School of Nursing
Respectful adult communication improves quality of care in Alzheimer's patients
Jul 28, 2008
Adults with Alzheimer's in nursing homes who are talked to like children are more likely to be resistive to care, according to research reported by Kristine Williams, RN, PhD, associate professor at the University of Kansas School of Nursing.
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| Kristine Williams, RN, PhD |
As effective pharmaceutical treatments and prevention for Alzheimer's remain elusive, researchers, including Williams, are focusing their efforts on improving quality of life and care – including communication.
"The style of communication that we use with people with Alzheimer's influences how they feel about themselves and how well they respond to those providing care," said Sam Fazio, PhD, Director, Medical and Scientific Relations at the Alzheimer's Association. "With the growing prevalence of Alzheimer's, it will be increasingly important for healthcare providers, caregivers and families to understand the effect Alzheimer's has on communication and, perhaps more importantly, the impact their communication may have on the individual's quality of life."
The growing population of adults with Alzheimer's presents complex challenges to care providers. Williams and colleagues at the KU School of Nursing explored the relationship between how nursing home staff communicates with those with dementia and subsequent behaviors that disrupt care, or resistiveness to care (RTC). Specifically, the study examined whether nursing staff "elderspeak" affected RTC behaviors.
The researchers defined elderspeak as overly caring, controlling and infantilizing communication, similar to "baby talk." Common features are simplified grammar and vocabulary, substitution of collective pronouns and overly intimate endearments.
RTC increases nursing staff stress, time needed to provide care and costs of care. At the same time, RTC may actually indicate unmet needs that the person with Alzheimer's is unable to communicate in a conventional way.
Twenty (20) nursing home residents with dementia were filmed during bathing, dressing, oral care and other care activities (2005-2006) and the sequences subsequently analyzed (2006-2008, and ongoing) for nursing staff communication (normal talk, elderspeak, or silence) and resident behavior (cooperative, resistive to care, or neutral). Residents and staff in Special Dementia Care Units in three skilled nursing facilities in Kansas were used for the study. The mean age of residents in the sample was 82.9 years, with a range of 69 to 97. Cognitive test scores indicated a relatively homogeneous sample in the moderate stage of dementia. Staff participants were primarily (78%) certified nursing assistants. The remaining staff participants included nurses, therapists, and social workers who were involved in direct care.
The probability of RTC behavior varied significantly with the type of nursing staff communication. Residents with dementia were more likely to resist care when nursing staff used elderspeak communication; they were more likely to cooperate with care when normal adult communication was used.
The Resistiveness to Care Scale (RTCS) is a measure of the occurrence of and intensity of behaviors of persons with dementia including those that disrupt care. It assesses 13 behaviors including grabbing objects, saying no, adduction [holding the arms or legs tight against the body], grabbing a person, pulling away, clenching teeth, crying, screaming, turning away, pushing away, hitting/kicking, threatening and moving the body in the opposite direction from staff. Each occurrence of the 13 RTC behaviors was scored by duration and intensity. The total RTC score was the sum of multiplying the duration of each incident by its observed intensity providing a weighted score within a possible range of 0 (no resistiveness) to 156 (maximum resistiveness).
When elderspeak communication was used, the probability of RTC was .55 (CrI = .44 - .66). In contrast, the probability of RTC was .26 (CrI = .12 - .44) when staff used normal adult communication. Silence resulted in a probability of .36 (CrI = .21-.55) for RTC.
"This study suggests that there is an association between communication style and resident behaviors," Williams said. "This may significantly impact nursing care and how nursing home staff should best be trained to communicate with residents with Alzheimer's. Future research is needed to test whether interventions that reduce nursing staff elderspeak communication will contribute to greater cooperation with care for persons with dementia.”
Williams is currently funded by the National Institutes of Nursing Research and Aging. She has a bachelor of science degree in nursing from Kent State University, a master of science degree in nursing from the University of Connecticut and was the first student to complete the Interdisciplinary PhD program in Gerontology from the University of Kansas, Lawrence.
To read the ABC News article or to view the story on Good Morning America, click on the following link:
http://abcnews.go.com/Health/ActiveAging/story?id=5452861&page=1
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