CODEM Instrument

Abstract

Communication and communication behaviors in situational contexts are essential conditions for well-being and quality of life in people with dementia. Measuring methods, however, are limited. The CODEM instrument, a standardized observational communication behavior assessment tool, was developed and evaluated on the basis of the current state of research in dementia care and social-communicative behavior. Initially, interrater reliability was examined by means of videoratings (N = 10 people with dementia). Thereupon, six caregivers in six German nursing homes observed 69 residents suffering from dementia and used CODEM to rate their communication behavior. The interrater reliability of CODEM was excellent (mean κ = .79; intraclass correlation = .91). Statistical analysis indicated that CODEM had excellent internal consistency (Cronbach’s α = .95). CODEM also showed excellent convergent validity (Pearson’s R = .88) as well as discriminant validity (Pearson’s R = .63). Confirmatory factor analysis verified the two-factor solution of verbal/content aspects and nonverbal/relationship aspects. With regard to the severity of the disease, the content and relational aspects of communication exhibited different trends. CODEM proved to be a reliable, valid, and sensitive assessment tool for examining communication behavior in the field of dementia. CODEM also provides researchers a feasible examination tool for measuring effects of psychosocial intervention studies that strive to improve communication behavior and well-being in dementia.

Communication behavior of cognitively impaired older inpatients

“…When explaining the communication behavior of people with dementia, three theoretical considerations deserve particular attention. First, communication has been defined as a context-dependent construct, which is closely related to well-being and distinct from functional linguistic skills of an individual [15, 23, 24]. In line with Watzlawick et al’s widely acknowledged first axiom [35] “one cannot not communicate” (p. 30), it can be assumed that even patients with strongly impaired linguistic skills are able to communicate, albeit by other channels.…”

“…The content aspect refers to the production and understanding of mainly verbal utterances; the relationship aspect refers to the underlying affective qualities of communication conveyed by mainly nonverbal stylistic (e.g., speech rate) and tonal features of communication (e.g., emotional tone of voice; [11]). The verbal content channel strongly declines in the course of dementia [22, 24, 26], whereas the nonverbal relationship channel can be preserved for a longer time [10, 24]. The ongoing functioning of the nonverbal relationship channel has also been supported by dementia-related challenging behavior occurring after the use of controlling tones [40].…”

“…Furthermore, previous instruments focused more on the verbal content than on the nonverbal relationship aspect. The CODEM instrument [24], an observational tool to assess Communication Behavior in Dementia, considers both the verbal content and the nonverbal relationship aspect inherent in communication behavior. In terms of previous CODEM validation efforts [23, 24], divergent validity was tested by correlations with the Barthel Index [27] examining functional performance in basic activities of daily living.…”

“…The CODEM instrument [24], an observational tool to assess Communication Behavior in Dementia, considers both the verbal content and the nonverbal relationship aspect inherent in communication behavior. In terms of previous CODEM validation efforts [23, 24], divergent validity was tested by correlations with the Barthel Index [27] examining functional performance in basic activities of daily living. Although functional status and communication behavior are considered as theoretically distinct constructs, there is an empirical overlap between both constructs in cognitively impaired older patients requiring other methods, such as factor analysis for determining divergent validity [3].…”

“…Although functional status and communication behavior are considered as theoretically distinct constructs, there is an empirical overlap between both constructs in cognitively impaired older patients requiring other methods, such as factor analysis for determining divergent validity [3]. A further limitation of previous studies [23, 24] may be seen in the fact that linguistic features as well as social-contextual variables have not been considered as validation measures for CODEM so far. To date, the CODEM instrument has been validated in the nursing home and the ambulatory setting but not in the acute care hospital setting.…”