# Resistiveness in Dementia: Nurse Communication in Acute Care

> **NIH NIH F31** · UNIVERSITY OF IOWA · 2020 · $18,103

## Abstract

Persons with dementia (PWD) are twice as likely to be hospitalized compared to cognitively intact older
adults, and while hospitalized experience significantly more hospital related complications, have
quadruple the length of stay, and accrue triple the annual inpatient costs. Persons with dementia often
exhibit behavioral and psychological symptoms of dementia during hospitalization, with aggression
being the most common form. When PWD are acutely-ill and requiring around-the-clock care, it is
essential that nursing staff be able to complete care using person-centered approaches. Challenging
behaviors exhibited during care are termed resistiveness to care (RTC) and leave patients at risk for
neglect and caregivers at risk for strain. Effective communication by nursing staff is critically important
in preventing RTC and to facilitate care completion while maintaining personhood in PWD. In long-term
care, the use of elderspeak communication (i.e. baby talk) by care staff doubles the probability of RTC
in PWD. Elderspeak markers are broad and include a variety of linguistic adjustments in rhythm, sound,
syntax, and meaning. Despite the known detrimental impact of elderspeak communication on PWD in
long-term care, elderspeak has yet to be explored in acute care where PWD remain at risk for health
and quality related complications. The aims of this cross-sectional study taking place in the acute care
setting are to: 1) identify and characterize elderspeak communication when enacted by nursing staff
during the provision of care to PWD, and 2) determine the association between elderspeak
communication by nursing staff and RTC in PWD during dyadic care interactions. Nursing staff will be
audio-recorded during care interactions and behavioral and psycholinguistic coding of recordings and
transcripts will be used to identify and describe elderspeak. Co-occurring observations will be
performed to evaluate RTC in PWD using the valid and reliable RTC Scale. Interventions targeting
enhanced dyadic communication have been successful in improving communication and reducing
behavioral symptoms in long-term care, yet there is a lack of research characterizing and testing
interventions to improve communication in acute care. This study will provide preliminary evidence for
the need to adapt and implement and educational intervention for elderspeak reduction and improved
communication in the acute care setting. The proposed research and training will cultivate knowledge
growth and skills related to research methods, expertise in dementia care, dissemination, and
professional development through a variety of activities and mentorship from an expert team. The
proposed research aligns with NINR's mission to improve health and quality of life by identifying
antecedents to behavioral symptoms of dementia and will identify the need for a nonpharmacological
intervention for acute care focused on improved communication to prevent RTC in PWD.

## Key facts

- **NIH application ID:** 9982071
- **Project number:** 5F31NR018580-02
- **Recipient organization:** UNIVERSITY OF IOWA
- **Principal Investigator:** Clarissa Anne Shaw
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $18,103
- **Award type:** 5
- **Project period:** 2019-07-09 → 2021-01-08

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9982071

## Citation

> US National Institutes of Health, RePORTER application 9982071, Resistiveness in Dementia: Nurse Communication in Acute Care (5F31NR018580-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9982071. Licensed CC0.

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