More research into the use of Intensive Interaction with people with late stage dementia

Following on from my last blog focusing on a 'discourse analysis' paper about changing the medicalised narrative that usually defines the process of caring for people with dementia, below I've summarised a 2014 paper about the actual use of Intensive Interaction with people with dementia.

Intensive Interaction: to build fulfilling relationships

Harris, C. & Wolverson, E. (2014) Journal of Dementia Care, 22 (6), 27-30.

In this paper the authors (CH & EW) share their experiences of using Intensive Interaction to support people with late stage of dementia. The authors point out that there is a growing recognition of the importance of reciprocity in dementia care, and that Intensive Interaction could be a means to this end as the approach focuses on social inclusion and emotional connectedness.

This paper reported on some research carried out by author CH with three people with dementia. For each of the participants in the research CH found a sense of relationship development over the week of the study, and also in the following weeks. Two of the participants in particular also showed signs of engagement and social interaction, such as ‘looking at carer’, ‘vocalising’, ‘initiating’, ‘smiling / laughing’, which were more prominent in the Intensive Interaction session than in the standard interaction.

For one participant Mr D (who was bed-bound) Intensive Interaction gave him an opportunity to initiate interactions e.g. moving his hand to his ear as CH sang. Mr D also started to change his vocalisations: outside of the Intensive Interaction sessions he vocalised loudly and constantly, but shortly into the first Intensive Interaction session he began to adapt his vocalisations so that they were gentler, and mirroring of CH’s sound): it felt like the give and take of a true conversation and led to a feeling of profound connection.

Mrs K flinched at touch and was isolated through her constant walking. She allowed CH to join her on her stroll.  During sessions there were shared moments of laughter and game playing as Mrs K showed CH her favoured routes and routines. As the Intensive Interaction sessions progressed Mrs K allowed CH to gently touch her arm, and this eventually developed, much to the shock of observing staff, into twirling each other’s hair. Perhaps most important of all was Mrs K’s husband’s comment that, for the first time in months, she had made eye contact with him.

As the authors themselves acknowledge, this study was small and exploratory, but the results suggest that there is great potential for the use of Intensive Interaction with people with dementia, and indicative of the impact it can have on their relationships and well-being.

This paper also goes to explore some other, Intensive Interaction related issues e.g.:

• As Intensive Interaction can be emotionally and physically demanding, ongoing supervision and support is essential. 

• A culture change in services is need to move away from models of reactive communication towards proactively seeking out ongoing dialogues and building trust.

• 'Personalisation' is key, which means communicating in a way that has meaning for the person.

• Concerns about the use of touch are a common barrier to Intensive Interaction, therefore services need to develop 'person-specific touch guidelines'. 

• Intensive Interaction has the potential to be renewing and transformative for staff.

The authors also note that family caregivers showed a keen interest in Intensive Interaction, with many family caregivers automatically communicating in an Intensive Interaction manner having spent a lifetime tuned-in to their family member or partner, particularly valuing the use of touch.

In conclusion: The authors state that Intensive Interaction can be an approach to improving well-being in dementia. Intensive Interaction is an approach that respects personhood, adds quality to the working lives of staff, and reintroduces the possibility of interactions based on 'fun' and 'understanding'.