Purpose: The aim of this paper is to delineate the underlying premises of the concept of engagement in persons with dementia and present a new theoretical framework of engagement. Setting/Subjects:The sample included 193 residents of 7 Maryland nursing homes. All participants had a diagnosis of dementia. Methodology:We describe a model of factors that affect engagement of persons with dementia. Moreover, we present the psychometric qualities of an assessment designed to capture the dimensions of engagement (OME, Observational Measurement of Engagement). Finally, we detail plans for future research as well as data analyses that are currently underway.Discussion: This paper lays the foundation for a new theoretical framework concerning the mechanisms of interactions between persons with cognitive impairment and environmental stimuli. Additionally, the study examines what factors are associated with interest and negative and positive feelings in engagement. KeywordsEngagement; dementia; nursing home residents; person attributes; environment attributes; stimulus attributesThe concept of engagement has been documented in a range of settings, including the clienttherapist relationship (1), providing intellectual tasks for students and professionals (2), and in studies of nursing home residents (3). Studies have shown that nursing home residents spend the majority of their time not engaged in any meaningful activity (3;4;5). Prolonged lack of stimulation can be particularly detrimental to persons in nursing homes who suffer from dementia, as it magnifies the apathy, boredom, depression, and loneliness that often accompany the progression of dementia (6;7). Consequently, it is of critical importance that engagement of these residents becomes a priority within nursing facilities.Engaging older persons with dementia in appropriate activities has been shown to yield beneficial effects such as increasing positive emotions, improving activities of daily living NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript (ADL) and improving the quality of life (8;9) developing constructive attitudes toward dementia among nursing staff members (10) and decreasing problem behaviors among nursing home populations (11).The study of engagement is a necessary foundation for the development of nonpharmacological interventions for persons with dementia, whether the interventions address depression, agitation, apathy, loneliness, or boredom. The analysis of different forms of engagement of persons with dementia is expected to help such persons by reducing boredom and loneliness, and by increasing interest and positive emotions. It is also expected to help staff members by providing them with tools that they can utilize in caring for these persons. Although apathy, boredom, depression, and loneliness frequently accompany the progression of dementia, engagement of the demented nursing home residents in constructive, meaningful activities creates a possibility for enhancing the level of their daily functioning and f...

The Unmet Needs Model states that problem behaviors of people with dementia result from unmet needs stemming from a decreased ability to communicate those needs and to provide for oneself. The purpose of this study is to describe the unmet needs of persons with dementia exhibiting behavior problems. Eighty-nine residents from 6 Maryland nursing homes with dementia were assessed by research assistants and nursing assistants for their unmet needs using multiple assessment tools. Three unmet needs per resident were identified on average, with informants rating boredom/sensory deprivation, loneliness/need for social interaction, and need for meaningful activity as the most prevalent needs. Discomfort was associated with higher levels of verbally agitated behaviors (e.g., complaining). Based on results and independent ratings of pain, the authors estimate notable under detection of discomfort and pain by both types of informants. The study demonstrates methodologies for uncovering unmet needs among persons with dementia and highlights the importance of developing programs that address those unmet needs, especially social and activity needs of nursing home residents. The detection of pain, and possibly that of discomfort, may require a different methodology.

Objectives-The objective of this paper was to assess the relative impact of different types of stimuli on agitated behaviors of nursing home residents with dementia.Design Setting/Participants-Participants were 111 residents of 7 Maryland nursing homes with a diagnosis of dementia who exhibited agitation.Intervention-Different types of stimuli (music, social stimuli, simulated social stimuli, and individualized stimuli based on the person's self-identity) to prevent behavior problems. Measurements-Agitation was directly observed and recorded via the Agitated Behaviors Mapping Instrument.Results-All stimulus categories were associated with significantly less physical agitation than baseline observations, and all except for manipulative stimuli were associated with significantly less total agitation. Live social stimuli were associated with less agitation than music, self-identity, work, simulated social, and manipulative stimulus categories. Task and reading stimulus categories were each associated with significantly less agitation than work, simulated social, and manipulative stimulus categories. Music and self-identity stimuli were associated with less agitation than simulated social and manipulative stimuli.Conclusion-Providing stimuli offers a proactive approach to preventing agitation in persons with dementia, with live social stimuli being most successful.