Interpersonal Communication in the Context of Dementia: Examining Family Caregivers\u27 Appraisals and Burden

Purpose and Objectives: The purpose of this study was to explore dementia family caregivers\u27 appraisals of communication behaviors and strategies, and their relationships to caregiver burden. Study objectives were to investigate: 1) the relationship between frequency of dementia-related communication behaviors and caregivers\u27 appraisals of frustration; 2) the relationship between caregivers\u27 use of communication strategies and appraisals of helpfulness; 3) the structural relationships between communication behavior appraisal, communication strategy appraisal, problem behaviors, and caregiver burden; and 4) caregiver education level as a moderating variable of the final structural model. Methods: A written, mailed questionnaire was developed to capture dementia family caregivers\u27 perceptions of communication behaviors, communication strategies, problem behaviors, and caregiver burden (N = 239). Results: Frequency and appraised frustration of the relatives\u27 communication behaviors were significantly correlated (rs = 0.631, p \u3c 0.001). Pairwise comparisons of frequency and appraisal revealed significant differences for 18 of 32 communication behaviors. The two behaviors rated highest for both frequency and frustration were: failure to retain instructions and repeated questions/comments. Frequency of use and appraised helpfulness of the caregivers\u27 communication strategies were also significantly correlated (rs = 0.631, p \u3c 0.001). Pairwise comparison of use and appraisal revealed strategy use was significantly greater than appraised helpfulness for 18 of 19 strategies. The two strategies rated highest for both use and helpfulness were: pay attention/actively listen and ask one question/give one instruction at a time. Results of structural equation modeling indicated that problem behaviors partially mediated the relationship between communication behavior appraisal and caregiver burden (z = 2.98, SE = 0.065, p \u3c 0.003). Caregivers\u27 education level did not moderate the mediated relationship. Caregivers\u27 appraisals of communication strategies did not predict problem behaviors or caregiver burden. Conclusions: Findings underscore the importance of understanding communication in the context of dementia family caregiving and dementia family caregivers\u27 perceptions of it. This study expands upon previous empirical investigations of the relationships between communication, problem behaviors, and caregiver burden

iPad use to Enhance Conversations between Persons with Dementia and their Family Caregivers

Electronic conversational memory notebooks, a more current application of previous hardcopy versions, consist of personally relevant photographs and accompanying sentences. The notebooks help persons with dementia access memories during conversations. Person-centred communication (PCC) recognizes the individual, accommodating for personal beliefs and intentions. The purpose of the current study was to determine whether persons with dementia and their family caregivers could be educated and trained to use PCC while using an iPad-based electronic conversational memory notebook. Seven persons with mild to moderate dementia and their family caregiver completed the six-week study. Participants were educated and trained to use PCC while conversing on 40 family photos uploaded to iPads. Results showed that persons with dementia and their family caregivers significantly increased PCC use post education and training. The findings indicate that conversing on family photos using an electronic conversational memory notebook can elicit PCC between persons with dementia and their family caregivers

Fostering Storytelling by Persons with Dementia in Multiparty Conversation

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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

Semantic 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

An interactional profile to assist the differential diagnosis of neurodegenerative and functional memory disorders

OBJECTIVE: Specialist services for dementia are seeing an increasing number of patients. We investigated whether interactional and linguistic features in the communication behavior of patients with memory problems could help distinguish between those with problems secondary to neurological disorders (ND) and those with functional memory disorder (FMD). METHODS: In part 1 of this study, a diagnostic scoring aid (DSA) was developed encouraging linguists to provide quantitative ratings for 14 interactional features. An optimal cut-off differentiating ND and FMD was established by applying the DSA to 30 initial patient-doctor memory clinic encounters. In part 2, the DSA was tested prospectively in 10 additional cases analyzed independently by 2 conversation analysts blinded to medical information. RESULTS: In part 1, the median score of the DSA was +5 in ND and -5 in FMD (P<0.001). The optimal numeric DSA cut-off (+1) identified patients with ND with a sensitivity of 86.7% and a specificity of 100%. In part 2, DSA scores of rater 1 correctly predicted 10/10 and those of rater 2 predicted 9/10 diagnoses. CONCLUSIONS: This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems

An Exploration of Dementia Friendly Communities from the Perspective of Persons Living with Dementia

The growing global prevalence of dementia coupled with a shift in public perception from a hopeless disease to the possibility of living well with dementia has led to the formation of dementia friendly communities (DFC). DFCs are a new phenomenon in the United States, with a gap in knowledge on input from people living with dementia (PLWD). This study investigated DFCs from the perspective of PLWD in Western North Carolina, with the following research questions: How are interactions and relationships experienced by persons living with dementia in the community? How is community engagement experienced by PLWD? To what extent and in what way is the impact of stigma associated with dementia? What are the attributes of a DFC from the perspective of PLWD? Eighteen older adults with reported dementia or memory loss were recruited from support groups or community organizations. Semi-structured interviews were conducted in participants’ homes and analyzed using conventional qualitative content analysis. Three major themes emerged from the transcribed interviews (a) transitions in cognition: vulnerable identities, (b) social connections, and (c) engagement in life activities. The dynamic experience of living with dementia revealed by participants suggested the following attributes of a DFC: (a) social inclusion, (b) support for role continuity, (c) availability of meaningful and contributory activities, (d) flexible support as cognition transitions, (e) community dementia awareness (to combat stigma), and (f) a supportive diagnostic process. The presence of care partners in the interviews was supportive, and the evaluation to sign consent tool assisted in determination of participant capacity to self-consent. The findings were interpreted through the theoretical frameworks of personhood, the social model of disability, human rights and citizenship, the environmental press model, and transitions theory. DFC development requires a contextual lens focused on well-being with input from multiple stakeholders including PLWD. Collaboration among community organizations supported by local, regional, and national policy supporting flexible service provision through cognitive transitions has the potential to provide a strong social network on which to build a DFC

Issues in the Development of Conversation Dialog for Humanoid Nursing Partner Robots in Long-Term Care

The purpose of this chapter is to explore the issues of development of conversational dialog of robots for nursing, especially for long-term care, and to forecast humanoid nursing partner robots (HNRs) introduced into clinical practice. In order to satisfy the required performance of HNRs, it is important that anthropomorphic robots act with high-quality conversational dialogic functions. As for its hardware, by allowing independent range of action and degree of freedom, the burden of quality exerted in human-robot communication is reduced, thereby unburdening nurses and professional caregivers. Furthermore, it is critical to develop a friendlier type of robot by equipping it with non-verbal emotive expressions that older people can perceive. If these functions are conjoined, anthropomorphic intelligent robots will serve as possible instructors, particularly for rehabilitation and recreation activities of older people. In this way, more than ever before, the HNRs will play an active role in healthcare and in the welfare fields

Exploring Male And Female Healthcare Provider Communication With Alzheimer’s Patients: A Qualitative Study

Indiana University-Purdue University Indianapolis (IUPUI)Today, Alzheimer’s is a devastating disease that affects more than 46.8 million people worldwide. Caring for people with AD is stressful and emotionally draining for both family members and healthcare providers and would be exacerbated by the breakdown in communication. While communication challenges can take many forms, one understudied area in AD patient-provider communication is how gender role might affect the outcomes and perceived feelings during interaction. Without knowledge and attentiveness of how gender may affect patient-provider communication, healthcare providers may become more frustrated in their attempts to apply unadjusted skills, which can cause further breakdown and stress. This study is to explore how gender might be a role affecting caregiving communication within the context of Alzheimer’s. Eleven participants were recruited to have a semi-structured interview through online flyers. The findings from this study yield broad suggestions for future work within the field of Alzheimer’s communication research and specific suggestions for designing the communication training

‘Till long-term care do we part’: Exploring the impacts of separating married couples on couplehood and well-being

This capstone project explores the impact of separating married couples when one spouse has dementia in long-term care settings. In particular, on couples’ abilities to maintain a sense of couplehood within the socio-physical environment of long-term care and its impacts on each spouse\u27s health and wellbeing. The theoretical perspectives of attachment theory and person-environment exchange are utilized to guide this project, providing a holistic and insightful approach to investigating spousal relationships in long-term care. The goals of this project are two-fold. First, a scoping review of the limited literature will be presented. Second, based on the Canadian Institute of Health Research (CIHR) Project Grant guidelines, a mock grant proposal was developed. The purpose of the grant is to critically examine the institutional practice of separating married couples in LTC settings in British Columbia when one spouse lives with dementia and requires more complex care and support. The proposed study will focus on couples\u27 abilities and challenges in maintaining their relationship within the LTC environment and the effects of separation on their health and wellbeing. Overall, this capstone project will help guide future research, practice, and policy in this important yet understudied topic in gerontology