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

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Project Abstract The COVID-19 pandemic has greatly impacted care of persons living with Alzheimer’s disease and other dementias (ADOD) in long-term service and support settings. Notably, nursing home residents, including an estimated 50% or more who experience dementia, have extremely high rates of infection and comprise a predominant number of deaths from COVID-19. New infection control precautions, regulations, and surveillance have been implemented to reduce these overwhelming effects on older adults in nursing home (NH) care. Central to infection control precautions is the use of personal protective equipment (PPE). Although a necessary and critical aspect of reducing COVID-19 transmission in NHs, secondary effects of PPE on communication, behavioral and psychological symptoms of dementia (BPSD), and other aspects of care for persons with dementia remain to be addressed. As PPE presents additional challenges to communication, interventions to optimize communication while using PPE have the potential to improve dementia care by reducing negative reactions by persons with ADOD and supporting nursing staff by identifying person-centered best practices. Our research team is currently conducting a randomized clinical trial (R01 AG069171-06A1), to test an online communication training program “Changing Talk Online” (CHATO). This staff educational intervention includes three evidence-based training modules that have resulted in improved communication and reduced BPSD in NHs. The CHATO pragmatic randomized controlled trial will test the effects of CHATO on BPSD and on use of psychotropic medication for residents with dementia in 120 NHs nationwide. In addition, we will test strategies to engage staff and maximize CHATO effects and evaluate cost and sustainability for widespread dissemination. The overall goal is to provide ready access and support to NH staff to improve communication that subsequently reduces BPSD and the need for psychoactive medications inappropriately and dangerously used to control these symptoms. This administrative supplement (CHAT-PPE) will expand the scope of our R01 study to: (1) identify evidence- based best practices for communication while using PPE; and (2) create and test a brief training module for nursing staff to be used alone or in conjunction with the CHATO training. Strategies for effective communication while wearing PPE are of critical importance across long-term service and support settings that care for older adults with dementia. Our research established evidence of the importance of communication in dementia care, noting that improved communication reduced BPSD and the need for antipsychotic medication use. Our team is uniquely qualified to identify communication best practices and then to develop and test interventions to overcome PPE communication barriers in dementia care. This research meets the NIA objective to develop novel interventions to meet the needs of dementia caregivers and care recipients.