Abstract
Background: Nursing home (NH) residents with dementia exhibit challenging behaviors or resistiveness to care (RTC) that increase staff time, stress, and NH costs. RTC is linked to elderspeak communication. Communication training (CHAT) was provided to staff to reduce their use of elderspeak.
Hypothesis: We hypothesized that CHAT would improve staff communication and subsequently reduce RTC.
Methods: Thirteen NHs were randomized to intervention and control groups. Dyads (n = 42) including 29 staff and 27 persons with dementia (PWD) were videorecorded during care before and/or after the intervention, and at a three month follow-up. Videos were behaviorally coded for 1) staff communication (normal, elderspeak, or silence) and 2) resident behaviors (cooperative or RTC). Linear mixed modeling was used to evaluate training effects.
Results: On average elderspeak declined from 34.6% (SD = 18.7) at baseline by 13.6 percentage points (SD = 20.00) post-intervention and 12.2 percentage points (SD=22.0) at 3-month follow-up. RTC declined from 35.7% (SD = 23.2) by 15.3 percentage points (SD = 32.4) post-intervention and 13.4 percentage points (SD=33.7) at 3-months. Linear mixed modeling determined that change in elderspeak was predicted by the intervention (b = -12.20, p = .028) and baseline elderspeak (b = -0.65, p < .001) while RTC change was predicted by elderspeak change (b = 0.43, p < .001); baseline RTC (b = -0.58, p < .001); and covariates.
Conclusions: A brief intervention can improve communication and reduce RTC, providing an effective nonpharmacological intervention to manage behavior and improve the quality of dementia care. No adverse events occurred.