Communication Intervention for Direct-Care Workers with Dementia Patients Language, Aging, and Health Patrick J. Payne Dr. Davis University of North Carolina at Charlotte May 6, 2006

Rationale Semantic Memory: The vast network of associations and concepts that underlies our general knowledge of the world (Arkin 2001) Semantic Memory: The vast network of associations and concepts that underlies our general knowledge of the world (Arkin 2001) Semantic memory is compromised early and severely in people with Alzheimer’s Disease: Semantic memory is compromised early and severely in people with Alzheimer’s Disease: Comprehending linguistic information is difficult due to deteriorated inferential capabilities and difficulty accessing and making connection between the contents of semantic memory (Arkin 2001)

Conversation Deficits Reduced relevant units of information and informational content Reduced relevant units of information and informational content Difficulty in word finding Difficulty in word finding Use of more pronouns without antecedants Use of more pronouns without antecedants Ideational preservation Ideational preservation Reduced cohesion and coherence Reduced cohesion and coherence Poor topic maintenance and frequent shifting Poor topic maintenance and frequent shifting Excessive use of verbs Excessive use of verbs Difficulty in comprehension of abstract language Difficulty in comprehension of abstract language

Intervention 1: Memory Wall Direct-Care Workers can help residents/patients decorate a wall in their room: Pictures of family and famous people from their past that they admire Pictures of family and famous people from their past that they admire Newspaper clippings of interesting topics Newspaper clippings of interesting topics Other important articles from their past Other important articles from their past During this activity, the Direct-Care worker can initiate discussion about these articles to exercise semantic memory

Intervention 2: Cooking Activities Direct-Care workers can help resident/patient in minor cooking activities During this activity, the Direct-Care worker can initiate discussion about favorite recipies and other opinions about food. It is validating for a person with dementia to have their opinion or advice sought, particularly by a younger adult (Arkin 2001)

Intervention 3: Scripted Discourse Direct-Care workers can use specific conversation starters to initiate conversation Limits word finding difficulty Limits word finding difficulty Increases verbal activity Increases verbal activity Decreases verbal repetitiveness Decreases verbal repetitiveness

Intervention 4: Music Therapy Direct-Care workers can play music from the patient/resident’s past Initiates discourse about favorites songs and how they make the resident/patient feel Initiates discourse about favorites songs and how they make the resident/patient feel Helps patients remember times when they were healthy and young Helps patients remember times when they were healthy and young

Intervention 5: Verbal Exercises Direct-Care workers can initiate discourse in the following ways: Free and prompted descriptions of pictures Free and prompted descriptions of pictures Associations to evocative words Associations to evocative words Proverb completion and interpretation Proverb completion and interpretation These interventions help patients/residents exercise semantic memory and build new neural pathways (Arkin 2001)

Intervention 6: Daily Routine Direct-Care workers can develop a daily schedule for the resident/patient Decreases agitation Decreases agitation Decreases meaningless wandering Decreases meaningless wandering Helps Direct-Care workers keep track of resident/patient Helps Direct-Care workers keep track of resident/patient

Conclusion These interventions are useful in developing a stronger relationship between the Direct-Care worker and the resident/patient with dementia. Improvements will be seen in the quality and quantity of discourse in Alzheimer’s Patients Arkin, S., Mahendra, N.(2001).Discourse Analysis of Alzheimer’s Patients Before and After Intervention: Methodology and Outcomes. Aphasiology, 15(6),