Correspondence

Communication Disabilities among Medical Inpatients

N Engl J Med 1998; 339:272-273July 23, 1998

Article

To the Editor:

The Americans with Disabilities Act requires equal access to services, including health care, and it applies not only to those with physical needs, such as wheelchair access, but also to those with disabilities affecting communication. We examined the frequency of such communication barriers among patients on a general medical inpatient service to assess the need for special accommodations for patients with these disabilities.

We evaluated a convenience sample of 611 patients admitted a total of 679 times to a general medical service at a university hospital. Simple functional criteria gave a practical assessment of accommodation needs. The patients were judged to have a serious communication disability if their vision was so poor that they were unable to read hospital consent forms or typical patient-education materials, even with their corrective lenses; if they could not understand shouted speech, even with their hearing aids; if they could not produce speech understandable to the medical team; or if they had altered mental states. Barrier status was judged by consensus of the medical team.

We found one or more severe disabilities affecting communication among 15.9 percent of our patients. Nine percent had altered mental states, 4.7 percent vision impairments, 2.8 percent speech impairments, and 0.5 percent hearing impairments. The patients with these disabilities were more likely to be older than unaffected patients (odds ratio, 1.3 for each decade of age; 95 percent confidence interval, 1.1 to 1.5) and male (odds ratio, 2.4; 95 percent confidence interval, 1.5 to 3.8). Race was not a significant risk factor for a communication disability. Communication disabilities were most commonly due to conditions such as diabetic retinopathy, glaucoma, cataracts, strokes or other neurologic disorders, or head and neck cancers.

Aids to communication often may not be provided in health care settings.1,2 Appropriate accommodations for people with disabilities affecting communication include large-print, Braille, or audiotape materials for those with poor vision; assistive listening devices, or interpreters of sign language when appropriate, for those who are hearing-impaired; tracheostomy speech adapters or communication boards for those with speech impairments; and surrogate sources of information and advance directives for those with impaired mental states. Our findings suggest that such accommodations for communication disabilities may be needed frequently by hospitalized medical patients.

David A. Ebert, M.D.
Mount Sinai Hospital, Chicago, IL 60608

Paul S. Heckerling, M.D.
University of Illinois College of Medicine, Chicago, IL 60612

2 References

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   Ebert DA, Heckerling PS. Communication with deaf patients: knowledge, beliefs, and practices of physicians. JAMA 1995;273:227-229
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   Kathryn M. Yorkston, Michelle S. Bourgeois, Carolyn R. Baylor. (2010) Communication and Aging. Physical Medicine and Rehabilitation Clinics of North America 21:2, 309-319
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   Sun Mi Shin, Eui Sook Kim, Chang Ki Park, Hee Woo Lee. (2010) The Medical Use of the Disabled Among Overusers of Medical Aid in Korea. Journal of Preventive Medicine and Public Health 43:1, 35
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   Robyn O'Halloran, Linda E. Worrall, Louise Hickson. (2009) The number of patients with communication related impairments in acute hospital stroke units. International Journal of Speech-Language Pathology 11:6, 438-449
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   J.-H. Park, J.-S. Lee, J.-Y. Lee, J. Gwack, J.-H. Park, Y.-I. Kim, Y. Kim. (2008) Disparities between persons with and without disabilities in their participation rates in mass screening. The European Journal of Public Health 19:1, 85-90
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