Rejection of care in hospitalized persons living with dementia: the impact of nurse communication

Behavioral symptoms of dementia, like aggression, are common during hospital dementia care. The impact of nursing staff communication on resistive behaviors has been established in the nursing homes where elderspeak communication (i.e., baby talk) has been demonstrated to double the probability of rejection of care (RoC) by residents with dementia. The purpose of this study was to determine the impact of elderspeak communication by nursing staff on RoC by hospitalized patients with dementia. Eighty-eight care encounters between 16 patients and 53 nursing staff were observed for RoC in one Midwestern hospital. Audio recordings of the care encounters were transcribed verbatim and coded for elderspeak. Over one fourth of nursing staff speech towards PLWD was elderspeak, and almost all of the 88 care encounters included some elderspeak. Nearly half of the observations included RoC behaviors by patients with dementia. Statistical modeling was used to determine the impact of elderspeak on RoC while controlling for additional characteristics of the patient and the observations. After adjusting for pain, length of stay, and gender, a 15-percentage-point decrease in the proportion of elderspeak communication by nursing staff reduced the odds of RoC by 62% (p = .002), and a one-unit decrease in pain reduced the odds of RoC by 63% (p < .001). In other words, lower pain levels of the patients and less elderspeak communication by the nursing staff meant that RoC by the patients was less likely. This study identified that pain and elderspeak are two important and modifiable factors of RoC.