Formal Caregivers Assisting Residents with Moderate and Severe Alzheimer’s Disease: Investigating the use of Communication Strategies during Activities of Daily Living

The prevalence of Alzheimer’s disease (AD) in Canada is on the rise, creating the need for evidence-based care practices designed to support individuals with AD and their care providers. Declines in memory, language, visual-spatial, executive abilities, and functional capacity associated with AD create the need for caregiver assistance during the completion of activities of daily living (ADLs). Unfortunately, assisting individuals with more advanced stages of AD is further complicated by communication breakdowns that occur in the dyad (i.e., caregiver and the individual with AD) established to meet a common goal: to complete ADLs. Clinically recommended communication strategies are the current solution used to support caregivers interacting with individuals with AD. However, there are limitations to these recommendations, including that the majority are based on caregiver experience, few are supported by empirical research, and little is known about which strategies are effective when assisting individuals with moderate to severe AD specifically during the context of completing ADLs. This dissertation presents novel research studies that systematically examined formal caregivers’ use of communication strategies while successfully assisting residents with moderate and severe AD during the completion of a representative ADL. Two observational studies and one focus group interview study were conducted to address our hypotheses and research objectives. Key findings from the studies comprising this dissertation were: (1) caregivers used a variety of verbal and nonverbal task-focused communication strategies when successfully assisting residents with AD during the completion of a representative ADL; (2) the task-focused communication strategies caregivers most frequently used were supported by empirical literature and included the use of one direction or idea (i.e., proposition) at a time, closed-ended questions, and paraphrased repetition; (3) when assisting residents with severe AD, caregivers used the resident’s name, one proposition, and paraphrased repetition significantly more than when assisting residents with moderate AD; and (4) the communication strategies that caregivers perceived to use in their care practice indicate that person-centered dementia care is a central aspect to facilitating the completion of ADLs. This research is an important step towards the development of evidence-based communication strategies for caregivers assisting individuals with AD during ADLs. Ph