ABSTRACT
Apathy is a symptom that presents with a deficit of motivation, reduced goal-directed behaviors and
responsiveness to environmental stimulation, and a flat mood. Nearly 50% of nursing home (NH) residents live
with Alzheimer’s disease and related dementias (ADRD) and 84% of NH residents with ADRD demonstrate
apathy. Apathy is a significant problem because it is associated with considerable negative outcomes,
including accelerated cognitive and functional decline, lower quality of life, poorer illness outcomes, greater
need for institutional care, and higher mortality. Caregiver-resident communication is fundamental for daily care
activities in NHs and significantly impacts quality of care. Interacting with residents with ADRD can be
challenging, due to their difficulty in understanding, remembering, and verbally expressing themselves.
Interacting with residents with ADRD and apathy is especially challenging, because they are socially
withdrawn, do not take initiative, and rely on others’ prompts to engage in interactions. Interventions to improve
caregiver communication and person-centered activities have been shown to reduce some behavioral
symptoms in ADRD. It is unclear to what extent that apathy symptoms differ over time for the same individual
and across different individuals. This information will help to clarify the potential extent to which apathy can be
changed. This proposed study will address this gap by analyzing variations in the magnitude and duration of
apathy symptoms within and between individuals. Further, it is unknown how caregiver communication impacts
apathy. Thus, this study will examine the impact of caregiver communication on apathy. This is a secondary
analysis using existing video data from a completed NIH-funded clinical trial. The dataset comprises video
observations from 46 residents during caregiver-resident interactions in 12 NHs. Videos were recorded during
routine care activities at multiple time points over 5-9 months. This study aims to examine variations in the
magnitude and duration of apathy symptoms and examine the concurrent and sequential relationships
between caregiver communication and apathy symptoms. First, we will test variations of apathy pattern across
residents, within the same resident across interactions, and within each interaction. Next, we will analyze four
aspects of caregiver communication qualities: 1) communication topic, 2) emotional tone, 3) person-centered
verbal communication, and 4) person-centered non-verbal communication. We anticipate that person-centered
communication approaches will be associated with lower levels of apathy symptoms. This is the first study
examining the impact of caregiver communication on apathy. Findings will help identify approaches to improve
caregiver communication, which can be used to develop interventions to reduce apathy, improve resident
health outcomes, quality of life, and reduce mortality for NH residents with ADRD. This study will help promote
care quality and efficiency for ADRD and achieve the major goal of the 2017 National Plan to Address
Alzheimer’s Disease.