A scoping review of friendship intervention for older adults: lessons for designing intervention for people with aphasia

"I Could Not Talk . . . She Did Everything . . . She's Now My Sister": People With Aphasia's Perspectives on Friends Who Stuck Around

PURPOSE

Aphasia may decrease the capacity to develop and maintain friendships. The aim of this study was to better understand the perspectives of people with aphasia on why some friendship bonds remain strong and some do not. Furthermore, we wanted to explore how age and aphasia severity shape views on friendship.

METHOD

We interviewed 27 people with aphasia about their experiences of friendship before and after the onset of aphasia. We then used framework analysis and reflexive thematic analysis to interpret the interview data.

RESULTS

From the interviews, we created four major themes concerning how friend relationships had been impacted by aphasia: (a) Not all bonds have the same chance of surviving the onset of aphasia; (b) people with aphasia's closest friends took active steps to keep relationships strong; (c) if friends knew some basic information about aphasia, bonds would stay stronger; (d) positive affective aspects of friendship play an important role in keeping bonds strong. We also noted differences in friendship experiences that appeared to be influenced by age and aphasia severity of participants.

CONCLUSIONS

Interview data provided actionable ideas including focusing on friends who are likely to be responsive to help with maintaining the friendship, providing them with strategies to keep the friendship active and communication meaningful, and acknowledging the positive impact that this will have on the friend recovering from aphasia. More research is needed to develop programs that empower people with aphasia to maintain their friendships.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.24688671.

Using bibliotherapy to rebuild identity for people with aphasia: A book club experience

BACKGROUND

Aphasia book clubs were developed to support connecting with literature and reading for pleasure within an aphasia-friendly environment. Bibliotherapy is an evidence-based therapeutic approach, in which a book is selected to address the challenges facing the reader. Its aim is to facilitate a deeper understanding of a lived experience in order to promote healing, strategy development, and adjustment. Aphasia book clubs provide an opportunity to discuss books about the challenges associated with aphasia. A recent book, Identity theft: Rediscovering ourselves after stroke recounts the stroke recovery story of Dr. Debra Meyerson and 22 other stroke survivors. Identity Theft focuses on the need to reconstruct positive identities despite remaining disabilities to facilitate rebuilding rewarding lives. The purpose of this study is to understand the impact of reading Identity Theft in an aphasia book club for people with aphasia (PwA).

METHOD

27 PwA read the book Identity Theft in one of four online aphasia book clubs offered by two universities. Weekly discussions were facilitated by graduate SLP students under the supervision of experienced clinicians. At the end of the 10 week program, semi-structured qualitative interviews were conducted with participants to understand the lived experience. Interviews were analyzed using reflexive thematic analysis.

RESULTS

Analysis of the interview data generated four main themes and 13 subthemes. The main themes included: Mechanism for Reflection, Power of Community, Engaged Learning, and Therapeutic Environment. Interview extracts illustrate the way these themes support increasing self-efficacy and rebuilding a positive identity.

CONCLUSION

The themes align positively with outcomes associated with the bibliotherapy process. Themes also integrate into a self-management model that promotes self-efficacy through education, support, awareness, problem solving and goal setting. Caveats included determining participant readiness to examine recovery issues and facilitator preparation. Aphasia book clubs surrounding psychosocial texts may help PwA reconstruct a positive post-stroke identity.

Aphasia and friendship: Stroke survivors' self-reported changes over time

INTRODUCTION

Friendships are an important contributor to quality of life. Due to communication and other stroke-related challenges, people with aphasia (PWA) can experience negative friendship changes, which have been linked with increased physiological distress. This study examined friendship experiences over time for PWA to understand how friendships evolve throughout the course of stroke and aphasia recovery.

METHODS

Fifteen stroke survivors with chronic aphasia completed language testing and a friendship questionnaire created by the researchers. The friendship questionnaire was composed of open and closed-ended questions that asked PWA to reflect back on their friendship satisfaction, support, activities, and communication during the time before aphasia and during the acute stage of recovery. The questionnaire also addressed their current friendships in the present-day chronic stage of recovery, as well as questions about an ideal friendship. Quantitative and qualitative methods were used to examine the data, with quantitative findings reported in this study.

RESULTS

The majority of PWA reported maintaining some friendships and developing new friendships, often with a fellow stroke survivor with aphasia; however, a few PWA in this study were not able to maintain or develop any new friendships. Average ratings of perceived friendship satisfaction and support improved from the acute to chronic stage, nearing those of the ratings pre-stroke, yet there was greater variability in the chronic stage with some currently feeling dissatisfied and not well supported. Aphasia severity, as measured by a standardized assessment, had a negative relationship with perceived friendship support. In contrast, perception of communicative participation had a positive relationship with friendship support.

CONCLUSIONS

This work highlights lasting social implications of aphasia. The overall health of PWA deserves greater attention, including interventions targeting friendship maintenance and development. Continued stakeholder-engaged research and clinical practice focused on the social and emotional consequences of aphasia on PWA, as well as their friends and family, is needed to assist all involved in aphasia recovery achieve better friendships and well-being.