The purpose of this clinical trial is to test the effects of the Changing Talk (CHAT) communication training intervention for nursing staff on decreasing resistive behaviors of nursing home (NH) residents with dementia. Resistiveness to care (RTC) includes aggression, withdrawal, vocal outbursts, and other "problem behaviors" that occur in 75-90% of persons with dementia. These behaviors disrupt and lengthen daily care, adding to staff stress, burnout, and turnover, increasing the costs of care by 25-30%. RTC can occur due to unmet needs of persons with dementia and has been empirically linked to communication style. The PI's recent research found that NH residents with dementia were twice as likely to resist care when nursing staff used elderspeak communication;a common and measurable speech style similar to baby talk, compared to normal adult communication. CHAT reduced elderspeak use by staff in quasi-experimental NH studies. However, the effect of CHAT on staff elderspeak use and on subsequent resident RTC has never been empirically tested. The proposed randomized clinical trial study aims to establish causal evidence of CHAT's reduction in staff elderspeak use and subsequent lessening of RTC in residents with dementia. The primary specific aim of the proposed clinical trial is to test CHAT's effect on decreasing RTC of nursing home residents with dementia. The 3-hour CHAT intervention will be provided to nursing staff in NHs (N=16) randomly assigned to INTERVENTION or CONTROL groups. Costs for CHAT will be tabulated in ratio to hypothesized effects on the proportion of RTC behavior, time required for resident morning care, staff charting of RTC, staff satisfaction and efficacy, and quarterly NH turnover rates. Staff-resident dyads (N=80) will be video recorded during morning care before, immediately after, and 3- months post-intervention. As in past studies, each video taped care episode (N=720) will be coded for the frequency and duration of resident RTC using established behavioral coding analyses. Linear mixed modeling will compare between group differences in RTC, coded from video recordings of morning care immediately and 3 months after CHAT. Video episodes also will be used to verify staff enactment of CHAT skills using behavioral, emotional tone, and psycholinguistic coding of elderspeak. And as in prior studies, sequential time relationships between staff elderspeak and RTC will be tested. Costs to provide CHAT will be tabulated in ratio to between group differences in time required to complete resident morning care, RTC in staff charting, staff job satisfaction, and turnover rates. Facility, resident, and staff factors that influence effects of CHAT will be analyzed in multi-level statistical models. This clinical trial, based on the Need-Based Dementia-Compromised Behavior model, will use a unique combination of research strategies and sophisticated analyses to test an intervention with potential to reduce resident RTC. The long term goal of this research is to improve the quality of nursing care for persons with dementia while reducing costs.

Public Health Relevance

This study tests the effects of the Changing Talk (CHAT) communication training intervention for nursing home staff on the common and problematic resistiveness to care behaviors of nursing home residents with dementia. CHAT reduces nursing staff use of patronizing elderspeak communication, that was found to double the likelihood of resident resistiveness to care. Determination of CHATs effect on resident resistiveness to care will contribute evidence for nursing interventions to manage behavioral symptoms of dementia, to improve dementia care.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Research Project (R01)
Project #
Application #
Study Section
Nursing Science: Adults and Older Adults Study Section (NSAA)
Program Officer
Tully, Lois
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Iowa
Schools of Nursing
Iowa City
United States
Zip Code