Elderspeak Communication: Impact on Dementia Care

Research documents that elderspeak is perceived as patronizing and can precipitate communication breakdown and problem behaviors for cognitively intact elders. In contrast, some social scientists promote the use of components of elderspeak to improve communication and cooperation in dementia care.  This study explored how LTC residents with dementia respond to nursing staff elderspeak communication, a measurable speech style similar to baby talk. The study aims were to determine the magnitude and direction of elderspeak effects on the behavior of persons with dementia and when it might comfort or contribute to problem behaviors.

Observational studies of nursing care for persons with dementia demonstrate that staff communication frequently precipitates problem behaviors. Such problem behaviors include measurable aggression, withdrawal, vocal outbursts, and wandering which occur in 75–90% of persons with dementia. These resistive problem behaviors result in disrupted care, adding to nursing stress, burnout, and turnover, and increase costs of care. Interventions to improve aspects of selected aspects of nursing communication have successfully reduced problem behaviors in dementia care. Reduction in staff elderspeak in previous studies has resulted in improved communication rated as less patronizing and more affirming.

This study used psycholinguistic, observational, and behavioral analyses to examine relationships between nursing staff elderspeak communication and resistiveness to care (RTC) behavior 16 of LTC residents with dementia. Video recordings of 80 nursing staff-resident interactions during ADLs were collected and analyzed to determine relationships between nursing staff elderspeak communication and resident RTC behavior. Frame-by-frame behavioral coding of nursing staff communication and resident RTC behavior tested the temporal relationships and probabilities of resident RTC following nursing staff communication (coded as elderspeak, normal talk, or silence).

CONCLUSIONS

This observational study supports a temporal relationship between nursing staff communication and resident RTC in dementia care. The likelihood of RTC behavior was significantly greater following use of elderspeak communication rather than normal talk or silence. If a randomly selected resident is in a care situation where nursing staff use elderspeak communication, the probability that the resident will exhibit RTC is significantly greater than under other communication conditions.

Because of the high frequency of elderspeak communication use by nursing staff and limited RTC behaviors in our sample, power was limited in establishing relationships. Contrary to previous research, persons with dementia in our sample did not exhibit differences in RTC behavior across care activities. This enabled us to combine the data across activities in a Bayesian model, increasing statistical power to detect relationships. Future research should be conducted to confirm whether the occurrence of elderspeak and RTC vary by care activity.

A temporal relationship between nursing staff use of elderspeak communication and resident RTC behavior was supported in this study. Silence resulted in higher probablities of RTC than normal talk, but a lower probability of RTC than elderspeak communication. Thus, elderspeak communication may be heard and understood by persons with dementia who may respond with RTC to indicate their unmet need for less patronizing, adult communication.

A research design that experimentally manipulates nursing staff communication and then assesses resulting resident RTC behaviors is essential to establish a true antecedent-consequent (cause and effect) relationship. Such ongoing research may provide strong evidence to guide communication practices in dementia care. Improved communication may better meet the needs and preferences of nursing home residents with dementia, as indicated in the Need-Driven Dementia-Compromised Behavior model.

This study included a limited sample of institutionalized older adults with dementia who consented to participate in videotaping in conjunction with their surrogate decision makers, and nursing staff. Although, nursing staff identified potential subjects who exhibited RTC for recruitment, RTC behaviors were relatively infrequent, especially for certain subjects. Other researchers have excluded subjects not demonstrating a minimal level of RTC behaviors. We included all subjects in our sample regardless of the occurrence of RTC behaviors of interest.

Considering the complexity of this data, advanced statistical techniques such as Generalized Estimating Equations (GEE) and Bayesian Heirarchical Modeling were essential approaches to analyze the clinically derived, behaviorally coded data. Future investgation of other complex nursing care problems and antecedent-consequent behaviors warrant continued used of advanced statistical techniques and inclusion of statistical experts on the research team.

In our examination of individual plots of behavioral changes in the 80 video clips, we noted that several residents tended to be always resistive or always cooperative, indicating that these residents may be less sensitive to communication as a trigger for RTC. Qualitative analysis of those residents exhibiting dynamic behavior within and between care interactions may provide additional clues to communication and other contextual factors that trigger RTC in selected individuals.

Our sample was limited by the homogeneity of the stage of dementia in the care recipients. Future research with larger samples is needed to examine the impact of dementia stage on RTC in response to staff communication. Of note, is that elderspeak use was frequent and that normal talk occurred infrequently.

This study suggests that nursing home residents with dementia are significantly more likely to exhibit RTC when nursing staff use elderspeak communication compared to normal adult talk. Reducing nursing staff use of elderspeak may better meet the needs of individuals with dementia, reduce resistiveness behaviors, and thus improve nursing care. Future research will evaluate whether an intervention empirically proven to decrease nursing home staff elderspeak use, will result in reductions in RTC behaviors of care recipients with dementia.

Read the original study in it’s entirety here on the NCBI.

Williams KN, Herman R, Gajweski B, Wilson K. Elderspeak Communication: Impact on Dementia Care. American journal of Alzheimer’s disease and other dementias. 2009;24(1):11-20. doi:10.1177/1533317508318472.