Rethinking Dementia with Adaptive Interaction

Scottish Care estimates that between 12,000 and 15,000 people with advanced dementia are currently living in Scottish care homes. While the physical needs of care home residents are often treated as the priority, there is an urgent need to provide specialised social support and connection for people with advanced dementia and their families.

The University of Reading’s Professor Arlene Astell and Dr Maggie Ellis of the School of Psychology & Neuroscience have made remarkable strides in dementia treatment. Thisresearch began in 2006, when Ellis & Astell demonstrated that the desire to communicate and interact with others is present in people with advanced dementia, despite their lack of language and understanding of speech. Thus, to provide social care, further research was required to find a way of communicating through means other than speech.

To do this, Ellis and Astell drew from the practice of ‘intensive interaction’, which increases communication with children with severe learning disabilities by using imitation of nonverbal behaviour. When applying this to patients with dementia, Ellis and Astell adapted interpersonal interactions to utilise a preserved capacity for nonverbal behaviour and imitation — hence creating the term ‘Adaptive Interaction’.

Notably, individuals with advanced dementia demonstrated higher frequency of smiling and imitation during sessions using Adaptive Interaction compared to standard attempts at verbal interaction. The research showed that, by identifying and responding to nonverbal communicative repertoires, caregivers and family members benefit from a previously unrealised method of interaction. Most importantly, those individuals with dementia can, once again, experience human connection with their loved ones.

Ellis & Astell went on to publish a book in 2017, aimed at public and professionals alike which is a guide to Adaptive Interaction explaining how to assess, access and utilize the communication repertoires of people with dementia who can no longer speak. The guide offers practical interventions for those who wish to interact with individuals with advanced dementia and has been referred to as a book ‘that will without doubt change the lives of people affected by dementia’.

Ongoing research through recent collaboration with Dr Oggie Arandelovic, of the School of Computer Science, has developed an artificial intelligence-based tool that quantifies the degree of participant engagement in Adaptive Interaction sessions. This approach, based on machine learning, has shown that the positive effects of Adaptive Interaction can be measured with an objective, quantitative approach.

Ellis’ work on Adaptive Interaction led to a partnership with Empowered Conversations, a charity that supports family members who provide care to those with dementia. Empowered Conversations applied Adaptive Interaction to their training programme, inviting 5 family carers to participate in an entirely new four-week course built around Ellis’ research. This marks the first delivery of Adaptive Interaction techniques to family carers, who found enormous benefit in the close connections enabled by the technique. Empowered Conversations saw that “the powerful and sometimes subtle effect of this approach was eye opening, emotional and inspiring to observe,” and intends to continue the partnership with further rounds of training. Participants found that the course taught them entirely new methods of communicating with their loved ones, with one commenting that “the course gave me the understanding and skills to connect with my mum.  It gives me hope for the future”.

Ellis and Astell’s research on Adaptive Interaction has provided a panacea for those with advanced dementia by changing practices within NHS, local authority, and private care facilities.  Alzheimer Scotland has also incorporated Ellis and Astell’s research into their practice guidelines for advanced dementia and end of life care. Ultimately, the research has changed public opinion about the communicative abilities of those with advanced dementia and has profoundly affected not only those living with advanced dementia, but also their carers and loved ones.

This work contributed to the University of St Andrews’ REF 2021 submission.

The Research Excellence Framework (REF) is a system which assesses research at UK Higher Education Institutions by discipline, based on three elements: outputs, impact and environment. This blogpost is based upon an impact case study that contributed to St Andrews’ outstanding results this REF cycle. Visit REF to view the submitted case study in the UKRI’s impact case study database.

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