Zorggroep Maas & Waal, Beneden-Leeuwen, the Netherlands.
Radboud university medical center, Department of Primary and Community Care, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.
Int J Lang Commun Disord. 2023 May;58(3):704-722. doi: 10.1111/1460-6984.12811. Epub 2022 Nov 17.
Communication difficulties are common in people with dementia, and often present from an early stage. However, direct treatment options for people with dementia that positively influence their daily communication are scarce.
To evaluate the potential impact and feasibility of a personalized logopaedic intervention.
METHODS & PROCEDURES: A total of 40 community-dwelling persons with dementia and their caregivers were recruited. Five experienced speech and language therapists (SLTs) delivered the six-session Com-mens intervention at home. Com-mens aims to improve positive communication between people with dementia and their primary caregivers and comprises five elements: interactive history-taking, dynamic observational assessment, education about the consequences of dementia on communication, development and use of personalized communication tools, use motivational, and person-centred strategies by the SLT. We conducted a single-group mixed-methods pilot study with five measurements: baseline, directly after intervention, and at 3, 6 and 9 months follow-up. Semi-structured interviews and questionnaires for Experienced Communication in Dementia, quality of life, psychological well-being and caregiver burden were conducted. Process evaluation was performed by interviewing participants, drop-outs, SLTs and other stakeholders.
OUTCOMES & RESULTS: A total of 32 dyads completed the intervention. Repeated measures analyses revealed no significant changes over time. In the interviews, participants reported a positive impact on their feelings, increased communication skills and better coping with the diagnosis. Participants would recommend the intervention to others. Facilitators were timely delivery, personalized content and adequate reimbursement. Barriers were unfamiliarity with Com-mens among referrers, an overburdened caregiver or disrupted family relationships.
CONCLUSIONS & IMPLICATIONS: This newly developed logopaedic intervention is feasible and has a perceived positive impact on both people with dementia and their caregivers, which is confirmed by a stable pattern over a period of 1 year. Future comparative studies are needed to test the effectiveness of personalized interventions in this patient population.
What is already known on the subject? SLTs are experts in the field of communication, but even though communication problems are common between people with dementia and their caregivers, there is a lack of logopaedic guidelines and materials for the direct treatment for this population. Interventions that are available either focus on (professional) caregivers only or aim to enhance cognitive functioning and do not target on joined communication. What this paper adds to the existing knowledge? A newly developed intervention called Com-mens can be provided by trained SLTs and takes an average of six 1-h sessions. The intervention is perceived to be valuable and feasible for people with dementia and their caregivers, by the participants themselves, as well as by healthcare professionals and other stakeholders. What are the potential or actual clinical implications of this work? Dissemination of this intervention will give SLTs skills, tools and materials to provide meaningful care to home-dwelling persons with dementia and their caregivers. Also, persons with dementia and their caregivers will receive education and materials that can help them increase their understanding of communication problems, enhance their communication skills and better cope with the communication problems that result from dementia. We consider the Com-mens intervention to be a valuable addition to the field of speech language therapy and dementia.
沟通困难在痴呆症患者中很常见，且通常从早期就出现。然而，直接针对积极影响他们日常沟通的痴呆症患者的治疗选择却很少。
评估个性化言语治疗干预的潜在影响和可行性。
共招募了 40 名居住在社区中的痴呆症患者及其照顾者。5 名经验丰富的言语治疗师（SLT）在家中提供六节的 Commens 干预。Commens 旨在改善痴呆症患者与其主要照顾者之间的积极沟通，包括五个要素：互动病史采集、动态观察评估、关于痴呆症对沟通影响的教育、个性化沟通工具的开发和使用、SLT 使用动机和以患者为中心的策略。我们进行了一项单组混合方法的试点研究，共进行了五次测量：基线、干预后直接测量，以及 3、6 和 9 个月的随访。进行了半结构化访谈和经验性沟通在痴呆症中的问卷、生活质量、心理幸福感和照顾者负担的评估。通过访谈参与者、脱落者、SLT 和其他利益相关者进行了过程评估。
共有 32 对完成了干预。重复测量分析显示，随着时间的推移没有显著变化。在访谈中，参与者报告说他们的感觉、沟通技巧和应对诊断的能力都有了积极的影响。参与者会向他人推荐该干预。促进因素包括及时交付、个性化内容和充足的报销。障碍包括转介者对 Commens 不熟悉、照顾者负担过重或家庭关系破裂。
这个新开发的言语治疗干预是可行的，对痴呆症患者及其照顾者都有感知到的积极影响，这在为期一年的时间里得到了稳定模式的证实。未来需要进行比较研究，以测试这种个性化干预措施在这一患者群体中的有效性。
关于该主题已经知道些什么？言语治疗师是沟通领域的专家，但即使痴呆症患者及其照顾者之间存在常见的沟通问题，针对这一人群的言语治疗指南和材料仍然缺乏。现有的干预措施要么只针对（专业）照顾者，要么旨在增强认知功能，而不是针对联合沟通。本文对现有知识有何新增内容？一项名为 Commens 的新干预措施可由经过培训的言语治疗师提供，平均需要进行六节 1 小时的课程。参与者本人以及医疗保健专业人员和其他利益相关者都认为该干预措施对痴呆症患者及其照顾者有价值且可行。这项工作的潜在或实际临床意义是什么？这种干预措施的传播将使言语治疗师具备为居家痴呆症患者及其照顾者提供有意义的护理的技能、工具和材料。此外，痴呆症患者及其照顾者将接受教育和材料，帮助他们更好地理解沟通问题，提高沟通技巧，并更好地应对痴呆症导致的沟通问题。我们认为 Commens 干预措施是言语治疗和痴呆症领域的一个有价值的补充。
