Adults in nursing homes who have Alzheimer's disease and are talked to like children are more resistant to care, according to new research reported at the 2008 Alzheimer's Association International Conference on Alzheimer's Disease in Chicago.

The growing population of adults with Alzheimer's presents complex challenges to care providers. Kristine Williams, RN, PhD, and colleagues at the University of Kansas School of Nursing explored the relationship between how nursing home staff communicates with those with dementia and subsequent behaviors that disrupt care, or resistiveness to care (RTC). Specifically, the study examined whether nursing staff "elderspeak" affected RTC behaviors.

The researchers defined elderspeak as overly caring, controlling, and infantilizing communication, similar to "baby talk." Common features are simplified grammar and vocabulary, substitution of collective pronouns, and overly intimate endearments.

RTC increases nursing staff stress, time needed to provide care, and costs of care. At the same time, RTC may actually indicate unmet needs that the person with Alzheimer's is unable to communicate in a conventional way.

Twenty (20) nursing home residents with dementia were filmed during bathing, dressing, oral care, and other care activities (2005-2006) and the sequences subsequently analyzed (2006-2008, and ongoing) for nursing staff communication (normal talk, elderspeak, or silence) and resident behavior (cooperative, resistive to care, or neutral). Residents and staff in Special Dementia Care Units in three skilled nursing facilities in Kansas were used for the study. The mean age of residents in the sample was 82.9 years, with a range of 69 to 97. Cognitive test scores indicated a relatively homogeneous sample in the moderate stage of dementia. Staff participants were primarily (78%) certified nursing assistants. The remaining staff participants included nurses, therapists, and social workers who were involved in direct care.

The probability of RTC behavior varied significantly with the type of nursing staff communication. Residents with dementia were more likely to resist care when nursing staff used elderspeak communication; they were more likely to cooperate with care when normal adult communication was used.

The Resistiveness to Care Scale (RTCS) is a measure of the occurrence of and intensity of behaviors of persons with dementia including those that disrupt care. It assesses 13 behaviors including grabbing objects, saying no, adduction [holding the arms or legs tight against the body], grabbing a person, pulling away, clenching teeth, crying, screaming, turning away, pushing away, hitting/kicking, threatening, and moving the body in the opposite direction from staff. Each occurrence of the 13 RTC behaviors was scored by duration and intensity. The total RTC score was the sum of multiplying the duration of each incident by its observed intensity providing a weighted score within a possible range of 0 (no resistiveness) to 156 (maximum resistiveness).

When elderspeak communication was used, the probability of RTC was .55 (CrI = .44 - .66). In contrast, the probability of RTC was .26 (CrI = .12 - .44) when staff used normal adult communication. Silence resulted in a probability of .36 (CrI = .21-.55) for RTC.

"This study suggests that there is an association between communication style and resident behaviors," Williams said. "This may significantly impact nursing care and how nursing home staff should best be trained to communicate with residents with Alzheimer's. Future research is needed to test whether interventions that reduce nursing staff elderspeak communication will contribute to greater cooperation with care for persons with dementia."