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Rodero E, Mas L, Larrea O, Rodríguez-de-Dios I, de-la-Mota C. The Relevance of Communication Between Alzheimer's Patients and Their Caregivers. Effective Prosody Strategies to Improve Communication. HEALTH COMMUNICATION 2023:1-14. [PMID: 38124466 DOI: 10.1080/10410236.2023.2292830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
One of the most critical factors in Alzheimer's disease (AD) is communication between patients and caregivers. A relevant part of the way of speaking is what is known as prosody, or the variations a speaker makes when talking. To our knowledge, no research has analyzed the relevance of communication for caregivers when speaking with AD patients or what they consider the most effective strategies to communicate with them. Therefore, this pilot study aims are twofold: to know the relevance caregivers (professionals and family) give to communication with AD patients; and to determine what prosody strategies they consider most effective. Two hundred fifty-two caregivers of AD patients (professional and family) participated in two online surveys, answering different questions about the relevance of communication and the best prosody strategies. They also performed an auditory perceptual assessment. The results showed that caregivers give communication a significant role in the patient's treatment behavior. They consider Alzheimer's (AD) patients should be spoken to with authority but with affection and positiveness. The most valued prosodic strategies were marked intonation, speaking affectionately, emphasizing essential words, a medium/low pitch, and a slow speed. This study highlights the value of communication in interacting with AD patients to improve their cognitive and emotional responses.
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Affiliation(s)
- Emma Rodero
- Media Psychology Lab, Department of Communication, Pompeu Fabra University, UPF-Barcelona School of Management, Barcelona, Spain
| | - Lluís Mas
- Department of Communication, Pompeu Fabra University, UPF-Barcelona School of Management, Barcelona, Spain
| | - Olatz Larrea
- Department of Philology and Communication, University of Barcelona, Barcelona, Spain
| | | | - Carme de-la-Mota
- Department of Spanish Philology, Autonomous University of Barcelona, Barcelona, Spain
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Munis ÖB, Parlak MM. Validity and reliability of the Turkish version of the Holden Communication Scale. Brain Behav 2023; 13:e3223. [PMID: 37587848 PMCID: PMC10498062 DOI: 10.1002/brb3.3223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION The communication skills of individuals with dementia are affected even in the early stages of the condition. To date, there is no scale for the evaluation of communication abilities in Turkish-speaking populations with dementia that can be used in clinical practice and research. The present study aimed to determine the validity and reliability of the Turkish version of the Holden Communication Scale (HCS-TR). MATERIALS AND METHODS The study was carried out with 141 participants (77 female and 64 male). Psychometric analyses were conducted to assess the internal consistency, construct and criterion validity, test-retest reliability, and inter-rater reliability of the HCS-TR. The Standardized Mini-Mental State Examination (SMMSE) test was used for criterion validity. For the inter-rater reliability of the scale, the two different caregivers of individuals with dementia were administered the scale separately at the same time. For test-retest reliability, 2 weeks later, the same caregivers who filled out the HCS-TR the first time were administered to fill out the scale again. To test the validity of the scale, an item factor analysis was performed, and the correlations between the items and subsections were determined. RESULTS The factor loadings indicating the adequate contribution of the scale items to the relevant dimension were within the 0.700-0.831 range. There were positive relationships between all the items of the HCS-TR, and there was a significant negative relationship (r = -.842) between HCS-TR and MMSE. The corrected item-total correlation values were found to be within the .676-.794 range. Cronbach's alpha values for the HCS-TR subsection and total scores in the first and second measurements were found to be in the range of .718-.944. There was no statistically significant difference (p = .709) between the mean total scores in the first and second measurements. CONCLUSION The HCS-TR is a valid and reliable tool that can be used for clinical and research purposes to assess the strengths and limitations of the communication skills of Turkish individuals with dementia.
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Affiliation(s)
| | - Mümüne Merve Parlak
- Department of Speech and Language Therapy, Faculty of Health SciencesAnkara Yıldırım Beyazıt UniversityAnkaraTurkey
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Braithwaite Stuart L, Jones CH, Windle G. A qualitative systematic review of the role of families in supporting communication in people with dementia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1130-1153. [PMID: 35714124 PMCID: PMC9796329 DOI: 10.1111/1460-6984.12738] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Cognitive-communication difficulties are often associated with dementia and can impact a person's ability to participate in meaningful conversations. This can create challenges to families, reflecting the reality that people living with dementia rarely have just one regular conversation partner, but interact with multiple family members. To date, there is limited evidence of the impact of changes in communication patterns in families. A family systems approach, with foundations in psychology, can be used to explore the impact of communication difficulties on multiple different family members, including the person living with dementia and potential coping strategies used by individuals, together with the family as a whole. METHODS & PROCEDURES A systematic review of primary qualitative research was conducted to identify and examine research exploring communication and interaction within families living with dementia. Studies were identified through a comprehensive search of major databases and the full-text articles were subject to a quality appraisal. We conducted a thematic analysis on the literature identified to consider the role of families in supporting communication for people with dementia. OUTCOMES & RESULTS The searches identified 814 possible articles for screening against the eligibility criteria. Nine articles were included in the final review. Three major themes emerged from the analysis of the included studies: (1) 'identities changing' reflected how interactions within the family systems impacted on identities; (2) 'loss' reflected the grief experienced by families due to changes in communication; and (3) 'developing communication strategies' highlighted strategies and approaches that families affected by dementia may use organically to engage in meaningful interactions and maintain connection. Only one study explicitly used a family systems approach to understand how families manage the changes in interaction resulting from dementia. CONCLUSIONS & IMPLICATIONS The findings may usefully inform the clinical practice of speech and language therapists in terms of communication strategies and coping mechanisms that may be advised to facilitate connection in families living with dementia. Further research using a family systems approach to exploring communication in dementia may help to support the implementation of family-centred practice as recommended in policy. WHAT THIS PAPER ADDS What is already known on the subject There is increasing recognition of the impact of dementia on whole families and the need for family-centred interventions to enhance quality of life. However, much of the research to date that explores communication within families affected by dementia examines interaction between dyads, largely overlooking the roles and skills of other familial communication partners. To the authors' knowledge, there has been no previous review of the literature using a family systems approach, which has the potential to inform clinical practice of those working in dementia care. What this paper adds to existing knowledge The review examines and understands what is known about the approaches used by families affected by communication changes resulting from dementia to preserve connection. It collates the evidence from qualitative studies examining approaches and strategies used by individual conversation partners, including people with dementia, as well as the family system as a whole, to facilitate meaningful interactions, and proposes recommendations for clinicians working in this field. Furthermore, we consider the potential benefits of using a family systems approach to understand the context of people living with dementia and how this could enhance communication, personhood and well-being. What are the potential or actual clinical implications of this work? This review highlights practical conversation strategies and interactional approaches that may serve to enhance communication and preserve relationships between people with dementia and their family members. Such techniques have the potential to be advised by Speech and Language Therapists working in dementia care as part of tailored, relationship-centred care and support that they provide.
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Affiliation(s)
| | - Catrin Hedd Jones
- School of Medical and Health SciencesBangor UniversityBangorUK
- DSDC Wales Research CentreBIHMRSchool of Medical and Health SciencesBangorUK
| | - Gill Windle
- School of Medical and Health SciencesBangor UniversityBangorUK
- DSDC Wales Research CentreBIHMRSchool of Medical and Health SciencesBangorUK
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Bott A, Meyer C, Hickson L, Pachana NA. "It's Huge, in a Way." Conflicting Stakeholder Priorities for Managing Hearing Impairment for People Living with Dementia in Residential Aged Care Facilities. Clin Gerontol 2022; 45:844-858. [PMID: 32807024 DOI: 10.1080/07317115.2020.1805537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aims of this study were to a) explore the impact of hearing impairment on people living with dementia in residential aged care facilities (RACFs) and b) investigate management of hearing impairment for this population. METHODS A descriptive qualitative approach, consisting of semi-structured interviews, was conducted with 23 participants across four stakeholder groups (audiologists, care staff, family members and individuals with dementia and hearing impairment living in RACFs). RESULTS Thematic analysis revealed an overarching theme of "different priorities for managing hearing impairment" that emerged from the data. Audiologists and care staff prioritized different practices for managing hearing impairment: audiologists emphasized hearing aids and care staff emphasized communication strategies. Care staff also identified that current management of hearing impairment was sub-optimal as they do not prioritize managing it. CONCLUSIONS Residents with dementia and hearing impairment living in RACFs are not receiving optimal hearing management. Further research is required to understand the factors that influence this. CLINICAL IMPLICATIONS Changes in practices of both care staff and audiologists are required to improve hearing impairment management for this population.
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Affiliation(s)
- Anthea Bott
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Carly Meyer
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Louise Hickson
- The HEARing Cooperative Research Centre, Melbourne, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
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Miron AM, Groves CL, Thompson AE, McFadden SH, Bowers HR, DeBraal JM. Fear of Incompetence in Family Caregivers and Dementia Care Transitions. Int J Aging Hum Dev 2022; 96:447-470. [PMID: 35686309 DOI: 10.1177/00914150221106075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Research on interpersonal interaction dynamics in relationships between persons with dementia and their family caregivers has been limited. We examine the role of these dynamics in decisions to transition a family member from home care to congregate care, with a particular focus on the role of fear of incompetence. Fear of incompetence is the fear of being unable to interact, communicate in a meaningful way, or take care of a close family member with dementia. In this study (N = 350 family caregivers), perceived negative changes in the family member with dementia predicted increased perceived dependency, which predicted both increased caregiver burden and greater fear of incompetence in caregivers, which, in turn, predicted stronger care transition desire. Strategies should be aimed not only at reducing dependency of the care recipient but also teaching family caregivers interaction skills that decrease their fear of interactional incompetence and thus promote home care continuation.
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Affiliation(s)
- Anca M Miron
- Department of Psychology, 200882University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Christopher L Groves
- Department of Psychology, 200882University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Ashley E Thompson
- 218995Department of Psychology, University of Minnesota Duluth, Duluth, MN, USA
| | - Susan H McFadden
- Department of Psychology, 200882University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Haley R Bowers
- Department of Psychology, 200882University of Wisconsin Oshkosh, Oshkosh, WI, USA
| | - Jordyn M DeBraal
- Department of Psychology, 200882University of Wisconsin Oshkosh, Oshkosh, WI, USA
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Haroon M, Dissanayaka NN, Angwin AJ, Comans T. How Effective are Pictures in Eliciting Information from People Living with Dementia? A Systematic Review. Clin Gerontol 2022:1-14. [PMID: 35672952 DOI: 10.1080/07317115.2022.2085643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Decline in language and cognitive functioning often deprives people living with moderate-to-severe dementia of self-reporting their quality of life (QoL) on the written and verbal formats of questionnaires. This systematic review aimed to evaluate the effectiveness of pictorial tools as an alternative method for enabling people living with dementia to self-report their QoL. METHODS PubMed, PsycINFO, CINAHL, and EMBASE were searched. Primary research studies reporting on information elicitation from people living with dementia through pictures were deemed eligible. Six studies satisfied the inclusion criteria. Methodological quality of the studies was evaluated through Downs and Black checklist. Data was extracted according to population, intervention, comparator, and outcomes (PICO) and results were summarized and supplemented by narrative synthesis. RESULTS Compared to usual communication methods, pictorial tools were found to have a superior effect on comprehension of conversations and decision-making abilities, minimal effect on preference consistency, and an undeterminable effect on discourse features. CONCLUSIONS There is consistent evidence that pictures enhance comprehension and might facilitate decision-making abilities. CLINICAL IMPLICATIONS QoL information can be elicited more effectively through pictorial tools. Future studies warrant development of pictorial versions of standardized QoL tools which will assist the inclusion of people living with severe dementia.
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Affiliation(s)
- Muhammad Haroon
- Centre for Health Services Research, Faculty of Medicine, the University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, the University of Queensland, Brisbane, Australia.,School of Psychology, the University of Queensland, Brisbane, Australia.,Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Anthony J Angwin
- School of Health and Rehabilitation Sciences, the University of Queensland, Brisbane, Australia
| | - Tracy Comans
- Centre for Health Services Research, Faculty of Medicine, the University of Queensland, Brisbane, Australia
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Teaching Elaborative Reminiscing to Support Autobiographical Memory and Relationships in Residential and Community Aged Care Services. Brain Sci 2022; 12:brainsci12030374. [PMID: 35326330 PMCID: PMC8946277 DOI: 10.3390/brainsci12030374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Memories of the past are critically important as we age. For older adults receiving formal care in a range of settings, reminiscing with care staff may provide frequent opportunities for recalling autobiographical memories with a supportive conversational partner. Importantly, prior research suggests that some reminiscing conversations are more supportive than others. In the developmental literature, a long tradition of sociocultural memory research has shown how children’s autobiographical memory is scaffolded and supported by parents during reminiscing, when parents use a particular kind of conversational technique, known as “elaborative reminiscing”. In the current project, we aimed to examine whether we could enhance conversations between staff and older people receiving aged care by teaching care staff about these beneficial conversational techniques and supporting them to reminisce more often with residents/clients. We also aimed to determine whether staff members’ use of elaborative reminiscing techniques was associated with autobiographical memory details recalled by residents/clients during routine conversations. We conducted a workshop with 16 staff within a residential aged care and community care setting. We followed this with a 4-week training-and-feedback period during which staff recorded their conversations with residents and clients. Staff feedback indicated successful use of the scaffolding techniques overall, and benefits as well as barriers to their use in day-to-day practice. Analysis of the conversations demonstrated that the use of particular elaborative reminiscing techniques by staff was associated with increased recall of episodic and semantic autobiographical memory details by residents/clients. Overall, findings suggest that the principles of elaborative reminiscing may apply across the lifespan, and that the benefits of elaborative reminiscing for autobiographical memory may be particularly important in times of cognitive need. Practically, training aged care staff in specific and practical conversational tools can facilitate reminiscing for people receiving aged care.
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Collins R, Hunt A, Quinn C, Martyr A, Pentecost C, Clare L. Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. DEMENTIA 2022; 21:1135-1153. [PMID: 35156412 PMCID: PMC9109550 DOI: 10.1177/14713012211069449] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives Dementia can affect language processing and production, making communication more
difficult. This creates challenges for including the person’s perspective in research
and service evaluation. This study aims to identify methods, tools and approaches that
could facilitate meaningful communication with people with moderate-to-severe dementia
and support the inclusion of their perspectives. Methods This qualitative study was conducted as part of the IDEAL programme and involved
in-depth, semi-structured interviews with 17 dementia research and/or care professionals
with expertise in communication. Transcripts were analysed using framework analysis. Findings Three main themes each with sub-themes were identified: (1) Awareness, knowledge and
experience; (2) Communication approach and (3) Personalization. A person-centred
orientation based on getting to know the participant and developing a bi-directional
exchange formed the fundamental context for effective communication. Building on this
foundation, an approach using pictures, photographs or objects that are meaningful to
the person and appropriate for that person’s preferences and ability could help to
facilitate conversations. The findings were integrated into a diagram illustrating how
the topics covered by the themes interrelate to facilitate communication. Conclusions Useful skills and approaches were identified to help researchers engage and work with
people with moderate-to-severe dementia and ensure their perspective is included. These
covered getting to know the participant, using a variety of tangible tools and
interactional techniques and considering the environment and context of the
conversation.
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Affiliation(s)
- Rachel Collins
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Anna Hunt
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Catherine Quinn
- The Centre for Applied Dementia Studies, 1905University of Bradford, Bradford, UK; Wolfson Centre for Applied Health Research, Bradford, UK
| | - Anthony Martyr
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Claire Pentecost
- College of Medicine and Health, 3286University of Exeter, Exeter, UK
| | - Linda Clare
- College of Medicine and Health, 3286University of Exeter, Exeter, UK; 3286NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK
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Hoel V, Wolf-Ostermann K, Ambugo EA. Social Isolation and the Use of Technology in Caregiving Dyads Living With Dementia During COVID-19 Restrictions. Front Public Health 2022; 10:697496. [PMID: 35186831 PMCID: PMC8854754 DOI: 10.3389/fpubh.2022.697496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 01/04/2022] [Indexed: 01/10/2023] Open
Abstract
Background People with dementia (PwD) and their informal caregivers (caregiving dyads) face multiple impacts of the COVID-19 pandemic, including restricted social support services and social isolation. With limited opportunities for caregiving dyads to participate in social activities during the pandemic, the potential of social technology to support social participation and dyadic relationships should be explored. As a part of an ongoing feasibility trial, this study assesses how COVID-19 has impacted community-dwelling dyads in a dementia caregiving context. The dyads' use of social technology and their motivations to invite technology into social interactions are explored. Methods A pilot case study employing baseline interview data from three community-dwelling caregiving dyads. Each dyad consisted of a husband with a dementia diagnosis and his wife, who performed most caregiving tasks. Interviews were audio-recorded, transcribed verbatim, and subjected to inductive thematic analysis. Two researchers independently coded the data, and collated the codes and themes collaboratively. Results Two themes and seven subthemes were identified: (i) living with dementia during COVID-19 (subthemes: social and leisure activities, dyadic interactions, adjusting as caregiver); and (ii) the role of technology in a pandemic (subthemes: facilitating social activities, facilitating dementia care-related activities, barriers and facilitators to using social technology, the underlying motivation to invite technology into interactions). Dyads who were socially active pre-COVID-19, and who managed to make good use of technology to facilitate and maintain their social engagement during COVID-19, reported to have been less negatively impacted by COVID-related social restrictions. Conclusion The dyads differed in how COVID-19 restrictions impacted their lives and how they coped with dementia, revealing different motivations for wanting to invite technology into their social interactions. During and beyond this pandemic, social technology can be a valuable tool for promoting social participation in this population, especially when in-person social contact is restricted. Successful uptake of social technology is dependent on customizing it to the individual's needs and conditions. Therefore, efforts are needed to tackle barriers that exist for older adults in using such technology.
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Affiliation(s)
- Viktoria Hoel
- Department of Nursing Science Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
- *Correspondence: Viktoria Hoel
| | - Karin Wolf-Ostermann
- Department of Nursing Science Research, Institute for Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Leibniz ScienceCampus Digital Public Health, Bremen, Germany
| | - Eliva Atieno Ambugo
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Kongsberg, Norway
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Davis L, Botting N, Cruice M, Dipper L. A systematic review of language and communication intervention research delivered in groups to older adults living in care homes. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:182-225. [PMID: 34841623 DOI: 10.1111/1460-6984.12679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The communication skills of older adults living in care homes is an underexplored topic. Ageing can lead to reduced communication ability and activity; and in the care home environment there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being, but no systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. AIMS To identify and evaluate the evidence for behavioural interventions with older adults, delivered in groups in care homes, that specifically included a language or communication activity. To explore the impact of such intervention on the specific domains of language, communication and social interaction. To determine whether behavioural mechanisms of action can be identified. METHODS & PROCEDURES Embase, Medline, Ovid Nursing database, Psych info and CINAHL complete were searched and produced 158 records for screening, of which 22 remained for review. In order to identify and evaluate the quality of the evidence base presented the following research questions were posed: What research has been conducted in this area? What is the methodological quality of the studies identified? How complete is the intervention reporting? How was change measured in the domains of language, communication and social interaction? Is there evidence of efficacy, indicated by statistically significant improvement, in these domains? How did the interventions work? Synthesis tools employed included the PEDro-P Scale, the TIDieR checklist and the ITAX. MAIN CONTRIBUTION A total of 22 studies met the criteria for review. One study used solely language or communication interventions, but the remaining 21 studies used behavioural interventions which incorporated language and communication activities to varying degrees. Studies fell into four broad intervention types: reminiscence or life review; cognitive stimulation; narrative or storytelling; and multi-modality group communication. The majority of studies were of fair methodological quality, with a moderate level of detail provided in treatment reporting. Statistically significant improvement was reported by authors in all four intervention types and across language, communication and social domains. Social interaction, social support and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions. CONCLUSIONS & IMPLICATIONS Despite limitations in the evidence base, there are important positive signs for the beneficial effects of supporting language and communication in care homes. Blinding of assessors, and the accuracy and accessibility of statistical reporting are important areas to address in order to improve the quality of the evidence base. WHAT THIS PAPER ADDS Ageing can lead to reduced communication ability and activity, and in the care home setting there may also be fewer communication opportunities. This situation is likely to negatively impact well-being. Previous reviews have found evidence of the effectiveness of behavioural interventions in increasing well-being. The communication skills of older adults living in care homes is an underexplored topic. No systematic review to date has focused specifically on the evidence base for group language and communication interventions in this population. This review reveals important positive signs for the beneficial effects of supporting language and communication in care homes. Social interaction, social support, and behavioural skills were the most consistent mechanisms of action in the reviewed behavioural interventions.
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Affiliation(s)
- Lydia Davis
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
| | - Nicola Botting
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
| | - Madeline Cruice
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
| | - Lucy Dipper
- Division of Language and Communication Science, School of Health Sciences, University of London, London, UK
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Lee K, Chung J, Meyer KN, Dionne-Odom JN. Unmet needs and health-related quality of life of dementia family caregivers transitioning from home to long-term care: A scoping review. Geriatr Nurs 2021; 43:254-264. [PMID: 34953331 DOI: 10.1016/j.gerinurse.2021.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 01/07/2023]
Abstract
This scoping review is to identify experiences, unmet needs, and health-related quality of life (HRQoL) of family caregivers transitioning their care recipients with dementia into long-term care (LTC). The methodological framework of Arksey and O'Malley guided the review. Themes from nineteen selected studies were organized around three categories. First, caregiver experiences during LTC placement featured challenges around placement decision-making and distress and changes in relationships and responsibilities. Second, unmet needs of caregivers were desired emotional support and information about transitions. Finally, caregivers' HRQoL varies around transition. Family caregivers experience unique challenges and can have unmet needs during the LTC placement of their care recipients with dementia. Findings suggest the need for interventions that teach skills, care planning, assistance with conflict resolution, communication training, and guidance finding services and resources.
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Affiliation(s)
- Kyungmi Lee
- School of Nursing, The University of Alabama at Birmingham, Alabama, United States.
| | - Jane Chung
- School of Nursing, Virginia Commonwealth University, Virginia, United States
| | - Kylie Nicole Meyer
- School of Nursing, University of Texas Health Center San Antonio, Texas, United States
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Perkins L, Felstead C, Stott J, Spector A. Communication training programmes for informal caregivers of people living with dementia: A systematic review. J Clin Nurs 2021; 31:2737-2753. [PMID: 34927300 DOI: 10.1111/jocn.16175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES Current research suggests that communication training programmes for caregivers of people living with dementia can benefit both parties by improving communication, quality of life and stress. Previous reviews in this area focus on mixed samples of formal and informal caregivers. This review aimed to evaluate current research for trainings specifically for informal caregivers, including the research quality and the key training components. DESIGN AND METHODS The review followed the PRISMA research reporting checklist. The electronic databases CINAHL, Embase, Medline and Psychinfo and reference lists of included literature were searched for studies relevant to the aims. Of the 45 identified studies, 36 were excluded based on pre-specified criteria. Nine studies were included in the final review and subject to quality appraisal using the Qualsyst tool. RESULTS The included studies' programmes averaged 5 to 6 hours in length over four to five sessions, were mostly face to face in both group and individual settings and were developed using various communication and psychological theories. Studies demonstrated variable quality and outcomes, making it difficult to identify optimal components. However, careful consideration of different factors enabled some suggestions for training dose, delivery method, content and outcomes to measure. CONCLUSIONS Communication training programmes can benefit people living with dementia and their informal caregivers in outcomes such as communication skills and quality of life. Suggestions are made on the training components that optimise these benefits. RELEVANCE TO CLINICAL PRACTICE Given the clear benefits on outcomes such as quality of life, there is a need for communication trainings to be offered in clinical contexts. However, given the limited pool of variable quality research and lack of accessible manuals, it is unlikely that this is the case. Consolidating and widening the evidence through further research is essential in making these trainings more widely available.
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Affiliation(s)
- Luke Perkins
- School of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Cerne Felstead
- School of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Joshua Stott
- School of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Aimee Spector
- School of Clinical, Educational and Health Psychology, University College London, London, UK
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Harper AE, Terhorst L, Moscirella M, Turner RL, Piersol CV, Leland NE. The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review. DEMENTIA 2021; 20:2746-2765. [PMID: 33899537 DOI: 10.1177/14713012211012606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. METHODS In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. RESULTS We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. CONCLUSION Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.
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Affiliation(s)
- Alexandra E Harper
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Marybeth Moscirella
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose L Turner
- Health Sciences Library System, 499478University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine V Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
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Cranley L, Sivakumaran G, Helfenbaum S, Galessiere D, Meyer R, Duggleby W, McGillis Hall L, McGilton KS. Development of communication tool for resident- and family-led care discussions in long-term care through patient and family engagement. Int J Older People Nurs 2021; 17:e12429. [PMID: 34618396 PMCID: PMC9285466 DOI: 10.1111/opn.12429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Effective communication between residents (older adults), families, and the healthcare team supports person-centred care. However, communication breakdowns can occur that can impact care and outcomes. The aim of this paper is to describe a feedback approach to developing a communication tool for residents and families to guide information sharing during care discussions with the healthcare team in long-term care. METHODS Development of the communication tool included consultation with key stakeholders for their feedback and input. Following initial development of the tool template by our research team, we invited feedback from our study collaborators. Next, individual interviews and a focus group were conducted with family members, followed by individual interviews with selected residents from two long-term care homes in Ontario, Canada. Participants were asked to provide input and feedback on the tool's content and usability and to share ideas for improving the tool. Content analysis was used to analyse the interview data. RESULTS Feedback from residents and family included suggestions to enhance the tool's content and use of plain language, and suggestions for potential application of the tool. CONCLUSION Feedback highlighted the value of engaging residents and family members in the development of a communication tool. The communication tool offers a structured format to support participation of residents and families in information sharing for care discussions with the healthcare team.
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Affiliation(s)
- Lisa Cranley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gajan Sivakumaran
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Shoshana Helfenbaum
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Baycrest, Toronto, ON, Canada
| | - Daniel Galessiere
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Baycrest, Toronto, ON, Canada
| | - Raquel Meyer
- Ontario Centres for Learning, Research and Innovation in Long-Term Care at Baycrest, Toronto, ON, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Linda McGillis Hall
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Katherine S McGilton
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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15
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Degen C, Frankenberg C, Meyer-Kühling I, Wendelstein B, Knebel M, Pantel J, Zenthöfer A, Rammelsberg P, Andrejeva N, Schröder J. Communication skills in nursing home residents with dementia : Results of a prospective intervention study over 21 months. Z Gerontol Geriatr 2021; 55:27-31. [PMID: 34170351 DOI: 10.1007/s00391-021-01929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND The dementia syndrome compromises effective communication and may thus lead to social isolation, psychological distress and decreased quality of life. It is therefore of importance to maintain communication capacity in dementia as long as possible. MATERIAL AND METHODS A total of 24 professional caregivers from 8 nursing homes were assigned to train 254 of their respective colleagues using the train-the-trainer program MultiTANDEMplus. As in the 6 control nursing homes, severity of dementia, depressive symptoms and communication capacity were assessed in a total of 358 residents at baseline and 21 months later. Overall, 189 residents completed the study. RESULTS Communication capacity declined in control home residents but remained stable in the intervention group although dementia severity increased in both groups. The intervention group exhibited significantly fewer depressive symptoms after the intervention than the control group. CONCLUSION A standardized training of communication skills for professional caregivers can stabilize communication capacity and reduce depressive symptoms in nursing home residents. These effects are likely sustainable and could be demonstrated 21 months postintervention.
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Affiliation(s)
- C Degen
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany.
| | - C Frankenberg
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - I Meyer-Kühling
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - B Wendelstein
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - M Knebel
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
| | - J Pantel
- Institute of General Medicine, Johann Wolfgang Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/M, Germany
| | - A Zenthöfer
- INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - P Rammelsberg
- INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - N Andrejeva
- INF 400, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - J Schröder
- Section Geriatric Psychiatry, Heidelberg University Hospital, Voßstr. 4, 69115, Heidelberg, Germany
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Olthof-Nefkens MWLJ, Derksen EWC, de Swart BJM, Nijhuis-van der Sanden MWG, Kalf JG. Development of the Experienced Communication in Dementia Questionnaire: A Qualitative Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211028181. [PMID: 34167366 PMCID: PMC8246470 DOI: 10.1177/00469580211028181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/27/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Maria W. L. J. Olthof-Nefkens
- Zorggroep Maas & Waal, Beneden-Leeuwen, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Els W. C. Derksen
- Radboud university medical center, Radboud Institute for Health Sciences, Department of Primary and Community Care, Nijmegen, The Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Bert J. M. de Swart
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
| | - Maria W. G. Nijhuis-van der Sanden
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
- Radboud university medical center, Radboud Institute for Health Sciences, Scientific Center for Quality of Care (IQ healthcare), Nijmegen, The Netherlands
| | - Johanna G. Kalf
- Radboud university medical center, Donders Institute for Brain, Cognition and Behaviour, Department of Rehabilitation, Nijmegen, The Netherlands
- Radboud university medical center, Radboudumc Alzheimer Center, Nijmegen, The Netherlands
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17
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Leslie M, Gray RP, Khayatzadeh-Mahani A. What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives. Scand J Caring Sci 2020; 35:220-232. [PMID: 32168399 DOI: 10.1111/scs.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,School of Public Policy, University of Calgary, Calgary, AB, Canada
| | | | - Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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18
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Langner H, Nordhausen T, Fleischer S, Meyer G, Berg A. [Improving cognitive resources of nursing home residents: a systematic review of prevention and health promotion interventions]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 149:1-11. [PMID: 32046938 DOI: 10.1016/j.zefq.2020.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 12/23/2019] [Accepted: 01/02/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The German Prevention Act mandated long-term care insurance funds to support long-term care facilities in designing health-promoting structures. One area of action is the promotion of the cognitive resources of nursing home residents. The objective of this systematic review was to describe and analyze interventions and intervention components that improve cognitive resources of nursing home residents. METHODS First, we conducted a search for systematic reviews to identify relevant randomised controlled trials in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo; additional sources were hand-searched. Second, references of all relevant randomized controlled trials (n=43) were extracted from the identified systematic reviews (n=26). The original articles of the primary studies included were then considered and data extracted using criteria for the evaluation of complex interventions. The quality of evidence was assessed using the GRADE approach. RESULTS Nine interventions to promote cognitive resources were identified: cognitive stimulation, cognitive training, physical training, art and music interventions, bright light, multicomponent stimulation, multisensory stimulation, care staff training and reminiscence. The quality of the underlying evidence in the inpatient long-term care setting was predominantly low, therefore, it was not always possible to draw clear conclusions regarding the efficacy of the interventions. The low quality of evidence was mainly due to the high heterogeneity as well as the low number and limited methodological quality of the primary studies. CONCLUSION In general, a wide range of nonpharmacological interventions were reported. Due to the limited evidence, however, these may be regarded as ideas only or possible options for promoting the cognitive resources of nursing home residents.
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Affiliation(s)
- Henriette Langner
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Magdeburger Straße 8, 06112 Halle (Saale)
| | - Thomas Nordhausen
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Magdeburger Straße 8, 06112 Halle (Saale)
| | - Steffen Fleischer
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Magdeburger Straße 8, 06112 Halle (Saale)
| | - Gabriele Meyer
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Magdeburger Straße 8, 06112 Halle (Saale)
| | - Almuth Berg
- Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Institut für Gesundheits- und Pflegewissenschaft, Magdeburger Straße 8, 06112 Halle (Saale).
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19
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Chang WZD, Bourgeois MS. Effects of Visual Aids for End-of-Life Care on Decisional Capacity of People With Dementia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:185-200. [PMID: 31869247 DOI: 10.1044/2019_ajslp-19-0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose This study evaluated the decision-making capacity of persons with mild and moderate dementia on end-of-life care when using visual aids. A secondary purpose was to learn whether the judges naive to the experimental conditions would rate participants' decisional abilities as better when augmented by visual aids, thereby validating the behavioral changes due to the use of these external support. Method Twenty older adults with mild and moderate dementia demonstrated Understanding, Expressing a Choice, Reasoning, and Appreciation of 2 medical vignettes under 2 counterbalanced conditions: verbal alone or verbal with visual aids. Transcripts were analyzed and scored to measure decisional skills. Twelve judges rated participants' decisional abilities using a 7-point Likert scale. Results Participants demonstrated significantly better overall decisional capacity in Understanding, Reasoning, and Appreciation when supported by visual aids during the decision-making process. No significant differences between conditions were found in Expressing a Choice, the decisional skill Logical Sequence under Reasoning, and Acknowledgment under Appreciation. Overall, the judges' ratings validated these outcomes; the judges' ratings reflected greater agreement in the visual condition than in the verbal condition. Conclusions Findings indicated that visual aids (a) improved the decision-making capacity of individuals with dementia in comprehending medical information, employing supportive reasons, and relating this information to his or her own situation and (b) contain the potential for judges who majored or are majoring in speech-language pathology to reach a stronger consensus when determining the decision-making capacity of individuals with dementia.
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Affiliation(s)
- Wan-Zu D Chang
- Department of Speech and Hearing Science, The Ohio State University, Columbus
| | - Michelle S Bourgeois
- Department of Communication Sciences & Disorders, University of South Florida, Tampa
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20
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Cao Y, Yang F. Objective and Subjective Dementia Caregiving Burden: The Moderating Role of Immanent Justice Reasoning and Social Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020455. [PMID: 31936738 PMCID: PMC7014207 DOI: 10.3390/ijerph17020455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 11/22/2022]
Abstract
Caregiving burden significantly effects the physical and mental health of family dementia caregivers. While the association between objective caregiving burden (OCB) and subjective caregiving burden (SCB) of family dementia caregivers is well documented, little is known as with how the association is moderated by the configuration of intrapersonal resource (e.g., immanent justice reasoning) and interpersonal resource (e.g., social support). The present study collected cross-sectional data on 157 major family caregivers of non-institutionalized persons with dementia in an urbanizing region of Western China’s Sichuan Province. They responded to questions on daily time spent on caregiving, the short version of Zarit Burden Interview (ZBI), a sub-scale of a caregiver meaning scale, Social Support Rating Scale (SSRS), and demographic questions. Controlling for the demographic variables of the caregivers, this study found that the objective and subjective dementia caregiving burden were significantly associated (p < 0.001), and immanent justice reasoning was positively correlated with subjective burden (p < 0.01). Moreover, the association between OCB and SCB was significantly positive when social support and immanent justice reasoning were both high (p < 0.001), but neutral when social support was high and immanent justice reasoning was low. The association between OCB and SCB was significantly positive when social support and immanent justice reasoning were both low (p < 0.05), but neutral when social support was low and immanent justice reasoning was high. This research suggests the importance of developing intervention programs that consider the configuration of the external supporting resources and internal meaning-making of caregiving of the family dementia caregivers.
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Affiliation(s)
- Yanchun Cao
- Faculty of Economics and Management, East China Normal University, Shanghai 200062, China;
| | - Fan Yang
- School of International and Public Affairs, China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai 200030, China
- Correspondence:
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21
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May AA, Dada S, Murray J. Review of AAC interventions in persons with dementia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:857-874. [PMID: 31321844 DOI: 10.1111/1460-6984.12491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Communication is an important priority in dementia research. Communication strategies and scaffolds, specifically through augmentative and alternative communication (AAC), offer vital compensatory support for persons with dementia in an attempt to maintain the latter's quality of life and well-being through participation with others. To date, no research review has been published that synthesizes the current research of AAC in the field of dementia. AIMS To provide an overview of current AAC strategies and techniques used for supporting communication in dementia by surveying the literature base in a systematic manner, synthesizing the findings and highlighting trends and gaps. METHODS & PROCEDURES A multifaceted search strategy included nine electronic database searches, using specific keywords. Application of predefined selection criteria during screening procedures led to the inclusion of 39 studies. Data were extracted and studies synthesized according to communication partners; description of AAC strategies and techniques; outcome measures; and communication outcomes. MAIN CONTRIBUTION This review shows that the majority of the research to date has focused on supporting the interactions of persons with dementia of the Alzheimer's type (DAT) using non-electronic memory and communication aids. Future research should focus on social participation and person-centred communication to optimize functional communication with AAC. Training programmes targeting dyadic interaction and supporting persons with dementia from diverse ethnic backgrounds are avenues for further research. CONCLUSIONS Research trends and, more importantly, the gaps highlighted in this research review present speech-language therapists and researchers with a set of current priorities that are necessary for the advancement of the knowledge base.
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Affiliation(s)
- Auriel A May
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Shakila Dada
- Centre for Augmentative and Alternative Communication, University of Pretoria, Pretoria, South Africa
| | - Janice Murray
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
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Balzotti A, Filograsso M, Altamura C, Fairfield B, Bellomo A, Daddato F, Vacca RA, Altamura M. Comparison of the efficacy of gesture-verbal treatment and doll therapy for managing neuropsychiatric symptoms in older patients with dementia. Int J Geriatr Psychiatry 2019; 34:1308-1315. [PMID: 30136743 PMCID: PMC6766963 DOI: 10.1002/gps.4961] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/25/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND The prevalence of neuropsychiatric symptoms (NPS) diminishes the quality of life and increases the care burden in patients with dementia. Despite the clinical importance of dementia-associated NPS, no protocols for treating NPS are already well established. Attention has turned to the effectiveness of nonpharmacological treatments for NPS since their potential safe alternative to pharmacotherapy. OBJECTIVE This study is aimed to compare the effects in older individuals with dementia living in a residential care, of two intervention programs, the gesture-verbal treatment (GVT), a treatment implemented by us on a previous method for word retrieval in individuals with aphasia, and the better-known doll therapy (DT). The GVT would act on both receptive and expressive language skills, the DT on attachment and emotional connections. METHODS We evaluated NPS by the neuropsychiatric inventory in a total of 30 patients divided into 3 groups, the GVT, the DT, and control groups, using a pre-post design. The treatment groups completed 12-week nonpharmacological interventions in addition to standard rehabilitative therapies, while the control group participated only in standard rehabilitative therapies. RESULTS The DT group showed significant improvements in agitation, irritability, apathy, depression, and delusions relative to controls. The GVT group showed significant improvements in apathy and depression with respect to controls. The DT intervention ameliorated symptoms of agitation compared to the GVT intervention whereas the GVT intervention improved apathy compared to the DT intervention. CONCLUSION Improved understanding of the potential therapeutic benefits of different treatments for neuropsychiatric symptoms is crucial for establishing nonpharmacological interventions in dementia.
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Affiliation(s)
- Angela Balzotti
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Marianna Filograsso
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Claudia Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Beth Fairfield
- Department of Psychological, Health and Territorial SciencesUniversity of ChietiChietiItaly
- Center of Excellence on Aging and Translational Medicine (CeSI‐MeT)University of ChietiChietiItaly
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
| | - Fabio Daddato
- Residenza Sociosanitaria Assistenziale per Anziani “Aurelia e Silvestro Storelli”BisceglieItaly
| | - Rosa Anna Vacca
- Institute of Biomembranes Bioenergetics and Molecular Biotechnologies, Italian National Research Council (CNR)BariItaly
| | - Mario Altamura
- Department of Clinical and Experimental Medicine, Psychiatry UnitUniversity of FoggiaFoggiaItaly
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Miron AM, Thompson AE, Bagley A, Anderson J, Melotik E, Rowley S. Fear of Incompetence in Intergenerational Relationships with a Family Member with Dementia. JOURNAL OF INTERGENERATIONAL RELATIONSHIPS 2019. [DOI: 10.1080/15350770.2019.1575783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Anca M. Miron
- University of Wisconsin Oshkosh, Oshkosh, Wisconsin, USA
| | | | | | | | - Emma Melotik
- University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Sarah Rowley
- University of Wisconsin Oshkosh, Oshkosh, Wisconsin, USA
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Douglas NF, Affoo RH. Certified Nursing Assistants Want to Use External Memory Aids for Residents With Dementia: Survey Results Within an Implementation Science Framework. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 28:591-598. [PMID: 31136234 DOI: 10.1044/2018_ajslp-18-0118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The purpose of this study was to assess the self-perceived knowledge and self-efficacy of certified nursing assistants (CNAs) when using external memory aids to enhance the communication and independence of residents with dementia living in skilled nursing facilities (SNFs). Method One hundred forty-four CNAs completed a measure pertaining to self-perceived knowledge and self-efficacy of external memory aids. Results CNAs had favorable beliefs about the usefulness of external memory aids to help both conversation and independence in activities of daily living for residents with dementia ( M = 4.0, SD = 0.84; M = 3.92, SD = 0.85) on a 5-point Likert scale, with 5 = strongly agree and 1 = strongly disagree. There were no statistically significant differences between CNAs who reported being trained to use external memory aids with residents with dementia and CNAs who reported they were not trained according to items related to self-efficacy ( U = 2203.5, z = -1.483, p = .138; U = 2179, z = -1.547, p = .122; U = 2115, z = -1.82, p = .069; U = 2320, z = -0.942, p = .346). Conclusions Results of this study indicated that the lack of uptake of external memory aids for residents with dementia in SNFs may not solely be due to lack of buy-in or lack of time on the part of the CNA. Speech-language pathologists should provide this training to support the uptake of external memory aids for residents with dementia; however, these data suggest that current training methods may not be considerate of the nuances of implementation. Speech-language pathologists and researchers should consider the finer aspects of theoretically grounded facilitation techniques as next steps to the broader implementation of this intervention for residents with dementia living in SNFs.
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Affiliation(s)
- Natalie F Douglas
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
| | - Rebecca H Affoo
- Department of Communication Sciences and Disorders, Central Michigan University, Mount Pleasant
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Troche J, Willis A, Whiteside J. Exploring supported conversation with familial caregivers of persons with dementia: a pilot study. Pilot Feasibility Stud 2019; 5:10. [PMID: 30680224 PMCID: PMC6337868 DOI: 10.1186/s40814-019-0398-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/09/2019] [Indexed: 11/13/2022] Open
Abstract
Background Dementia can lead to difficulties in communication between caregivers and patients. Teaching conversational strategies has been effective for a wide array of clients with acquired neurologic disorders and their caregivers. Research indicates positive results for Supported Conversation for adults with Aphasia (SCA) secondary to stroke. Applying this method to work with caregivers of individuals with dementia could prove to be a valid intervention tool. This investigation examined the applicability of SCA with individuals with dementia and their familial caregivers. Method Four dyads (caregiver and individual with dementia) participated in the SCA program with some adaptation for dementia. The program was 4 weeks with a pre-training and post training assessment. The Measure of Skill in Supported Conversation (MSC) and Measure of Level of Participation in Conversation (MPC) were given to measure the overall effectiveness of SCA at teaching and improving communication, respectively. A qualitative analysis of unproductive coping mechanisms also occurred. The Zarit Burden Interview (ZBI) was given to gauge caregiver burden from pre- to post-training. Results MSC and MPC scores were significantly improved from baseline to post training, and a significant reduction in unproductive coping behaviors also occured. ZBI scores were variable across participants. Conclusions Results suggest that the SCA has the potential to be used to improve communication between persons with dementia and their caregivers. Findings suggest that further research is warranted into the effectiveness of SCA in dementia. Trial registration Retrospectively registered 9/5/2018 ISRCTN17622451.
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Affiliation(s)
- Joshua Troche
- 1School of Communication Sciences and Disorders, University of Central Florida, P.O. Box 162215, Orlando, FL 32816 USA
| | - Arielle Willis
- 2Department of Communication Sciences and Disorders, Baylor University, Waco, TX USA
| | - Janet Whiteside
- 1School of Communication Sciences and Disorders, University of Central Florida, P.O. Box 162215, Orlando, FL 32816 USA
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Bourgeois MS. Caregiving for Persons with Dementia: Evidence-based resources for SLPs. TOPICS IN LANGUAGE DISORDERS 2019; 39:89-103. [PMID: 31031509 PMCID: PMC6483391 DOI: 10.1097/tld.0000000000000166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Speech–language pathologists (SLPs) have an important role in supporting the caregivers of persons with dementia from diagnosis through the end of life in 4 major areas: education, training to use effective cognitive communication strategies identified for clients with dementia, psychosocial/emotional support, and counseling. Speech–language pathologists may be involved in this process from the initial diagnosis when families need guidance to navigate the vast amounts of information on the Internet and elsewhere, until they need assistance in making end-of-life decisions. Speech–language pathologists must recognize that caregivers have needs, and differing needs, depending on the stage of dementia of the person to whom they are providing care. The research in caregiving interventions for family, professional, and paraprofessional caregivers provides an understanding of effective, evidence-based approaches, resources, and promising caregiver outcomes for the SLP working with individuals with dementia and their caregivers. It is important for SLPs to know that these interventions exist and to seek out appropriate services to which to refer the caregivers of their clients. Other person-centered interventions specifically developed for SLPs to implement with their clients with dementia and their family and professional caregivers are crucial for ensuring a quality life for clients and caregivers and for meeting the demands of a quality dementia care workforce.
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Gerritsen DL, Koopmans RTCM, Walravens V, van Vliet D. Using Video Feedback at Home in Dementia Care: A Feasibility Study. Am J Alzheimers Dis Other Demen 2018; 34:153-162. [PMID: 30352521 PMCID: PMC6463273 DOI: 10.1177/1533317518808021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Video feedback at home (VFH) aims to improve the well-being of informal caregivers and persons with dementia by training the caregiver to communicate successfully. This feasibility study had 2 aims: (1) to investigate possible effects regarding VFH, caregiver self-efficacy and the burden experienced, and the frequency of challenging behavior in persons with dementia, and (2) to perform a process evaluation of barriers and facilitators regarding the use of VFH. The respondents were caregivers of home-dwelling persons with dementia participating in VHF (N = 10), a group of caregivers who declined participating in VFH (N = 18), stakeholders (N = 6), and field experts (N = 55). The assessments performed were Positive and Negative Affect Scales, Cohen-Mansfield Agitation Inventory, Sense of Competence Scale, semistructured interviews, and questionnaires. Results demonstrated that caregivers were satisfied with VFH and that various (sub)scores on questionnaires improved. Caregivers mentioned a reluctance toward being filmed and both caregivers and referrers were unfamiliar with VFH. Recommendations have been made for health-care professionals and researchers to overcome these barriers.
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Affiliation(s)
- Debby L Gerritsen
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands.,3 Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Raymond T C M Koopmans
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands.,4 Joachim en Anna, Centre for Specialized Geriatric Care, Nijmegen, the Netherlands
| | - Veerle Walravens
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands
| | - Deliane van Vliet
- 1 Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands.,2 Radboud Alzheimer Centre, Nijmegen, the Netherlands
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Olthof-Nefkens M, Kruse H, Derksen E, de Swart B, Nijhuis-van der Sanden M, Kalf J. Improving Communication between Persons with Mild Dementia and Their Caregivers: Qualitative Analysis of a Practice-Based Logopaedic Intervention. Folia Phoniatr Logop 2018; 70:124-133. [DOI: 10.1159/000491081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/15/2018] [Indexed: 11/19/2022] Open
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From conversation to connection: a cross-case analysis of life-story work with five couples where one partner has semantic dementia. AGEING & SOCIETY 2018. [DOI: 10.1017/s0144686x18000533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractSemantic dementia causes progressive communication difficulties that significantly impact on the person and their family. There is a paucity of research examining conversation skills in this condition and associated interventions to support interaction, such as life-story work. This study used a multiple case study design to: (a) explore the everyday conversation experiences of five individuals with semantic dementia and their spouses; and (b) examine how intervention using interaction-focused life-story work could support communication needs. A total of 74 home visits were conducted over a longitudinal period. An innovative combination of conversation analysis of video and audio data alongside biographical interviewing was used. Information derived from these strands was utilised to design an individually tailored life-story intervention. Cross-case analysis examined the contribution of life-story work to interaction and other aspects of care. Results showed that a range of challenges and skills were present within conversation. Life-story work was delivered in all cases using a variety of formats and the work could be conceptualised under various points of connection: interactional, emotional, new, practical and future. Detailed assessment was important to define aims for intervention and appropriate format(s) for life-story work for the individual concerned. Outcomes for communication in this study were not solely about supporting the telling of facts about the person's life but represented a broader focus to facilitate embodied and emotional connections. This study demonstrates that creativity within life-story work is important to foster social interaction, beyond information exchange, using both verbal and non-verbal behaviours. In addition, video data show promise for exploring in-the-moment outcomes for research and practice, particularly to capture the non-verbal dimensions of this work.
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Swan K, Hopper M, Wenke R, Jackson C, Till T, Conway E. Speech-Language Pathologist Interventions for Communication in Moderate-Severe Dementia: A Systematic Review. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:836-852. [PMID: 29554196 DOI: 10.1044/2017_ajslp-17-0043] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 11/28/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE The purpose of this study is to evaluate the evidence for direct and indirect interventions for communication in people with moderate-severe dementia. METHOD A systematic search of the literature was conducted, as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysed guidelines, across 8 electronic databases. Studies were included if they included direct or indirect interventions, which could be administered by a speech-language pathologist to people with moderate-severe dementia (defined as having Mini-Mental State Examination of ≤ 15; Folstein, Folstein, & McHugh, 1975). Studies also were required to include outcome measures, which reported on communication function or participation and/or well-being related to communication. Included studies were evaluated for methodological quality using the McMaster critical appraisal tool (Law et al., 1998). RESULTS Eleven studies met the inclusion criteria. Ten of these studies related to direct interventions and included cognitive stimulation approaches using group (n = 5) or individual therapy (n = 1); cognitive training, including naming therapy (n = 1) and spaced retrieval training (n = 1); and cognitive rehabilitation approaches using augmentative and alternative communication (n = 2). One study reported an indirect intervention: conversation partner training. Due to the heterogeneity of studies, a meta-analysis was unable to be conducted. A descriptive synthesis of results indicated that interventions generally resulted in positive changes to communication and related quality-of-life outcomes compared with baseline or control groups. CONCLUSIONS Preliminary evidence was found to support communication interventions for people with moderate-severe dementia. The use of cognitive stimulation approaches, which use a group treatment model and conversation, as a therapy medium show promise as direct intervention options. Implications for clinical practice for speech-language pathologists and future research are discussed. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.5985241.
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Affiliation(s)
- Katina Swan
- Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
| | - Marie Hopper
- Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
| | - Rachel Wenke
- Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
- Gold Coast Health, Clinical Governance, Education and Research (Allied Health), Southport, Queensland, Australia
- School of Allied Health Sciences, Griffith University (Adjunct Appointment), Gold Coast, Queensland, Australia
| | - Claire Jackson
- Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
| | - Tracy Till
- Gold Coast Health, Speech Pathology Service, Southport, Queensland, Australia
| | - Erin Conway
- School of Allied Health, Australian Catholic University, Banyo, Queensland
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Barnes CJ, Markham C. A pilot study to evaluate the effectiveness of an individualized and cognitive behavioural communication intervention for informal carers of people with dementia: The Talking Sense programme. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2018; 53:615-627. [PMID: 29460337 DOI: 10.1111/1460-6984.12375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 12/12/2017] [Accepted: 01/11/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND People with dementia and family carers often experience difficulties communicating together. These difficulties are considered to contribute significantly to the depression, anxiety and negative feelings such as guilt often reported by dementia family carers. AIMS To develop and contribute to the theory and evidence base for single-component, psychosocial interventions that address these difficulties by evaluating the effectiveness of the Talking Sense programme which was designed to reflect existing best evidence. METHODS & PROCEDURES Talking Sense was delivered as an individualized, one to one, cognitive behavioural approach for developing knowledge, skills, thinking and behaviour of dementia family carers in managing communication difficulties. In this study, a randomized controlled trial compared 27 carers who completed three one-to-one individualized sessions using Talking Sense with 25 carers who received a single, knowledge-only, control discussion. OUTCOMES & RESULTS There were no significant differences for the primary outcome measure of carer anxiety and depression as well as carer quality of life and general self-efficacy. Statistically significant results suggested carers receiving the Talking Sense intervention had fewer communication difficulties happening (p = 0.046) and felt more valued by their relatives (p = 0.046). A score close to significance (p = 0.052) suggested they perceived their relatives to be more communicatively competent. CONCLUSIONS & IMPLICATIONS The intervention and research design were shown to be effective with low attrition and high adherence to treatment. A non-significant finding for the primary outcome measure does not support the potential for this intervention to effect carer anxiety and depression. The potential for perceived change in the person with dementia, with statistically fewer communication difficulties happening and the carer feeling more valued by their relative, was the most significant finding from this programme of research. Recommendations for further research are made.
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Affiliation(s)
| | - Chris Markham
- School of Health Sciences and Social Work, University of Portsmouth, Portsmouth, UK
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Campos CH, Ribeiro GR, Rodrigues Garcia RCM. Mastication and oral health-related quality of life in removable denture wearers with Alzheimer disease. J Prosthet Dent 2017; 119:764-768. [PMID: 28967408 DOI: 10.1016/j.prosdent.2017.07.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/18/2017] [Accepted: 07/19/2017] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM Alzheimer disease (AD) can affect masticatory function, affecting oral health-related quality of life (OHRQoL). Whether oral rehabilitation with conventional removable prostheses can restore masticatory function and improve OHRQoL in these individuals is unknown. PURPOSE The purpose of this clinical study was to evaluate the influence of oral rehabilitation with removable prostheses on masticatory efficiency and OHRQoL in elders with and without AD. MATERIAL AND METHODS Thirty-two elders with mild AD (n=16, mean age=76.7 ±6.3 years) or without AD (n=16, mean age=75.2 ±4.4 years) were recruited. All participants first underwent masticatory efficiency and OHRQoL evaluations, and 2 months after insertion of new removable prostheses, the variables were reassessed. Masticatory efficiency was determined using the sieving method, and OHRQoL was measured by applying the Geriatric Oral Health Assessment Index (GOHAI). The data from the baseline and after insertion of the new removable prostheses were compared by paired t test. Group differences at each time point were assessed by t test (α=.05). RESULTS After insertion of the new removable prostheses, masticatory efficiency and OHRQoL improved in both the elders with AD and the control. At baseline, elders with AD had lower masticatory efficiency and higher OHRQoL than controls (P<.05). After removable prosthesis insertion, elders with AD continued to show lower masticatory efficiency values than controls, but their OHRQoL was similar. CONCLUSIONS Oral rehabilitation with new removable prostheses improved the masticatory efficiency and OHRQoL of elders with and without AD, although masticatory efficiency did not reach control levels in elders with AD.
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Affiliation(s)
- Camila H Campos
- Postgraduate student, Department of Prosthodontics and Periodontology, Piracicaba Dental School (UNICAMP), University of Campinas, São Paulo, Brazil
| | - Giselle R Ribeiro
- Postgraduate student, Department of Prosthodontics and Periodontology, Piracicaba Dental School (UNICAMP), University of Campinas, São Paulo, Brazil
| | - Renata C M Rodrigues Garcia
- Professor, Department of Prosthodontics and Periodontology, Piracicaba Dental School (UNICAMP), University of Campinas, São Paulo, Brazil.
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Morello ANDC, Lima TM, Brandão L. Language and communication non-pharmacological interventions in patients with Alzheimer's disease: a systematic review. Communication intervention in Alzheimer. Dement Neuropsychol 2017; 11:227-241. [PMID: 29213519 PMCID: PMC5674666 DOI: 10.1590/1980-57642016dn11-030004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Alzheimer's disease considerably compromises communication skills. Language changes become more prominent as the disease progresses. Deterioration of language and cognition reduces the ability of holding conversations, which has a negative impact on social interaction.
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Affiliation(s)
| | - Tatiane Machado Lima
- Instituto de Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre, RS, Brazil
| | - Lenisa Brandão
- Departamento de Saúde e Comunicação Humana, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre, RS Brazil
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Piersol CV, Canton K, Connor SE, Giller I, Lipman S, Sager S. Effectiveness of Interventions for Caregivers of People With Alzheimer’s Disease and Related Major Neurocognitive Disorders: A Systematic Review. Am J Occup Ther 2017; 71:7105180020p1-7105180020p10. [DOI: 10.5014/ajot.2017.027581] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. The goal of the evidence review was to evaluate the effectiveness of interventions for caregivers of people with Alzheimer’s disease and related major neurocognitive disorders that facilitate the ability to maintain participation in the caregiver role.
METHOD. Scientific literature published in English between January 2006 and April 2014 was reviewed. Databases included MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews.
RESULTS. Of 2,476 records screened, 43 studies met inclusion criteria. Strong evidence shows that multicomponent psychoeducational interventions improve caregiver quality of life (QOL), confidence, and self-efficacy and reduce burden; cognitive reframing reduces caregiver anxiety, depression, and stress; communication skills training improves caregiver skill and QOL in persons with dementia; mindfulness-based training improves caregiver mental health and reduces stress and burden; and professionally led support groups enhance caregiver QOL.
CONCLUSION. Strong evidence exists for a spectrum of caregiver interventions. Translation of effective interventions into practice and evaluation of sustainability is necessary.
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Affiliation(s)
- Catherine Verrier Piersol
- Catherine Verrier Piersol, PhD, OTR/L, FAOTA, is Associate Professor, Department of Occupational Therapy, and Director, Jefferson Elder Care, Thomas Jefferson University, Philadelphia, PA;
| | - Kerry Canton
- Kerry Canton, MS, OTR/L, is Occupational Therapist, Beaumont Hospital, Taylor, MI. At the time of the systematic review, she was Student, Entry-Level Master's Program in Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Susan E. Connor
- Susan E. Connor, OTD, OTR/L, CCHP, is Occupational Therapist, Rutgers University Correctional Health Care, Newark, NJ. At the time of the systematic review, she was Student, Postprofessional Doctoral Program in Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Ilana Giller
- Ilana Giller, OTD, OTR/L, is Occupational Therapist, Ellicott City Healthcare Center, Ellicott City, MD. At the time of the systematic review, she was Student, Occupational Therapy Doctoral Program, Thomas Jefferson University, Philadelphia, PA
| | - Stacy Lipman
- Stacy Lipman, OTD, OTR/L, is Occupational Therapist, Veterans Administration Medical Center, Washington, DC. At the time of the systematic review, she was Student, Postprofessional Doctoral Program in Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
| | - Suzanne Sager
- Suzanne Sager, MS, OTR/L, is Occupational Therapist, Exceptional Rehab, Lexington, KY. At the time of the systematic review, she was Student, Entry-Level BSMS Program in Occupational Therapy, Thomas Jefferson University, Philadelphia, PA
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Grasso SM, Shuster KM, Henry ML. Comparing the effects of clinician and caregiver-administered lexical retrieval training for progressive anomia. Neuropsychol Rehabil 2017; 29:866-895. [PMID: 28662598 DOI: 10.1080/09602011.2017.1339358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
There is a growing body of literature indicating that lexical retrieval training can result in improved naming ability in individuals with neurodegenerative disease. Traditionally, treatment is administered by a speech-language pathologist, with little involvement of caregivers or carry-over of practice into the home. This study examined the effects of a lexical retrieval training programme that was implemented first by a clinician and, subsequently, by a trained caregiver. Two dyads, each consisting of one individual with anomia caused by neurodegenerative disease (one with mild cognitive impairment and one with logopenic primary progressive aphasia) and their caregiver, participated in the study. Results indicated medium and large effect sizes for both clinician- and caregiver-trained items, with generalisation to untrained stimuli. Participants reported improved confidence during communication as well as increased use of trained communication strategies after treatment. This study is the first to document that caregiver-administered speech and language intervention can have positive outcomes when paired with training by a clinician. Caregiver-administered treatment may be a viable means of increasing treatment dosage in the current climate of restricted reimbursement, particularly for patients with progressive conditions.
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Affiliation(s)
- Stephanie M Grasso
- a Communication Sciences and Disorders , University of Texas at Austin , Austin , TX , USA
| | - Kaleigh M Shuster
- a Communication Sciences and Disorders , University of Texas at Austin , Austin , TX , USA
| | - Maya L Henry
- a Communication Sciences and Disorders , University of Texas at Austin , Austin , TX , USA
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Nóbrega J, Lousada M, Figueiredo D. Exploring the Clinical Practice of Speech and Language Therapists with Adults with Dementia: A Cross-Sectional Survey in Portugal. Folia Phoniatr Logop 2017. [PMID: 28624817 DOI: 10.1159/000464350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Adults with acquired communication and swallowing disorders secondary to dementia can benefit from speech and language therapy services. However, there is limited information on the role of speech and language therapists (SLTs) in the treatment of individuals with dementia. The aim of this study was to explore the clinical practice of SLTs with adults with dementia. METHODS A cross-sectional survey of SLTs was conducted in Portugal using a web-based questionnaire designed specifically for the purpose of this study. RESULTS A total of 230 SLTs responded to the survey. Among the respondents, 52.2% had limited clinical practice with individuals with dementia, with only 14.3% having worked with more than 10 cases. CONCLUSION In Portugal, the clinical practice of SLTs in dementia is limited and mostly centred on the assessment of language, communication, and swallowing. The current findings highlight the need to address training in dementia within graduate and post-graduate programmes for SLTs.
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Affiliation(s)
- Jossie Nóbrega
- Secção Autónoma de Ciências da Saúde, University of Aveiro, Aveiro, Portugal
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Karlsson E, Zingmark K, Axelsson K, Sävenstedt S. Aspects of Self and Identity in Narrations About Recent Events: Communication with Individuals with Alzheimer's Disease Enabled by a Digital Photograph Diary. J Gerontol Nurs 2017; 43:25-31. [PMID: 28152153 DOI: 10.3928/00989134-20170126-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/30/2016] [Indexed: 11/20/2022]
Abstract
The ability to narrate autobiographical memories is important for maintaining the identity of individuals with Alzheimer's disease (AD). The current study explored how the sense of self is manifested in narrations about recent events, enabled via a digital photograph diary. Use of a digital photograph diary was tested with seven individuals with AD and their household members. Narrative analysis was used to analyze audiorecordings of the pairs' communication about recent events shown in the photographs. The results show how individuals with AD understand events illustrated in recent photographs in relation to their sense of self and associated skills and abilities that are facets of their selfhood. This type of digital photograph diary has the potential to support individuals with AD to maintain their sense of self and participation in everyday life, and strengthen their relationships with household members; it could be an important tool in person-centered care. [Journal of Gerontological Nursing, 43(6), 25-31.].
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"There isn't an easy way of finding the help that's available." Barriers and facilitators of service use among dementia family caregivers: a qualitative study. Int Psychogeriatr 2017; 29:765-776. [PMID: 28351450 DOI: 10.1017/s1041610216002532] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Family caregivers of people with dementia have significant unmet needs in regard to their caregiving role. Despite this, they are reluctant to utilize services to reduce their burden. The aim of this study was to examine the barriers and facilitators of service use among family caregivers of people with dementia. METHOD Semi-structured interviews were conducted with 24 family caregivers of community-dwelling people with dementia. Of these, 12 were partner caregivers (4 men, 8 women) and 12 were offspring caregivers (2 men, 10 women). The interviews were transcribed and analyzed using thematic analysis. RESULTS Six main barriers and three facilitators were identified. These barriers and facilitators were relevant across many types of services and supports. The barriers were: the inability to find information about relevant services or support, the poor quality or mistrust of the services, the inflexibility of services, caregivers' beliefs about their obligations to the caregiving role and resistance by the care recipient. Key facilitators were: having good communication with the care recipient, having an "expert" point of contact, and having beliefs about the caregiving role that enabled the use of services. CONCLUSION Given the significant changes in the aged care service-system, it is important to discuss the barriers faced by family caregivers of people with dementia. This will inform the development of targeted strategies to address the lack of service use among these family caregivers.
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Strøm BS, Engedal K, Benth JS, Grov EK. Effect of the Sonas Programme on Communication in People with Dementia: A Randomized Controlled Trial. Dement Geriatr Cogn Dis Extra 2017; 7:122-135. [PMID: 28553314 PMCID: PMC5425769 DOI: 10.1159/000468147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background Strategies to improve communication in people with dementia are warranted. We examined the effect of the Sonas programme on communication ability in persons with moderate to severe dementia. Methods A 24-week 3-armed (Sonas, reading, and control group) randomized controlled trial including 120 nursing home residents with dementia was conducted; 105 completed the follow-up assessments. The main outcome was change in communication abilities measured by the Holden Communication Scale (HCS). Results We found no overall significant effect of the Sonas programme with regard to communication ability as measured by the HCS. However, an effect between the Sonas group and the reading group and between the Sonas group and the control group from T0 to T1 and T2 was found, as well as a significant improvement in communication in the Sonas group. Among people with severe dementia, the Sonas group scored significantly better on the HCS compared to the reading group after 12 weeks, but not after 24 weeks. Conclusion This study failed to document an overall effect of the Sonas programme on communication; however, the findings indicate that the Sonas programme has a significant effect on communication among those with severe dementia.
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Affiliation(s)
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway.,Department of Geriatrics, Oslo University Hospital, Oslo, Norway
| | | | - Ellen-Karine Grov
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Saldert C. Pragmatic Assessment and Intervention in Adults. PERSPECTIVES IN PRAGMATICS, PHILOSOPHY & PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-47489-2_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Strøm BS, Engedal K, Šaltytė Benth J, Grov EK. Psychometric evaluation of the Holden Communication Scale (HCS) for persons with dementia. BMJ Open 2016; 6:e013447. [PMID: 27965255 PMCID: PMC5168700 DOI: 10.1136/bmjopen-2016-013447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the psychometric properties of the Holden Communication Scale (HCS) and the association between scores on HCS and cognitive function among persons with dementia. METHOD Internal consistency was assessed by the Cronbach's α coefficient and inter-item correlations. Test-retest was carried out to test the instrument's stability. An exploratory factor analysis with the principal components extraction method and oblimin rotation was performed to evaluate construct validity. Pearson's correlation coefficients were calculated to explore associations between the scores on the HCS and cognitive function. RESULTS A total of 128 persons with moderate-to-severe cognitive impairment (mean Mini-Mental State Examination (MMSE) score 8.9 (SD 7.0)) participated. The mean age was 85.2 (SD 7.2) and 101 of the participants were women. The Cronbach's α of the HCS was 0.94 and test-retest reliability was r=0.71. The corrected item-total correlation ranged from 0.63 to 0.79 and factor analysis showed a 1-factor structure of the HCS, which explained 63% of the variance. However, a forced 3-factor structure explained 76% of the variance. The correlation between cognitive function as measured by the MMSE and ability to communicate as measured with HCS was found to be moderate for those with an MMSE score of 0-10 (-0.61) and low for persons with an MMSE score of 11-20 (-0.06). CONCLUSIONS The HCS is a reliable and valid scale for assessing communication ability in persons with moderate and severe cognitive impairment, and might have a 1-factor or 3-factor structure.
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Affiliation(s)
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway
- Department of Geriatrics, Oslo University Hospital, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Ellen-Karine Grov
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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McGilton KS, Rochon E, Sidani S, Shaw A, Ben-David BM, Saragosa M, Boscart VM, Wilson R, Galimidi-Epstein KK, Pichora-Fuller MK. Can We Help Care Providers Communicate More Effectively With Persons Having Dementia Living in Long-Term Care Homes? Am J Alzheimers Dis Other Demen 2016; 32:41-50. [PMID: 27899433 PMCID: PMC5302128 DOI: 10.1177/1533317516680899] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Effective communication between residents with dementia and care providers in long-term care homes (LTCHs) is essential to resident-centered care. Purpose: To determine the effects of a communication intervention on residents’ quality of life (QOL) and care, as well as care providers’ perceived knowledge, mood, and burden. Method: The intervention included (1) individualized communication plans, (2) a dementia care workshop, and (3) a care provider support system. Pre- and postintervention scores were compared to evaluate the effects of the intervention. A total of 12 residents and 20 care providers in an LTCH participated in the feasibility study. Results: The rate of care providers’ adherence to the communication plans was 91%. Postintervention, residents experienced a significant increase in overall QOL. Care providers had significant improvement in mood and perceived reduced burden. Conclusion: The results suggest that the communication intervention demonstrates preliminary evidence of positive effects on residents’ QOL and care providers’ mood and burden.
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Affiliation(s)
- Katherine S McGilton
- 1 Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,2 Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Rochon
- 1 Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,3 Faculty of Medicine, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Souraya Sidani
- 4 School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Alexander Shaw
- 1 Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,5 School of English and Liberal Studies, Seneca College Newnham Campus, Toronto, Ontario, Canada
| | - Boaz M Ben-David
- 1 Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,3 Faculty of Medicine, Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,6 Communication, Aging and Neuropsychology Lab (CANlab), Baruch Ivcher School of Psychology, Interdisciplinary Center (IDC) Herzliya, Herzliya, Israel.,7 Rehabilitation Sciences Institute (RSI), University of Toronto, Toronto, Ontario, Canada.,8 St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Veronique M Boscart
- 9 School of Health & Life Sciences and Community Services, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Ontario, Canada
| | - Rozanne Wilson
- 10 School of Nursing, Trinity Western University, Langley, British Columbia, Canada.,11 Centre for Health Evaluation & Outcome Sciences (CHÉOS), University of British Columbia, Vancouver, British Columbia, Canada.,12 Patient-Centred Performance Measurement & Improvement, Providence Health Care, Vancouver, British Columbia, Canada
| | | | - M Kathleen Pichora-Fuller
- 1 Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,14 Department of Psychology, University of Toronto, Mississauga, Ontario, Canada
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Lind C, Meyer C, Young J. Hearing and Cognitive Impairment and the Role of the International Classification of Functioning, Disability and Health as a Rehabilitation Framework. Semin Hear 2016; 37:200-15. [PMID: 27489399 PMCID: PMC4954787 DOI: 10.1055/s-0036-1584410] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The International Classification of Functioning, Disability and Health (ICF) has been applied widely in the literature to describe and differentiate the broad implications of hearing impairment (HI) and cognitive impairment (CI) on communication. As CI and HI are largely age-related conditions, the likelihood of comorbidity of these conditions is high. In the context of an aging population, the prevalence of comorbidity is likely to rise, yet much of the clinical assessment and intervention in HI and CI occur separately. The benefit of addressing the dual impact of these conditions is of increasing clinical importance for all clinicians working with older adults and for audiologists and speech pathologists in particular. In this article, the ICF model will be applied to explore the everyday implications of HI and CI. Furthermore, the clinical implications of the ICF model are explored with particular respect to communication assessment and intervention options. The potential benefit of combining activity- and participation-focused interventions currently offered for HI and CI independently is examined.
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Affiliation(s)
- Christopher Lind
- Department of Speech Pathology & Audiology, Flinders University, Adelaide, Australia
| | - Carly Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Australia
| | - Jessica Young
- Department of Speech Pathology & Audiology, Flinders University, Adelaide, Australia
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Strøm BS, Engedal K, Grov EK. A Psychometric Evaluation of the Threadgold Communication Tool for Persons with Dementia. Dement Geriatr Cogn Dis Extra 2016; 6:150-60. [PMID: 27239188 PMCID: PMC4881245 DOI: 10.1159/000444789] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this study was to investigate the psychometric properties of the Threadgold Communication Tool (TCT). Method Internal consistency reliability was measured using Cronbach's α coefficient and inter-item correlation. Test-retest was performed to examine the instrument's stability. Exploratory principal component analysis (PCA) with oblimin rotation was carried out to evaluate construct validity. Finally, the score on each item of the TCT was correlated with the person's Mini Mental State Examination (MMSE) and Barthel Index of activities of daily living scores. Results A total of 51 persons participated, with a mean age of 86.7 (SD 6.6) years, of whom 46 were women with moderate-to-severe dementia [mean MMSE score 7.5 (SD 6.7)]. There were two measurement points 2 weeks apart. The results showed a satisfactory level for internal consistency and a high test-retest reliability (r = 0.76). The corrected item-total correlation ranged between 0.50 and 0.87, and a two-factor structure was revealed at the PCA. ‘Vocalizing’ seemed to measure another aspect of communication and was the only item which was negatively loaded. Conclusion Despite the low sample size in this study, the results revealed the TCT as a reliable and valid instrument, suitable for measuring communication among people with dementia. We suggest clarifying the understanding of ‘vocalizing’ before considering removing it from the scale.
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Affiliation(s)
| | - Knut Engedal
- Norwegian Advisory Unit for Aging and Health, Vestfold Hospital HF, Tønsberg, Norway; Department of Geriatrics, Oslo University Hospital, Tønsberg, Norway
| | - Ellen-Karine Grov
- Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Morhardt D, Weintraub S, Khayum B, Robinson J, Medina J, O'Hara M, Mesulam M, Rogalski EJ. The CARE pathway model for dementia: psychosocial and rehabilitative strategies for care in young-onset dementias. Psychiatr Clin North Am 2015; 38:333-52. [PMID: 25998120 PMCID: PMC4635684 DOI: 10.1016/j.psc.2015.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of the Care Pathway Model for Dementia (CARE-D) is to improve quality of life and daily functioning both for individuals diagnosed with dementia and for their families or other caregivers. This is accomplished by developing individualized recommendations focused on a person's strengths and weaknesses as determined by formal neurocognitive and psychosocial evaluations. Careful attention is given to the stage of illness and an individual's stage in life, to connecting families with services that target an individual's cognitive and behavioral symptoms, and to providing education and emotional support specific to symptoms, clinical diagnosis, and prognosis.
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Affiliation(s)
- Darby Morhardt
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA, Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 East Ontario, Chicago, IL 60611, USA, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Becky Khayum
- MemoryCare Corporation, 634 Brooklyn Drive, Aurora, IL 60502, USA
| | - Jaimie Robinson
- Christ Hospital Cancer Center, 2139 Auburn Avenue, Cincinnati, OH 45219, USA
| | - Jennifer Medina
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA
| | - Mary O'Hara
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA
| | - Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA, Department of Neurology, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, Chicago, IL 60611, USA
| | - Emily J. Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 East Superior Street, Searle Building 11th Floor, Chicago, IL 60611, USA, Corresponding author.
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Slaughter SE, Hopper T, Ickert C, Erin DF. Identification of hearing loss among residents with dementia: perceptions of health care aides. Geriatr Nurs 2014; 35:434-40. [PMID: 25212262 DOI: 10.1016/j.gerinurse.2014.07.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 07/08/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
| | - Tammy Hopper
- Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Carla Ickert
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Daniel F Erin
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Abstract
ABSTRACTThe purpose of this study is to develop and extend our understanding of dementia care-giving by introducing a typology of informal care-giving across four different diseases. Care-giving factors were examined with respect to specific dementia presentation in mild cognitive impairment, Alzheimer's disease, dementia with Lewy bodies and Parkinson's disease-associated dementia. Informal care-giving literature in the four diseases was systematically searched to identify specific disease symptoms and resultant care-giving strains and outcomes. Key concepts were extracted and grouped thematically. The first classification, ‘role-shift’, reflects care-giving where cognitive deterioration results in changing roles, uncertainty and relational deprivation among married partners. The second classification, ‘consumed by care-giving’, refers to those caring for persons with dementia-motor decline that greatly increases worry and isolation. Finally, in the ‘service use’ classification, formal support is needed to help care-givers cope with daily responsibilities and behaviour changes. In each case, the dementia presentation uniquely impacts care-giver strains. A major conclusion is that the same support to all care-givers under the umbrella term ‘dementia’ is unwarranted; the development of targeted support is required.
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Constand MK, MacDermid JC, Dal Bello-Haas V, Law M. Scoping review of patient-centered care approaches in healthcare. BMC Health Serv Res 2014; 14:271. [PMID: 24947822 PMCID: PMC4079171 DOI: 10.1186/1472-6963-14-271] [Citation(s) in RCA: 285] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 06/16/2014] [Indexed: 12/30/2022] Open
Abstract
Background The purpose of this scoping review was to describe how three tenants of patient-centered care provision: communication, partnership, and health promotion are addressed in patient-centered care models/frameworks across the literature. Methods A scoping review of literature published in English since 1990 was conducted using Medline, CINAHL, and EMBASE. A key term search strategy was employed using “patient-centered care”, “client-centered care”, “framework” and “model” to identify relevant studies. Results Application of the search strategy resulted in a hit total of 101 articles. Nineteen articles met inclusion criteria, of which 12 were review articles; 5 were qualitative research papers; one was a randomized control trial; and one was a prospective study. From these articles, 25 different patient-centered care frameworks/models were identified. Conclusions The fact that all identified approaches to patient-centered care incorporated strategies to achieve effective communication, partnership, and health promotion indicates that clinicians can select a patient-centered approach from the literature that best suits their patient’s needs, and be confident that it will satisfy the three core elements of patient-centered care provision. While empirical literature on specific patient-centric frameworks and models was limited, much empiric evidence was sourced for the most consistently defined component of patient-centered care, communication.
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Affiliation(s)
- Marissa K Constand
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, L8S 1C7, Hamilton, Ontario, Canada.
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Abstract
BACKGROUND During the course of Alzheimer's disease (AD), cognitive processes, including language and communication, become increasingly impaired. The aim of this review was to highlight the impact of communication deficits in AD, and discuss the need for effective treatments. METHOD PubMed was searched for studies relating to language and communication in AD. The publications identified were used as a basis for the commentary in this paper. Studies relating to the clinical effectiveness of pharmacological treatment for language and communication issues were identified systematically. RESULTS Communication deficits are common in AD. From the earliest disease stage, the patient's capacity for communication declines as problems develop with the use of language and all aspects of functional communication. There is a loss of the ability to communicate thoughts and needs, and it becomes increasingly difficult to interact socially and sustain personal relationships with caregivers, family, and friends. It is unsurprising that patients become frustrated at their loss of self-expression, and studies have demonstrated that impaired communication is strongly linked with the development of significant behavioral concerns. Overall, poor communication contributes to caregiver strain, and adds notably to the burden of disease. Clinical data and post-hoc analyses provide preliminary indications that anti-AD therapies (memantine and the cholinesterase inhibitors, ChEIs) and non-pharmacological cognitive-linguistic stimulation techniques may be helpful in addressing communication difficulties. CONCLUSIONS The capacity to treat or slow the progression of communication deficits in AD would prolong patient independence, and have a profound impact on the quality of life of patients and caregivers. The use of pharmacological (anti-AD therapies) and non-pharmacological (cognitive-linguistic stimulation) treatments may be useful management methods and warrant further investigation.
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Abstract
Social isolation is a key concern for individuals with dementia in long-term care. A possible solution is to promote social interaction between residents. A first step toward facilitating positive relationships between residents with dementia is to understand the mechanisms behind their interactions with each other, and also how their relationships with each other are built through such interactions. Drawing on casual conversations between residents in a special care unit for dementia, this paper uses systemic functional linguistics to examine how people with dementia use language to enact and construct their role-relations with each other. Results suggest people with dementia are able and willing conversationalists. However, factors such as the extent of communication breakdown and compatibility of the interlocutors may influence whether positive relations develop or not. Casual conversation is suggested to be a promising activity to encourage positive interpersonal processes between individuals with dementia in residential care.
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