of the user we are targeting.
• We cannot fall into contradictions, being consistent in our verbal and non-verbal language.
• We must pay close attention to the feedback process, since through it we will be aware of the interpretation that our interlocutor has made of the information and whether their degree of understanding is the required one.

3. Non-verbal communication
Non-verbal communication refers to information that is transmitted to the receiver without using the word. Generally, it refers to body language (posture, gestures, facial expression, eye contact, movement of arms and hands, the inflection of the voice, the sequence, the rhythm, the cadence of words, …)

Unlike verbal communication, it does not focus only on the transmission of information, messages and knowledge, but also crosses that border of content to also express the emotions of the sender. In addition, nonverbal signs complete and support or contradict verbal communication, substitute oral communication, externalize attitudes and favor personal interactions.

We must not forget that all communication has a content aspect and a relational aspect. Therefore, both modes of communication do not exist separately, but complement each other in each message, they overlap and feed back. There is a need to combine these two languages; the person, in their role as sender and receiver, must translate from one to the other, being at this moment when communication dilemmas can appear, giving way to dysfunctional communication and communication barriers. To achieve effective communication with the interlocutor, there must be harmony between the verbal and non-verbal messages emitted, since on many occasions it is the discrepancy between them that hinders the communication process itself.

As professionals we must bear in mind that many of the patients in situations of dependency have poor language development, so it is essential to understand the body language and gestures of each user and capture the nuances of eye contact to communicate more effectively and understand Only a minimal part of communication is verbal; most of the information expressed is done through non-verbal communications.

We must bear in mind that the inability to communicate with others has consequences for dependent people such as the impossibility of accessing information and social isolation. We already know that a series of physiological and psychological factors that are present in both the sender and the receiver intervene in the communication process, and that these elements can hinder said process; and even more so in the case of disabled users.

In communication processes, the main barrier appears when verbal language does not coincide with gestural or body language, but there are also other environmental interferences that can distort our communicative interactions. As professionals, we must be able to detect all these distorting elements in order to avoid them and establish effective communications with the users of the centers in which we carry out our activity.

The barriers that can block the communication process between the caregiver and the user can be classified into three types:

1. Physical barriers.

We refer to the environmental factors that surround communicative interaction and that can hinder it. Among others, we highlight the following:

• Noise: it implies auditory-type distractions that suppose the loss of information and, as a consequence, the failure of communication. Lighting: poor lighting prevents the correct visual perception of different non-verbal aspects present (gestures, movements, looks,…).
• Physical dimensions of the site where the communication takes place.
• Inappropriate channel or context.

2. Psychological barriers.

They refer to those distortions that, due to emotional states or cognitive deficits, that the sender or the receiver make of the messages. They can be the following:

• Deformation of the message. When the receiver correctly receives the various units of the message but does not properly organize it, which leads to an incorrect interpretation.
• Misperception. The images, impressions or sensations that the person captures from the environment through the senses can cause the sender or the receiver to attribute a wrong meaning to the shared information, processing the situation in an erroneous way.
• Forgetfulness. Users who have difficulty retaining information in memory are common, as a result of the natural aging process or cognitive disorders.
• Lack of attention. Many types of disabilities involve attentional deficits that prevent the dependent from maintaining attention during the entire period of time that a communication process entails.
• Absence of feedback during the communicative process. Certain intellectual alterations can also affect this part of the process.

3. Difficulties in understanding:

• Failure to establish correct eye contact, which prevents the user from capturing non-verbal communicative elements.
• As professionals we must take into account, if our objective is to minimize the barriers present in communication as much as possible, we recommend:
• Carefully observe the expressive register of the users to obtain good information on the level of understanding of the message and the emotional state of the patient, which is very useful during the performance of professional tasks.
• Think about what we are going to say and how we are going to say it; that is, trying to ensure that there is coherence between what we say and the way we say it, so that the interpretation of the messages by the patients is correct and does not generate mistrust or uncertainty.
• Listen carefully. Active listening involves understanding communication by placing ourselves in the perspective of the person who sends the message, focusing on their verbal and non-verbal emissions. Through it, the speaker perceives signs that the listener has understood his words and also his ideas and feelings.
• Establish a connection with the patient’s feelings and interests; try to put ourselves in their place and share their feelings (empathize).
• Simplicity. Use phrases that do not lend themselves to double interpretations and summarize ideas in short sentences. It is about oral language being within the reach of the receiving person, being brief, concise and with words that are easy to understand and remember.

Aging is a process of change that develops naturally and that involves adaptation to that change by the person. Despite the fact that the concepts of old age and dependency are often linked, it is necessary to emphasize that illness and not age is the main cause of dependency, which implies that old age should in no case be synonymous with illness or dependency. Moreover, over the last 20 years, different sectors have tried to stimulate successful, active or competent aging, all concepts that point to a new type of old age free of disease and functional disability.

On an individual level, people can do a lot to improve the way they age and prevent disease. It can be affirmed that, in the absence of demential illnesses, cognitive functioning can be enhanced throughout old age through appropriate techniques and measures. Authors such as Díaz-Veiga have highlighted the importance of social support when describing social functioning in old age. The quantity and quality of the relationships that an individual has and that provide him with help, affection and personal self-affirmation have not only an influence on the person’s social functioning, but also mediate the maintenance of self-esteem during old age and have a possible buffering function in relation to losses.

Given the higher incidence of some specific pathologies in older people with intellectual disabilities in the aging process, the lower capacity for recovery that age itself implies and the difficulties that, especially seriously affected people, present for the expression of their physical discomfort , it is important to carry out specific control and monitoring of the health status of people with intellectual disabilities, especially from the age of 45.

To develop positive active ageing, society must provide the greatest opportunities for them to be independent, to enjoy good health and to be productive. Likewise, it is important that they enjoy greater safety and comfort, promoting well-being and creating more conducive and favorable environmental environments. We must think more about training, considering the elderly as active participants and contributors to society.