Abstract
The progressive neuropathology involved in dementia frequently causes a gradual decline in communication skills. Communication partners who are unaware of the specific communication problems faced by people with dementia (PWD) can inadvertently challenge their conversation partner, leading to distress and a reduced flow of information between speakers. Previous research has produced an extensive literature base recommending strategies to facilitate conversational engagement in dementia. However, empirical evidence for the beneficial effects of these strategies on conversational dynamics is sparse. This study uses a time-efficient computational discourse analysis tool called Discursis to examine the link between specific communication behaviours and content-based conversational engagement in 20 conversations between PWD living in residential aged-care facilities and care staff members. Conversations analysed here were baseline conversations recorded before staff members underwent communication training. Care staff members spontaneously exhibited a wide range of facilitative and non-facilitative communication behaviours, which were coded for analysis of conversation dynamics within these baseline conversations. A hybrid approach combining manual coding and automated Discursis metric analysis provides two sets of novel insights. Firstly, this study revealed nine communication behaviours that, if used by the care staff member in a given turn, significantly increased the appearance of subsequent content-based engagement in the conversation by PWD. Secondly, the current findings reveal alignment between human- and computer-generated labelling of communication behaviour for 8 out of the total 22 behaviours under investigation. The approach demonstrated in this study provides an empirical procedure for the detailed evaluation of content-based conversational engagement associated with specific communication behaviours.
Highlights
Dementia is a common and significant health condition
Out of the total of 22 facilitative and non-facilitative communication behaviours that were included in the analysis, nine of the facilitative communication behaviours were found to significantly increase the likelihood of people with dementia (PWD) content-based engagement in the short, medium, and/or long-term, while one facilitative behaviour was found to significantly decrease the likelihood of PWD engagement
Other facilitative communication behaviours that reliably elicited PWD engagement in the short term were ‘Rephrase question’ (28%, p = .004, OR = 3.350), ‘PWD knowledge’ (19%, p = .009, OR = 2.135), ‘Give time’ (17%, p = .001, OR = 1.946) and ‘Active listening’ (15%, p = .002, OR = 1.757)
Summary
Dementia is a common and significant health condition. Within the last 13 years, the number of people living with dementia worldwide has doubled from an estimated 24.3 million people in 2006 [1] to 47.5 million people reported in 2015 [2]. In addition to impaired memory functioning [3,4,5,6], one of the hallmark characteristics of dementia is a progressive decline in language skills [7,8,9,10,11,12,13,14] contributing to reduced quality of life in people with dementia and increased carer stress and burden [12, 13, 15, 16]. The main communication partners for people with dementia are typically their family and carers at home or residential aged care facility staff, with the overall opportunity for conversations being reduced [17]. One recently published set of strategies is the MESSAGE training programme developed by communication experts at The University of Queensland, Australia [21,22,23]
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