Adapting the CHATO Communication Intervention for Diverse Nursing Home Communities

Dementia is most prevalent in Black and Hispanic older adults who are increasingly cared for in nursing homes (NHs). Staff shortages and lack of dementia care skills limit care quality, especially in NHs with high proportions of ethnoracially diverse residents. Care for persons living with dementia (PLWD) in NHs is

complicated by behavioral and psychological symptoms of dementia (BPSD) when residents cannot express unmet physical and psychosocial needs. BPSD increase staff stress and time to complete care, contribute to staff turnover and injury, and lead to use of inappropriate psychoactive medication to control resident BPSD.

Our team demonstrated that BPSD occur when staff use elderspeak (speech that sounds like baby talk). Elderspeak features inappropriately intimate terms of endearment (diminutives such as “honey”), belittling pronoun substitutions that imply dependence (“we” need a bath), and harsh task-oriented commands (“sit

down”). Elderspeak conveys a message of disrespect and incompetence to PLWD who react with withdrawal or BPSD. Our prior research established that elderspeak use more than doubled the occurrences of BPSD responses in NH residents with dementia. We later confirmed that the three-session Changing Talk (CHAT)

communication education intervention reduced staff elderspeak use that significantly reduced resident BPSD. CHAT in online format (CHATO) has demonstrated communication knowledge and confidence gains and is currently being testing in a national clinical trial. However, NHs serving higher proportions of diverse

residents have not shown interest in participation, despite having more frequent and serious care deficiencies including higher rates of BPSD and antipsychotic medication use. Research has established that tailoring and intensification approaches are often needed for interventions across care settings to reduce care disparities.

We will first engage staff in six NHs caring for diverse residents and our expert stakeholder panel to adapt the current CHATO intervention using the ADAPT framework to increase cultural competency. We will test the adapted intervention (CHATO-I) in a waitlist-controlled trial in 40 NHs that care for high proportions of

minority residents (