Developing Behavioral Coding to Understand Family Communication Breakdown in Dementia Care

Responses of Persons Living With Dementia to Caregiver Validating Communication: A Secondary Analysis

Background and Purpose: Good communication between persons living with dementia and their caregivers is one important consideration when fostering a positive relationship and improving the effectiveness of care. Care can be a challenge if the person living with dementia does not feel understood or fails to cooperate with care. The individual may feel disrespected and may resist assistance. Validation therapy is a person-centered method for communicating with persons living with dementia that involves validating the experiences, feelings, and reality of an individual to encourage cooperation or provide for safety. The purpose of this study was to identify frequencies of four behavioral responses (cooperation, apathy, resistiveness, and distress) from persons living with dementia when validation communication strategies were used during care activities. Methods: This was a secondary analysis of homecare videos (n = 41) of family caregivers interacting with a person living with dementia during daily care. Behavioral coding was used to examine the relationships between validating communication and the response of a person living with dementia. Caregiver use of specific validation techniques in their communication (affirmation, acknowledging emotions, and verbalizing understanding) was coded along with subsequent responses of the person living with dementia (resistiveness, distress, apathy, or cooperation). Results: Affirmations produced an 11% probability of a cooperative response by the person living with dementia. Caregiver verbalization of understanding resulted in a 6% probability of cooperation, and silence was associated with an 8% probability of cooperation. Nonvalidating communication behaviors were associated with negative reactions. Implications for Practice: Effective person-centered communication between caregivers and persons living with dementia improved cooperation with care and decreased distress. Affirmations and verbalizing understanding were two types of validating communication more likely to elicit a cooperative response and can improve care quality, decrease caregiver burnout, and mitigate challenging behavioral responses in persons living with dementia.

Determining Evidence for Family Caregiver Communication: Associating Communication Behaviors With Breakdown and Repair

BACKGROUND AND OBJECTIVES

Communication is fundamental for dementia care. The trouble source repair (TSR) framework can identify strategies that facilitate or impede communication in dyadic interactions.

RESEARCH DESIGN AND METHODS

A secondary analysis of videos (N = 221) from a clinical trial of a family caregiver telehealth intervention was analyzed using sequential behavioral coding of communication behaviors and breakdowns for 53 caregiver and person with dementia dyads. Coded data from 3,642 30-s observations were analyzed using penalized regression for feature selection followed by Bayesian mixed-effects modeling to identify communication strategies associated with communication breakdown and repair.

RESULTS

Breakdown (coded as 0) was associated with caregivers changing topic (median = -11.45, 95% credibility interval [CrI; -24.34, -4.37]), ignoring (median = -11.49, 95% CrI [-24.49, -4.72]), giving commands (median = -10.74, 95% CrI [-24.22, -3.38]), and taking over the task (median = -4.06, 95% CrI [-7.28, -1.77]). Successful repair of breakdown was associated with verbalizing understanding (median = 0.46, 95% CrI [0.09, 0.86]), tag questions, (median = 2.4, 95% CrI [0.33, 5.35]), and silence (median = 0.78, 95% CrI [0.42, 1.15]) and negatively associated with ignoring and changing topic (median = -3.63, 95% CrI [-4.81, -2.57] and -2.51 [-3.78, -1.33], respectively).

DISCUSSION AND IMPLICATIONS

The TSR was effective in identifying specific communication strategies to avoid (changing topic, ignoring, commands, and taking over the task) and to use to repair breakdown (verbalize understanding, tag questions, and silence). Future research is needed to test these strategies and explore the potential effects of dementia stage, diagnosis, and dyad characteristics in additional samples. Behavioral coding provides evidence of communication best practices as a basis for family caregiver communication training.