Speech-Language Pathologists' Assessment and Treatment of Dementia: a Mixed Methods Study Alyssa Mount University of Nebraska-Lincoln, [email protected]
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University of Nebraska - Lincoln DigitalCommons@University of Nebraska - Lincoln Public Access Theses and Dissertations from the Education and Human Sciences, College of (CEHS) College of Education and Human Sciences 7-2019 Speech-Language Pathologists' Assessment and Treatment of Dementia: A Mixed Methods Study Alyssa Mount University of Nebraska-Lincoln, [email protected] Follow this and additional works at: https://digitalcommons.unl.edu/cehsdiss Part of the Other Education Commons Mount, Alyssa, "Speech-Language Pathologists' Assessment and Treatment of Dementia: A Mixed Methods Study" (2019). Public Access Theses and Dissertations from the College of Education and Human Sciences. 339. https://digitalcommons.unl.edu/cehsdiss/339 This Article is brought to you for free and open access by the Education and Human Sciences, College of (CEHS) at DigitalCommons@University of Nebraska - Lincoln. It has been accepted for inclusion in Public Access Theses and Dissertations from the College of Education and Human Sciences by an authorized administrator of DigitalCommons@University of Nebraska - Lincoln. Speech-Language Pathologists’ Assessment and Treatment of Dementia: A Mixed Methods Study by Alyssa L. Mount A THESIS Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Master of Science Major: Speech Language Pathology and Audiology Under the Supervision of Professor Kristy Weissling Lincoln, Nebraska July, 2019 Speech-Language Pathologists’ Assessment and Treatment of Dementia: A Mixed Methods Study Alyssa Mount, M.S. University of Nebraska, 2019 Advisor: Kristy Weissling The intent of this research was to investigate how speech-language pathologists (SLPs) are assessing and treating people with dementia (PWD). To examine this the researcher first completed a literature review to determine prominent evaluation and treatment procedures for dementia. Then the researcher set out to identify whether there was a gap between the external evidence found in the literature and the practice patterns of SLPs, and subsequently attempt to delineate potential reasons for the differences. Using a mixed-method design, the researcher conducted 10 phone interviews and 114 SLPs participated in an online survey. The researcher engaged in grounded theory coding procedures for the interviews. Survey data were analyzed based on demographic groups (e.g., rural versus urban) using non-parametric procedures. In general, the results suggested that SLPs are completing some of the assessment and treatment procedures identified in the literature. In regard to assessment, there was a departure from the literature in terms of the need to screen for vision/hearing and depression and engaging differential diagnosis to inform the evaluation. Both qualitative and quantitative results yielded a discrepancy in the use of vocabulary across participants. In fact, some SLPs reported engaging in procedures without having a name for them. SLPs with more years of experience and more dementia-related CEUs had higher confidence in completing several dementia-related procedures than those with fewer years/CEUs. Participants with fewer dementia-CEUs and a smaller caseload of PWD were less familiar with treatment approaches identified in the extant literature than those with more CEUs/higher caseloads. Participants with fewer dementia-CEUs reported using external memory aids less frequently than those with more CEUs; and, SLPs with fewer years of experience used errorless learning less frequently than those with more years of experience. Barriers that emerged that identify sources of gaps between the literature and clinical practice (i.e., implementation of EBP) included: lack of time, lack of carryover by caregivers, insurance barriers, lack of applicability of research, limited evidence, and lack of materials/resources. Author’s Acknowledgements I first would like to thank my thesis advisor, Dr. Weissling, who has shown me great guidance throughout my undergraduate and graduate career and never hesitated to drop what she was doing to assist me with my project. Her mentorship has not only taught me better ways to be a researcher, but also to be a better clinician. I would also like to thank my other committee members, Dr. Harvey and Dr. Lambert. I appreciate you both taking the time out of your busy schedules to answer my questions and probe me with questions to make me a stronger researcher. I would also like to thank Jacquelyn King and Sam Galligan, the undergraduate students who served as reliability agents throughout my project. I hope I was as helpful to you as you were to my project! I’d also like to thank Nikki Scott, Beth Dineen, Jessie Kohn, Alicia Davis, and Abby Pelster who all provided me with insightful feedback for the content of my survey. Of course, I’d like to express my gratitude to my family for always being understanding of the long hours and supportive throughout. I’d like to thank Michaela Sullivan, Anthony Kohtz, and other close friends who were there to provide moral support, ideas, and show genuine interest in my work throughout the years of this project. I also thank all my peers and clinic supervisors at UNL for supporting me throughout my graduate career. To Dr. Champley, my clinic supervisor during my medical externship, I appreciate your frequent encouraging words to get this project completed. v Table of Contents Chapter 1: Background .................................................................................................................... 1 Review of Relevant Literature ................................................................................................... 1 Related Research ........................................................................................................................ 7 Pilot Studies ............................................................................................................................... 9 Statement of the Problem ......................................................................................................... 13 Chapter 2: Study Design and Methods .......................................................................................... 16 Reviews of Literature ............................................................................................................... 16 Treatment ..................................................................................................................... 16 Assessment ................................................................................................................... 25 Study Design ........................................................................................................................... 28 Methods .................................................................................................................................. 31 Recruitment ............................................................................................................................. 34 Chapter 3: Qualitative Results ....................................................................................................... 36 Interviewee Demographics .................................................................................................... 36 Open Coding .......................................................................................................................... 40 Axial Coding .......................................................................................................................... 44 Phenomenon: Evaluation ....................................................................................................... 47 Causal Conditions ....................................................................................................... 48 Context ........................................................................................................................ 51 Actions/Strategies ....................................................................................................... 53 Consequences .............................................................................................................. 55 Phenomenon: Treatment ........................................................................................................ 56 Causal Conditions ...................................................................................................... 56 Context ....................................................................................................................... 61 Actions/Strategies ...................................................................................................... 64 Consequences ............................................................................................................. 69 Selective Coding ................................................................................................................... 73 The Theory of SLP Dementia Practice .................................................................................. 74 vi Chapter 4: Quantitative Results ..................................................................................................... 83 Survey Demographics ............................................................................................................ 83 General Dementia Questions ................................................................................................