A pilot study to evaluate the effectiveness of an individualized and cognitive behavioural communication intervention for informal carers of people with dementia: The Talking Sense programme
International journal of language and communication disorders
People with dementia and family carers often experience difficulties communicating together. These difficulties are considered to contribute significantly to the depression, anxiety and negative feelings such as guilt often reported by dementia family carers. Aims: To develop and contribute to the theory and evidence base for single-component, psychosocial interventions that address these difficulties by evaluating the effectiveness of the Talking Sense programme which was designed to reflect
... isting best evidence. Methods & Procedures: Talking Sense was delivered as an individualized, one to one, cognitive behavioural approach for developing knowledge, skills, thinking and behaviour of dementia family carers in managing communication difficulties. In this study, a randomized controlled trial compared 27 carers who completed three one-to-one individualized sessions using Talking Sense with 25 carers who received a single, knowledge-only, control discussion. Outcomes & Results: There were no significant differences for the primary outcome measure of carer anxiety and depression as well as carer quality of life and general self-efficacy. Statistically significant results suggested carers receiving the Talking Sense intervention had fewer communication difficulties happening (p = 0.046) and felt more valued by their relatives (p = 0.046). A score close to significance (p = 0.052) suggested they perceived the irrelatives to be more communicatively competent. Conclusions & Implications: The intervention and research design were shown to be effective with low attrition and high adherence to treatment. A non-significant finding for the primary outcome measure does not support the potential for this intervention to effect carer anxiety and depression. The potential for perceived change in the person with dementia, with statistically fewer communication difficulties happening and the carer feeling more valued by their relative, was the most significant finding from this programme of research. Recommendations for further research are made. There are an estimated 670,000 people in the UK acting as primary family carers (hereafter referred to as 'carers') for people with dementia (Alzheimer's Society 2014). Levine and Murray (2004) argue that the culture of caregiving for family carers is distinctly different from that of professionals. Between 18% and 47% of dementia carers report feelings of anxiety and related depression (Akkerman and Ostwold 2004). This appears to be influenced by factors such as increased isolation, outside pressures, feelings of disappointment and poorer health of the carer (Andren and Elmstahl 2008). Communication difficulty is one of the earliest presenting features for most people with dementia. The most common early language symptoms of a typical presentation are word-finding, naming and verbaldescription difficulties. The ability to interpret meaning from facial expression, tone of voice and touch remain relatively intact until the later stages of most dementia presentations (Bourgeois and Hickey 2009). Communication difficulty is one of the most frequent and hardest-to-cope-with experiences for carers (Egan et al. 2010). Carers suffering from depressive symptoms have also been found to use less positive communication themselves (Braun et al. 2010). How long an informal carer of a person with dementia (PWD) provides care has been strongly correlated with their experience of challenging behaviours and communication difficulties (Searson et al. 2008). The most common way of addressing communication difficulties with carers is to provide a list of generic guidelines aimed at supporting successful communication, such as 'slow your speech' or 'use yes/no questions' (Small et al. 2003) and recommended approaches such as validation therapy (Feil 1995). Psychosocial interventions in dementia care are defined by the INTERDEM group as 'interventions that involve interactions between people to improve psychological or social functioning' (Moniz-Cook et al. 2011). Schulz (2000) describes psychosocial interventions as constructed from a unique combination of single or multiple components (e.g., components could include communication strategies, anxiety management, use of services, managing finances etc.), domains targeted (e.g., thinking, knowledge, skills, behaviour), delivery methods (e.g., one to one or group, generic or individualized) and theoretical methods of action. This research programme was preceded by a systematic review of dementia carer multi-component and communication-specific single-component psychosocial interventions studies (Barnes 2016). The bestquality evidence for multi-component interventions appeared to support the use of individualized behaviour management therapy, such as cognitive behaviour or reframing therapy (Vernooij-Dassen et al.