[Communication training for family caregivers of dementia patients]

[The method of "town hall talks": a study protocol]

BACKGROUND AND AIM

Society is responsible for strengthening "caregiver-sensitive" communities based on the principle of social services to the public and are thus oriented towards the appreciation of caring relatives (CR) of people with dementia (PwD), their capability for self-care and participation. This requires methods to emphasize the social value of informal care and to re-evaluate existing support services. The article aims to present the method of "town hall talks".

METHOD

In 20 communities throughout Germany a public town hall talk in which CR, actors in the community (AC) and the citizens enter into a dialogue, was conducted. In three moderated discussion groups the question of communal responsibility for the provision of resources was addressed. These resources should encourage the CR ability of self-care as well as strategies for their support. In order to make a statement regarding the success of the project planning, three pilot town hall talks were evaluated.

PREVIOUS RESULTS

The recruitment of the population sample and the organization of the town hall talks in particular are administratively and logistically challenging. The project can only be successful through networking and intensive cooperation between scientists and the communities. In terms of content and logistics, the project planning of the pilot town hall talks was successful. The method received excellent ratings from the majority of the CR and AC.

CONCLUSION

Regarding the creation of caregiver-sensitive communities the town hall talks promise great potential. The specific benefit of the method for the CR and the community will be examined.

CODEMamb - an observational communication behavior assessment tool for use in ambulatory dementia care

INTRODUCTION

Communication improves well-being and quality of life for both people with dementia and their professional and family caregivers. Individualized communication, as required in informed consent procedures and psychosocial interventions, can improve quality of life, especially in ambulatory settings. However, few valid and reliable instruments exist that enable communication to be assessed and communication and behavioral resources to be identified. We, therefore, extended and adapted the newly developed observational instrument CODEM for use in ambulatory settings (CODEM_amb).

METHODS AND RESULTS

Reliability and validity of the new instrument were studied in a total of 171 patients, whereby principal component analysis revealed three important factors: relationship aspects, verbal communication behavior and nonverbal communication behavior. CODEM_amb[Formula: see text]s internal consistency, interrater and retest reliability were satisfactory to excellent. Convergent validity indices, as shown by examining correlations with similar but not identical constructs (CERAD-NP verbal subscales), were medium-high, while the divergent validity index (constructional praxis) was relatively low. The relationship to peer-rating remained nonsignificant. Criterion validity was investigated in groups of patients in accordance with their cognitive status. As expected, verbal communication abilities deteriorate faster than the relationship aspects of communication as the disease progresses.

CONCLUSIONS

In summary, CODEM_amb is a reliable and valid instrument that can be used to collect important information with the ultimate aim of supporting communication with people with dementia.

Living with mild to moderate Alzheimer patients increases the caregiver's burden at 6 months

The objective of our study was to demonstrate that living with a person affected by mild to moderate Alzheimer's disease can lead to an increased perception of the caregiver's burden using the Caregiver Burden Inventory (CBI). The sample consisted of 153 dyads, caregiver-patient. At baseline, a greater perception of the caregiver's burden was observed in the live-in caregivers. A further increase in the total burden of the live-in caregivers was noticed at the 6-month follow-up. More specifically, with the inclusion of correction factors such as the caregiver's age and the CBI subscales at baseline, the social and emotional burden becomes statistically significant (P < .001). The present paper confirms our hypothesis that live-in caregivers perceive a greater burden than nonlive-in, and this difference increases further after 6 months. The difference in involvement between live-in and nonlive-in caregivers could be the foundation to tailor more specific interventions.

Communication skills training in dementia care: a systematic review of effectiveness, training content, and didactic methods in different care settings

BACKGROUND

Caring for and caring about people with dementia require specific communication skills. Healthcare professionals and family caregivers usually receive little training to enable them to meet the communicative needs of people with dementia. This review identifies existent interventions to enhance communication in dementia care in various care settings.

METHODS

We searched MEDLINE, AMED, EMBASE, PsychINFO, CINAHL, The Cochrane Library, Gerolit, and Web of Science for scientific articles reporting interventions in both English and German. An intervention was defined as communication skills training by means of face-to-face interaction with the aim of improving basic communicative skills. Both professional and family caregivers were included. The effectiveness of such training was analyzed. Different types of training were defined. Didactic methods, training content, and additional organizational features were qualitatively examined.

RESULTS

This review included 12 trials totaling 831 persons with dementia, 519 professional caregivers, and 162 family caregivers. Most studies were carried out in the USA, the UK, and Germany. Eight studies took place in nursing homes; four studies were located in a home-care setting. No studies could be found in an acute-care setting. We provide a list of basic communicative principles for good communication in dementia care. Didactic methods included lectures, hands-on training, group discussions, and role-play.

CONCLUSION

This review shows that communication skills training in dementia care significantly improves the quality of life and wellbeing of people with dementia and increases positive interactions in various care settings. Communication skills training shows significant impact on professional and family caregivers' communication skills, competencies, and knowledge. Additional organizational features improve the sustainability of communication interventions.

TANDEM: Communication training for informal caregivers of people with dementia

OBJECTIVES

Dementia increasingly diminishes the ability to communicate. We aimed to develop and evaluate a psychosocial intervention program that focuses on communication in dementia care. This was intended to enhance the quality of life (QoL) of people with dementia and to reduce the burden on their informal caregivers.

METHOD

A training program for informal caregivers of people with dementia was developed. The training combines the expertise of geriatric psychiatry, geriatric care, and educational psychology. Caregivers acquire and deepen competencies required to improve communication in dementia care. The training was evaluated with a pre-post-control group design and time-series analyses. Twenty-four informal caregivers participated in the study.

RESULTS

The results of the study provide evidence that TANDEM training increases caregivers' use of strategies that are relevant for communication in dementia care and the care receivers' QoL.

CONCLUSION

The results of research in this program show the relevance of including caregivers in interventions and the importance of communication for the QoL of people with dementia.

Optimal management of Alzheimer's disease patients: Clinical guidelines and family advice

Family members provide most of the patient care and administer most of the treatments to patients with Alzheimer's disease (AD). Family caregivers have an important impact on clinical outcomes, such as quality of life (QoL). As a consequence of this service, family caregivers suffer high rates of psychological and physical illness as well as social and financial burdens. Hence, it is important to involve family caregivers in multimodal treatment settings and provide interventions that are both suitable and specifically tailored to their needs. In recent years, several clinical guidelines have been presented worldwide for evidence-based treatment of AD and other forms of dementia. Most of these guidelines have considered family advice as integral to the optimal clinical management of AD. This article reviews current and internationally relevant guidelines with emphasis on recommendations concerning family advice.

[Development and evaluation of a training program for nursing home professionals to improve communication in dementia care]

The purpose of this study was to develop and evaluate a skill training aimed at increasing the social competence of caregivers of nursing home residents suffering from dementia. Herewith, the professional burden and occupational stress of the caregivers should be reduced and the quality of life of dementia patients should be increased. The contents of the training focused on problems and strategies in the communication with dementia patients and the communication with colleagues. The effectiveness of the intervention was tested in a controlled training study using a multiple control group design and process measurement. The participants of the trainings were 53 nursing home professionals, who were in daily contact with residents suffering from dementia. The results of the study verify effects for all relevant variables. The "social competence" of the caregivers increased and their "work stress" decreased while the "quality of life of dementia patients" increased. Therefore it can be concluded that training the social competence of nursing home professionals is a method to indirectly reduce their work stress and support dementia patients. The results of research in this program underline very clearly that the developed training is an effective option to improve the situation of dementia care in nursing homes. To make the intervention widely applicable we are currently developing a "multiplier program" in a follow-up project.