Alzheimer’s Disease Core Center 

Introduction 

Strategies that increase the effectiveness of communication between individuals who have 
Alzheimer’s Disease (AD) and their caregivers may modify some of the persistent behavioral 
problems associated with AD. Improved communication may help to reduce disruptive 
behaviors, such as combativeness and agitation. It may also make daily interactions more 
meaningful and enjoyable for both the individuals with AD and their caregivers, with resultant 
improvements in quality of life for both parties. 

Maximizing effective communication is particularly important in long-term care environments, 
where communicative interactions are typically impoverished for even those residents with no 
communication impairments (Caris-Verhallen, Kerkstra, & Bensing, 1997; Erber, 1994; 
Kaakinen, 1992; Lubinski, 1995; Lubinski et al, 1981). With the number of individuals residing 
in long-term care living arrangements increasing (Bates, 1999), and a significant portion of long-
term care residents struggling with the effects of AD (Kraditor, 2001), it is becoming 
increasingly important to focus efforts on developing and advancing programs for maximizing 
communication and quality of life for this population. 

The purpose of this study was to investigate the effectiveness of an established video-based 
inservice protocol (ORegon Center for Applied Science [ORCAS]: Strategies for Dementia, 
Communication Skills for Professional Caregivers; Bourgeois & Irvine, 2000) for training 
communication skills to professional caregivers in long-term care environments. Secondly, it 
aimed to ascertain factors that might improve the outcomes of this and similar training protocols. 

Methods 

Ten professional caregivers in a single assisted living facility participated in this investigation. In 
addition, ten long-term care residents with Alzheimer’s Disease, under the care of these 
caregivers, also participated. The long-term care residents represented a wide range of dementia 
severities, with Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) 
scores ranging from 5 to 26. 

Subjects participated in a five-phase protocol: (1) pre-control data collection, (2) control phase, 
(3) post-control (pre-training) data collection, (4) training phase, and (5) post-training data 
collection. Data were collected in each of the three data collection phases, as follows. The 
caregivers completed a knowledge questionnaire to determine their understanding of factual 
information about Alzheimer’s Disease. They also completed a comprehensive semi-structured 
interview about their interactions with their AD residents, as well as behavior tracking forms to 
document disruptive behaviors exhibited by these residents. The long-term care residents each 
completed the MMSE, the Visual Analog Mood Scales (VAMS; Stern, 1997), the Quality of Life 
Assessment Schedule (QOLAS; Selai, Trimble, Rossor, & Harvey, 2001), the short form of the 
Geriatric Depression Scale (GDS; Sheikh & Yesavage, 1986), and the Quality of 
Communication Life Scale (QCL; Paul, et al., 2004). They also completed an interview about 


their interactions with their caregivers and their quality of life. The questionnaires, tracking 
forms, and interviews were developed by the investigators. 

During the control phase, the principal investigator was stationed in the Wellness Center of the 
long-term care facility two afternoons per week, for approximately one hour, for four 
consecutive weeks. The investigator was accessible to staff and residents but did no training 
during this time. In the training phase, professional caregivers participated in a video-based 
training protocol developed by ORCAS and facilitated by the principal investigator. The training 
protocol comprises four sessions: (a) Dementia Overview, (b) Speaking and Reacting Skills, (c) 
Redirection Skills, and (d) Communication Cards. Skill demonstrations, quizzes, review, and 
role-play are all incorporated into the ORCAS protocol to promote learning. In this study, 
sessions were approximately one hour in duration and were offered two times per week, for four 
consecutive weeks, to accommodate caregivers’ schedules. 

Results 

Preliminary analyses of overall scores on the knowledge questionnaire revealed that the 
caregivers did not demonstrate a significant change in knowledge scores following the control 
phase; however, there was a significant increase in scores on this questionnaire following the 
ORCAS training protocol. Interview responses and behavior tracking forms will be analyzed to 
determine if there were perceived changes in the interactions between the caregivers and the 
residents and any disruptive behaviors exhibited by the residents, respectively, following the 
control and training phases. 

Review of the standardized measures completed by the residents demonstrated no significant 
changes in total VAMS, QOLAS, GDS, or QCL scores following the control and training phases. 
Interview responses will be analyzed for further appraisal of perceived changes in interpersonal 
communication and quality of life. Qualitative and quantitative analyses of the initial responses 
of the long-term care residents to interview questions on quality of communication and quality of 
life revealed interesting information about the nature of communication in long-term care 
environments. Recurring themes included the following: residents lamented that they had no one 
to talk to, they often stayed in their rooms, they had poor self-esteem, they were often bored, and 
they lacked energy. 

Discussion 

Caregivers demonstrated an improved understanding of Alzheimer’s Disease following the 
ORCAS training. They also reported that they enjoyed the training program. Further analysis 
will reveal if there was a significant increase in ratings of communication or a decrease in 
disruptive behaviors following training. Caregiver recommendations for improving the training 
program will be reported 

Standardized measures did not demonstrate a significant improvement in communication or 
quality of life, as perceived by the residents, after training. Possible contributing factors, 
including concerns with caregivers’ lack of carryover of skills and limitations of the 
measurement tools, will be discussed. 


References 

Bates, E. (1999). The shame of our nursing homes. Nation, 268(12), 11-16. 

Bourgeois, M. & Irvine, B. (2000). Strategies for Dementia: Communication Skills for 
Professional Caregivers. Eugene, OR: ORegon Center for Applied Science, Inc. 

Caris-Verhallen, W.M.C.M., Kerkstra, A., & Bensing, J.M. (1997). The role of communication 
in nursing care for elderly people: A review of the literature. Journal of Advanced 
Nursing, 25, 915-933. 

Erber, N.P. (1994). Conversation as therapy for older adults in residential care: The case for 
intervention. European Journal of Disorders of Communication, 29, 269-278. 

Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-mental state: A practical method for 
grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 
12, 189-198. 

Kaakinen, J.R. (1992). Living with silence. The Gerontologist, 32(2), 258-264. 

Kraditor, K. (2001). Facts and trends: The assisted living sourcebook. Washington, DC: 
National Center for Assisted Living. 

Lubinski, R. (1995). State-of-the-art perspectives on communication in nursing homes. Topics in 
Language Disorders, 15(2), 1-19. 

Lubinski, R., Morrison, E.B., & Rigrodsky, S. (1981). Perception of spoken communication by 
elderly chronically ill patients in an institutional setting. Journal of Speech and Hearing 
Disorders, 46, 405-412. 

 

Paul, D.R., Frattali, C.M., Holland, A.L., Thompson, C.K., Caperton, C.J., & Slater, S.C. (2004). 
Quality of Communication Life (QCL) Scale. Rockville, MD: American Speech-
Language-Hearing Association. 

Selai, C.E., Trimble, M.R., Rossor, M., & Harvey, R. (2001). Assessing quality of life (QOL) in 
dementia: the feasibility and validity of the Quality of Life Assessment Schedule 
(QOLAS). Neuropsychological Rehabilitation, 11 (3/4), 219-243. 

Sheikh, J.I., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS): Recent evidence and 
development of a shorter version. In T.L. Brink (Ed.), Clinical Gerontology: A Guide to 
Assessment and Intervention (pp. 165-173). New York: The Haworth Press. 

Stern, R.A. (1997). Visual Analog Mood Scales (VAMS). Odessa, FL: Psychological Assessment 
Resources, Inc.