Jeff A. Small

Personhood in dementia care Developing a research agenda for broadening the vision

Dementia has been understood primarily as a biomedical phenomenon with a trajectory of irrevocable decline related to neurodegenerative changes. However, growing evidence suggests that the performance and behaviour of persons with dementia are not exclusively determined by neuropathology but are also influenced by personal histories, social interactions and social contexts. This evidence shifts attention from the disease process to the need for a more in-depth understanding of the place of personhood in dementia care. Despite its intuitive appeal however, there is limited empirical research grounding this approach to care. This article articulates a framework for organizing research in this area that is based on a critical review and synthesis of research. It encompasses three interrelated and intersecting domains of inquiry: the subjective experience of the person with dementia, the immediate interactional environment and the broader socio-cultural context. Each domain encapsulates a unique but interrelated dimension of a person-centred approach to dementia care.

Communication between individuals with dementia and their caregivers during activities of daily living

Much previous research has focused on linguistic factors that can lead to communication breakdown in caregiver-patient interactions. However, the impact of such linguistic deficits on communication may vary depending on the context, goals, and complexity of the interaction. As a result, the likelihood of experiencing communication problems is expected to differ across different activities. In the present study, family caregivers of persons with dementia were asked to discuss communication challenges that they have experienced in a range of daily activities in the home. Four focus groups, involving a total of 22 caregivers, were conducted in community settings. The main goal of the focus groups was to identify specific daily activities in the home in which caregivers most often experience communication problems. The content of the focus groups was audio recorded and transcribed, and then coded and analyzed using qualitative and quantitative analytic techniques. The analyses focused on identifying trends across caregivers in which particular activities were noted as being prone to communication breakdown at different stages of the disease. Information about which activities are most communicatively challenging should assist caregivers in preparing for and adapting to these changes.

The Role of Conflict Resolution Styles on Nursing Staff Morale, Burnout, and Job Satisfaction in Long-Term Care

This study focuses on the ability of nursing staff to interact with residents in a way that affects positively on the nurses’ well-being and occupational satisfaction. It investigates the role of coping skills related to staff-resident interactions, in particular, the use of conflict resolution styles and their influence on the level of morale, burnout and job satisfaction of nursing professionals. A self-administered questionnaire was used to collect information from 161 direct care nursing staff. The authors used a multiple regression procedure to examine the influence of predictors on nursing staff outcomes. Multivariate analyses indicated that nurses’ psychological morale, occupational stress, and job satisfaction are influenced by conflict resolution styles, after controlling by individual characteristics, work demands, and work resources factors. The findings highlight the importance of considering personal coping abilities to foster positive staff-resident interactions and to increase nurses’ morale and job satisfaction.

A new frontier in spaced retrieval memory training for persons with Alzheimer's disease

The objective of this pilot study was to investigate how a memory training technique called “Spaced Retrieval” (SR) might be effectively applied in helping persons with Alzheimers disease improve their recall of recent events. Capitalising on the interdependence among spared and impaired memory systems, it was hypothesised that SR training with support at encoding and retrieval would facilitate the retention and recall of meaningful recent events. Eight participants with a diagnosis of Alzheimers disease or related disorder were recruited for this study. The study employed a quasi-experimental multiple baseline treatment design across participants, items, and behaviours. SR training was provided in three domains: Semantic, Prospective, and Episodic recent memory. The results show important training gains made by all participants across conditions at post-training follow-up. In the Episodic condition, participants were able to recall specific details about recent events following training. This study provides preliminary evidence that individuals with mild to severe cognitive impairment can learn and recall new episodic information through Spaced Retrieval training. If replicated, these findings would support the use of Spaced Retrieval as an intervention tool to help individuals maintain their functioning in the area of episodic recent memory.

Episodic and semantic memory influences on picture naming in Alzheimer's disease

This study investigated the relationship between semantic and episodic memory as they support lexical access by healthy younger and older adults and individuals with Alzheimers disease (AD). In particular, we were interested in examining the pattern of semantic and episodic memory declines in AD (i.e., word-finding difficulty and impaired recent memory) vis-à-vis more preserved remote memories. We administered a picture naming task in which the episodic period of the pictures and whether the pictured items were unique to one period or commonly used across periods were varied. Groups of younger adults (N=40), healthy older adults (N=20) and older adults with AD (N=18) were asked to name drawings of objects in four conditions: dated unique, contemporary unique, dated common, and contemporary common. The results indicated that all participants named items that were common to both episodic periods more successfully than items unique to one period. An interaction was observed such that the healthy older and AD groups were more successful in retrieving names of objects presented in the dated compared to contemporary unique conditions, whereas the younger adults showed the reverse pattern. These results indicate that naming ability is affected both by the cumulative frequency of using an item over a lifetime and by when an item was first acquired. The findings support a theoretical stance which proposes an enduring reciprocal link between semantic and episodic memory. This theoretical relationship has practical implications for the development of intervention strategies when interacting with persons who have AD.

Verbal and nonverbal indicators of quality of communication between care staff and residents in ethnoculturally and linguistically diverse long-term care settings

Linguistic and ethnocultural diversity in long-term residential care is a growing trend in many urban settings. When long-term care staff and residents do not share the same language or ethnocultural background, the quality of their communication and care are jeopardized. There is very little research addressing how staff and residents communicate when they experience a mismatch in their language and ethnocultural backgrounds. Thus, the goals of the present study were to 1) document the verbal and nonverbal behaviours used by staff and residents in diverse interactions, and 2) identify and account for behaviours that either promoted or detracted from positive communication by drawing on principles from ‘Communication Accommodation Theory’. Two long-term care facilities in British Columbia Canada were selected due to the diverse linguistic and ethnocultural backgrounds of their staff and residents. Twenty-seven staff and 27 residents consented to being video-recorded during routine activities (e.g., mealtimes, recreational activities). The recorded observations were transcribed, translated, and coded using qualitative descriptive and interpretive analyses. A number of verbal and nonverbal behaviours were identified and interpreted in relation to whether they promoted or detracted from positive communication. The findings point to considering a variety of proactive strategies that staff and administrators could employ to effectively accommodate to language and ethnocultural diversity in long-term care practice.

Perceptions of family caregivers' psychosocial behavior when communicating with spouses who have Alzheimer's disease.

The literature for caregivers of persons with Alzheimer s disease (AD) notes the importance of attending to the linguistic and psychosocial dimensions of communication. The objective of this study was to investigate the relationship between psychosocial aspects of caregivers’ behavior and communication outcomes for persons with AD and their spousal caregivers. In the first part of the study, we selected 40 segments of audio-recorded conversations between persons with AD and their spouses. We then asked 20 healthy seniors who were not caregivers to listen to and read the conversation segments and evaluate each segment along four psychosocial dimensions. They were also asked to independently rate how smooth the communication was in each segment. We hypothesized that when caregivers’ speech is perceived to be respectful, caring, not controlling, and/or it ascribes competence to their spouses, it would be associated with more effective communication. Our results supported these hypotheses in that communication was more likely to be rated higher in smoothness when the content and manner of caregivers’ speech were perceived to have positive psychosocial qualities. The findings have implications for training caregivers on effective psychosocial behavior when interacting with persons who have AD.

The Role of Caregiver Prosody in Conversations With Persons Who Have Alzheimer’s Disease

This research was supported in part by funding from the British Columbia Medical Services Foundation (BCM02-0115). The funding source had no role in the design, methods, participant recruitment, data collection, interpretation of the study, or in the preparation of the manuscript for publication. Approval for the study was granted by the University of British Columbia Behavioural Ethics Review Board, and participants provided informed consent. This study investigated whether aspects of family caregivers’ prosody (pitch and loudness) would be associated with successful or unsuccessful conversations with spouses who have Alzheimer’s disease (AD). Secondary analysis was conducted of 12 caregivers’ speech when interacting with spouses who have AD. Acoustic analyses were conducted to calculate the fundamental frequency (pitch) and intensity (loudness) of caregivers’ speech. The results showed no significant overall differences between the caregivers’ pitch or loudness in either successful or unsuccessful conversations. However, for 1 subgroup of caregivers, an increase in pitch variation and loudness was associated with unsuccessful communication, whereas for another subgroup the opposite pattern was observed—reduced pitch variation and loudness with unsuccessful communication. The results provide preliminary directions for helping family caregivers become aware of how characteristics of their speech prosody may relate to the quality of communication when interacting with persons who have AD.

The Effect of a Community-Engaged Arts Program on Older Adults' Well-being

Cette étude utilisant des méthodes mixtes a évalué l’effet d’un programme d’arts communautaires engagés sur le bienêtre physique, émotionnel et social des personnes âgées. Ateliers hebdomadaires ont été offerts pendant une période de trois ans dans des centres communautaires où les artistes ont collaboré avec quatre groupes de personnes âgées pour produire une oeuvre d’art collective ou la performance d’une présentation publique. Les participants ont rempli questionnaires avant et après et des entretiens de groupe ont été menées à la fin du programme. Des analyses t-test appariés ont indiqué que les personnes âgées ont connu une amélioration perçue dans leur état de santé générale, l’expérience de la douleur, et le sens de la communauté. Une analyse descriptive et intérpretative des entretiens de groupe a révélé six thèmes qui ont éclairé la compréhension: (1) fournissant de la structure et de la discipline; (2) facilitant l’adaptation; (3) nécessitant un travail acharné et des efforts; (4) faisant ressortir son côté artistique; (5) la promotion de la participation sociale; et (6) apportant une contribution. Ces résultats concordent avec les recherches antérieures et contribuent à une meilleure compréhension de la façon dont les arts communautaires engagés peuvent favoriser le bien-être des personnes âgées. This mixed-methods study evaluated the effect of a community-engaged arts program on the physical, emotional, and social well-being of seniors. Weekly workshops were offered over a three-year period at community centers where artists worked with four groups of seniors to produce a collective art piece or performance for public presentation. Participants completed pre- and post- questionnaires, and group interviews were conducted at the program’s end. Paired t-test analyses indicated that seniors experienced improvement in perceived overall health, experience of pain, and sense of community. Interpretive descriptive analysis of the group interviews revealed six themes that informed understanding: (1) providing structure and discipline; (2) facilitating coping; (3) requiring hard work and effort; (4) bringing out one’s artistic side; (5) promoting social involvement; and (6) making a contribution. These results are consistent with previous research and contribute to further understanding of how community-engaged arts can benefit the well-being of older people.

Lexical activation effects on children's sentence planning and production

We investigated the relationship between lexical activation and syntactic planning in childrens sentences. Four- and 7-year-old children described transitive scenes following patient-related prime pictures and control pictures. We examined syntactic choices, and compared onset latency, sentence length, and dysfluency rates for active transitive sentences in the two conditions. Early activation of the patient in the primed condition did not lead to the production of patient-subject sentences, but it did have consequences for active transitive sentence production. Namely, onset latencies were longer and sentences were shorter in the primed condition. Dysfluency rates did not differ between the two conditions. Correlation analyses revealed a stronger pattern of association between working memory scores and language variables in the patient-primed condition. The results indicate that conflicts between lexical activation order and syntactic plans are a source of processing difficulty during childrens sentence production.