Abstract
Background: People with dementia and family carers experience difficulties communicating. This research aimed to review and contribute to the theory and evidence-base for single component, psychosocial interventions that address these difficulties.Methodology: A systematic review identified and critically appraised controlled trials addressing dementia carer communication difficulties. The best evidence identified by this review supported the one-to-one, individualised, cognitive behavioural approach used in the previously developed Talking Sense manual.
A pilot, randomised controlled trial then compared 27 carers who completed three 1:1 individualised sessions using Talking Sense with 25 carers who received a single, knowledge-only, control session. The primary outcome was measured by the Hospital Anxiety and Depression Scale. Semi-structured interviews were conducted with 15 purposively selected carers from the treatment group. Finally, a concurrent mixed methods analysis identified similarities and differences in data sets which are synthesised in the final discussion.
Results: Some statistically significant results suggested carers receiving the Talking Sense intervention had fewer communication difficulties happening and felt more valued by their relatives. A score close to significance suggested they perceived their relatives to be more communicatively competent. There were no significant differences for the primary outcome measure of carer anxiety and depression as well as carer quality of life, general and communication self-efficacy.
Thematic analysis of the interviews suggested that carers benefitted from meeting with an expert and an individualised programme. Carers reported changes in feelings, thinking and reactive communication and positive changes in their relative’s communication but had difficulty recalling specific learning, developing self-insight and describing implementation intention-setting.
The mixed methods analysis supported changes in person with dementia competence and communication difficulties happening, and the absence of changes in anxiety and depression.
Conclusion: The results of this research support the use of Talking Sense by expert interventionists. The mixed methods analysis suggests that at least part of the change in person with dementia communication was attributable to actual or perceived change by that person. The potential for change in the person with dementia, associated with changes in carer thinking and behaviour, is the most significant finding from this programme of research.
| Date of Award | Apr 2016 |
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| Original language | English |
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| Supervisor | Chris Markham (Supervisor) & Rebecca Stores (Supervisor) |