Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use

Shaw, Clarissa; Williams, Kristine; Perkhounkova, Yelena

doi:10.1016/j.jamda.2018.09.030

Cited by 30 publications

(21 citation statements)

References 21 publications

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“…Following training, elderspeak by formal caregivers declined by 13.6 percentage points and resistiveness to care by residents with dementia declined by 15.3 percentage points. In a follow-up analysis, nursing homes that received training demonstrated a reduction in antipsychotic medication administration relative to statewide medication rates ( Shaw et al, 2018 ). These findings reflect the negative impact that elderspeak can have on the well-being of persons with dementia and the potential for training to ameliorate this effect.…”

Section: Resultsmentioning

confidence: 99%

Understanding Elderspeak: An Evolutionary Concept Analysis

Shaw

Gordon

2021

Innovation in Aging

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Background and Objectives Elderspeak is an inappropriate simplified speech register that sounds like baby talk and is used with older adults, especially in healthcare settings. Understanding the concept of elderspeak is challenging due to varying views about which communicative components constitute elderspeak and whether elderspeak is beneficial or harmful for older adults. Research Design and Methods Rodgers’ evolutionary concept analysis method was used to evaluate the concept of elderspeak through identification of elderspeak’s attributes, antecedents, and consequences. A systematic search using the PubMed, CINAHL, PsycINFO, and Embase databases was completed. Results Eighty-three theoretical or research articles from 1981 to 2020 were identified. Elderspeak characteristics were categorized by semantic, syntactic, pragmatic, paralinguistic, and nonverbal attributes. The primary antecedent to elderspeak is implicit ageism, in which old age cues and signs of functional or cognitive impairment led to simplified communication, usually from a younger caregiver. Research studies varied in reporting whether elderspeak facilitated or interfered with comprehension by older adults, in part depending on the operational definition of elderspeak and experimental manipulations. Exaggerated prosody, a key feature of elderspeak, was found to reduce comprehension. Elderspeak was generally perceived as patronizing by older adults and speakers were perceived as less respectful. In persons with dementia, elderspeak also increases the probability of resistiveness to care, which is an important correlate of behavioral and psychological symptoms of dementia. Discussion and Implications Based on this concept analysis, a new definition of elderspeak is proposed, in which attributes that have been found to enhance comprehension are differentiated from those that do not. Recommendations for consistent operationalization of elderspeak in future research are made.

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Section: Resultsmentioning

confidence: 99%

Understanding Elderspeak: An Evolutionary Concept Analysis

Shaw

Gordon

2021

Innovation in Aging

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“…A recent randomized controlled trial in 11 nursing homes found that an intervention to simply increase person-centered communication led to a nearly 23% decrease of antipsychotic prescribing over 6 months of follow-up. 34…”

Section: Conceptualizing Behaviors As Expressions and Focusing On Behavioral Supportmentioning

confidence: 99%

What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia? Guidance from The Alzheimer's Association Dementia Care Provider Roundtable

Fazio

Zimmerman

Doyle

et al. 2020

Journal of the American Medical Directors Association

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“…18 An educational program, trying to enhance communication in nursing home dementia care, increased person-centered communication by staff and resulted in reduced resistiveness to care and in decreased use of antipsychotics. 19 The second factor is the care that is being provided. A resident may resist the type of care that he/she is not used to, for example, shower bath.…”

Section: Reactive Aggression In Dementiamentioning

confidence: 99%

Section: Reactive Aggression In Dementiamentioning

confidence: 99%

Importance of Distinguishing Reactive and Proactive Aggression in Dementia Care

Volicer

2020

J Geriatr Psychiatry Neurol

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Aggressive behavior is one of the most disturbing symptoms of Alzheimer disease and other progressive neurodegenerative dementias. Development of strategies for management of aggressive behaviors in people with dementia is hindered by a lack of recognition that aggression is not a uniform behavioral construct. It is possible to distinguish 2 types of aggression: reactive or impulsive aggression and proactive or premeditated aggression. Research concerning aggressive behaviors in people with dementia is hindered by scales describing behavioral symptoms of dementia which do not distinguish between reactive and proactive aggressions because they do not consider the factors leading to these behaviors. Reactive aggression is caused by lack of understanding, leading to rejection of care, while proactive aggression could be caused by a psychopathic personality, hallucinations or delusions, and other determinants. It is difficult to underestimate the importance of distinguishing reactive and proactive aggressions in people with dementia because there are different strategies that can be used for management of these behaviors. For reactive aggression, delayed treatment, distraction, improved communication, and change in treatment strategy is useful, while antipsychotic medication may be needed for treatment of proactive aggression. Dementia is increasing the risk of both types of aggressions and antidepressant treatment can be helpful. Most importantly, persons exhibiting reactive aggression should not be labeled “aggressors” because this behavior could be caused by unmet persons’ needs, pain and poor communication with care providers.

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Educating Nursing Home Staff in Dementia Sensitive Communication: Impact on Antipsychotic Medication Use

Cited by 30 publications

References 21 publications

Understanding Elderspeak: An Evolutionary Concept Analysis

Understanding Elderspeak: An Evolutionary Concept Analysis

What Is Really Needed to Provide Effective, Person-Centered Care for Behavioral Expressions of Dementia? Guidance from The Alzheimer's Association Dementia Care Provider Roundtable

Importance of Distinguishing Reactive and Proactive Aggression in Dementia Care

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