Abstract
Person-Centered Memory and Communication Interventions for Dementia: A Case Study Approach is the third volume in the Medical Speech-Language Pathology book series. Purchase of the book includes access to the supplementary materials on a PluralPlus companion
Website. Resources online include a list of resources, assessment templates and tools, external memory aids, and other materials. “The purpose of this book is to bring to life ideas for evidence-based, person-centered interventions for persons with dementia and their care partners” (Hickey & Douglas, 2021, p. 1). The book is organized by eight case studies based on actual cases; however, the individuals’ details are altered to protect the privacy of the individuals. The cases include ethnically and racially diverse men and women living in Canada and the United States, large cities and small towns, home settings, and long-term care facilities with Alzheimer’s disease, vascular dementia, Parkinson’s disease, and other causes of cognitive and communication dysfunction. This book has several strengths. First, the book presents an application of evidence-based practice interventions and approaches that focus on providing a tailored, culturally responsive approach to person-centered dementia care. The book “is a practical, peer-reviewed resource for speech-language pathologists (SLPs) working with dementia” (Hickey & Douglas, 2021, p. back cover of the book) and other rehabilitation clinicians, healthcare providers, and caregivers. This 10-chapter book includes an introductory chapter, eight case-study chapters, and a concluding chapter.
The first chapter sets the stage for the eight case studies by describing person-centered assessment and care, culturally responsive practice, evidence-based interventions, healthcare environments, and challenges. This first chapter also delineates examples of the necessary components to complete a systematic assessment designed for treatment planning, which includes formal and informal measures. The components of the latter form of assessment are identified as Ethnographic Assessment, Preference Assessment, Responsive Behavior Assessment, and Environmental Assessment. The authors outline steps that can facilitate the completion of each assessment category. This chapter also includes a chart that demonstrates an example of this assessment procedure using the Flip the Rehab Model (Bourgeois, 2014), adapted from the Living with Aphasia Framework for Outcomes Measurement (Kagan & Simmons-Mackie, 2007), a model focusing on patient outcomes. Sample tools and resources, such as the Patient-Reported Outcome Measures for Persons with Dementia, that can be used during the assessment process are also provided in chapter 1. The authors highlight the importance of developing a treatment plan using an intervention method that supports the independence and life participation of individuals with dementia while considering their contextual factors. This chapter describes evidence-based practices, such as using memory and communication aids, and provides a chart with examples of electronic and nonelectronic external aids. Additionally, the authors describe how to use space retrieval training (SRT) to facilitate the acquisition of forgotten information or behaviors using external aids with a person with dementia. Therefore, in this introductory chapter, the authors guide the reader on how to use the assessment outcomes in developing a treatment plan that includes evidence-based practices that meet regulatory and reimbursements guidelines.
In the subsequent case-study chapters, each titled with the pseudonym of the person with dementia, for example, Ivan, the Mentor, and Elsie, the Nana, drives home the point, consistent with the groundbreaking work of Tom Kitwood (1997). Kitwood stresses that the person's identity, life history, preferences, and interests need to be recognized and incorporated into person-centered care. Each case study includes background information, results of ethnographic approach for person-centered assessment, results of the cognitive-communication assessment, and sample goals for implementing evidence-based person-centered care. All of the case studies utilize the assessment approach Flip the Rehab Model. The case histories are derived from reviewing patient charts, interviewing communication partners, observing the person with dementia, and collecting information on responsive behaviors during dynamic and static assessments. This process culminates in the preparation of person-centered interventions using functional goals. The chapters are organized in a similar format. This uniformity makes it easier for the reader to follow and apply recommendations in clinical practice.
Each case-study chapter identifies specific factors that should be addressed when assessing and determining a treatment plan for each person with dementia. The format of the case studies' depiction highlights the importance of seeing the whole person in a relatable manner. Each person with dementia depicted in the chapters has different capabilities and weaknesses, which are summarized at the beginning of each chapter. Each chapter describes the distinction between the case studies by providing details of their premorbid state, vocational history, personal and medical background, key factors of the primary diagnosis, family interests, environment, culture, spoken languages, ethnicity, race, religion, capabilities, and weaknesses. The authors include (a) templates for identifying participation opportunities within daily activities; (b) interview sample questions for each person with dementia and/ or caregivers; and (c) sample artifacts to collect personal information on special items, photographs, or terms of interest.
Each case-study chapter includes charts describing the results of the ethnographic and cognitive/ communication assessments (formal and informal measurements) and swallowing assessments (when applicable). The authors also included a chart with desired outcomes, goals, and sample evidence-based intervention using external memory/ communication aids, space retrieval training, and care partner instruction that supports the needs of each case study. Sample figures included in each chapter highlight the specific needs of the person with dementia. These figures depict external memory and communication aids for orientation tasks, meeting individual needs, reminders, caregiver communication and/ or swallowing tips, activities, schedules, medical decision aids, photo books, communication do’s and don’ts, and/ or mobile devices organizational pictures. The authors also provide examples of how to improve the engagement for each person by identifying key personnel and describing their roles within an interprofessional practice approach.
Finally, the authors describe potential barriers to implementation and possible suggestions for addressing these concerns. For instance, one of the case studies focuses on a person with mild cognitive impairment hospitalized for coronavirus disease (COVID-19) that is timely and provides examples of high-tech external memory aids and organizational strategies. With permission from the patient, the SLP reorganized the person’s disorganized iPhone and deleted unused applications (apps) to simplify the display. After the iPhone was reorganized, the patient was able to access multiple applications (apps), including iPhone Calendar, Notes app, and use FaceTime to communicate with loved ones. We have all seen healthcare providers on the news improvising to assist persons hospitalized with COVID-19 to communicate with family members not permitted to visit. A particularly poignant photo in the book addresses the issue of communication barriers during the pandemic. The picture is of "Julie,” the speech-language pathologist, in full Personal Protective Equipment (face obscured). Julie has a badge attached to her face shield with her name and a picture of her smiling to promote a human connection with a smiling facial expression. Each chapter closes with a summary of their background, diagnosis, intervention process, and barriers to implementation.
Throughout the book, the authors stress the importance of completing a thorough assessment to develop a treatment plan for a person with dementia that includes evidence-based practice, interprofessional practice, and cultural humility, which are consistent with the American Speech-Language-Hearing Association’s standards for clinical competence (ASHA, 2021). They highlight the difference between an assessment completed aimed to determine a diagnosis versus develop a treatment plan. Formal standardized assessments are necessary to diagnose a person with dementia by determining cognitive-communication abilities. However, informal measures can also provide valuable information on the cognitive-communication abilities of a person with dementia. The latter assessment supports a person-centered view by observing the whole person. Therefore, the authors demonstrate the importance of using informal criterion-based assessments to develop goals by identifying the individual's capabilities and weaknesses.
Another strength of the book is the inclusion of many figures with pictures of external aids for Activities of Daily Living (ADL), Independent Activities of Daily Living (IADL), memory, and communication. More than forty figures in the book illustrate family pictures, various external memory and communication aids, and communication tips for staff and family. The authors suggest that volunteers and students create memory and communication aids with the patient and family as part of therapy. The book is well organized and provides numerous examples of applied memory and communication interventions for ethnically and racially diverse individuals with dementia. The authors acknowledge that the process and approach in providing memory and communication interventions have challenges (in terms of staffing, administration, and fiscal support); however, they inspire hope for the provision of person-centered dementia care.
The final chapter includes a message that empowers future clinicians with this sense of hope. Therefore, this book will inspire new SLPs, health care providers, and caregivers to develop and implement culturally responsive, tailored person-centered memory and communication interventions for persons living with dementia. This book highlights valuable information that can benefit professionals, such as SLPs, nurses, and professors teaching undergraduate and graduate courses in higher education. This book can be used as a primary textbook in courses focusing on dementia. Moreover, this book can also be used as a supplemental textbook for courses focusing on adult cognition and language disorders, adult language disorders, neuromotor speech disorders concomitant with dementia, augmentative and alternative communication, gerontology, interprofessional education and practice, and cognitive assessment and treatment.