School of Health Studies, Western University.
Int J Lang Commun Disord. 2014 Jan-Feb;49(1):49-59. doi: 10.1111/1460-6984.12043. Epub 2013 Oct 24.
Communication problems stemming from Alzheimer's disease (AD) often result in misunderstandings that can be linked with problem behaviours and increased caregiver stress. Moreover, these communication breakdowns also can result either from caregivers' use of ineffective communication strategies, which paradoxically are perceived as helpful, or can occur as a result of not using effective communication strategies that are perceived as unhelpful.
The two primary aims were to determine the effectiveness of strategies used to resolve communication breakdowns and to examine whether caregivers' ratings of strategy effectiveness were consistent with evidence from video-recorded conversations and with effective communication strategies documented in the literature.
METHODS & PROCEDURES: Twenty-eight mealtime conversations were recorded using a sample of 15 dyads consisting of individuals with early, middle and late clinical-stage AD and their family caregivers. Conversations were analysed using the trouble-source repair paradigm to identify the communication strategies used by caregivers to resolve breakdowns. Family caregivers also rated the helpfulness of communication strategies used to resolve breakdowns. Analyses were conducted to assess the overlap or match between the use and appraisals of the helpfulness of communication strategies.
OUTCOMES & RESULTS: Matched and mismatched appraisals of communication strategies varied across stages of AD. Matched appraisals by caregivers of persons with early-stage AD were observed for 68% of 22 communication strategies, whereas caregivers of persons with middle- and late-stage AD had matched appraisals for 45% and 55% of the strategies, respectively. Moreover, caregivers of persons with early-stage AD had matched appraisals over and above making matched appraisals by chance alone, compared with caregivers of persons in middle- and late-stage AD.
CONCLUSIONS & IMPLICATIONS: Mismatches illustrate the need for communication education and training, particularly to establish empirically derived evidence-based communication strategies over the clinical course of AD.
源于老年痴呆症（AD）的沟通问题常常导致误解，这些误解可能与行为问题和增加的护理人员压力有关。此外，这些沟通障碍可能是由于护理人员使用无效的沟通策略造成的，而这些策略却被认为是有帮助的，也可能是由于没有使用被认为是无益的有效沟通策略而导致的。
两个主要目的是确定用于解决沟通障碍的策略的有效性，并检查护理人员对策略有效性的评价是否与视频记录的对话中的证据以及文献中记录的有效沟通策略一致。
使用包含 15 对个体（包括早期、中期和晚期临床阶段的 AD 患者及其家庭护理人员）的样本，记录了 28 个用餐时间的对话。使用故障源修复范式分析对话，以确定护理人员用于解决障碍的沟通策略。家庭护理人员还对用于解决障碍的沟通策略的有用性进行了评分。进行了分析，以评估使用和评估沟通策略的有用性之间的重叠或匹配。
在 AD 的不同阶段，匹配和不匹配的沟通策略评估有所不同。对于 22 种沟通策略中的 68%，早期 AD 患者的护理人员有匹配的评估，而对于中期和晚期 AD 患者的护理人员，匹配的评估分别为 45%和 55%。此外，与中期和晚期 AD 患者的护理人员相比，早期 AD 患者的护理人员的匹配评估超过了仅凭匹配评估的机会。
不匹配表明需要进行沟通教育和培训，特别是在 AD 的临床病程中建立基于经验的循证沟通策略。
