Communication Style and Resistiveness to Care in Dementia Residents

About 65 percent of Oregon’s nursing home residents are cognitively impaired (very mild to severe). Caring for this population can present complex challenges to providers. How nursing home staff communicate with these residents can actually increase care challenges. A study at the University of Kansas School of Nursing suggests that adult nursing home residents with dementia are more resistant to care when talked to like children. The study explored the relationship between nursing home staff communication with dementia residents and subsequent behaviors that disrupt care, often called resistiveness to care (RTC). Specifically, the study examined the impact of “elderspeak” on RTC behaviors.

Elderspeak involves an overly caring but controlling tone of voice, shortened sentences, repetition, use of inappropriately intimate terms of endearment (e.g., sweetie, dear), and using infantile communication, similar to “baby talk.” Kristine Williams, RN, PhD, who led the study explained, “[Caregivers and nursing staff] also tend to alter the pronouns, so they might say, ‘Are we ready for our bath?’ That really gives the message that the person isn’t able to act independently, instead of, ‘Are you ready for me to help you with your bath?’.”

The study examined 13 RTC behaviors which included grabbing objects, saying no, adduction (holding the arms or legs tight against the body), crying, screaming, pulling/pushing away, hitting/kicking, and threatening. When elderspeak communication was used, the probability of RTC was 55 percent. Conversely, the probability of RTC was only 26 percent when staff used normal adult communication. The study concluded that “reducing nursing staff use of elderspeak may better meet the needs of individuals with dementia, reduce resistiveness behaviors, and thus improve nursing care.”