title: A Communication Intervention to Reduce Resistiveness in Dementia Care: A Cluster Randomized Controlled Trial.
abstract: Nursing home (NH) residents with dementia exhibit challenging behaviors or resistiveness to care (RTC) that increase staff time, stress, and NH costs. RTC is linked to elderspeak communication. Communication training (Changing Talk [CHAT]) was provided to staff to reduce their use of elderspeak. We hypothesized that CHAT would improve staff communication and subsequently reduce RTC.
  
  
  
  Thirteen NHs were randomized to intervention and control groups. Dyads (n = 42) including 29 staff and 27 persons with dementia were videorecorded during care before and/or after the intervention and at a 3-month follow-up. Videos were behaviorally coded for (a) staff communication (normal, elderspeak, or silence) and (b) resident behaviors (cooperative or RTC). Linear mixed modeling was used to evaluate training effects.
  
  
  
  On average, elderspeak declined from 34.6% (SD = 18.7) at baseline by 13.6% points (SD = 20.00) post intervention and 12.2% points (SD = 22.0) at 3-month follow-up. RTC declined from 35.7% (SD = 23.2) by 15.3% points (SD = 32.4) post intervention and 13.4% points (SD = 33.7) at 3 months. Linear mixed modeling determined that change in elderspeak was predicted by the intervention (b = -12.20, p = .028) and baseline elderspeak (b = -0.65, p < .001), whereas RTC change was predicted by elderspeak change (b = 0.43, p < .001); baseline RTC (b = -0.58, p < .001); and covariates.
  
  
  
  A brief intervention can improve communication and reduce RTC, providing an effective nonpharmacological intervention to manage behavior and improve the quality of dementia care. No adverse events occurred.
authors.affiliation: College of Nursing, University of Iowa.
authors.forename: Kristine N
authors.initials: KN
authors.lastname: Williams
authors.affiliation: College of Nursing, University of Iowa.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Perkhounkova
authors.affiliation: Center for Public Partnerships and Research, University of Kansas, Lawrence.
authors.forename: Ruth
authors.initials: R
authors.lastname: Herman
authors.affiliation: College of Nursing, University of Iowa.
authors.forename: Ann
authors.initials: A
authors.lastname: Bossen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D009735:Nursing Homes; D013060:Speech; D014743:Videotape Recording; D055815:Young Adult
keywords: Communication; Dementia; Problem behaviors