Changing Talk Online Training (CHATO): A National Trial to Reduce Behavioral Symptoms in Long Term Care Residents with Alzheimer's Disease and Other Dementias

Project Abstract The growing population of persons with dementia presents challenges to providing high quality nursing home (NH) care. Care is complicated by behavioral and psychosocial symptoms of dementia (BPSD) such as aggression, vocal outbursts, wandering, and withdrawal that occur as persons with dementia lose cognitive and communication abilities and cannot verbally express unmet physical and psychosocial needs. NH staff use “elderspeak,” speech similar to baby talk that is demeaning to residents. Residents react to elderspeak with BPSD resulting in increased use of psychotropic medication to control BPSD, higher staffing needs, more staff stress and turnover, and increased costs. The Changing Talk (CHAT) training program educates staff about elderspeak and person-centered communication strategies and is proven to reduce staff elderspeak and BPSD. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. Providing this training online (CHATO) can improve access for busy staff and those in rural and small NHs to increase dissemination across care settings to improve dementia care. This continuing renewal study will test a new, online version of CHAT, a nonpharmacological intervention that effectively decreases staff elderspeak communication and subsequently reduces BPSD in NH residents with dementia. The interactive CHATO modules provide flexible access to training, continuously accessible to staff via the internet. In this pragmatic trial, 120 NHs will be randomly assigned to CHATO training or to the control group. BPSD and psychotropic medication rate data, extracted from the Center for Medicare and Medicaid Services Nursing Home Compare and Minimum Data Set, will be compared using linear mixed modeling. NH strategies used to engage staff (paid time to complete, recognition) and other supports will be analyzed in relation to staff participation rates and changes in the outcome measures. Costs will be determined in relation to changes in the outcomes and ongoing use and reinforcement of training will be assessed at a one-year follow-up survey for participating nursing homes. The overall goal of this study is to prepare for large scale dissemination and implementation of this evidence-based nonpharmacological intervention to reduce RTC for residents with dementia across long term care settings. This research addresses NIA's milestones for nonpharmacological dementia care interventions, NINR's symptom management and caregiver support missions, the National Plan to Address Alzheimer's Disease goal to enhance care quality and efficiency, and the Alzheimer's Association Plan to build a workforce with high- quality care skills. Reducing inappropriate use of psychoactive medications to control BPSD is the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons with dementia triples in the next 30 years, empowering care providers to provide high quality dementia care is of critical importance.