College of Nursing, University of Iowa.
Center for Public Partnerships and Research, University of Kansas, Lawrence.
Gerontologist. 2017 Aug 1;57(4):707-718. doi: 10.1093/geront/gnw047.
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.
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.
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.
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.
养老院（NH）中患有痴呆症的居民表现出具有挑战性的行为或抗拒护理（RTC），这增加了员工的时间、压力和 NH 成本。RTC 与长者说话有关。为了减少员工使用长者说话，向员工提供了沟通培训（改变说话[CHAT]）。我们假设 CHAT 将改善员工沟通，随后减少 RTC。
13 家 NH 被随机分为干预组和对照组。在干预前和/或干预后以及 3 个月随访期间，对包括 29 名员工和 27 名痴呆症患者在内的 42 对员工进行录像。对视频进行了行为编码，用于（a）员工沟通（正常、长者说话或沉默）和（b）居民行为（合作或 RTC）。线性混合模型用于评估培训效果。
平均而言，长者说话从基线时的 34.6%（SD = 18.7）下降了 13.6 个百分点（SD = 20.00），干预后下降了 12.2 个百分点（SD = 22.0），3 个月随访时下降了 12.2 个百分点（SD = 22.0）。RTC 从基线时的 35.7%（SD = 23.2）下降了 15.3 个百分点（SD = 32.4），干预后下降了 13.4 个百分点（SD = 33.7），3 个月时下降了 13.4 个百分点（SD = 33.7）。线性混合模型确定，长者说话的变化由干预（b = -12.20，p =.028）和基线长者说话（b = -0.65，p <.001）预测，而 RTC 的变化由长者说话的变化预测（b = 0.43，p <.001）；基线 RTC（b = -0.58，p <.001）；和协变量。
简短的干预可以改善沟通，减少 RTC，为管理行为和提高痴呆症护理质量提供有效的非药物干预措施。没有发生不良事件。
