Thirty-four participants commenced CCI, however, three dyads (six participants) did not complete the intervention. The reasons given were health-related for one dyad and two dyads were nervous to attend the hospital due to the COVID-19 pandemic. Outcome measures were re-administered with the remaining 28 participants at three months post intervention. Participants with dementia presented with Alzheimer’s disease (n=8), vascular dementia (4) and mixed dementia (n=2) all with a GDS score of 3 -4.
Communication Abilities-PCAD Assessment
Participants with dementia outcomes: Initial P-CAD scores identified 36% (n=5) participants with a moderate cognitive communication impairment (mid stage dementia) and 64% (n=9) with a mild cognitive communication impairment associated with early dementia. The P-CAD total scores were maintained at three months for 71% of participants (n=10) indicating no decline in communication function and 29% participants (n=4) had increased scores and improved communication function (see Figure 1).
Participants with improved P-CAD scores had specific improvements in conversation ability and the use of communication support strategies. Participants with higher baseline scores (total scores of 20) were more likely to show improvement on retesting and those with lower baseline scores ( all maintained communication function. In summary all participants with dementia either maintained or improved their communication function as measured by P-CAD total following the intervention. Further analysis suggests that while total scores increased, the severity level of cognitive communication impairment (as measured by the P-CAD) was unchanged for each participant.
Within P-CAD subtests 6 and 7 there were changes (n=6) in adaptation and compensation to the existing communication impairment. An example of this was increased and more successful attempts at resolving communication breakdown and increased conversational engagement. An increase in conversation abilities P-CAD scores of the person with dementia pre and post intervention confirms these improvements (see Appendix 3).
Communication Partner Outcomes: CPs demonstrated increased use of communication support strategies such as allowing longer turns and reducing the amount of questioning. Of the CPs that attended for post intervention assessment 8/14 scored higher on the conversation abilities subtest of the P-CAD (see Figure 2).
CPs who showed improvement in their ability to adjust their own communication (n=7) were noted to do so by slowing their rate of speech, asking fewer test questions and giving the person with dementia more time to get their message across. CPs who showed improvements in resolving communication breakdowns (n=4) were observed offering repetitions and simplifying their language more often (see Appendix 4).
Communication Goals
All participants with dementia reported that CCI helped them achieve their individual communication goals, 29% indicated this was to a level more than expected (n=4) and 71% much more than expected (n=10). All CPs reported that they too had achieved their communication goals as expected (n=2) or to a level more than expected (n=7) or much more than expected (n=5) (see Figure 3).
Some examples of goals set by PwD and their CPs were summarised into themes Table 1. Each dyad’s goals were individual to them, but there were some reoccurring themes identified: an increased understanding of dementia, improved communication, having group support and a shared experience.
Table 1. Participant Goals
Theme
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People with dementia
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Communication Partners
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Improved understanding
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“to learn about dementia”
“how to help myself
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“to learn about how dementia impacts communication”
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Improved communication
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“ to keep track more in conversations
“ To be more involved in conversations”
“to be able to manage my word finding problems in conversations”
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“ to understand each other better in conversation”
“ to support x in conversations with others”
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Shared experience and group support
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“to meet others who feel like I feel”
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“to meet others in the same boat”
“ to learn from the experience of others”
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Participant Well-being
Ten (71%) PwD rated their well-being as higher on the ICE-CAP-O following intervention with 29% (n=4) rating no change in well-being from initial assessment (see Figure 4).
Over three quarters of CPs, (79%: n=11), reported an increased sense of well-being following intervention and 21% (n=3) rating no change in well-being (see Figure 5).