Communication strategies to help people with dementia complete ADLs

Once a month several SLP bloggers are blogging about recent research related to the field. Learn more here.

The article I read this month regarded moderate severe Alzheimer’s Disease (AD) and verbal and nonverbal strategies to improve the success of ADL tasks, specifically hand washing. The reason to study this area is AD is characterized by deterioration of cognition, social or occupational functioning, and behavior. Completing ADLs falls into the functional tasks domain and due to communication deficits assisting people with AD may become quite challenging or frustrating for communication partners.

AD specifically impacts the “ability to plan spontaneously, initiate the correct sequencing of steps of a task, and use the appropriate tools for carrying out the steps of a task”, with makes caregiver assistance necessary for tasks like hand washing. The goal of the study was to close the gap in current research regarding verbal and nonverbal communication strategies that are effective, ineffective, or potentially counterproductive to completing ADL tasks.

The study consisted of 12 caregiver-resident dyads which each completed 6 hand washing sessions. Verbatim transcripts were employed and SALT was used to analyze the communication sequences. The Mini Mental State Examination was used to identify severity of AD, with 9 residents scoring with severe dementia. None of the residents had a history of stoke, depression, psychosis, alcoholism, drug abuse, or physical agression toward caregivers, which is a fairly usually occurrence in my experience. The residents consisted of 11 women and 1 man, which seems realistic given my experience with the AD population in the LTC setting.

Also unusual based on my experience was the caregiver qualifications. All of the caregivers were women and their average age was 53.5 years (range 47-59), which is more mature than the skilled caregivers (CNAs) I am used to working with in the LTC. Many of the CNAs I have worked with are in their 20s or 30s. Being older may suggest a more career mindset toward their jobs. Also unusually 10 of the caregivers reported they completed onsite training regarding communication skills for working with residents with dementia.

Common errors in completing a hand washing sequence by residents with AD include reverting back to previous steps, skipping steps,  and getting “stuck” on one step. Sessions were determined unsuccessful if residents did not complete any of the steps given the opportunity. Residents showed a 90% success rate in task completion given the assistance of caregivers.

Verbal communication strategies that led to successful completion of hand washing task included:

  • One idea or direction at a time
  • Closed-ended questions
  • Paraphrased repetition
  • Verbal praise, which in other studies has been shown “to facilitate engagement in talking and topic maintenance in conversation, and this benefit is present even in later stages of dementia.”
  • Using the residents’ names to gain their attention

It should be noted that authors hypothesized that slowed speech rate, commonly recommended though without empirical evidence, would improve task success; however, this study indicated slowed speech rate was unrelated to task success.

Nonverbal communication strategies that led to successful completion of hand washing task included:

  • Guided touch
  • Pointing to an object
  • Handing an object to the resident
  • Demonstrating an action

It should be noted that nonverbal strategies were often paired with verbal communication strategies.

From the authors’ analysis they were able to determine “a strong positive relationship between disease progression and caregivers’ relative use of verbatim repetition, paraphrased repetition, and demonstrating gestures”. This study also identified two strategies not commonly found in clinical literature: verbal praise and use of resident’s name.

I have made this handout to provide assistance with training others for improved communication strategies to assist those with AD with successful ADL completion.


Examining Success of Communication Strategies Used by Formal Caregivers Assisting Individuals With Alzheimer’s Disease During an Activity of Daily Living J Speech Lang Hear Res, Vol. 55, No. 2. (1 April 2012), pp. 328-341, doi:10.1044/1092-4388(2011/10-0206) by Rozanne Wilson, Elizabeth Rochon, Alex Mihailidis, Carol Leonard

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