Aging & Mental Health Vol. 15, No. 3, April 2011, 405–413 TANDEM: Communication training for informal caregivers of people with dementia Julia Haberstroh, Katharina Neumeyer, Katharina Krause, Judith Franzmann and Johannes Pantel * Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Goethe University, D-60528 Frankfurt a. M., Germany (Received 26 April 2010; final version received 25 October 2010) Objectives: Dementia increasingly diminishes the ability to communicate. We aimed to develop and evaluate a psychosocial intervention program that focuses on communication in dementia care. This was intended to enhance the quality of life (QoL) of people with dementia and to reduce the burden on their informal caregivers. Method: A training program for informal caregivers of people with dementia was developed. The training combines the expertise of geriatric psychiatry, geriatric care, and educational psychology. Caregivers acquire and deepen competencies required to improve communication in dementia care. The training was evaluated with a pre–post-control group design and time-series analyses. Twenty-four informal caregivers participated in the study. Results: The results of the study provide evidence that TANDEM training increases caregivers’ use of strategies that are relevant for communication in dementia care and the care receivers’ QoL. Conclusion: The results of research in this program show the relevance of including caregivers in interventions and the importance of communication for the QoL of people with dementia. Keywords: dementia; home care; communication; caregiver intervention; evaluation study Introduction Alzheimer’s Disease (AD) and Vascular Dementia (VD) increasingly diminish the ability to communicate (Bayles, 2003; Bickel, Pantel, Eysenbach, & Schro¨der, 2000; Small & Gutman, 2002). This seems to be one of the reasons that victims feel excluded from the social world, and results in a progressing social withdrawal and apathy of the suffering person (Ellis & Astell, 2004). Apathy is arguably the most common neuro- psychiatric syndrome in dementia and in most cases is accompanied by signs of social withdrawal (Aalten et al., 2007; Georges et al., 2008; Landes, Sperry, Strauss, & Geldmacher, 2001; Mega, Cummings, Fiorello, & Gornbein, 1996; Piccininni, DiCarlo, Baldereschi, Zaccara, & Inzitari, 2005). Quality of Life (QoL) of people with dementia is strongly influenced by communication and social relationships (Livingston, Cooper, Woods, Milne, & Katona, 2008). To enhance QoL, it is therefore essential for victims to maintain contact with the social environment. Problem behaviors and language deficits in demen- tia can contribute significantly to a caregiver’s burden (Germain et al., 2009); however, caregiver communi- cation can simultaneously impact a patient’s problem behaviors (Germain et al., 2009). Supportive caregiver strategies (e.g., patience, a cautious manner) that adjust to the behaviors and abilities of the care receiver can reduce problem behaviors and thus minimize the caregiver’s burden (DeVugt et al., 2004; Harvath, 1994). Therefore, training caregivers in supportive communication strategies is a promising approach to reduce the burden on caregivers and to enhance care receivers’ QoL. Communication disorders in dementia syndromes differ in quantity and quality. Differences in quality can be detected, for example, by comparing early AD and frontotemporal dementia. In early AD, commu- nication is mainly affected by memory (particularly working memory) deficits, whereas in early frontotem- poral dementia, distinct aphasic and semantic impair- ments can be observed (Bayles, 2003; Wolf, 2009). The differences in quantity can often be attributed to the severity of the disease. For example, in AD, we find a cumulative augmentation of communication disorders with only a few symptoms in the early stages (e.g., word-finding difficulties) and various symptoms in advanced stages (Bickel et al., 2000). Since AD and VD are the leading causes of dementia (Weyerer & Scha¨ufele, 2004), the following theoretical and conceptual explanations focus on communication disorders in these syndromes. In AD and VD, a combination of various communication disorders can be detected: (1) expressive and receptive disorders (Bayles, 2003); (2) attention deficits (Perry & Hodges, 1999); (3) pragmatic, semantic, and syntactic impairment (Bickel et al., 2000); and (4) working memory deficits (Bayles, 2003). However, the course of the disease is unique in each individual. Research on communication in dementia is still given insufficient attention, although the majority of *Corresponding author. Email: Johannes.Pantel@kgu.de ISSN 1360–7863 print/ISSN 1364–6915 online ß 2011 Taylor & Francis DOI: 10.1080/13607863.2010.536135 http://www.informaworld.com