J. B. Orange

Communication and Dementia: Staff Perceptions of Conversational Strategies

Abstract This study examined the impact of two communication-enhancing strategies used on people with dementia. The strategies were manipulated using scripted staff-resident conversations that were evaluated by 71 long-term care staff participants. We hypothesized that vocal and nonverbal characteristics, along with their communication behaviors would be perceived more positively when staff members used personhood strategies compared to when they used directive language. We examined whether perceptions of the resident depicted identically in the scripts would be more positive in the personhood versus directive conversations. We also considered if simplified language and repetitions would affect the positive impact of personhood on perceptions of staff and residents. In support of our hypotheses, results showed that personhood strategies had positive effects on perceptions of staff and residents. Furthermore, simplified language enhanced those effects by showing staff as less patronizing and residents as more competent. Findings suggest that these strategies can enhance staff-resident interactions.

Evidencing Kitwood’s Personhood Strategies: Conversation as Care in Dementia

The purpose of this chapter is to highlight the communication and language strategies involved in key positive care interactions identified by Kitwood (1997a) as central to affirming personhood of individuals with dementia. We focus upon the enactment of these strategies in the challenging environment of long-term care. In these facilities, residents typically are in the moderate or severe stages of dementia; staff are necessarily task-oriented; and very little knowledge is available about the residents prior to disease onset. Communication features of the positive care interactions are illustrated through transcript selections from recorded conversations in a long-term care facility with one individual in the moderate stage of dementia. As person-centered conversations lead to reciprocity, contributions on the part of the person with dementia are also shown. The real value of the examples of positive care interactions is that they reinforce the position that individuals with dementia, even those who are in the more advanced stages, retain communicative competence and are active contributors to interpersonal relationships. Moreover, the examples serve to debunk the myth that individuals with dementia in long-term care facilities are nonfunctioning, passive communicators.

Communication Enhancement for Family Caregivers of Individuals with Alzheimer’s Disease

Family caregivers of individuals with dementia have been studied extensively over the past two decades by health and psychosocial care researchers representing a diverse range of professions and working in a variety of rehabilitation, long-term care and community settings. Speech-language pathologists, occupational therapists, communication specialists, nurses, social workers and psychologists, among other professionals, have all contributed to the extant literature regarding the experiences and needs of family caregivers of individuals with dementia. Given the expanding prevalence of dementia in the aging population worldwide, health and psychosocial care professionals are increasingly faced with the need to provide treatment to individuals with some form of dementia. These professionals are necessarily working in close proximity with family caregivers in community contexts because individuals with dementia continue to live at home and are usually cared for by a family member, typically a spouse (Canadian Study of Health and Aging Working Group 1994).

Combined impairments in vision, hearing and cognition are associated with greater levels of functional and communication difficulties than cognitive impairment alone: Analysis of interRAI data for home care and long-term care recipients in Ontario

Objectives The objective of the current study was to understand the added effects of having a sensory impairment (vision and/or hearing impairment) in combination with cognitive impairment with respect to health-related outcomes among older adults (65+ years old) receiving home care or residing in a long-term care (LTC) facility in Ontario, Canada. Methods Cross-sectional analyses were conducted using existing data collected with one of two interRAI assessments, one for home care (n = 291,824) and one for LTC (n = 110,578). Items in the assessments were used to identify clients with single sensory impairments (e.g., vision only [VI], hearing only [HI]), dual sensory impairment (DSI; i.e., vision and hearing) and those with cognitive impairment (CI). We defined seven mutually exclusive groups based on the presence of single or combined impairments. Results The rate of people having all three impairments (i.e., CI+DSI) was 21.3% in home care and 29.2% in LTC. Across the seven groups, individuals with all three impairments were the most likely to report loneliness, to have a reduction in social engagement, and to experience reduced independence in their activities of daily living (ADLs) and instrumental ADLs (IADLs). Communication challenges were highly prevalent in this group, at 38.0% in home care and 49.2% in LTC. In both care settings, communication difficulties were more common in the CI+DSI group versus the CI-alone group. Conclusions The presence of combined sensory and cognitive impairments is high among older adults in these two care settings and having all three impairments is associated with higher rates of negative outcomes than the rates for those having CI alone. There is a rising imperative for all health care professionals to recognize the potential presence of hearing, vision and cognitive impairments in those for whom they provide care, to ensure that basic screening occurs and to use those results to inform care plans.

Non-Alzheimer Dementias

Dementias, not attributable to Alzheimer’s disease, include a varied group of neurodegenerative disorders with myriad and diverse neuropathology and clinical features. Collectively, these disorders are often referred to as ‘non-Alzheimer’s dementias’ (non-AD dementias). Language impairments, at the single word and discourse levels, are becoming well documented in non-AD dementias and are recognized as having great impact on the use of language for social purposes. However, an emerging body of literature suggests that in addition to impairments in language form and content, social cognition deficits may manifest downstream as pragmatic language impairments. Moreover, socially inappropriate and disinhibited behaviours that are core to several subtypes of non-AD dementias may contribute significantly to pragmatic communication impairments. Given the importance of social communication and language use to quality of life for persons with non-AD dementias, their families, and carers, increasing our understanding of how discrete impairments in cognition, language, and behaviour affect pragmatic communication abilities is of paramount importance for both clinicians and researchers in fields of communication and dementia. This chapter undertakes a wide-ranging examination of the pragmatic communication abilities of persons with non-AD dementias, which is informed by research evidence and clinical experience.