The growing population of persons with dementia presents challenges to providing high quality nursing home (NH) care. Care is complicated by behavioral and psychosocial symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur as persons with dementia lose cognitive and communication abilities and cannot verbally express unmet physical and psychosocial needs. NH staff use ?elderspeak,? speech similar to baby talk, which is demeaning to residents. Residents react to elderspeak with BPSD resulting in increased use of psychotropic medication to control BPSD, higher staffing needs, more staff stress and turnover, and increased costs. The Changing Talk (CHAT) training program educates staff about elderspeak and better communication strategies and is proven to reduce staff elderspeak and BPSD in NH residents. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. CHAT training Online (CHATO) can improve access for busy staff and those in rural and small NHs to increase dissemination across care settings to improve dementia care. This 1-year R34 Clinical Trial Planning Grant will prepare for a future clinical trial (in response to PA- 17-014, Addressing Unmet Needs in Persons with Dementia to Decrease Behavioral Symptoms and Improve Quality of Life) that will test the effects of CHATO training on resident BPSD in 120 NHs. The R34 project will orient our multidisciplinary research team to address new aims; recruit and enroll NHs; develop the clinical trial protocol, manual of operations, study documents, and data forms; solidify plans for data management and sharing and fidelity assurance, and obtain IRB approvals. The feasibility of an elderspeak feedback app for staff that may improve CHATO effects will also be demonstrated in the NH to prepare for the clinical trial. In the planned R01 clinical trial, 120 NHs will be randomized to the CHATO training group or to the control group. BPSD data, extracted from the Center for Medicare and Medicaid Services Nursing Home Compare and Minimum Data Set, will be compared using linear mixed modeling. NH strategies used to engage staff in CHATO (paid time off, recognition) and costs for various approaches will be identified. The effects of a self-monitoring app that uses natural language processing to give staff immediate feedback on their elderspeak use will be tested. This research addresses NINR's symptom management and caregiver support missions, NIA's milestones for nonpharmacological dementia care interventions, the National Plan to Address Alzheimer's Disease goal to enhance care quality and efficiency, and the Alzheimer's Association Plan to build a workforce with high-quality care skills. The potential for reducing inappropriate use of psychoactive medications to control BPSD will be explored, addressing the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons diagnosed with dementia triples in the next 30 years, empowering care providers to provide high quality care for individuals with dementia is of critical importance.
The National Plan to Address Alzheimer's disease has identified education of dementia care providers as a top priority to address the need for quality care for the population of persons with dementia that will triple in the next 30 years. This R34 clinical trial planning grant will prepare for a future clinical trial testing online interactive communication training for nursing home staff that reduces ineffective elderspeak communication and behavioral and psychological symptoms of persons with dementia. Innovative approaches to reach care providers are essential to achieve implementation of evidence-based practices to improve dementia care.
