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Identifying Effective CommunicatioN Strategies Utilized by Caregivers interacting with Individuals Diagnosed with Alzheimer’s disease

Keywords: Alzheimer’s disease, communication, caregiver, activities of daily living (ADL).

Overview of Research

Interest in communication processes and communication breakdown affiliated with Alzheimer’s disease (AD) has increased over the past decade largely due to the growing seniors demographic in Canada (increased incidences of AD), the increased understanding of the special circumstances of caregivers of persons with AD, and the societal costs of AD. Cognitive decline associated with AD, including language impairments, negatively affects the interaction between a caregiver and a care recipient. Specifically, language impairments associated with AD contribute to communicative challenges during the completion of activities of daily living (ADLs).

Difficulties in completing ADLs increase as problems related to language and memory decline progress. Sometimes it becomes difficult to remember the proper sequence of events that must occur during an activity, such as handwashing. Often a caregiver will give reminders or gestures to the person attempting the activity in order to guide him or her onto the next step. The use of these reminders has proven to be effective. However, the types of reminders and interactions that are used by caregivers have never been studied, and guidelines based on such data have not been published. Therefore, there is an overwhelming need to identify and utilize effective communication strategies during daily tasks that will increase the quality of life for both individuals with AD and their caregivers.

Currently, Rozanne Wilson, under the supervision of Dr. Rochon and Dr. Mihailidis is involved in research investigating individuals with dementia and their caregivers via videotaped communication interactions during basic ADLs (e.g., handwashing Figure 1 and Figure 2; and toothbrushing). Verbal and non-verbal behaviours of caregivers were systematically analysed to identify which communication strategies caregivers are actually using during task completion and which of these strategies are most frequently used during successful task completion. A coding scheme was developed to quantify the communication interactions and was motivated by findings from empirical research (Figure 3). Two studies have been completed for this PhD thesis project.

Study 1 examined caregivers’ use of communication strategies while assisting individuals with moderate to severe AD during successful completion of handwashing (Wilson, Rochon, Mihailids & Leonard, 2011. Manuscript accepted with minor revisions). Findings indicate that caregivers utilize a variety of verbal and non-verbal task-focused communication strategies. Specifically, the use of one proposition, closed-ended questions, paraphrased repetition, verbal praise, and us of the resident’s name were the most frequently used verbal strategies, while guided touch, demonstrating an action, pointing to an object, and handing an object to the resident were the top used non-verbal strategies.  Study 2 examined caregivers’ use of effective communication strategies while assisting residents with moderate to severe AD during completion of toothbrushing. Data analysis is currently underway for this project.

The results from this PhD thesis project will help to develop evidence-based guidelines on how to effectively assist a person with dementia during an ADL. In turn, the use of effective communication strategies can promote collaborative participation in daily tasks, which can support autonomy and dignity of individuals living with dementia. The findings will also help to develop optimal cues for future automated systems that might use a computer to monitor and prompt a patient.

Photo of sink   Photo of camera



Figure 1: a) Sink at test facility and b) position of camera over sink

Photo of subject washing her hands

Figure 2: Subject washing her hands while supervised by a caregiver (off screen to right)

Photo of transcription process

Figure 3: Example transcription of subject-caregiver interaction for later coding (click to enlarge)

Funding Sources

Doctoral Fellowship, CIHR Strategic Research and Training Initiative, Health Care, Technology, & Place (HCTP) (2010-2011)

Alzheimer Society of Canada (2008-2010)

Social Sciences and Humanities Research Council of Canada (SSHRC) (2005-2008)

Research Team

Rozanne Wilson, Ph.D. Candidate (University of Toronto)
Elizabeth Rochon, Ph.D. (University of Toronto)
Alex Mihailidis, Ph.D. P.Eng. (University of Toronto)