{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T14:54:08Z","timestamp":1781276048688,"version":"3.54.1"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2016,4,5]],"date-time":"2016-04-05T00:00:00Z","timestamp":1459814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01NR011455"],"award-info":[{"award-number":["R01NR011455"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["NCT01324219"],"award-info":[{"award-number":["NCT01324219"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose of the Study<\/jats:title>\n                    <jats:p>Nursing home (NH) residents with dementia exhibit challenging behaviors or resistiveness to care (RTC) that increase staff time, stress, and NH costs. RTC is linked to elderspeak communication. Communication training (Changing Talk [CHAT]) was provided to staff to reduce their use of elderspeak. We hypothesized that CHAT would improve staff communication and subsequently reduce RTC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirteen NHs were randomized to intervention and control groups. Dyads (n = 42) including 29 staff and 27 persons with dementia were videorecorded during care before and\/or after the intervention and at a 3-month follow-up. Videos were behaviorally coded for (a) staff communication (normal, elderspeak, or silence) and (b) resident behaviors (cooperative or RTC). Linear mixed modeling was used to evaluate training effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On average, elderspeak declined from 34.6% (SD = 18.7) at baseline by 13.6% points (SD = 20.00) post intervention and 12.2% points (SD = 22.0) at 3-month follow-up. RTC declined from 35.7% (SD = 23.2) by 15.3% points (SD = 32.4) post intervention and 13.4% points (SD = 33.7) at 3 months. Linear mixed modeling determined that change in elderspeak was predicted by the intervention (b = \u221212.20,p = .028) and baseline elderspeak (b = \u22120.65,p &amp;lt; .001), whereas RTC change was predicted by elderspeak change (b = 0.43,p &amp;lt; .001); baseline RTC (b = \u22120.58,p &amp;lt; .001); and covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>A brief intervention can improve communication and reduce RTC, providing an effective nonpharmacological intervention to manage behavior and improve the quality of dementia care. No adverse events occurred.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geront\/gnw047","type":"journal-article","created":{"date-parts":[[2016,4,5]],"date-time":"2016-04-05T23:24:56Z","timestamp":1459898696000},"page":"707-718","source":"Crossref","is-referenced-by-count":38,"title":["A Communication Intervention to Reduce Resistiveness in Dementia Care: A Cluster Randomized Controlled Trial"],"prefix":"10.1093","volume":"57","author":[{"given":"Kristine N.","family":"Williams","sequence":"first","affiliation":[{"name":"College of Nursing, University of Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yelena","family":"Perkhounkova","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Herman","sequence":"additional","affiliation":[{"name":"Center for Public Partnerships and Research, University of Kansas , Lawrence"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Bossen","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Iowa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,4,5]]},"reference":[{"key":"2026010517320411400_CIT0001","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1177\/153331759601100603","article-title":"Need-driven dementia-compromised behavior: An alternative view of disruptive behavior","volume":"11","author":"Algase","year":"1996","journal-title":"American Journal of Alzheimer\u2019s Disease and Other Dementias"},{"key":"2026010517320411400_CIT0002","volume-title":"Handling missing data by maximum likelihood","author":"Allison","year":"2012"},{"key":"2026010517320411400_CIT0003","first-page":"3","article-title":"2015 Alzheimer\u2019s disease facts and figures","volume":"11","author":"Alzheimer\u2019s Association","year":"2015","journal-title":"Alzheimer\u2019s and Dementia"},{"key":"2026010517320411400_CIT0004","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1017\/S1041610200006773","article-title":"Behavioral and psychological symptoms of dementia as a risk factor for nursing home placement","volume":"12","author":"Balestri","year":"2000","journal-title":"International Psychogeriatrics"},{"key":"2026010517320411400_CIT0005","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1207\/s15327027hc0803_3","article-title":"Patterns of communication in old age: The dependence-support and independence-ignore script","volume":"8","author":"Baltes","year":"1996","journal-title":"Health Communication"},{"key":"2026010517320411400_CIT0006","first-page":"68","article-title":"Herding cats: Barriers to implementing a nurse aide educational program","volume":"8","author":"Banazak","year":"2000","journal-title":"Annals of Long-Term Care"},{"key":"2026010517320411400_CIT0007","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1002\/gps.490","article-title":"The cost of behavioral and psychological symptoms of dementia (BPSD) in community dwelling AD patients","volume":"17","author":"Beeri","year":"2002","journal-title":"International Journal of Geriatric Psychiatry"},{"issue":"Suppl. 1","key":"2026010517320411400_CIT0008","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1093\/geront\/45.suppl_1.56","article-title":"Characteristics associated with behavioral symptoms related to dementia in long-term care residents","volume":"45","author":"Boustani","year":"2005","journal-title":"Gerontologist"},{"key":"2026010517320411400_CIT0009","doi-asserted-by":"crossref","DOI":"10.1002\/0470023589","volume-title":"Applied mixed models in medicine","author":"Brown","year":"2006","edition":"2nd"},{"key":"2026010517320411400_CIT0010","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1016\/j.gerinurse.2007.11.001","article-title":"Levels of personhood: A model for dementia care","volume":"29","author":"Buron","year":"2008","journal-title":"Geriatric Nursing"},{"key":"2026010517320411400_CIT0011","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1037\/0022-3514.40.5.876","article-title":"The paralanguage of caregiving: Baby talk to the institutionalized aged","volume":"40","author":"Caporael","year":"1981","journal-title":"Journal of Personality and Social Psychology"},{"key":"2026010517320411400_CIT0012","article-title":"Expected and adjusted staff time values data set","author":"Centers for Medicare and Medicaid Services","year":"2015"},{"key":"2026010517320411400_CIT0013","volume-title":"Applied multiple regression\/correlation analyses for the behavioral sciences","author":"Cohen","year":"2003","edition":"3rd ed"},{"key":"2026010517320411400_CIT0014","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/00019442-200111000-00005","article-title":"Nonpharmacologic interventions for inappropriate behaviors in dementia","volume":"9","author":"Cohen-Mansfield","year":"2001","journal-title":"American Journal of Geriatric Psychiatry"},{"key":"2026010517320411400_CIT0015","first-page":"19","article-title":"Treating behavioral symptoms: Nonpharmacological interventions for persons with dementia","volume":"6","author":"Cohen-Mansfield","year":"2005","journal-title":"Alzheimer\u2019s Care Quarterly"},{"key":"2026010517320411400_CIT0016","doi-asserted-by":"crossref","first-page":"M77","DOI":"10.1093\/geronj\/44.3.M77","article-title":"A description of agitation in a nursing home","volume":"44","author":"Cohen-Mansfield","year":"1989","journal-title":"Journals of Gerontology: Medical Sciences"},{"key":"2026010517320411400_CIT0017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3928\/00989134-20150515-88","article-title":"Comparing person centered communication education in long term care using onsite and online formats","volume":"41","author":"Coleman","year":"2015","journal-title":"Journal of Gerontological Nursing"},{"key":"2026010517320411400_CIT0018","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1177\/0193945906287053","article-title":"An exploration of nursing home organizational processes","volume":"28","author":"Forbes-Thompson","year":"2006","journal-title":"Western Journal of Nursing Research"},{"key":"2026010517320411400_CIT0019","article-title":"Genworth 2015 cost of care survey","author":"Genworth Financial","year":"2015"},{"key":"2026010517320411400_CIT0020","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3928\/0098-9134-19940401-05","article-title":"Assessment and management of agitation in Alzheimer\u2019s patients: A nursing challenge","volume":"20","author":"Gerdner","year":"1994","journal-title":"Journal of Gerontological Nursing"},{"key":"2026010517320411400_CIT0021","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3928\/0098-9134-19980101-08","article-title":"Assignment, staff ratios, and training in Alzheimer\u2019s special care units","volume":"24","author":"Grant","year":"1998","journal-title":"Journal of Gerontological Nursing"},{"key":"2026010517320411400_CIT0022","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1177\/1077558703254692","article-title":"Nursing home staffing, turnover, and case mix","volume":"60","author":"Harrington","year":"2003","journal-title":"Medical Care Research and Review"},{"key":"2026010517320411400_CIT0023","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1177\/1533317509341949","article-title":"Elderspeak\u2019s influence on resistiveness to care: Focus on specific behavioral events in dementia care","volume":"24","author":"Herman","year":"2009","journal-title":"American Journal of Alzheimer\u2019s Disease and Other Dementias"},{"key":"2026010517320411400_CIT0024","first-page":"17","article-title":"Elderspeak: Speech accommodations to older adults","volume":"1","author":"Kemper","year":"1994","journal-title":"Aging and Cognition"},{"key":"2026010517320411400_CIT0025","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1037\/0882-7974.14.4.656","article-title":"Experimentally disentangling what\u2019s beneficial about elderspeak from what\u2019s not","volume":"14","author":"Kemper","year":"1999","journal-title":"Psychology and Aging"},{"key":"2026010517320411400_CIT0026","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1076\/anec.5.1.43.22","article-title":"Use of elderspeak by young and older adults to impaired and unimpaired listeners","volume":"5","author":"Kemper","year":"1998","journal-title":"Aging, Neuropsychology, and Cognition"},{"key":"2026010517320411400_CIT0027","first-page":"15","article-title":"The experience of dementia","volume":"7","author":"Kitwood","year":"1997","journal-title":"Aging and Mental Health"},{"key":"2026010517320411400_CIT0028","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1017\/S0144686X0000502X","article-title":"Towards a theory of dementia care: Personhood and wellbeing","volume":"12","author":"Kitwood","year":"1992","journal-title":"Ageing and Society"},{"key":"2026010517320411400_CIT0029","first-page":"153","article-title":"Improving outcomes in geriatric rehabilitation: The impact of reducing cumulative illness","volume":"6","author":"Knoefel","year":"2003","journal-title":"Geriatrics Today"},{"key":"2026010517320411400_CIT0030","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1097\/00006199-199403000-00003","article-title":"Contextual factors associated with disturbing behaviors in institutionalized elders","volume":"43","author":"Kolanowski","year":"1994","journal-title":"Nursing Research"},{"key":"2026010517320411400_CIT0031","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/j.1547-5069.2005.00025_1.x","article-title":"A model of consequences of need-driven, dementia-compromised behavior","volume":"37","author":"Kovach","year":"2005","journal-title":"Journal of Nursing Scholarship"},{"key":"2026010517320411400_CIT0032","article-title":"In \u201cSweetie\u201d and \u201cDear,\u201d a hurt beyond insult for the elderly","author":"Leland","year":"2008","journal-title":"The New York Times (National Edition)"},{"key":"2026010517320411400_CIT0033","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3928\/00989134-20061101-04","article-title":"Providing quality care in assisted living facilities: Recommendations for enhanced staffing and staff training","volume":"32","author":"Maas","year":"2006","journal-title":"Journal of Gerontological Nursing"},{"key":"2026010517320411400_CIT0034","article-title":"Instruction manual for resistiveness to care scale","author":"Mahoney","year":"1991"},{"key":"2026010517320411400_CIT0035","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/(SICI)1098-240X(199902)22:1<27::AID-NUR4>3.0.CO;2-T","article-title":"Development and testing of the resistiveness to care scale","volume":"22","author":"Mahoney","year":"1999","journal-title":"Research in Nursing and Health"},{"key":"2026010517320411400_CIT0036","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1093\/geront\/39.5.546","article-title":"Educating nursing assistants to communicate more effectively with nursing home residents","volume":"39","author":"McCallion","year":"1999","journal-title":"The Gerontologist"},{"key":"2026010517320411400_CIT0037","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1093\/geront\/gnt020","article-title":"Culture change practice in U.S. nursing homes: Prevalence and variation by state medicaid reimbursement policies","volume":"54","author":"Miller","year":"2014","journal-title":"The Gerontologist"},{"issue":"Suppl. 2","key":"2026010517320411400_CIT0038","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1093\/geront\/43.suppl_2.37","article-title":"The quality of quality measurement in U.S. nursing homes","volume":"43","author":"Mor","year":"2003","journal-title":"The Gerontologist"},{"key":"2026010517320411400_CIT0039","volume-title":"Nursing research principles and methods","author":"Polit","year":"2007","edition":"7th"},{"key":"2026010517320411400_CIT0040","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1177\/0261927X95141008","article-title":"Communication predicaments of aging: Patronizing behavior toward older adults","volume":"14","author":"Ryan","year":"1995","journal-title":"Journal of Language and Social Psychology"},{"key":"2026010517320411400_CIT0040a","doi-asserted-by":"crossref","DOI":"10.1017\/S0714980800006048","article-title":"Evaluative perceptions of patronizing speech addressed to institutionalized elders in contrasting conversational contexts","volume":"13","author":"Ryan","year":"1994","journal-title":"Canadian Journal on Aging"},{"issue":"Suppl. 1","key":"2026010517320411400_CIT0041","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1017\/S1041610292001157","article-title":"Functional assessment staging (FAST) in Alzheimer\u2019s disease: Reliability, validity, and ordinality","volume":"4","author":"Sclan","year":"1992","journal-title":"International Psychogeriatrics"},{"key":"2026010517320411400_CIT0042","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1097\/00001786-200501000-00007","article-title":"Assessing nursing homes\u2019 capacity to create and sustain improvement","volume":"20","author":"Scott","year":"2005","journal-title":"Journal of Nursing Care Quality"},{"key":"2026010517320411400_CIT0043","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s13142-013-0194-3","article-title":"A staff training and management intervention in VA long-term care: Impact on feeding assistance care quality","volume":"3","author":"Simmons","year":"2013","journal-title":"Translational Behavioral Medicine"},{"key":"2026010517320411400_CIT0044","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1177\/1533317507305593","article-title":"Provision of morning care to nursing home residents with dementia: Opportunity for improvement?","volume":"22","author":"Sloane","year":"2007","journal-title":"American Journal of Alzheimer\u2019s Disease"},{"key":"2026010517320411400_CIT0045","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3928\/0098-9134-20030801-08","article-title":"Disruptive behaviors of older adults in an institutional setting: Staff time required to manage disruptions","volume":"29","author":"Souder","year":"2003","journal-title":"Journal of Gerontological Nursing"},{"key":"2026010517320411400_CIT0046","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1093\/geront\/42.2.169","article-title":"Mental health correlates of aggression in nursing home residents with dementia","volume":"42","author":"Talicero","year":"2002","journal-title":"The Gerontologist"},{"key":"2026010517320411400_CIT0047","volume-title":"Modeling longitudinal data","author":"Weiss","year":"2005"},{"key":"2026010517320411400_CIT0048","volume-title":"Improving nursing home communication Dissertation Abstracts International","author":"Williams","year":"2001"},{"key":"2026010517320411400_CIT0049","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1002\/nur.20117","article-title":"Improving outcomes of nursing home interactions","volume":"29","author":"Williams","year":"2006","journal-title":"Research in Nursing and Health"},{"key":"2026010517320411400_CIT0051","doi-asserted-by":"crossref","first-page":"38","DOI":"10.3928\/02793695-20050701-05","article-title":"Meeting communication needs: Topics of talk in the nursing home","volume":"43","author":"Williams","year":"2005","journal-title":"Journal of Psychosocial Nursing and Mental Health Services"},{"key":"2026010517320411400_CIT0052","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1093\/geront\/43.2.242","article-title":"Improving nursing home communication: An intervention to reduce elderspeak","volume":"43","author":"Williams","year":"2003","journal-title":"The Gerontologist"},{"key":"2026010517320411400_CIT0053","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3928\/0098-9134-20041001-08","article-title":"Enhancing communication with older adults: Overcoming elderspeak","volume":"30","author":"Williams","year":"2004","journal-title":"The Journal of Gerontological Nursing"},{"key":"2026010517320411400_CIT0054","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1177\/1533317508318472","article-title":"Elderspeak communication: Impact on dementia care","volume":"24","author":"Williams","year":"2009","journal-title":"American Journal of Alzheimer\u2019s Disease and Other Dementias"},{"key":"2026010517320411400_CIT0055","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.gerinurse.2008.09.002","article-title":"Aggressive behavior of nursing home residents toward caregivers: A systematic literature review","volume":"30","author":"Zeller","year":"2009","journal-title":"Geriatric Nursing"},{"key":"2026010517320411400_CIT0056","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/geront\/45.suppl_1.96","article-title":"Attitudes, stress, and satisfaction of staff who care for residents with dementia","volume":"45","author":"Zimmerman","year":"2005","journal-title":"The Gerontologist"}],"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/57\/4\/707\/66266562\/gerontologist_57_4_707.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/57\/4\/707\/66266562\/gerontologist_57_4_707.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T22:32:16Z","timestamp":1767652336000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/article\/57\/4\/707\/2631994"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,4,5]]},"references-count":56,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2017,8,1]]}},"URL":"https:\/\/doi.org\/10.1093\/geront\/gnw047","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,8]]},"published":{"date-parts":[[2016,4,5]]}}}