Harsh communication: characteristics of caregivers and persons with dementia

Sleep quality differences among caregivers for persons living with and without dementia

OBJECTIVES

This study examined the relationship between caring for a person with/without dementia and caregiver sleep quality, and analyzed the extent to which perceived benefits of caregiving and assessments of caregiver-recipient relationship quality explain the relationship between care recipient dementia status and caregiver sleep quality.

METHOD

Data were analyzed from caregivers for persons with no or probable dementia who participated in the 2017 National Study of Caregiving (NSOC) and National Health and Aging Trends Study. Caregiver sleep quality was measured using NSOC time diary interview. Perceptions of caregiving and relationship quality were assessed using 4-item surveys. We used multivariable logistic regressions to examine the association between care recipient dementia status and caregiver sleep quality controlling for covariates.

RESULTS

The sample consisted of 1,374 caregivers (mean age = 62.3, SD = 14, 68.3% women, 69.4% non-Hispanic White). In multivariable models adjusting for caregiver and care recipient characteristics, being a caregiver for someone with dementia was associated with 23% lower odds of reporting "excellent/very good" sleep quality (OR: 0.77, 95%CI: 0.61-0.98, p = 0.032). Greater perception of caregiving benefits was associated with 8% greater odds of "excellent/very good" sleep quality (AOR: 1.08, 95%CI: 1.02-1.15, p = 0.013), but did not explain the relationship between dementia and caregiver sleep quality. Positive ratings of relationship quality explained the relationship between care recipient dementia status and caregiver sleep quality (AOR: 0.82, 95%CI: 0.65-1.05, p = 0.12).

CONCLUSION

Improving assessments of relationship quality and amplifying perceptions of caregiving benefits may reduce disparities in sleep quality between caregivers of persons living with or without dementia.

Communication Patterns and Characteristics of Family Caregivers and Persons Living With Dementia: Secondary Analysis of Video Observation

BACKGROUND

It is essential to characterize communication patterns for better health outcomes for family caregivers and persons living with dementia.

OBJECTIVE

This study aimed to examine the relationships between communication patterns and the characteristics of dyads of family caregivers and persons living with dementia.

METHODS

A secondary analysis was conducted using 75 video-recorded home care observations from 19 dyads. Participant characteristics and caregiver burden, depression, and sense of competence were collected from the parent study. The video-recorded dyadic communication patterns were assessed using a coding scheme developed based on Communication Accommodation Theory and Classical Test Theory. The relative frequency of the communication patterns was compared between groups.

RESULTS

Overall, 8311 caregiver and 8024 care recipient communication behaviors were observed. Caregiver communication patterns were categorized as facilitative, disabling, and neutral. Care recipient communication patterns were categorized as engaging, challenging, and neutral. Caregiver gender, care recipient gender, care recipient education level, dementia diagnosis length, types of dementia, dyadic gender difference, burden, depression, and competence of caregiver, and types of communication were significantly associated with caregiver communication. Dementia diagnosis length, caregiver competence, dyadic gender difference, and types of communication were significantly associated with care recipient communication.

CONCLUSIONS

The findings demonstrated different communication patterns depending on individual and dyad characteristics and evidence for dyadic communication support to promote meaningful interaction for persons living with dementia. Further analysis is needed to identify mediating factors and causal relationships.

Development and psychometric testing of the dyadic communication observational coding scheme in DEmentia care (DCODE): family dyadic communication in dementia

OBJECTIVES

Understanding family dyadic communication in dementia is essential to promote the well-being of family caregivers and persons living with dementia. The Dyadic Communication Observational coding scheme in DEmentia care (DCODE) was developed and tested to assess family dyadic communication in dementia.

METHODS

The DCODE was developed from a review of literature, expert review, and pretesting. A secondary analysis of the 75 in-home care video observations from 19 family caregiver-care recipient dyads was conducted to test psychometric properties.

RESULTS

The DCODE consists of 43 caregiver items and 41 care recipient items. We observed internal consistency, intra-rater reliability, and inter-rater reliability as adequate. Content validity and convergent validity were moderate. Predictive validity was moderate in predicting caregiver burden. The overall psychometric properties demonstrated a moderate quality of the DCODE.

CONCLUSIONS

Findings provided the preliminary psychometric evidence of the DCODE as a promising instrument to assess family dyadic communication in dementia. Future testing for concurrent, divergent, and structural validity of the DCODE is needed.

Preliminary evaluation and implications of the SPECAL method as an intervention for informal dementia care partners

Objective: The degenerative nature of Alzheimer's disease and related dementias (ADRD) means that people diagnosed with ADRD often rely on friends and family to provide care as their cognitive and physical abilities decline. Caring for a person with dementia is complicated, in part because ADRD changes a person's ability to communicate and create memories. Practitioners have increasingly identified communication-centered interventions as one way to address care partner needs while also improving well-being for the person with dementia. In this study, we evaluated one program, the SPECAL® method.Method: Using mixed-methods research, we assessed the effectiveness of a seven-week SPECAL course at facilitating positive outcomes for informal care partners. Participants completed pre- and post-program surveys (n = 17) as well as post-program interviews (n = 20).Results: Results showed several positive changes from pre- to post-program. Participants also reported several key themes in their experiences and implementation of SPECAL, including many beneficial and some challenging outcomes.Conclusion: Results from this study underscore the importance of communication as an intervention target for dementia care partners, identifying opportunities and challenges in working to help care partners communicate with people with ADRD in ways that sustain their relationship and foster mutual well-being.