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

PURPOSE

To examine how formal (i.e., employed) caregivers' use verbal and nonverbal communication strategies while assisting individuals with moderate to severe Alzheimer's disease (AD) during the successful completion of an activity of daily living (ADL). Based on the literature, the authors hypothesized that caregivers' use of 1 proposition, closed-ended questions, and repetition would be of most benefit.

METHOD

Twelve caregiver-AD dyads participated in this observational study. Each dyad was videorecorded on 6 separate occasions while completing handwashing. Handwashing sessions were transcribed and systematically coded for the use of communication strategies during completion of the ADL.

RESULTS

Caregiver-AD dyads successfully completed 90% of all handwashing sessions, and caregivers employed a variety of communication strategies. Consistent with our hypotheses, during successful task completion, caregivers most frequently provided individuals with AD with 1 direction or idea (i.e., proposition) at a time, closed-ended questions, and paraphrased repetition. Caregivers also frequently used encouraging comments and the resident's name during the task; however, use of these strategies was not correlated to task success rate.

CONCLUSION

This study adds to the limited body of evidence supporting the use of specific communication strategies by caregivers assisting individuals with moderate to severe AD during successful completion of ADLs.

Hippocampal amnesia disrupts the flexible use of procedural discourse in social interaction

BACKGROUND: We have worked to develop rich communicative environments as a way to study the real-world demands that communication places on language-and-memory-in-use by focusing on the impact of declarative memory impairments on social interaction. Here, we analyse procedural discourse-the practice of telling another person how to do something (e.g., giving directions). AIMS: To facilitate comparison to previous research on procedural discourse, this study includes an analysis of the procedural steps produced by target participants. This study also offers a novel approach by focusing on the collaborative and interactional nature of how procedural discourse is produced to meet the demands of real-world communication. METHODS AND PROCEDURES: Procedural discourse samples were obtained on nine individuals with hippocampal amnesia and nine comparison participants each interacting with a clinician. Using traditional procedural and linguistic-based measures and interactional discourse measures, we analysed target participants' individual contribution to procedural descriptions and contributions of both the clinician and participant across the samples. OUTCOMES #ENTITYSTARTX00026; RESULTS: No significant group differences were observed for procedural and linguistic-based measures. Rather, participants with amnesia were more reliably distinguished on interactional discourse measures (e.g., lack of engagement and support for clinician, less detail and personalisation of procedural steps, difficulty in shifting social stance). CONCLUSIONS: These findings accord with our previous research suggesting that hippocampal amnesia disrupts the flexible deployment of declarative knowledge and the ability to shift social stances/perspectives to meet the demands of social interaction. These findings contribute to the evolving portrait of language-and-memory-in-use and further support the value of examining interactional aspects of communication in the empirical study of brain-behaviour relationships.

A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's disease

Objectives. Our main purpose was to examine similarities and differences in patterns of interpersonal interaction between Alzheimer's disease (AD) caregiving and noncaregiving couples (n = 54). Methods. Twenty-seven wives caring for moderately impaired husbands with probable AD and 27 noncaregiving wives from comparable sociodemographic backgrounds were videotaped in their homes during both mealtime and a future event planning task. In addition, they completed self-report questionnaires to assess depression, stress, relationship mutuality, and perceived hope. Results. Compared with their counterparts, caregiving wives reported higher levels of depression and stress, but similar shared values and closeness. For the three factors developed from the Marital Interaction Coding System (MICS, version IV; Supportive Facilitative, and Rapport Building), a complex pattern of results was found in which disease status, type of task, and gender interacted significantly. Noncaregiving couples were more interactive overall and expressed more support to each other. Caregiving wives were found to be most facilitative during the planning task, whereas AD husbands were highest on interactions that built rapport (e.g., smiling) during that same task. Caregiving wives actually increased their facilitative behavior from the mealtime to planning task, probably reflecting the increased demand characteristics of the latter.

DISCUSSION

This study is one of a small body of literature to describe the negative impact of AD on spousal communication as observed and coded in two videotaped interaction situations in the home. Suggestions are made for future research, including the inclusion of longitudinal designs and non-Caucasian couples.