Introduction
Communication with people with dementia: empirical and theoretical aspects
Measurement issues and gaps
Objectives and hypotheses
Methods
Recruitment
Observational procedure and sample
CI (n = 43) | CU (n = 50) | p-value | |||||
---|---|---|---|---|---|---|---|
M | SD | % | M | SD | % | ||
Age (years) | 83.6 | 5.7 | – | 82.1 | 6.3 | – | 0.212 |
Gender (female/male) | – | – | 51/49 | – | – | 56/44 | 0.641 |
Mother tongue (German/non-German) | – | – | 95/5 | – | – | 96/4 | 0.858 |
Lower/intermediate/upper secondary school | – | – | 62/23/15 | – | – | 71/10/19 | 0.297 |
Private/nursing/retirement/residential home | – | – | 87/10/0/3 | – | – | 92/0/2/6 | 0.090 |
Hospital (general/geriatric) | – | – | 53/47 | – | – | 54/46 | 0.961 |
Shift (morning/evening) | – | – | 56/44 | – | – | 38/62 | 0.086 |
Length of hospital stay (days) | 14.9 | 7.4 | – | 13.3 | 6.6 | – | 0.271 |
Admission to examination (days) | 7.3 | 6.5 | – | 6.4 | 4.9 | – | 0.432 |
CODEM (total mean score; 0–5)a | 3.2 | 1.1 | – | 4.8 | 0.2 | – | <0.001 |
Cognitive status (6CIT error sum scores; 0–28)b | 19.0 | 5.3 | – | 3.9 | 3.1 | – | <0.001 |
Functional status (sum scores; 0–100)c | 48.6 | 26.0 | – | 75.9 | 23.3 | – | <0.001 |
Subjective hearing capacity (1–5)d | 2.8 | 1.0 | – | 2.7 | 1.0 | – | 0.696 |
Speech rate (words per min) | 122.3 | 32.8 | – | 146.5 | 23.4 | – | <0.001 |
Mean length of utterances (words per utterance)e | 2.4 | 0.7 | – | 3.1 | 0.9 | – | <0.001 |
M | SD | % | |
---|---|---|---|
Age (years) | 39.2 | 12.5 | – |
Gender (female/male) | – | – | 84/16 |
Mother tongue (German/non-German) | – | – | 63/37 |
Lower/intermediate/qualification for applied upper secondary studies/upper secondary school | – | – | 3/47/27/23 |
Registered nurse/geriatric trained nurse | – | – | 73/27 |
Experience as a nurse (<5/5–10/11–15/>15 years) | – | – | 23/30/3/44 |
Measures
Data analysis
Results
Factorial structure
Items | Rotated factor loadings | Item reliability | ||
---|---|---|---|---|
Factor 1 Content | Factor 2 Relationship | Communality | ITCs | |
Presentation | ||||
03. She/he uses a sensible sentence structure | 0.70 | 0.26 | 0.81 | 0.86 |
04. She/he uses words according to their meaning | 0.66 | 0.23 | 0.70 | 0.80 |
05. She/he comes up with the right words | 0.64 | 0.23 | 0.67 | 0.77 |
01. She/he signalizes the need to communicate | 0.27 | 0.61 | 0.67 | 0.76 |
02. She/he shows interest in the interaction partner | 0.02 | 0.89 | 0.81 | 0.86 |
06. She/he shows emotions | −0.16 | 1.01 | 0.82 | 0.83 |
Attention | ||||
07. She/he can make eye contact | −0.22 | 0.93 | 0.63 | 0.67 |
08. She/he maintains eye contact appropriately | 0.23 | 0.61 | 0.61 | 0.72 |
Comprehension | ||||
09. She/he understands complex questions and sentences | 1.01 | −0.18 | 0.81 | 0.83 |
10. She/he responds sensibly to what is said | 1.04 | −0.23 | 0.81 | 0.82 |
11. She/he demonstrates appropriate nonverbal responses to what is said | 0.33 | 0.60 | 0.74 | 0.79 |
12. She/he reacts to the feelings of the other | 0.11 | 0.83 | 0.82 | 0.87 |
Remembering | ||||
13. She/he performs the task independently | 0.81 | 0.13 | 0.81 | 0.86 |
14. She/he communicates without memory aids from the other | 0.80 | 0.10 | 0.77 | 0.83 |
15. She/he remains on an issue | 0.82 | −0.04 | 0.63 | 0.73 |
Factor statistics | ||||
Cronbach’s alpha (CI 95%) | 0.95 (0.92, 0.97) | 0.93 (0.90, 0.96) | – | – |
Initial eigenvalue | 9.65 | 1.45 | ||
Initial variance (%) | 64.36 | 9.66 |
Reliability
Validity
Measures | n | M | SD | Level | CODEM total (r) | CODEM content (r) | CODEM relationship (r) | Corrected p-value | |
---|---|---|---|---|---|---|---|---|---|
Convergent validity | |||||||||
Speech rate (words per min) | 43 | 122.3 | 32.8 | Patients | 0.51** | 0.50** | 0.49** | 1 | |
Mean length of utterances (in words) | 43 | 2.4 | 0.7 | Patients | 0.38* | 0.36* | 0.40** | 1 | |
Divergent validity | |||||||||
Subjective hearing capacity (1–5)a | 36 | 2.8 | 1.0 | Patients | −0.14 | −0.12 | −0.16 | 1 | |
Verbal memory recall (6CITerror scores; 0–10)b | 43 | 8.2 | 2.4 | Patients | −0.17 | −0.21 | −0.08 | 0.868 | |
Social-contextual constructs | |||||||||
Speech rate (words per min) | 43 | 156.1 | 22.3 | Nurses | 0.18 | 0.21 | 0.15 | 1 | |
Mean length of utterances (in words) | 43 | 3.3 | 0.7 | Nurses | 0.24 | 0.33* | 0.12 | 0.256 | |
Controlling tone of voice (1–5)c | 38 | 2.5 | 0.6 | Nurses | −0.19 | −0.14 | −0.25 | 1 | |
Person-centered tone of voice (1–5)d | 38 | 3.6 | 0.5 | Nurses | 0.02 | −0.01 | 0.09 | 1 | |
Shift (morning/evening) | 24/19 | – | – | Organization | 0.12 | −0.01 | 0.31* | 0.027 |
Discussion
Limitations
Practical conclusion
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The CODEM instrument is a largely feasible and easily applicable instrument to assess the verbal and nonverbal communication behavior of older patients with CI in the acute care hospital setting.
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CODEM enables the examination of communication in terms of behavior that is relevant for well-being.
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Applying CODEM does not require more than three minutes when combined with established screening routines.
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CODEM revealed sound psychometric properties including internal consistency, convergent, divergent, and criterion validity.
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CODEM might serve as an important diagnostic and interventional tool for acutely ill older patients with CI if it is administered by trained hospital staff.
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Further studies including larger samples and a more heterogeneous set of acute care hospital settings are required.