Examining success of communication strategies used by formal caregivers assisting individuals with Alzheimer's disease during an activity of daily living

"You're the only thing he comes out [of his room] for": A qualitative study of engagement between Laughter Care Specialists and families of people with dementia in long-term care

OBJECTIVES

Family involvement in the lives of people who have dementia and live in long-term care is important, but family members may face challenges communicating and connecting with their loved one as dementia progresses. A type of therapeutic humor (Laughter Care) delivered by trained specialists aims to engage people with dementia who reside in long-term care through creative play and laughter. This study aimed to explore the perceptions of Laughter Care Specialists (LCSs) regarding families' engagement with the program.

METHODS

Semi-structured interviews were conducted with LCSs (n = 8) and analyzed inductively using thematic analysis.

RESULTS

Family members were reported to initially have varied degrees of openness toward Laughter Care, but often become more accepting after observing positive engagement with the person with dementia. Family members were perceived to benefit from the program through witnessing the person with dementia enjoy joyous and light interactions, learn new ways of communicating and connecting with the person with dementia, and engage in positive interactions at end of life.

SIGNIFICANCE OF RESULTS

Laughter Care may provide family members with novel ways of communicating and connecting with people who have dementia at end of life as well as comfort into bereavement.

The Role of Different Aspects of Communication Behavior in the Assessment of Capacity to Consent

Abstract: Any medical treatment that interferes with physical integrity requires the informed consent of a patient capable of such consent. For people with dementia, the capacity to consent is questioned even in the early course of the disease. Particularly diagnostic instruments like the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) often deny people with dementia the capacity to consent because of high confounding of the results with patients’ verbal abilities. To date, it remains unclear whether not only verbal but also nonverbal communication is associated with assessments of capacity to consent. The current study investigates associations between patients’ verbal and nonverbal communication behaviors as assessed by the measure for Communication Behavior in People with Dementia in Ambulant Settings (CODEMamb) and capacity to consent as assessed by the MacCAT-T. We expected the strongest positive associations for verbal communication behaviors compared to nonverbal communication behaviors. Data of N = 43 patients with dementia ( n = 8 capable of consent) were collected at two different German psychiatric clinics. The results show small to moderate correlations between the overall scores of CODEMamb and MacCAT-T. As expected, correlations were strongest for the verbal CODEMamb subscale. The results support current findings on the dependency of the MacCAT-T on verbal communication. Based on the findings, the discussion addresses how people with dementia can be enabled to make self-determined medical treatment decisions.

Language-Based Strategies that Support Person-Centered Communication in Formal Home Care Interactions with Persons Living with Dementia

Language-based strategies are recommended to improve coherence, clarity, reciprocity, and continuity of interactions with persons living with dementia. Person-centered care is the gold standard for caring for persons with dementia. Person-centered communication (PCC) strategies include facilitation, recognition, validation, and negotiation. Little is known about which language-based strategies support PCC in home care. Accordingly, this study investigated the overlap between language-based strategies and PCC in home care interactions. Analysis of conversation of 30 audio-recorded interactions between personal support workers (PSWs) and persons living with dementia was conducted. The overlap between PCC and language-based strategies was analyzed. Of 11,347 communication units, 2578 overlapped with PCC. For facilitation, 21% were yes/no questions. For recognition, 25% were yes/no questions and 22% were affirmations. For validation, 81% were affirmations and positive feedback. Finally, 60% were yes/no questions for negotiation. The findings highlight the person-centeredness of language-based strategies. PSWs should use diverse language-based strategies that are person-centered.

Formal caregivers' perceptions of everyday interaction with Deaf people with dementia

OBJECTIVES

Deteriorating interactive ability of people with dementia challenges formal caregivers. In Finland, Deaf people with advanced dementia may live in a nursing home designed for their care where the staff use Finnish Sign Language (FiSL). This study describes the perceptions of formal caregivers, focusing on the challenges, how they solve the challenges, and what support they need to improve interaction with Deaf residents.

METHODS

Semi-structured interviews with 13 formal caregivers who work with Deaf people with dementia were conducted and analyzed using qualitative content analysis. A purposive sampling was used.

RESULTS

Three key themes were challenges in interaction, strategies in supporting interaction, and support for coping. Caregivers perceived challenges in interaction caused by linguistic changes, deteriorating physical mobility and memory, and Deaf residents' behavioral challenges. Caregivers supported Deaf residents by learning to know them and using personal and linguistic strategies. Support for coping comprised supporting family members and other caregivers.

CONCLUSIONS

Efficient skills in sign language (SL) and knowledge of dementia are essential in interacting with Deaf residents and to build interpersonal relationships for care.

CLINICAL IMPLICATIONS

Supporting Deaf residents requires learning the way they interact which can be achieved over time.

A framework for rehabilitation for older adults living with dementia

Introduction & Background

The aging of the population assures increased prevalence of Individuals Living with Dementia (ILwD) and there will be an increased representation of this cohort requiring physical rehabilitation. If physical therapists (PTs) manage these patients as they do their age-matched, cognitively-intact peers, they will likely be unsuccessful. ILwD have unique needs related to interpersonal and pragmatic components of rehabilitation. Therapeutic nihilism (doubting the benefit of therapy) is well-documented in PTs, either because of existing biases about dementia or previous challenges in working with ILwD. Physical rehabilitation eligibility and placement decisions are often made by PTs without special training in dementia, based upon brief exposure to patients in environments not well-designed for their best functioning. This can lead to underestimation of rehabilitation potential and denial of future PT services. PTs who work with ILwD desire more practical knowledge and targeted skills. Those with more education and training have a more positive attitude and outlook related to ILwD.

Purpose

The purpose of this paper is to introduce a framework for rehabilitation with ILwD equipped with pragmatic ideas to facilitate therapeutic success. The four primary components of the model are: (1) Establish a personal RELATIONSHIP, (2) Use intentional verbal and nonverbal COMMUNICATION, (3) Understand and optimize MOTOR LEARNING capabilities, and (4) Create a safe, purposeful ENVIRONMENT. Specific strategies to help PTs optimize each component are provided with supporting evidence. The model is intended to be dynamic, encouraging PTs to capitalize on the most accessible strategies within their control for a given patient and setting.

Implications

This framework provides a practical resource for working with ILwD with immediate implications for facilitating therapeutic success. The model is displayed in a schematic that reminds the reader of ideas at a glance within the context of each of the components. If an appreciation for this content was among core competencies required among PTs working with ILwD, perhaps there would be significantly fewer patients written off as “uncooperative” or “unable to participate” in PT.

Preserved Consciousness in Alzheimer's Disease and Other Dementias: Caregiver Awareness and Communication Strategies

Alzheimer's disease is an insidious onset neurodegenerative syndrome without effective treatment or cure. It is rapidly becoming a global health crisis that is overwhelming healthcare, society, and individuals. The clinical nature of neurocognitive decline creates significant challenges in bidirectional communication between caregivers and persons with Alzheimer's disease (AD) that can negatively impact quality-of-life. This paper sought to understand how and to what extent would awareness training about the levels of consciousness in AD influence the quality-of-life interactions in the caregiver-patient dyad. A literature review of multiple databases was conducted utilizing a transdisciplinary approach. The sum of findings indicates a positive relationship between enhanced caregiver awareness and training, positive interactions, and improved QOL measures among patients and caregivers. A multidirectional relationship was found among healthcare policies, training and education resources, caregivers, and persons with AD. Specifically, the current lack of policy and inadequate training and educational resources has various detrimental effects on patients and caregivers, while improvements in training and education of caregivers yields positive outcomes in communication and QOL. Furthermore, evidence of preserved consciousness in persons with AD was demonstrated from multiple disciplines, including neurobiological, psychological, and biopsychosocial models. The literature further revealed several methods to access the preserved consciousness in persons with AD and related dementias, including sensory, emotional, and cognitive stimulations. The evidence from the literature suggests a reframed approach to our understanding and treatment of persons with AD is not only warranted, but crucial to address the needs of those affected by AD.

Use of the Children's Communication Checklist-2 in School-Aged Students with Autism: A Psychometric Analysis

Measurement of social-pragmatic communication skills is essential for clinicians and researchers working with school-aged children on the autism spectrum. Many measures of these skills require time-intensive training and coding that is impractical for clinical assessment settings. Using a sample of 299 elementary school children (M = 8.6 years, sd = 1.7) with autism whose teachers completed the Children's Communication Checklist-2, we evaluated the psychometric properties of the CCC-2, a commonly used measure of social-pragmatic skills in order to assist researchers and clinicians in identifying the utility of this measure related to their assessment needs. Our results indicate strong psychometric properties for the CCC-2 with this population and a 3-factor model fit: Structural Language, Pragmatic Communication, and Pragmatic Social. Evidence of racial/ethnic bias was found for the structural language factor. Clinical recommendations are provided for using the CCC-2 with students with autism as reported by teachers.

Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study

BACKGROUND

Long-term care (LTC) homes provide 24-hour care for people living with complex care needs. LTC staff assist older adults living with chronic conditions such as Alzheimer disease, related dementias, and stroke, which can cause communication disorders. In addition to the complex cognitive challenges that can impact communication, further difficulties can arise from cultural-language differences between care staff and residents. Breakdowns in caregiver-resident communication can negatively impact the delivery of person-centered care. Recent advances in mobile technology, specifically mobile devices (tablets and smartphones) and their software apps, offer innovative solutions for supporting everyday communication between care staff and residents. To date, little is known about the care staff's perspectives on the different ways that mobile technology could be used to support communication with residents.

OBJECTIVE

This study aims to identify care staff's perspectives on the different ways of using devices and apps to support everyday communication with adults living in LTC homes and the priority care areas for using mobile technology to support communication with residents.

METHODS

This descriptive study employed concept mapping methods to explore care staff's perspectives about ways of using mobile technology with residents and to identify the usefulness, practicality, and probable uses of mobile technology to support communication in priority care areas. Concept mapping is an integrated mixed methods approach (qualitative and quantitative) that uses a structured process to identify priority areas for planning and evaluation. In total, 13 care staff from a single LTC home participated in this study. Concept mapping includes 2 main data collection phases: (1) statement generations through brainstorming and (2) statement structuring through sorting and rating. Brainstorming took place in person in a group session, whereas sorting and rating occurred individually after the brainstorming session. Concept mapping data were analyzed using multidimensional scaling and cluster analysis to generate numerous interpretable data maps and displays.

RESULTS

Participants generated 67 unique statements during the brainstorming session. Following the sorting and rating of the statements, a concept map analysis was performed. In total, 5 clusters were identified: (1) connect, (2) care management, (3) facilitate, (4) caregiving, and (5) overcoming barriers. Although all 5 clusters were rated as useful, with a mean score of 4.1 to 4.5 (Likert: 1-5), the care staff rated cluster 2 (care management) as highest on usefulness, practicality, and probable use of mobile technology to support communication in LTC.

CONCLUSIONS

This study provided insight into the viewpoints of care staff regarding the different ways mobile technology could be used to support caregiver-resident communication in LTC. Our findings suggest that care management, facilitating communication, and overcoming barriers are 3 priority target areas for implementing mobile health interventions to promote person-centered care and resident-centered care.

Mobile Apps to Support Caregiver-Resident Communication in Long-Term Care: Systematic Search and Content Analysis

BACKGROUND

In long-term residential care (LTRC), caregivers' attempts to provide person-centered care can be challenging when assisting residents living with a communication disorder (eg, aphasia) and/or a language-cultural barrier. Mobile communication technology, which includes smartphones and tablets and their software apps, offers an innovative solution for preventing and overcoming communication breakdowns during activities of daily living. There is a need to better understand the availability, relevance, and stability of commercially available communication apps (cApps) that could support person-centered care in the LTRC setting.

OBJECTIVE

This study aimed to (1) systematically identify and evaluate commercially available cApps that could support person-centered communication (PCC) in LTRC and (2) examine the stability of cApps over 2 years.

METHODS

We conducted systematic searches of the Canadian App Store (iPhone Operating System platform) in 2015 and 2017 using predefined search terms. cApps that met the study's inclusion criteria underwent content review and quality assessment.

RESULTS

Although the 2015 searches identified 519 unique apps, only 27 cApps were eligible for evaluation. The 2015 review identified 2 augmentative and alternative cApps and 2 translation apps as most appropriate for LTRC. Despite a 205% increase (from 199 to 607) in the number of augmentative and alternative communication and translation apps assessed for eligibility in the 2017 review, the top recommended cApps showed suitability for LTRC and marketplace stability.

CONCLUSIONS

The recommended existing cApps included some PCC features and demonstrated marketplace longevity. However, cApps that focus on the inclusion of more PCC features may be better suited for use in LTRC, which warrants future development. Furthermore, cApp content and quality would improve by including research evidence and experiential knowledge (eg, nurses and health care aides) to inform app development. cApps offer care staff a tool that could promote social participation and person-centered care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/10.2196/17136.

What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives

INTRODUCTION

With governments worldwide reducing their involvement in the provision of institutional long-term elder care, community-based family caregivers (FCs) have become a key element in policies aimed at improving the quality of healthcare systems and maintaining their financial sustainability. This paper uses data from focus groups with FCs providing care to older adults to describe their approaches to and priorities for achieving care quality and sustainability as they work with formal health and social care systems. It describes FCs' views on information and communications technology (ICT) as potential supports for achieving these care quality and sustainability goals.

METHODS

We held 10 focus groups from May 2017 to August 2018 and recruited 25 FCs through a mix of convenience and snowball sampling strategies. We employed an inductive approach and used qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis.

RESULTS

Quality of care - as delivered by both FCs themselves, and formal health and social care systems - was a major preoccupation for our participants. They saw communications quality as a key aspect of the broader concept of care quality. Our data analysis produced a typology of communications quality from the FC perspective. Analysis of our data also revealed ICT development opportunities and available products in key areas.

CONCLUSIONS

Our findings suggest that the formal care system providers could be more caregiver-oriented in their communications by engaging FCs in the decision-making process and allowing them to express their own concerns and goals. The implication of our findings for those seeking to develop policies and ICT products in support of FCs is that these should focus on human relationships and seek to expand facilitative communications.

The effect of repetition on pronoun resolution in patients with memory impairment

Referring to things in the world - that woman, her idea, she - is a central component of language. Understanding reference requires the listener to keep track of the unfolding discourse history while integrating multiple sources of information to interpret the speech stream as it unfolds in time. Pronouns are a common way to establish reference. But due to their impoverished form, to understand them listeners must relate features of the pronoun (e.g., gender, animacy) with existing representations of potential discourse referents. Successful referential processing seems to place demands on memory. In a previous study, patients with hippocampal amnesia and healthy participants listened to short stories as their eye movements were monitored. When interpreting ambiguous pronouns, healthy participants demonstrated order-of-mention effects, whereby ambiguous pronouns are interpreted as referring to the first-mentioned referent in the story. By contrast, memory-impaired patients exhibited significant disruptions in their ability to use information about which character had been mentioned first to interpret pronouns. Repetition of the most salient information is a common clinical recommendation for improving pronoun resolution and communication in individuals with memory disorders (e.g., Alzheimer's disease) but this recommendation lacks an evidentiary basis. The present study seeks to determine whether the pronoun resolution performance of hippocampal patients can be improved, by repetition of the target referent, increasing its salience. Results indicate that patients with hippocampal damage demonstrate improved processing of pronouns following repetition of the target referent, but benefit from this repetition to a significantly smaller degree compared to healthy participants. These results provide further evidence for the role of the hippocampal-dependent memory system in language processing and point to the need for empirically tested communication interventions.

Qualitative study of affective identities in dementia patients for the design of cognitive assistive technologies

Our overall aim is to develop an emotionally intelligent cognitive assistant (ICA) to help older adults with Alzheimer's disease (AD) to complete activities of daily living more independently. For improved adoption, such a system should take into account how individuals feel about who they are. This paper investigates different affective identities found in older care home residents with AD, leading to a computational characterization of these aspects and, thus, tailored prompts to each specific individual's identity in a way that potentially ensures smoother and more effective uptake and response. We report on a set of qualitative interviews with 12 older adult care home residents and caregivers. The interview covered life domains (family, origin, occupation, etc.), and feelings related to the ICA. All interviews were transcribed and analyzed to extract a set of affective identities, coded according to the social–psychological principles of affect control theory (ACT). Preliminary results show that a set of identities can be extracted for each participant (e.g. father, husband). Furthermore, our results provide support for the proposition that, while identities grounded in memories fade as a person loses their memory, habitual aspects of identity that reflect the overall “persona” may persist longer, even without situational context.

CODEMamb - an observational communication behavior assessment tool for use in ambulatory dementia care

INTRODUCTION

Communication improves well-being and quality of life for both people with dementia and their professional and family caregivers. Individualized communication, as required in informed consent procedures and psychosocial interventions, can improve quality of life, especially in ambulatory settings. However, few valid and reliable instruments exist that enable communication to be assessed and communication and behavioral resources to be identified. We, therefore, extended and adapted the newly developed observational instrument CODEM for use in ambulatory settings (CODEM_amb).

METHODS AND RESULTS

Reliability and validity of the new instrument were studied in a total of 171 patients, whereby principal component analysis revealed three important factors: relationship aspects, verbal communication behavior and nonverbal communication behavior. CODEM_amb[Formula: see text]s internal consistency, interrater and retest reliability were satisfactory to excellent. Convergent validity indices, as shown by examining correlations with similar but not identical constructs (CERAD-NP verbal subscales), were medium-high, while the divergent validity index (constructional praxis) was relatively low. The relationship to peer-rating remained nonsignificant. Criterion validity was investigated in groups of patients in accordance with their cognitive status. As expected, verbal communication abilities deteriorate faster than the relationship aspects of communication as the disease progresses.

CONCLUSIONS

In summary, CODEM_amb is a reliable and valid instrument that can be used to collect important information with the ultimate aim of supporting communication with people with dementia.

Estratégias comunicativas de cuidadores de idosos com demência: uma revisão sistemática

RESUMO Objetivo Conduzir uma revisão sistemática de estudos que investigaram estratégias comunicativas utilizadas por cuidadores de idosos com demência, publicados entre 1995 e 2015. Métodos O levantamento de estudos foi feito usando as seguintes palavras-chave “comunicação e cuidador e demência” e “comunicação e cuidador e Alzheimer”, e os termos em inglês “elderspeak and dementia”, “caregiver’s talk and dementia”, “communication and caregiver and dementia” e “communicative and caregiver and Alzheimer”. Desta revisão sistemática, foram excluídos os artigos de intervenção e aqueles que não tinham descrito entre seus objetivos investigar estratégias comunicativas usadas por cuidadores de idosos com demência. Resultados Apenas 22 estudos preencheram os critérios de inclusão. Os estudos revisados mostraram que os cuidadores de idosos com demência utilizam estratégias comunicativas que são ineficazes (por exemplo, comunicação infantilizada; comunicação “controle” e complexa) e eficazes (usar frases simples; dar um comando por vez; realizar perguntas em que a opção de resposta é sim ou não, entre outras). Conclusão É importante avaliar as percepções e avaliações dos cuidadores acerca da eficácia da estratégia utilizada, para que depois sejam ensinadas habilidades de comunicação para cuidadores familiares e cuidadores formais. A comunicação bem-sucedida deve promover a participação dos idosos com demência, contribuindo para manutenção da autonomia e participação tanto dos cuidadores quanto das pessoas acometidas por esse quadro.

Practice-Based Research: Another Pathway for Closing the Research-Practice Gap

PURPOSE

Practice-based research is proposed as an additional way to bridge the divide between research and practice.

METHOD

The article compares the traditional, laboratory-based research with research that is generated from practice: practice-based research. The defining features of each are described, with an emphasis on contrasting internal and external validity. Retrospective and prospective practice-based studies are described. Guidelines for designing a retrospective study are provided along with a specific example from practice focusing on social communication learning. Last, the authors discuss the value of information generated from practice-based research for contributing to the knowledge base of not only a practice, but also a discipline.

CONCLUSION

The argument is made that approaching research from more than one perspective is necessary for ultimately improving the quality of client and patient care. Practice-based research acknowledges the value of understanding clinical decision making in everyday contexts as an important complement to evidence generated in laboratories. This article is intended to invigorate interest in the uniqueness of practice-based research as a way of encouraging the talents of researchers and practitioners as they work together to gather evidence for improving the lives of individuals with communication disorders.

Language-based communication strategies that support person-centered communication with persons with dementia

BACKGROUND

There are many recommended language-based strategies for effective communication with persons with dementia. What is unknown is whether effective language-based strategies are also person centered. Accordingly, the objective of this study was to examine whether language-based strategies for effective communication with persons with dementia overlapped with the following indicators of person-centered communication: recognition, negotiation, facilitation, and validation.

METHODS

Conversations (N = 46) between staff-resident dyads were audio-recorded during routine care tasks over 12 weeks. Staff utterances were coded twice, using language-based and person-centered categories. There were 21 language-based categories and 4 person-centered categories.

RESULTS

There were 5,800 utterances transcribed: 2,409 without indicators, 1,699 coded as language or person centered, and 1,692 overlapping utterances. For recognition, 26% of utterances were greetings, 21% were affirmations, 13% were questions (yes/no and open-ended), and 15% involved rephrasing. Questions (yes/no, choice, and open-ended) comprised 74% of utterances that were coded as negotiation. A similar pattern was observed for utterances coded as facilitation where 51% of utterances coded as facilitation were yes/no questions, open-ended questions, and choice questions. However, 21% of facilitative utterances were affirmations and 13% involved rephrasing. Finally, 89% of utterances coded as validation were affirmations.

CONCLUSIONS

The findings identify specific language-based strategies that support person-centered communication. However, between 1 and 4, out of a possible 21 language-based strategies, overlapped with at least 10% of utterances coded as each person-centered indicator. This finding suggests that staff need training to use more diverse language strategies that support personhood of residents with dementia.

Speech Interaction with Personal Assistive Robots Supporting Aging at Home for Individuals with Alzheimer’s Disease

Increases in the prevalence of dementia and Alzheimer’s disease (AD) are a growing challenge in many nations where healthcare infrastructures are ill-prepared for the upcoming demand for personal caregiving. To help individuals with AD live at home for longer, we are developing a mobile robot, called ED, intended to assist with activities of daily living through visual monitoring and verbal prompts in cases of difficulty. In a series of experiments, we study speech-based interactions between ED and each of 10 older adults with AD as the latter complete daily tasks in a simulated home environment. Traditional automatic speech recognition is evaluated in this environment, along with rates of verbal behaviors that indicate confusion or trouble with the conversation. Analysis reveals that speech recognition remains a challenge in this setup, especially during household tasks with individuals with AD. Across the verbal behaviors that indicate confusion, older adults with AD are very likely to simply ignore the robot, which accounts for over 40% of all such behaviors when interacting with the robot. This work provides a baseline assessment of the types of technical and communicative challenges that will need to be overcome for robots to be used effectively in the home for speech-based assistance with daily living.

Auditory and Visual Cues for Topic Maintenance with Persons Who Exhibit Dementia of Alzheimer’s Type

This study compared the effectiveness of auditory and visual redirections in facilitating topic coherence for persons with Dementia of Alzheimer's Type (DAT). Five persons with moderate stage DAT engaged in conversation with the first author. Three topics related to activities of daily living, recreational activities, food, and grooming, were broached. Each topic was presented three times to each participant: once as a baseline condition, once with auditory redirection to topic, and once with visual redirection to topic. Transcripts of the interactions were scored for overall coherence. Condition was a significant factor in that the DAT participants exhibited better topic maintenance under visual and auditory conditions as opposed to baseline. In general, the performance of the participants was not affected by the topic, except for significantly higher overall coherence ratings for the visually redirected interactions dealing with the topic of food.

Changes in communication of Deaf people with dementia: A thematic interview with a close family member

BACKGROUND AND AIM

Learning about changes in communication of Deaf with dementia (DWD) is important in order to improve services and support DWD and their families. We explored family members' views on the changes in communication DWD have and the ways communication was adapted due to progression of dementia.

METHODS

A qualitative content analysis of thematic interviews that were conducted with eight close family members of DWD.

RESULTS

With decreasing vocabulary and increasing sign-finding difficulties, conversations became poorer, and DWD tended to diverge from the topic. Nonverbal communication became more important as the verbal communication abilities of DWD deteriorated, and the adult children took a more active role by taking initiative and guiding conversations.

CONCLUSION

DWD seem to go through similar changes in communication as hearing people with dementia. Adult children of DWD need to get used to interpreting and assisting their parent's communication through different phases of dementia.

Identification of hearing loss among residents with dementia: perceptions of health care aides

Effective communication can be difficult when working with individuals with dementia and hearing loss. Given the high prevalence of both dementia and hearing loss among individuals in long term care, direct care providers in this setting, will almost certainly confront frequent communication challenges. To understand health care aide perspectives of caring for residents with dementia and hearing loss, 12 health care aides from five nursing homes participated in audio-recorded, semi-structured interviews. Transcripts were coded and themes were identified. Health care aides reported the difficulties in distinguishing the relative contributions of hearing loss and dementia to communication breakdowns. They reported that familiarity with residents helped them differentiate between sensory versus cognitive impairments in conversations with residents. Although able to identify strategies to support communication, communication difficulty complicated both their provision of care and support of quality of life for residents with dementia and hearing loss. Suggestions for practice and education are provided.

Matched and mismatched appraisals of the effectiveness of communication strategies by family caregivers of persons with Alzheimer's disease

BACKGROUND

Communication problems stemming from Alzheimer's disease (AD) often result in misunderstandings that can be linked with problem behaviours and increased caregiver stress. Moreover, these communication breakdowns also can result either from caregivers' use of ineffective communication strategies, which paradoxically are perceived as helpful, or can occur as a result of not using effective communication strategies that are perceived as unhelpful.

AIMS

The two primary aims were to determine the effectiveness of strategies used to resolve communication breakdowns and to examine whether caregivers' ratings of strategy effectiveness were consistent with evidence from video-recorded conversations and with effective communication strategies documented in the literature.

METHODS & PROCEDURES

Twenty-eight mealtime conversations were recorded using a sample of 15 dyads consisting of individuals with early, middle and late clinical-stage AD and their family caregivers. Conversations were analysed using the trouble-source repair paradigm to identify the communication strategies used by caregivers to resolve breakdowns. Family caregivers also rated the helpfulness of communication strategies used to resolve breakdowns. Analyses were conducted to assess the overlap or match between the use and appraisals of the helpfulness of communication strategies.

OUTCOMES & RESULTS

Matched and mismatched appraisals of communication strategies varied across stages of AD. Matched appraisals by caregivers of persons with early-stage AD were observed for 68% of 22 communication strategies, whereas caregivers of persons with middle- and late-stage AD had matched appraisals for 45% and 55% of the strategies, respectively. Moreover, caregivers of persons with early-stage AD had matched appraisals over and above making matched appraisals by chance alone, compared with caregivers of persons in middle- and late-stage AD.

CONCLUSIONS & IMPLICATIONS

Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD.

Performance of daily activities by older adults with dementia: the role of an assistive robot

Older adults with cognitive impairment often have difficulties in remembering the proper sequence of activities of daily living (ADLs) or how to use the tools necessary to perform ADLs. They, therefore, require reminders in a timely fashion while performing ADLs. This is a very stressful situation for the caregivers of people with dementia. In this paper we describe a pilot study where a tele-operated assistive robot helps a group of older adults with dementia (OAwD) to perform an ADL, namely making a cup of tea in the kitchen. Five OAwD along with their caregivers participated in this study which took place in a simulated-home setting. The purpose of this study was to investigate the feasibility and usability of a robotic system in assisting the OAwD to perform ADL in a home setting. The findings from this study will contribute to achieve our ultimate goal of designing a full-fledged assistive robot that assists OAwD aging in their own homes. The assistive robots designed for people with dementia mostly focus on companionship. This is, to the best of our knowledge, the first attempt to design an assistive robot which will provide step-by-step guidance to people with dementia in their activities of daily living.

A computer-aided telephone system to enable five persons with Alzheimer's disease to make phone calls independently

This study extended the assessment of a computer-aided telephone system to enable five patients with a diagnosis of Alzheimer's disease to make phone calls independently. The patients were divided into two groups and exposed to intervention according to a non-concurrent multiple baseline design across groups. All patients started with baseline in which the technology was not available, and continued with intervention in which the technology was used. The technology involved a net-book computer provided with specific software, a global system for mobile communication modem (GSM), a microswitch, and lists of partners to call with related photos. All the patients learned to use the system and made phone calls independently to a variety of partners, such as family members, friends, and caregivers. A social validation assessment, in which care and health professionals working with persons with dementia were asked to rate the patients' performance with the technology and with the help of a caregiver, provided generally more positive scores for the technology-assisted performance. The positive implications of the findings for daily programs of patients with Alzheimer's disease are discussed.

Quantitative analysis of formal caregivers' use of communication strategies while assisting individuals with moderate and severe Alzheimer's disease during oral care

This cross-sectional observational study examined formal caregivers' use of task-focused and social communication strategies while assisting individuals with moderate and severe Alzheimer's disease residing in a long-term care facility during a basic activity of daily living: toothbrushing. Thirteen formal caregiver-resident dyads were observed during a total of 78 separate toothbrushing sessions. All caregiver utterances occurring during the task were transcribed and coded for type of communication strategy utilizing a multidimensional observational coding scheme, which was developed a priori. Overall, the majority of residents, irrespective of disease severity, successfully completed toothbrushing with the support of caregiver assistance. Caregivers assisting residents with moderate and severe AD were found to use a variety of communication strategies, with task-focused strategies accounting for the majority of use. For the most part, the communicative strategies employed did not differ across disease severity. However, some differences were identified including the use of one proposition, paraphrased repetition, using the resident's name, and provision of full assistance, with these strategies being used more often when assisting individuals with severe AD. This study adds to the emerging literature supporting the use of specific communication strategies while assisting residents with AD during the completion of daily tasks.

LEARNING OUTCOMES

From reviewing this study, readers will be able to identify a variety of communication strategies, both task-focused and relational, that formal caregivers utilize while assisting residents with moderate and severe Alzheimer's disease (AD) during a basic activity of daily living. Furthermore, the reader will be able to distinguish between communication strategies that are optimal when assisting individuals with moderate AD as compared to assisting individuals with severe AD.