Synchronized Communication Between People with Dementia and their Volunteer Caregivers. A Video-Based Explorative Study on Temporal Aspects of Interaction and the Transfer to Education

Abstract

Processes of demographic change are leading to decreasing human resources in professional as well as lay care; this decrease necessitates new concepts of care, especially for the growing number of people with dementia (p.w.d.). Since the amendment to the German Care Insurance Law (2002), family carers have been entitled to regular weekly relief, provided by volunteers who have been given a thirty-hour-training. As difficulties in information processing in p.w.d. form an important part of the symptoms in dementia sufferers--with a high impact on communication as well as competent functioning in activities associated with daily life, we wanted to establish how much awareness and sensitivity voluntary attendants show in "tuning in" to the p.w.d. and her/his individual capacity to interact. In an exploratory study the authors analyzed videotaped interactions between volunteer caregivers and dementia-sufferers which were recorded in everyday situations during the process of ongoing care. Using methods of Video Interaction Analysis and Grounded Theory, we developed categories which describe how in tune the helpers are with the timing skills--or lack of them--of p.w.d.. We think that understanding the different ways in which p.w.d. structure their time can improve their communication and interaction. The categories --"speed and adjustment of speed", "mutuality" and "time control"--seemed crucial in understanding the subsequent course of the interactions. In a second step, these categories have recently been used by students and staff of the Lausitz University of Applied Sciences to provide training that sensitizes volunteer attendants to the topic and to learn about volunteers; judgement on the importance of continuing education in this field.

Conceptualizing attunement in dementia care: a meta-ethnographic review

“…In order to understand the person with dementia, the caregivers must be aware of the history, wishes and relations of the individual. Coates and Fossey (2016), Jost et al (2010), and Palmer (2013) described how caregivers attune to personhood in order to fulfil the person's needs: "The caregivers were attuned to the needs, desires, moods and concerns of their family members with dementia; thus, they were attuned to personhood" (Palmer, 2013, p. 224). Working with personhood involved acknowledging the needs and life story of the individual.…”

“…According to Häggström et al (1998) and Jost et al (2010), attunement is a process that guides the caregiver to an understanding of the person, their feelings, and needs. When applying attunement, the caregivers used emotionally loaded words, and actions such as singing, laughing and seeking physical contact in a timed structure (Häggström et al, 1998;Isaksson et al, 2013;Jost et al, 2010). For the caregivers to be able to involve themselves emotionally, it was essential that they felt safe in their working environment and that they were acknowledged professionally.…”

“…happened between the caregiver and the person with dementia, it created a feeling of reciprocity that could diminish isolation for the person and be deeply pleasing for the caregivers (Coates & Fossey, 2016;Häggström et al, 1998;Jost et al, 2010). Reciprocity also went the other way, and the caregiver might experience the negative emotions that the person with dementia encountered, which could be stressful for them (Coates & Fossey, 2016;Isaksson et al, 2013).…”

“…The moment of reciprocity between the person with dementia and the caregiver was characterized by shared focus and equality (Coates & Fossey, 2016;Häggström et al, 1998;Jost et al, 2010). The professional roles of helper and receiver dissolved, and an intersubjective atmosphere was created between them.…”

“…Even when the caregiver was not using music, there are musical elements in their interaction with the person with dementia. Adjustment of tempo when interacting was a central element of attunement according to Jost et al (2010), Häggström et al (1998), andJost et al (2010) described attunement in dementia care as: ". .…”