Caregiver Singing Intervention: do Emotions and Resistance differ between Vascular dementia and Alzheimer’s?

Persons with dementia in residential care commonly express resistance of aggressiveness. Caregivers Singing (CS) - when caregivers sing for or together with persons with dementia during caring, has shown to reduce these expressions and increase communication and cooperation. Previous studies of CS have included both persons with Alzheimer’s disease (AD) and persons with Vascular dementia (VD), but no studies have been done focusing on possible differences regarding these diagnoses. As disabilities and symptoms differ between these diagnoses, the emotions and expressions, such as resistance may differ regarding response to CS. This polit study aims to describe emotions and resistiveness to care among persons with vascular or Alzheimer’s disease. Participants were five persons with AD and five persons with VD living at two different nursing homes. Video observations (VIO) occurred with them and their caregivers during morning care situations four times without CS and four times with CS. In all, 80 VIOs were rated using the Observed Emotion Rating Scale and the Resistiveness to Care Scale. These were then analyzed with descriptive statistics. Results revealed that for both persons with AD and VD, the positive emotion pleasure were never observed without CS while with CS it increased for both groups. In contrast to the positive emotion effect of CS, the negative emotions and resistiveness decreased more for persons with VD than for persons with AD. For persons with VD, the number of observations without anger increased, while observation without anger or anxiety/fear for persons with AD remind the same.

The Effectiveness of FFC-AL-EIT on Psychosocial Outcomes and Care Interactions

This study included a subset of 59 communities and 550 residents from the full FFC-AL-EIT study. Participants were mostly white (98%), female (69%) and had a mean age of 89.30 (SD=7.63). Sites were randomized to the four step FFC-AL-EIT intervention implemented by a function focused care nurse facilitator working with a facility champion over 12 months versus education only. Resident measures included depression, agitation, resistiveness to care and the quality of care interactions and were obtained at baseline, 4 and 12 months. There was a significant positive treatment effect related to depression, agitation, resistiveness to care and quality of care interactions with either less decline or some improvement in these behaviors and symptoms and improvement in the quality of care provided between the treatment versus control group. The study suggests there is some benefit to implementing FFC-AL-EIT for psychosocial outcomes and care interactions among residents in assisted living communities.

The Influence of Staff-Resident Interactions on Resistiveness to Care Behavior in Assisted Living

Resistiveness to care (RTC) is a behavioral and psychological symptom of dementia that is common among dementia residents in assisted living facilities. RTC encompasses verbal and nonverbal behaviors that oppose care, such as crying, grabbing, hitting, or yelling, among many other resistive behaviors. The quality of care interactions which can be positive, neutral or negative, have been associated with increased RTC. The purpose of this study was to test the association between quality of care and RTC. This was a secondary data analysis using baseline data from the Function-Focused Care for Assisted Living Using the Evidence Integration Triangle (FFC-AL-EIT) implementation study. Controlling for cognition, age, gender, medication use, and comorbidities, it was hypothesized that quality of care interactions would be associated with resistiveness to care. A linear regression analysis was conducted to test the hypothesis. The sample included 794 participants the majority of whom were white women with a mean age of 89.48 (SD=7.61). The mean RTC was .09 (SD=.41, range 0-13) and the mean quality of care interactions were 5.96 (SD=1.44, range 0-7). Based on the regression analysis there was no significant association between quality of care and RTC. These findings may be due to the high quality of care provided and limited RTC in this sample. Ongoing research is needed, however, to continue to explore these relationships and assure that all RTC is being reported among staff and that there is no evidence of negative quality of care interactions in these settings.

Rejection of Care in Hospitalized Persons Living With Dementia: The Impact of Nurse Communication

Rejection of care (RoC) by persons living with dementia (PLWD) has yet to be measured in the hospital setting. Elderspeak communication (i.e., baby talk or infantilization) is an established antecedent to RoC in nursing home dementia care. The purpose of this study was to determine the impact of elderspeak communication by nursing staff on RoC by hospitalized PLWD. Eighty-eight care encounters between 16 PLWD and 53 nursing staff were observed for RoC using the Resistiveness to Care scale in one Midwestern hospital. Audio-recordings of the care encounters were transcribed verbatim and coded for semantic, pragmatic, and prosodic features of elderspeak. Over one-quarter (28.7%) of the duration of nursing staff speech towards PLWD constituted elderspeak and nearly all (96.6%) of the 88 care encounters included some elderspeak. Almost half of the observations (48.9%) included RoC behaviors by PLWD. Rejection of care was modeled as present or absent using a GEE method. Characteristics of the PLWD (e.g., pain, delirium) and the observation (e.g., environmental simulation) were evaluated as potential covariates. After adjusting for pain, length of stay, and gender, a 15-percentage point decrease in the proportion of elderspeak communication by nursing staff reduced the odds of RoC by 62% (OR=0.38, 95% CI=0.21-0.71, p=.002,) and a one unit decrease in pain reduced the odds of RoC by 63% (OR=0.37, 95% CI=0.22-0.63, p<.001). This study identified that pain and elderspeak are two modifiable factors of RoC. Person-centered interventions are needed that address communication practices and approaches to pain management for hospitalized PLWD.

Factors Associated With the Quality of Staff-Resident Interactions in Assisted Living

Care interactions are essential to understand and respond to resident needs in assisted living (AL). The factors that influence care interactions in AL have not been directly examined. In this study, we explored the factors associated with the quality of care interactions in AL. It was hypothesized that resident functional status, agitation, depression, and resistiveness to care as well as facility size and ownership would be significantly associated with the quality of care interactions in AL after controlling for resident demographics (age, gender, marital status), comorbidities, and cognition. To test the hypothesis, we utilized baseline data including 379 residents from the second and third cohorts recruited in a randomized trial titled ‘Dissemination and Implementation of Function Focused Care for Assisted Living Using the Evidence Integration Triangle’. Regression analysis was performed using a stepwise method. The care interactions were mostly positive (mean=6.3; range = 0-7). Resident agitation and facility ownership were significantly associated with care interactions and accounted for 8.2% of the variance. Increased resident agitation was associated with negative or neutral interaction while for-profit ownership was associated with positive interactions. To promote positive care interactions, staff should be educated about strategies to minimize resident agitation (e.g., calm posture and respectful listening) and encouraged to engage with residents using resident-centered care and communication approach. Findings also suggest the need to work towards optimizing care interactions in nonprofit stings. Future research could further explore the impact of facility-level factors (e.g., staffing ratios, staff longevity, and job satisfaction) on care interactions.

Behaviour-directed Interventions for Problematic Person Transfer Situations in Two Dementia Care Dyads: A Single-case Design Study

Background:Persons with dementia living in nursing homes need assistance with moving and transfers; however, caregivers assisting persons with dementia in their daily person transfers report strain-related and complicated transfer-related behavioural problems. The reciprocity of complex dyadic transfer-related behaviours is affected by environmental factors, the health status of the person with dementia and the caregiver’s skills and knowledge. The aim of this study was to explore tailored interventions guided by a functional behaviour analysis for problematic person transfer situations in two dementia care dyads.Methods:This study was a quasi-experimental single-case study with an A-B design. Tailored interventions were developed in a five-step model for functional behavioural analysis. The study was conducted in a dementia special care unit at a nursing home, and the inclusion criteria were caregivers’ experiences of physical strain and/or resistiveness to care, which led to complex transfer-related behaviour. Two care dyads were included. Transfer situations were video-recorded and evaluated with the Dyadic Interaction in Dementia Transfer Assessment Scale, Pain Assessment in Advanced Dementia Scale, and Resistiveness to Care Scale for Dementia of the Alzheimer’s Type. The caregiver experience was evaluated with study-specific items addressing caregiver self-efficacy, catastrophizing thoughts, perceived control, and perceived physical strain. Scorings were graphically displayed. The graphs were inspected visually to identify changes in trend, level, latency, and variability. Nonoverlap of all pairs (NAP), including 90% confidence intervals (CIs), was calculated to complement the visual inspection.Results:Verbal and nonverbal discomfort decreased in care dyad 1, which mirrored the caregiver changes in adapting their actions to the needs of the person with dementia. High variability was seen in both the intervention and the baseline phases in care dyad 2. In both care dyads, caregiver transfer-related behaviour improved significantly.Conclusions:The results indicate that the transfer-related behaviours of the care dyad might be improved through a behaviour-directed intervention tailored to meet the care dyad´s needs. The study is a replication of a previous study in a new clinical setting, which in turn strengthens the generalizability for a functional behavioural analysis-guided intervention for problematic transfer situations in dementia care dyads.

Understanding Elderspeak: An Evolutionary Concept Analysis

Background and Objectives Elderspeak is an inappropriate simplified speech register that sounds like baby talk and is used with older adults, especially in healthcare settings. Understanding the concept of elderspeak is challenging due to varying views about which communicative components constitute elderspeak and whether elderspeak is beneficial or harmful for older adults. Research Design and Methods Rodgers’ evolutionary concept analysis method was used to evaluate the concept of elderspeak through identification of elderspeak’s attributes, antecedents, and consequences. A systematic search using the PubMed, CINAHL, PsycINFO, and Embase databases was completed. Results Eighty-three theoretical or research articles from 1981 to 2020 were identified. Elderspeak characteristics were categorized by semantic, syntactic, pragmatic, paralinguistic, and nonverbal attributes. The primary antecedent to elderspeak is implicit ageism, in which old age cues and signs of functional or cognitive impairment led to simplified communication, usually from a younger caregiver. Research studies varied in reporting whether elderspeak facilitated or interfered with comprehension by older adults, in part depending on the operational definition of elderspeak and experimental manipulations. Exaggerated prosody, a key feature of elderspeak, was found to reduce comprehension. Elderspeak was generally perceived as patronizing by older adults and speakers were perceived as less respectful. In persons with dementia, elderspeak also increases the probability of resistiveness to care, which is an important correlate of behavioral and psychological symptoms of dementia. Discussion and Implications Based on this concept analysis, a new definition of elderspeak is proposed, in which attributes that have been found to enhance comprehension are differentiated from those that do not. Recommendations for consistent operationalization of elderspeak in future research are made.

Gender Differences in Disease, Function, and Behavioral Symptoms in Residents with Dementia

The purpose of this study was to consider gender differences in depressive symptoms, agitation, resistiveness to care, physical function, and use of psychotropic medications in older adults with moderate to severe dementia in nursing homes. Sixty-seven nursing homes and 889 residents from two states were included. The majority of the participants were female (n = 640, 72%) and White (n = 618, 70%) with a mean age of 86.58 years ( SD = 10.31). Differences by gender with regard to age, physical function, depressive symptoms, agitation/aggression, and resistiveness to care were tested using multivariate analysis of variance. Older females with moderate to severe dementia present with more depressive symptoms (anxiety, sadness, and somatic complaints) than males. Males present with more aggressive behavior and are more likely to receive anticonvulsants. Caregivers should focus on preventing and managing depressive symptoms including anxiety, sadness, and somatic complaints among older females and aggressive behavior in older males with dementia.

Reliability and Validity Testing of the Quantified Quality of Interaction Scale (QuIS)

Background and PurposeThe purpose of this study was to test the reliability and validity of the Quality of Interaction Survey (QuIS) using a quantification scoring approach.MethodsBaseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) study was used.ResultsA total of 553 residents participated. There was evidence of inter-rater reliability with Kappa scores of .86 to 1.00 and internal consistency based on the Rasch analysis (item reliability of .98). There was some support for validity based on item fit and hypothesis testing as resistiveness to care was significantly associated with total QuIS scores.ConclusionThis study supports the use of the quantified QuIS to evaluate the quality of interactions over time and to test interventions to improve interactions.