Persons with dementia (PWD) are twice as likely to be hospitalized compared to cognitively intact older adults, and while hospitalized experience significantly more hospital related complications, have quadruple the length of stay, and accrue triple the annual inpatient costs. Persons with dementia often exhibit behavioral and psychological symptoms of dementia during hospitalization, with aggression being the most common form. When PWD are acutely-ill and requiring around-the-clock care, it is essential that nursing staff be able to complete care using person-centered approaches. Challenging behaviors exhibited during care are termed resistiveness to care (RTC) and leave patients at risk for neglect and caregivers at risk for strain. Effective communication by nursing staff is critically important in preventing RTC and to facilitate care completion while maintaining personhood in PWD. In long-term care, the use of elderspeak communication (i.e. baby talk) by care staff doubles the probability of RTC in PWD. Elderspeak markers are broad and include a variety of linguistic adjustments in rhythm, sound, syntax, and meaning. Despite the known detrimental impact of elderspeak communication on PWD in long-term care, elderspeak has yet to be explored in acute care where PWD remain at risk for health and quality related complications.
The aims of this cross-sectional study taking place in the acute care setting are to: 1) identify and characterize elderspeak communication when enacted by nursing staff during the provision of care to PWD, and 2) determine the association between elderspeak communication by nursing staff and RTC in PWD during dyadic care interactions. Nursing staff will be audio-recorded during care interactions and behavioral and psycholinguistic coding of recordings and transcripts will be used to identify and describe elderspeak. Co-occurring observations will be performed to evaluate RTC in PWD using the valid and reliable RTC Scale. Interventions targeting enhanced dyadic communication have been successful in improving communication and reducing behavioral symptoms in long-term care, yet there is a lack of research characterizing and testing interventions to improve communication in acute care. This study will provide preliminary evidence for the need to adapt and implement and educational intervention for elderspeak reduction and improved communication in the acute care setting. The proposed research and training will cultivate knowledge growth and skills related to research methods, expertise in dementia care, dissemination, and professional development through a variety of activities and mentorship from an expert team. The proposed research aligns with NINR's mission to improve health and quality of life by identifying antecedents to behavioral symptoms of dementia and will identify the need for a nonpharmacological intervention for acute care focused on improved communication to prevent RTC in PWD.
Behavioral symptoms of dementia, like aggression, are common during hospitalizations. Nurse communication during care interactions can have a direct impact on resistive dementia behaviors. Understanding how nurse communication in the acute care setting impacts resistiveness in dementia will aid in the development of non-pharmacological interventions to prevent resistive behaviors and improve the health and well-being of patients with dementia while hospitalized.
