Preliminary Psychometric Properties of the Verbal and Nonverbal Interaction Scale: An Observational Measure for Communication in Persons with Dementia

Living with a person with young onset dementia - spousal experience

PURPOSE

Being of working age while at the same time needing to help a partner with young onset dementia has specific consequences for spouses. Research to date has been sparse concerning this particular group of spouses. The aim of the study was to explore spouses' everyday experiences when living with a person with young onset dementia.

METHOD

The study had a descriptive qualitative design with semi-structured interviews with nine spouses. The interviews were analysed using content analysis.

RESULT

The interviewed spouses experienced emotions that varied from feelings of loneliness, frustration, and worry to peace of mind. They said that they used coping strategies, which included adopting a positive mindset, adapting to inabilities, adopting an avoidant approach, and finding ways to recharge. Spouses also felt that they could use more support, both formal and informal.

CONCLUSION

The spouse of a person with young onset dementia has a range of emotional experiences and has resourceful ways of handling everyday life. Various types of support are offered to spouses, however, they seemed to desire more from health care services.

Development of the Observable Well-Being in Living With Dementia-Scale

The Observable Well-being in Living with Dementia-Scale was developed to address conceptual and methodological issues in current observational scales for music therapy. Creative interventions may receive lowered scores, as existing instruments rely heavily on verbal behavior. Methods were (1) Systematic review of observational instruments: (2) field work with music therapy and sociable interactions to operationalize the items; (3) field testing assessing feasibility and preliminary psychometric properties; (4) focus groups with experts to investigate content validity; (5) final field test and revision. 2199 OWLS-ratings were conducted in 11 participants. Hypotheses of construct validity and responsiveness were supported (r = .33 -.65). Inter-rater reliability was good (84% agreement between coders, Cohen's Kappa = .82), and intra-rater reliability was excellent (98% agreement, Cohen's Kappa = .98). Focus groups with 8 experts supported the relevance of the items and suggested further refinements to increase comprehensiveness. The final field-tested OWLS showed improved inter-rater reliability and usability.

Musical Bridges to Memory: A Pilot Dyadic Music Intervention to Improve Social Engagement in Dementia

BACKGROUND

Music-based psychosocial interventions may provide effective management of behavioral symptoms in persons with dementia (PWDs). However, there has been a paucity of studies that measured their effect on social engagement. This proof-of-concept study evaluates efficacy of the Musical Bridges to Memory (MBM) intervention on PWD's social engagement, behavioral symptoms, and associated caregiver distress.

METHODS

Twenty-nine PWDs and caregivers (8 control dyads, 21 intervention) participated in this dyadically designed, prospective, blinded, 12-week controlled interventional study. The intervention consisted of weekly MBM sessions, led by board-certified music therapists and performers, including caregiver training, live performances, and social breakout groups. Outcomes were measured by the Verbal and Nonverbal Interaction Scale for Care Receivers (VNVIS-CR) to code interactions between PWDs and caregivers for verbal and nonverbal sociable and unsociable behaviors. Symptom severity and caregiver distress were measured using Neuropsychiatric Inventory.

RESULTS

Nonverbal sociable interactions significantly increased ( P =0.012) in those who completed the MBM program as compared with a decrease observed in the control group. Family/caregiver distress associated with PWDs neuropsychiatric symptoms showed significant improvement in the experimental group as compared with controls ( P =0.045).

CONCLUSIONS

This study provides proof-of-concept that MBM improves nonverbal sociable content of PWDs interactions and reduces caregivers' distress.

Observing Music Therapy in Dementia: Repeated Single-case Studies Assessing Well-being and Sociable Interaction

OBJECTIVES

This study compared behavioral expressions of momentary well-being and sociable behavior toward significant others during music therapy and regular social interaction.

METHODS

A 10-week active music therapy intervention was provided for people living with dementia and family caregivers. A bi-phasic AB single-case design was replicated for three sessions per dyad and coded using the Observable Well-being in Living with Dementia-Scale (OWLS) and the Verbal and Nonverbal Sociable Interaction Scale-Care Receiver (VNVIS-CR). Effect sizes (Log Response Ratio) were calculated for each session and analyzed with robust cluster meta-analysis.

RESULTS

Eleven dyads were included, and 32 sessions analyzed (2102 observations). Within sessions we found a 48% increase in well-being, and a 32% increase in sociable interaction during music therapy. Heterogeneity was high. Dementia severity predicted an increase in nonverbal sociable interaction (93% for moderate dementia). Depression and time did not predict any change.

CONCLUSION

The potential of music therapy to increase well-being and sociable interactions toward significant others calls for further investigation of heterogeneity and covariates. Single-case designs are demonstrated to be feasible for these investigations.

CLINICAL IMPLICATIONS

Preference-based music therapy may alleviate some of the individual and relational consequences of living with dementia, facilitating positive emotions and connection to significant others.

Analysing the use of music to facilitate social interaction in care home residents with dementia: Narrative synthesis systematic review

INTRODUCTION

Individuals with dementia residing in care homes can rely heavily on care staff to access activities and meaningful interactions. Previous research suggests that care home interactions can be short, fragmented and task-orientated due to staff workload and residents' language impairments. However, music has the potential to be an alternative communication form that remains intact in the later stages of dementia. This systematic review aims to explore how care home music interventions can facilitate social interactions.

METHODS

A narrative synthesis was conducted to explore the mechanisms behind how and why care home music intervention facilitate social interactions. The four-element framework guided analysis; (1) Developing a theory, (2) Developing a preliminary synthesis, (3) Exploring relationships, (4) Assessing robustness.

FINDINGS

The final synthesis included 23 articles. The studies consisted of music therapy sessions, personalised music listening, structured music singing or instrument playing sessions and music therapeutic care. Despite the difference in music interventions, most studies reported an increase in residents' sociable verbal and non-verbal communication and a decrease in unsociable communication. Music interventions allowed residents to reminisce, express themselves, focus and connect with others.

DISCUSSION

The studies highlighted music interventions are accessible to all residents with dementia despite their impairments. The adaptability allows individuals to continue to connect and express themselves even when language deteriorates. More research is needed into the enablers and barriers to implementing interventions into practice, as this systematic review has highlighted that some form of music intervention for all residents can be highly beneficial. Care homes use of music could increase social interactions and meaningful activities.

Clinimetric Evaluation of the Experienced Communication in Dementia Questionnaire

BACKGROUND AND OBJECTIVES

Tools to measure self-perceived communication between persons with early-stage dementia and their caregivers are lacking. Therefore, we developed a questionnaire for Experienced Communication in Dementia (ECD) with a patient version (ECD-P) and a caregiver version (ECD-C), which contains items on (a) caregiver competence, (b) social communication, (c) communication difficulties, and (d) experienced emotions. This article describes the feasibility and clinimetric evaluation of this instrument.

RESEARCH DESIGN AND METHODS

A prospective observational cohort study was conducted with 57 dyads (community-dwelling person with dementia and primary caregiver). ECD-P, ECD-C, and measures on quality of life, caregiver burden, cognitive functioning, physical functioning, and functional independence were administered. After 2 weeks, the dyads filled out the ECD again. Feasibility (completion time and missing values per item), internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficients [ICCs]), and construct validity (hypotheses testing with Spearman's r) were evaluated.

RESULTS

Mean completion time was 10 min per questionnaire. ICCs for test-retest reliability ranged from 0.67 to 0.78, except for ECD-P2 (ICC = 0.31). Internal consistency ranged from α = 0.75 to 0.82 for ECD-P1 and all parts of ECD-C, except for ECD-P2 (α = 0.66). Correlation coefficients for convergent validity ranged from r = 0.31 to 0.69 and correlation coefficients for divergent validity were r < 0.20 and statistically insignificant.

DISCUSSION AND IMPLICATIONS

Pending future research, the ECD, except part ECD-P2, seems to be a promising tool to measure experienced communication between persons with early-stage dementia and their caregivers.

Measuring the interactions of people with dementia and their conversation partners: a preliminary adaption of the Kagan measures of support and participation in conversation

OBJECTIVE

While dementia can negatively affect communication, positive interactions can be facilitated by the conversation partners of people with dementia. There are few assessment tools designed to evaluate the support provided by the conversation partner and the resulting participation of the person with dementia. This study reports on an adaptation of the Measure of Support in Conversation (MSC) and Measure of Participation in Conversation (MPC) scales for use with people with dementia and their conversation partners (the MSC Dementia and MPC Dementia, respectively) and investigates the inter-and intra-rater reliability of these adapted measures.

METHOD

The MSC-D and MPC-D scales were adapted from the original MSC and MPC scales to reflect current knowledge of communication and interaction involving people with dementia. Audio recordings of a total of 25 casual conversations, lasting 5-10 min, between a person with dementia and familiar aged care staff were independently rated by two raters to investigate inter-rater reliability and by one rater on two separate occasions to investigate intra-rater reliability.

RESULTS

ICC analyses on the MSC-D indicated good inter-rater reliability (ICC = 0.718-0.812) and intra-rater reliability (ICC = 0.628-0.760). The MPC-D had excellent inter-rater reliability (ICC = 0.904-0.945) and intra-rater reliability (ICC = 0.925-0.957). 93.6% of all ratings were within 0.5 of each other on a nine point scale from 0 to 4.

CONCLUSION

The results provide preliminary support for the use of these adapted scales. Further research is required to investigate the validity and reliability of these scales using video recordings and across a wider range of communication genres.

Development of the Experienced Communication in Dementia Questionnaire: A Qualitative Study

Communication problems with their caregivers are common in people with dementia. Although interventions for improvement of communication are being developed, a tool to measure how participants experience their communication is lacking. The objective of this article is to describe the development of a questionnaire that measures the "experienced communication" of persons with dementia (ECD-P) as well as of their caregivers (ECD-C). Interviews were conducted with five person with dementia-caregiver dyads who had recently received a new communication intervention. Reflexive thematic analysis was performed on the transcripts using ATLAS.ti. Codes were created, categories and themes were identified, and items for the questionnaires were generated. Selection of items and response scales was done in collaboration with the same dyads. The final version was established after pilot testing with seven other dyads and discussion with five experts in the field of dementia care. Analysis of the transcripts resulted in 212 codes and 17 categories within four themes: caregiver competence, social communication, communication difficulties in daily life, and experienced emotions during conversations. The final version of the ECD-P consists of part 1 with 22 items and 4-point Likert scales, and part 2 with two items and 1 to 10 scales. In the final ECD-C (proxy version), part 1 and part 2 are similar to the ECD-P, while a part 3 was added to assess caregivers' own perspective and emotions (five items). Based on the experiences of people with dementia and their caregivers, we constructed a face-valid questionnaire. This justifies future research to test its clinimetric characteristics.

The Use of Virtual and Immersive Technology in Creating Personalized Multisensory Spaces for People Living With Dementia (SENSE-GARDEN): Protocol for a Multisite Before-After Trial

Background

The number of people living with dementia is rapidly increasing. With dementia’s impact on memory, communication, and self-identity, it is important to identify ways of meeting individual needs of diagnosed individuals and their caregivers. This study will test a new intervention, SENSE-GARDEN, that integrates autobiographical music, films, pictures, and scents with innovative technology to create an immersive environment tailored specifically for the individual.

Objective

The SENSE-GARDEN study is an Active Assisted Living Program–funded multicenter project. The primary objective of the study is to assess whether a personalized, innovative technology-based intervention can improve the well-being of older adults living with moderate to severe dementia. The study will also assess whether the intervention can improve coping and reduce burden in caregivers.

Methods

A controlled before-after study design will be used. There will be 3 sites in 3 trial countries: Belgium, Norway, and Portugal. A total of 55 people with dementia (PWDs) will be recruited. All eligible participants for the study will be randomized into the intervention or control group. For the first three months of the study, all participants will receive the SENSE-GARDEN intervention. For the final month of the study, the intervention group will continue visits to the SENSE-GARDEN, and the control group will discontinue visits. A mixed-methods approach will be used, including the use of standardized outcome measures, quantitative physiological data, and qualitative interview data.

Results

The trials commenced recruitment in August 2019, and all data are expected to be collected by the end of May 2020. A user-centered design process is underway, with results from the first phase of user interviews indicating that people with mild cognitive impairment, family caregivers, and professional caregivers consider the SENSE-GARDEN to be a potentially valuable tool in providing numerous benefits to dementia care. Feasibility testing of the SENSE-GARDEN has been completed and results are expected to be published in October 2019.

Conclusions

Findings from the SENSE-GARDEN trials will provide insights into the use of technology for personalizing interventions to the PWD. This will have potential implications on not only dementia research, but it may also have influences on care practice.

International Registered Report Identifier (IRRID)

DERR1-10.2196/14096

Music and Dementia: Individual Differences in Response to Personalized Playlists

Personalized music playlists are increasingly being used in health-care contexts to address the psychological and behavioral symptoms in people with dementia. However, there is little understanding of how people with different mental health histories and symptoms respond differently to music. A factorial experiment was conducted to investigate the influence of depression, anxiety, apathy, and cognitive decline on affective response to music. Ninety-nine people with dementia listened to three music playlists based on personal preferences. Activation of facial action units was measured, and behavioural responses continuously observed. Results demonstrated that people with high levels of depression and with symptoms of Alzheimer's type dementia demonstrated increased levels of sadness when listening to music. People with low depression but high levels of apathy demonstrated the highest behavioral evidence of pleasure during music listening, although behavioral evidence declined with severity of cognitive impairment. It is concluded that as well as accounting for personal preferences, music interventions for people with dementia need to take mental health history and symptoms into account.

That mr. Alzheimer… you never know what he's up to, but what about me? A discourse analysis of how Swedish spouse caregivers can make their subject positions understandable and meaningful

The spouses of people suffering from dementia are commonly first-in-line caregivers. This can have a considerable effect on their own lives, health and marriages. Several studies have focused on spouses' experiences, but very few have focused in any depth on their descriptions of themselves as subjects. Therefore, the aim of this study is to describe how spouse caregivers can express themselves when living with and caring for their partners with dementia. The study has a qualitative approach with a discourse analysis design and uses analytical tools such as rhetoric, subject positions and categorization. The results reveal three subject positions: as an actor, as a parent and as a survivor. The results show that as spouses struggle with external and internal clashes as subjects, they therefore need to develop coping strategies. They also experience pronounced loneliness and a risk to their own health. There is thus a need to support these spouses as individuals in their differing and changing needs.

The social functioning in dementia scale (SF-DEM): Exploratory factor analysis and psychometric properties in mild, moderate, and severe dementia

Introduction

The psychometric properties of the social functioning in dementia scale over different dementia severities are unknown.

Methods

We interviewed 299 family carers of people with mild, moderate, or severe dementia from two UK research sites; examined acceptability (completion rates); conducted exploratory factor analysis; and tested each factor's internal consistency and construct validity.

Results

Of 299, 285 (95.3%) carers completed questionnaires. Factor analysis indicated three distinct factors with acceptable internal consistency: spending time with other people, correlating with overall social function (r = 0.56, P < .001) and activities of daily living (r = −0.48, P < .001); communicating with other people correlating with activities of daily living (r = −0.66, P < .001); and sensitivity to other people correlating with quality of life (r = 0.35, P < .001) and inversely with neuropsychiatric symptoms (r = −0.45, P < .001). The three factors' correlations with other domains were similar across all dementia severities.

Discussion

The social functioning in dementia scale carer version measures three social functioning domains and has satisfactory psychometric properties in all severities of dementia.

Preliminary study of a communication intervention for family caregivers and spouses with dementia

OBJECTIVE

This study was to designed to examine the feasibility and preliminary outcomes of CARE: Caring About Relationships and Emotions, a 10-week, home-based, intervention to support married couples affected by dementia.

METHODS

Fifteen older couples participated in a single group repeated measures feasibility study. Weekly, video-recorded conversations over 10 weeks were used to rate communication using the Verbal/Nonverbal Interaction Scale for caregivers and care receivers.

RESULTS

Accounting for mental status of care recipients, the ratio of social to unsocial communication showed a significant improvement across sessions-an average of 4.46 points per session [β = 4.46, t(10) = 1.96, p = .039]. Spouse caregiver (CG) communication showed a significant decrease in the number of disabling communications with approximately .65 decreased comments per session [β = 0.654, t(11) = -2.61, p = .024].

CONCLUSIONS

At home dyadic, relationship-focused psychoeducational intervention to improve communication in spouses affected by dementia has the potential to improve communication outcomes. Creative ways of working with couples are needed to help them sustain their relationships and maintain their health.