Changing Talk Online (CHATO): A Pragmatic Trial to Reduce Behavioral Symptoms in Dementia Care

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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 better communication strategies and is proven to reduce staff elderspeak and BPSD in NH residents. The next step to increase the impact of this effective classroom-based training is to test CHAT content provided in online internet modules. CHAT 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 R61/R33 study will develop and conduct a pragmatic clinical trial in response to PAR-18-585, Pragmatic Trials for Dementia Care I Long-term Services and Support (LTSS) Settings. We will test the effects of CHATO training on resident BPSD and psychotropic medication use in 120 NHs. In the R61 planning phase we will pilot test the online modules with NH staff to establish effects; recruit NH sites for the R33 trial; develop the clinical trial protocol, manual of operations, and data forms; develop data management, sharing, and fidelity assurance protocols; and obtain IRB approvals. A panel of NH administrators and staff will advise the team on recruitment strategies and a natural processing elderspeak feedback app will be tested in the clinical setting. In R33 phase we will conduct the pragmatic trial in 120 NHs that 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 in CHATO (paid time off, recognition) and costs will be identified. The effects of a self-monitoring app that uses natural language processing to give staff immediate feedback on their elderspeak use will be tested. This research addresses NIA's milestones for nonpharmacological dementia care interventions, 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. The goal of reducing inappropriate use of psychoactive medications to control BPSD using this nonpharmacological approach aligns with the top priority goal of the National Partnership to Improve Dementia Care. As the number of persons diagnosed with dementia triples in the next 30 years, empowering care providers to provide high quality care for individuals with dementia is of critical importance.