A Communication Intervention to Reduce Resistiveness in Dementia Care: A Cluster Randomized Controlled Trial

Abstract

Purpose of the study: 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 (Changing Talk [CHAT]) was provided to staff to reduce their use of elderspeak. 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 were videorecorded during care before and/or after the intervention and at a 3-month follow-up. Videos were behaviorally coded for (a) staff communication (normal, elderspeak, or silence) and (b) 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% points (SD = 20.00) post intervention and 12.2% points (SD = 22.0) at 3-month follow-up. RTC declined from 35.7% (SD = 23.2) by 15.3% points (SD = 32.4) post intervention and 13.4% 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), whereas RTC change was predicted by elderspeak change (b = 0.43, p < .001); baseline RTC (b = -0.58, p < .001); and covariates.

Implications: 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.

Trial registration: ClinicalTrials.gov NCT01324219.

Keywords: Communication; Dementia; Problem behaviors.

© The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Figures

Figure 1.

Consort diagram.

Figure 2.

Mean elderspeak and resistiveness to care at three time points prior to the intervention and two time points after the intervention, for all dyads available at a given time point.

Figure 3.

Conceptual model of the effects of the Changing Talk intervention and covariate factors on reductions in elderspeak and resistiveness to care. Some coefficient signs were reversed for clinical interpretation.