Engagement in persons with dementia: the concept and its measurement

Impact of Modern Board Games on Executive Functions and Quality of Life in the Elderly: A Randomized Controlled Trial

Purpose: This study aimed to assess the effects of modern board games (MBG) on executive functions, quality of life, and volitional behaviors in elderly individuals residing in nursing homes. Methods: A 12-week randomized controlled trial was conducted in a nursing home with 30 participants (age = 83.2 years). Participants were randomly assigned to either the experimental group (EG; n = 16) or the control group (CG; n = 14). The EG engaged in twice-weekly MBG sessions facilitated by trained professionals, while the CG continued with their usual activities without additional interventions. Cognitive performance was assessed using the Cambridge Cognitive Examination (CAMCOG-R) and the Test of the Paths (TESEN). Quality of life was evaluated using the FUMAT scale, and volitional behaviors were measured using the Volitional Questionnaire. Results: The EG demonstrated significant improvements in executive functions, including comprehension (9.9%, P < 0.05), remote memory (22.6%, P < 0.05), and attention and calculation (83.3%, P < 0.05), as measured by the CAMCOG-R. No significant changes were observed in the TESEN test. The EG also showed significant gains in quality of life, with improvements in emotional well-being (5.0%, P < 0.01), interpersonal relationships (15.4%, P < 0.05), personal development (7.5%, P < 0.001), and social inclusion (6.3%, P < 0.001) on the FUMAT scale. Volitional behaviors, particularly competence (7.1%, P < 0.05), also improved significantly in the EG. Conclusion: MBG offer a promising nonpharmacological intervention to enhance executive functions, quality of life, and volitional behaviors in elderly individuals in nursing homes. The structured facilitation of these games, tailored to participants' cognitive levels, may support cognitive stimulation and foster social engagement in this population.

Constructive engagement in cognitive stimulation therapy groups among people with dementia: A mixed-methods study

Introduction

Clinical guidelines recommend personalized activities and group cognitive stimulation therapy (CST) for promoting cognition, independence, and well-being in persons with dementia. Constructive engagement (CE), the state of being occupied positively in purposeful activities, is theoretically an essential process in personalized activities and CST. However, whether CE develops over time and what contributes to it are unknown. We investigated changes in CE during CST and its contributors.

Methods

This is a mixed-methods study. We used time sampling to record the time proportion of persons with dementia (n = 113) spent in constructive, passive, non-task-related engagement and non-engagement during early, middle, and late phases in a 14-session group CST. We tested changes in time proportion between phases using repeated analysis of variance (ANOVA). We analyzed qualitative interviews of CST facilitators (n = 12) thematically to explore contributors to CE.

Results

Persons with dementia spent 51% and 46% of their time in constructive and passive engagement, respectively. Time of engagement in non-task-related activities and non-engagement was minimal. CE remained stable at around 50% of activity time throughout the intervention course, except for a slight increase from the early to middle phase (48% to 55%, F (2224) = 3.779, p < 0.05). Age (r = -0.26, p < 0.01), cognitive function (r = -0.29, p < 0.01), and activities of daily living (r = 0.20, p < 0.05) at baseline were significantly correlated with CE, but gender and education were not. Contributors to CE include (1) tailoring activities, (2) using group dynamics, and (3) promoting positive experiences.

Discussions

Group CST engages persons with dementia well, regardless of their differences in gender and literacy levels. CE remained relatively stable during CST, and younger, more physically and cognitively able people showed slightly greater CE. In group-based interventions, facilitators' skills and techniques could enhance CE. Future studies may focus on how CE as a plausible change mechanism further improves the intervention outcomes of persons with dementia.

Highlights

Cognitive stimulation therapy (CST) is a non-pharmacological intervention that involves group-based activities and exercises to improve cognition and quality of life for persons with dementia, but the specific mechanisms behind it are not yet fully understood.This study is the first to investigate constructive engagement (CE), which describes active involvement in meaningful activities or complex interventions, specifically CST, for persons with dementia.CST engages them well, regardless of gender and literacy differences. CE time increases at the early intervention phase and stabilizes later on. CE occupies around half of the intervention time throughout CST, which can still be further increased by activity design and facilitators' skills.

The Food Resources and Kitchen Skills intervention: Protocol of a randomized controlled trial

INTRODUCTION

Individuals with food insecurity are disproportionately burdened by hypertension (HTN) and type 2 diabetes and face greater barriers to self-managing these conditions.

METHODS

Food Resources and Kitchen Skills (FoRKS) is an ongoing 2-arm parallel randomized controlled trial (RCT) that will enroll 200 adults (35-75 y) with food insecurity and elevated systolic blood pressure (≥120 mmHg) at a large federally qualified health center (FQHC) network in Central Indiana. Blood pressure is measured using an ambulatory blood pressure monitoring (ABPM) device. The (FoRKS, N = 100) intervention integrates hypertension self-management education and support (SMES) with a home-delivered ingredient kit and cooking skills program (16 weeks). Enhanced Usual Care (EUC, N = 100) includes usual care services by the FQHC network, SMES classes (separate from FoRKS), and grocery assistance. This paper describes the protocol for this RCT that will: 1) test the efficacy of FoRKS compared to EUC for reducing systolic blood pressure using an intention to treat protocol, 2) identify behavior change levers (e.g., engagement, social support) and their associations with change in food insecurity, diet quality, and systolic blood pressure, 3) examine the maintenance of outcomes, and 4) assess cost-effectiveness.

CONCLUSIONS

Establishing that a food insecurity and SMES intervention, compared to usual care services, is feasible in FQHCs and efficacious for improving blood pressure and related outcomes would have important public health implications. Understanding the behavior change levers of FoRKS that are associated with changes in health outcomes, whether these outcomes are maintained, and its cost-effectiveness will inform future efforts to address health disparities.

Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia

Early in our longitudinal qualitative study on meaningful engagement and quality of life among assisted living (AL) residents with dementia, researchers observed differences between the activities scheduled on monthly engagement calendars and those taking place. Yet, we were unable to identify any research examining such deviations or their implications. Thus, drawing on data from three diverse AL communities studied over a one-year period, we aim to: 1) examine deviations in scheduled engagement programming; 2) identify influential factors; and 3) understand resident outcomes. Our analysis identified general adherence to calendars but also deviations involving cancellations and substitutions. Factors influencing deviations included staff and staffing, engagement capacity, programming guidance and support, care staff attitudes and beliefs, and unforeseen circumstances. Cancellations typically meant resident inactivity and sometimes boredom, disappointment, and anxiety; substitutions appear less detrimental. This analysis has implications for research and practice and underscores the significance of engagement among persons living with dementia.

Examining pain, function, behavioral symptoms and associations with engagement in meaningful activity for residents with dementia in assisted living

OBJECTIVES

The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents' age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living.

METHOD

This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity.

RESULTS

A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= -2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity.

CONCLUSION

Findings from this study show that pain is a significant factor that is negatively associated with residents' engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.

Perceptions and Experiences of Animal-Assisted Interventions for People Living With Dementia: A Qualitative Evidence Synthesis

AIM

To synthesise stakeholders' experiences and perceptions of animal-assisted intervention (AAI) for people with dementia in community care settings.

DESIGN

Qualitative evidence synthesis.

METHODS

We systematically searched Medline, CINAHL, Embase, Scopus, Web of Science, PsycINFO and AgeLine for potentially eligible studies. Thematic synthesis was used to analyse the data from included studies. We assessed the methodological limitations of included studies using an adaptation of the Critical Appraisal Skills Programme checklist and used Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) tool to assess confidence in review findings. This review is reported using the ENTREQ checklist.

RESULTS

We included 14 reports from 11 studies and developed three analytical themes incorporating a gardening analogy: planting-connecting with animals, growing-engaging in AAI and nurturing-making AAI work; and six subthemes: willingness to connect, building relationships, a rich experience, the benefits of AAI, individualised and holistic approach and training and support, with 15 key findings.

CONCLUSION

This review describes people's experiences and perceptions of AAI for people with dementia, and provides recommendations on the development and implementation of AAI, with moderate to high confidence. Nurses need to consider the factors that influence the implementation of AAI identified in this review, to facilitate engagement and long-term impacts while adopting AAI in community care settings.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This review may enhance healthcare professionals' understanding of AAI for people with dementia in community care settings. AAI is a complex intervention that can be delivered in varied manner. A multicomponent, flexible and individualised AAI is important. Additional training and education for staff are needed.

PATIENT OR PUBLIC CONTRIBUTION

A man with dementia and his wife who share a love of dogs, advised at each step of the review, providing insights and perspectives and contributing as co-authors.

The Impact of Engagement with the PARO Therapeutic Robot on the Psychological Benefits of Older Adults with Dementia

OBJECTIVES

This study aimed to examine the effect of 8-weeks of a 60-minute PARO intervention to reduce depressive symptoms and loneliness in older adults with dementia and investigated changes in their emotional or behavioral expressions and level of engagement with the PARO robot.

METHODS

This was a quasi-experimental study with a repeated measures design. The outcome measures were evaluated at four time-points: before the intervention, week 4, immediately after the intervention, and one month after the PARO intervention.

RESULTS

Fifty-two participants were recruited. The age of the participants ranged from 65 to 96 years, with a mean age of 81.81 years (SD = 8.54) in the PARO group and 79.08 years (SD = 7.71) in the control group. Using a mixed between-within subjects' analysis of variance, the results showed that there were significant interaction effects between the groups and time-periods for depression (p < .000), loneliness (p < .000), and engagement (p < .000).

CONCLUSIONS

The PARO intervention alleviated depression and loneliness for older adults. Furthermore, the process of engagement with PARO may play an important role in the PARO effects.

CLINICAL IMPLICATIONS

A tailored PARO intervention of at least 4 weeks could engender positive psychological benefits for older adults.

Deploying Robot-Led Activities for People with Dementia at Aged Care Facilities: A Feasibility Study

OBJECTIVES

To explore the feasibility of deploying robot-led activities for people with dementia living in aged care facilities.

DESIGN

Embedded mixed-methods design.

SETTING AND PARTICIPANTS

Eleven residents (aged ≥65 years) with mild to moderate cognitive impairment were recruited from 2 aged care facilities in Brisbane, Australia.

METHODS

We implemented a novel control logic, "Adam Program," for a human-like robot to provide proactive robot activities for people with dementia. Participants individually participated in a nonfacilitated robot intervention thrice a week for 5 weeks from November to December 2022. We video-recorded each intervention session and quantified participants' visual, behavioral, and verbal engagement. A semi-structured interview was conducted at the end of the 5-week intervention. The treatment fidelity strategies and finances were reported and evaluated. The Bowen Feasibility Framework guided data analysis into 6 focus areas: acceptability, demand, implementation, efficacy, integration, and practicality.

RESULTS

Based on participants' perceptions, findings demonstrated adequate acceptability and demand for robot-led activities. Findings reported a high level of visual engagement (98.54%) and an increased trend of behavior engagement over 5 weeks. Participants independently communicated with Adam, with most (97.02%) verbal engagements free of human facilitation. The treatment fidelity strategies regarding the activity delivery, intervention received, and intervention skills are provided alongside the equipment expenses, revealing the feasibility of integrating robot-led activities for people with dementia in aged care facilities.

CONCLUSIONS AND IMPLICATIONS

Using human-like robots to independently lead interactive activities for people with dementia at aged care facilities is feasible and acceptable. Although robot-led activities require further improvement, this study explored a practical-driven solution that provided guidelines for developing and implementing robot-led activities in aged care settings. Future studies could replicate similar robot-led activities for further investigation and evaluation. Strategies for multilevel determinants of Adam's implementation based on a context assessment are recommended for future research.

An observational study protocol to capture, validate and characterise lucid episodes in people living with advanced dementia receiving hospice care

INTRODUCTION

Lucid episodes (LEs) in advanced neurodegenerative disease, characterised by a transient recovery of abilities, have been reported across neurological conditions, including Alzheimer's disease and related dementias. Evidence on LEs in dementia is extremely limited and draws predominantly from retrospective case reports. Lucidity in dementia has received growing attention given the clinical, caregiving and potential epidemiological implications of even a temporary return of abilities in advanced disease. Following a funding initiative by the National Institute on Aging, several new investigations are focused on establishing foundational evidence on lucidity in dementia. The objectives of this study are to capture, characterise and validate potential LEs via audiovisual observation, computational linguistic and timed-event coding of audiovisual data, and informant case review for face validation of LEs.

METHODS AND ANALYSIS

This prospective multifaceted observational study will investigate LEs in advanced dementia through longitudinal audiovisual observation within an inpatient hospice unit. Audiovisual data will be coded to generate variables of participant verbal output, verbal expressions, non-verbal communicative actions and functional behaviours to enable measurement of features that can be used to characterise LEs. Multiple methods will be used to identify potential LEs including field interviews with caregivers/clinicians who witness significant events during data collection, reports from research staff who witness significant events during data collection and detection by researchers during video data processing procedures. Potential LEs will undergo a structured case review with informants familiar with the participant to facilitate validation and enable triangulation across measures generated through coding.

ETHICS AND DISSEMINATION

This study will be conducted in accordance with all Federal Policies for the Protection of Human Subjects and the protocol (ID 2021-1243) has been approved by the University of Wisconsin-Madison Institutional Review Board. Findings will be disseminated via scientific conferences, journal publications and newsletters shared with participants and through dementia-focused and caregiver-focused networks.

Experiences of Families, Staff, Volunteers, and Administrators With Namaste Care for Persons With Advanced Dementia in Canadian Long-Term Care Homes

OBJECTIVE

To explore the experiences of the Namaste Care intervention for persons with advanced dementia (ie, moderate and late-stage) in long-term care (LTC).

DESIGN

A qualitative descriptive design was used. Staff Carers (eg, personal support worker, nurse, or activity aide) delivered Namaste Care with the support of volunteers in a small group. Activities provided during the Namaste Care sessions to enhance quality of life included massages, aromatherapy, music, and snacks/beverages.

SETTING AND PARTICIPANTS

Family carers of residents with advanced dementia, LTC staff, administrators, and volunteers from 2 Canadian LTC homes, located in a midsize metropolitan area, were included.

METHODS

Experiences and acceptability of Namaste Care was assessed through semistructured interviews ranging from 30 to 60 minutes following the 6-month study duration period with family carers, LTC staff, administrators, and volunteers. Thematic analysis was used for interview transcripts.

RESULTS

A total of 16 family carers and 21 LTC staff, administrators, and volunteers participated in the study. Namaste Care was found to be acceptable and successful in enhancing the quality of life of residents due to collaborative efforts of all group of participants. Families, volunteers, and staff noted positive responses in residents, such as smiling and laughing. The program environment supported the development of relationships within the LTC community, which included families, residents, staff, and volunteers.

CONCLUSIONS AND IMPLICATIONS

Namaste Care was perceived by the LTC community as an acceptable intervention for persons with advanced dementia. It was perceived as offering multiple benefits for residents with advanced dementia such as improved communication and mood.

Can Residents With Late-Stage Dementia Still Engage?

Institutionalized persons with dementia often lack access to meaningful activity, which can lead to agitation, loneliness, and depression. Engagement in activity may improve negative symptoms but is difficult in most settings. In this study, we investigated the degree to which the Reading Buddies Program, in which occupational therapy graduate students read books with residents with dementia, engaged residents. We further assessed whether the level of engagement was affected by various parameters, including those related to interaction, environment, attention, attitude, and activity. The primary outcome measure was engagement percentage-duration of time the book was read divided by duration of time the person with dementia engaged with the book. As expected, increased attention, attitude, and activity parameters were associated with increased engagement. None of the environmental parameters significantly affected engagement. Overall, we found that reading with persons with dementia led to a very high level of engagement and appeared to reduce negative symptoms.

The Wellbeing Index for Persons with Dementia-An Observational Study Based on the Group Observational Measurement of Engagement (GOME)

The Group Observational Measurement of Engagement (GOME) was developed to capture the impact of group recreational activities on the engagement and general wellbeing of persons with dementia. The psychometric properties of the GOME were originally described in a study of group activities conducted at one large Canadian geriatric center. Continuing this work in Israel, this article reports on further psychometric properties of the GOME based on observations of 115 persons with dementia from 10 geriatric units, of which four were senior day center units (in three institutions) and six were nursing units (representing five other institutions). Very good inter-rater reliability between research observers was found. Factor analysis suggests that the GOME's four individual-level outcomes can be combined into one indicator, the Wellbeing Index. Validity, examined via agreement between research observers and group activity leaders who were staff members in the facilities where the group activities were conducted, also showed high levels of positive correlations. The GOME provides a practical tool for assessing wellbeing in the context of group activities. It can be useful in clarifying the relative impact of process variables on participants' general wellbeing.

Older Adults' Engagement and Mood During Robot-Assisted Group Activities in Nursing Homes: Development and Observational Pilot Study

BACKGROUND

Promoting the well-being of older adults in an aging society requires new solutions. One resource might be the use of social robots for group activities that promote physical and cognitive stimulation. Engaging in a robot-assisted group activity may help in the slowdown of physical and cognitive decline in older adults. Currently, our knowledge is limited on whether older adults engage in group activities with humanlike social robots and whether they experience a positive affect while doing so. Both are necessary preconditions to achieve the intended effects of a group activity.

OBJECTIVE

Our pilot study has 2 aims. First, we aimed to develop and pilot an observational coding scheme for robot-assisted group activities because self-report data on engagement and mood of nursing home residents are often difficult to obtain, and the existing observation instruments do have limitations. Second, we aimed to investigate older adults' engagement and mood during robot-assisted group activities in 4 different nursing care homes in the German-speaking part of Switzerland.

METHODS

We developed an observation system, inspired by existing tools, for a structured observation of engagement and mood of older adults during a robot-assisted group activity. In this study, 85 older adult residents from 4 different care homes in Switzerland participated in 5 robot-assisted group activity sessions, and they were observed using our developed system. The data were collected in the form of video clips that were assessed by 2 raters regarding engagement (direction of gaze, posture as well as body expression, and activity) and mood (positive and negative affects). Both variables were rated on a 5-point rating scale.

RESULTS

Our pilot study findings show that the engagement and mood of older adults can be assessed reliably by using the proposed observational coding scheme. Most participants actively engaged in robot-assisted group activities (mean 4.19, SD 0.47; median 4.0). The variables used to measure engagement were direction of gaze (mean 4.65, SD 0.49; median 5.0), posture and body expression (mean 4.03, SD 0.71; median 4.0), and activity (mean 3.90, SD 0.65; median 4.0). Further, we observed mainly positive affects in this group. Almost no negative affect was observed (mean 1.13, SD 0.20; median 1.0), while the positive affect (mean 3.22, SD 0.55; median 3.2) was high.

CONCLUSIONS

The developed observational coding system can be used and further developed in future studies on robot-assisted group activities in the nursing home context and potentially in other settings. Additionally, our pilot study indicates that cognitive and physical stimulation of older adults can be promoted by social robots in a group setting. This finding encourages future technological development and improvement of social robots and points to the potential of observational research to systematically evaluate such developments.

Music Therapy Increases Social and Emotional Well-Being in Persons With Dementia: A Randomized Clinical Crossover Trial Comparing Singing to Verbal Discussion

The number of people living with Alzheimer's disease and related dementias (ADRD) is growing proportional to our aging population. Although music-based interventions may offer meaningful support to these individuals, most music therapy research lacks well-matched comparison conditions and specific intervention focus, which limits evaluation of intervention effectiveness and possible mechanisms. Here, we report a randomized clinical crossover trial in which we examined the impact of a singing-based music therapy intervention on feelings, emotions, and social engagement in 32 care facility residents with ADRD (aged 65-97 years), relative to an analogous nonmusic condition (verbal discussion). Both conditions were informed by the Clinical Practice Model for Persons with Dementia and occurred in a small group format, three times per week for two weeks (six 25-minute sessions), with a two-week washout at crossover. We followed National Institutes of Health Behavior Change Consortium strategies to enhance methodological rigor. We predicted that music therapy would improve feelings, positive emotions, and social engagement, significantly more so than the comparison condition. We used a linear mixed model approach to analysis. In support of our hypotheses, the music therapy intervention yielded significant positive effects on feelings, emotions, and social engagement, particularly for those with moderate dementia. Our study contributes empirical support for the use of music therapy to improve psychosocial well-being in this population. Results also highlight the importance of considering patient characteristics in intervention design and offer practical implications for music selection and implementation within interventions for persons with ADRD.

Understanding Capacity and Optimizing Meaningful Engagement among Persons Living with Dementia

Meaningful engagement is a key dimension of quality of life among persons living with dementia, yet little is known about how to best to promote it. Guided by grounded theory methods, we present analysis of data collected over a 1-year period in four diverse assisted living (AL) communities as part of the study, "Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia." Our aims are to: (a) learn how meaningful engagement is negotiated among AL residents with dementia and their care partners; and (b) identify how to create these positive encounters. Researchers followed 33 residents and 100 care partners (formal and informal) and used participant observation, resident record review, and semi-structured interviews. Data analysis identified "engagement capacity" as central to the negotiation of meaningful engagement. We conclude that understanding and optimizing the engagement capacities of residents, care partners, care convoys, and settings, are essential to creating and enhancing meaningful engagement among persons living with dementia.

[Les effets de l'environnement de soins sur les comportements réactifs des personnes ayant des troubles neurocognitifs vivant en centre d'hébergement : Une revue de la portée]

Les personnes âgées atteintes de troubles neurocognitifs (démences) vivant en centre d'hébergement adoptent fréquemment des comportements réactifs qui limitent leur engagement dans des occupations. La présente étude vise à identifier des moyens d'intervention centrés sur l'engagement des personnes âgées ayant un trouble neurocognitif avec l'environnement humain et non humain en centre d'hébergement afin de diminuer leurs comportements réactifs, en particulier les comportements d'errance, d'apathie et d'agitation. Cette revue de la portée est basée sur la méthode proposée par Levac et ses collaborateurs (2010). Parmi les 21 études retenues, la plupart s'intéressent à des interventions ciblant l'environnement non humain (n=9) ou ciblant simultanément l'environnement humain et non humain (n=9). Plusieurs de ces interventions sont efficaces pour diminuer les comportements réactifs et permettent aux personnes âgées de s'engager avec leur environnement. Le support de l'environnement humain semble toutefois nécessaire à l'utilisation optimale de plusieurs interventions.

A Tutorial for Speech-Language Pathologists: Physical Activity and Social Engagement to Prevent or Slow Cognitive Decline in Older Adults

PURPOSE

This tutorial provides an overview of two behavioral approaches, physical activity and social engagement, to prevent or slow cognitive decline in older adults and to increase awareness in the field of speech-language pathology of the important role that speech-language pathologists (SLPs) play in an interprofessional team working with this population.

METHOD

A review of exercise science, neuroscience, and social science literature was used to synthesize evidence and to outline the impact of physical activity and social engagement on cognition. The following topics were explored: How do exercise and social engagement support cognition? What are modifiable risk factors of dementia? What is the impact of inactivity and isolation on cognition? What is the potential role of the SLP on an interprofessional team focusing on preventive measures for cognitive decline? What is the impact of physical exercise and social engagement on nursing home residents?

RESULTS

Research increasingly points to the critical importance of physical activity and social engagement to prevent cognitive decline in normal aging and to slow cognitive decline associated with mild cognitive impairment and dementia. Research suggests that physical activity maintains or improves memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function. Social engagement has been found to maintain and improve general cognitive function.

CONCLUSIONS

Behavioral interventions are an effective strategy to prevent or slow cognitive decline in the older adult population. SLPs have a role to play on an interprofessional team that works to prevent cognitive decline. By considering factors that play a role in the prevention of cognitive decline, such as physical activity and social engagement, the quality of life and overall health of older adults can be improved. Areas of improvement include memory, attention, executive function, visuospatial function, speed of processing, and general cognitive function.

Exploring the factors influencing meaningful engagement of persons living with advanced dementia through the Namaste Care Program: a qualitative descriptive study

Background:

Meaningful engagement has been described as active participation based on a person’s interests, preferences, personhood, or perceived value. It has many benefits for persons living with dementia in long-term care (LTC) homes, including improvement in physical and cognitive function, and mental health. People with advanced dementia continue to need and benefit from inclusion and social contact in LTC, yet there is not a well-developed understanding of how to support this. A tailored intervention called Namaste Care has been shown to be an effective approach to meaningfully engage residents in LTC, decrease behavioral symptoms, and improve their comfort and quality of life. There is a need to consider how best to deliver this intervention.

Objective:

The aim of this study was to describe environmental, social, and sensory factors influencing meaningful engagement of persons with advanced dementia during Namaste Care implementation in LTC.

Methods:

In this qualitative descriptive study, focus groups and interviews were conducted with families, volunteers, staff, and managers at two LTC homes. Directed content analysis was conducted. The Comprehensive Process Model of Engagement was used as a coding framework.

Results:

With respect to environmental attributes, participants emphasized that a designated quiet space and a small group format were helpful for engagement. In terms of social attributes, participants emphasized Namaste Care staff capacity to deliver individualized care. Regarding sensorial factors, familiarity with the activities delivered in the program was emphasized.

Conclusion:

Findings reveal the need to offer small group programs that include adapted recreational and stimulating activities, such as Namaste Care, for residents at the end of life in LTC. Such programs facilitate meaningful engagement for persons with dementia as they focus on individual preferences, comfort, and inclusion while recognizing changing needs and abilities of residents.

Measuring engagement among older adults using a multidimensional approach to communication

Characterizing older adult engagement is important to determine the effectiveness of interventions. Engagement refers to the occupying of oneself in external stimuli and is observable across multiple dimensions of behavior. Engagement of older adults is commonly investigated using a single behavioral dimension. There is a dearth of analytical methods that can simultaneously quantify both verbal and non-verbal forms of communication as proxies for engagement. In this article, we present a multidimensional technique to measure engagement of older adults using techniques appropriate for people with varying degrees of dementia. The new analytical approach measures facial movement, lexical use, and prosodic patterns of speech as indices of affective and behavioral outcomes of engagement. Contexts for engagement included a dyadic reminiscence therapy interview and a 12-week technology-driven group reminiscence therapy. Illustrative examples of the technique are described by two participants from two different groups in a naturalistic setting. Application of these analytical techniques can enhance measurement precision and further develop the science and evidence base, especially for, but not confined to, non-pharmacological interventions.

Verbal and Nonverbal Expressions of Persons Living With Dementia as Indicators of Person-Centered Caregiving

BACKGROUND AND OBJECTIVES

Improved measures capable of capturing the influence of person-centered caregiving by staff in formal care settings on people living with dementia beyond deficit-oriented outcomes such as absence or reduction of symptoms are important for measuring progress toward improvements in well-being. This exploratory ethnographic study aimed to identify verbal and nonverbal expressions evidenced by people living with dementia surrounding person-centered caregiving approaches and to consider their use in informing temporally specific observational measures.

RESEARCH DESIGN AND METHODS

This study adopted a microethnographic approach through secondary analysis of 5.3 h of audiovisual observations of people living with dementia (N = 9) in nursing home settings at mealtimes. We observed expressions surrounding person-centered caregiving approaches. A systematic review of audiovisual observations generated codes (observable indicators) of expressions that were characterized at their most discrete and unambiguous level.

RESULTS

Drawing from 82 observable verbal and nonverbal expressions by people living with dementia, 14 discrete observable indicators were identified, broadly evidencing shifts in engagement and communication. We found that people living with dementia's expressions served both responsive and initiatory communicative purposes.

DISCUSSION AND IMPLICATIONS

Efforts to expand positive outcome measurement for people living with dementia should extend beyond characterizing them as passive respondents toward active participants in their lived experiences. Identified observable indicators can inform efforts to refine and validate measures of expressions among people living with dementia. Further research can extend this inquiry into different contexts and engage input from people living with dementia and caregivers.

A Biopsychosocial Model of Mealtime Management in Persons with Dementia, an Asset-Based Approach to Patient-Centered Care

Considering the rapid increase in the population over the age of 65, there is increasing need to consider models of care for persons with dementia (PWD). One common deficit associated with dementia progression is difficulty with successful participation in mealtimes. Difficulty participating in mealtimes in PWD is not the result of one factor, but rather a confluence of biological, psychological, and social characteristics common in dementia. Factors leading to mealtime difficulties for PWD may include changes in cognitive status, altered sensorimotor functioning, and increased reliance on caregiver support. The complex nature of biological, psychological, and social factors leading to mealtime difficulty highlights the need for a pragmatic model that caregivers can utilize to successfully support PWD during mealtimes. Existing models of dementia and mealtime management were reviewed and collated to create a model of mealtime management that considers this complex interplay. The Biopsychosocial Model of Mealtime Management builds on past research around patient-centered care and introduces an asset-based approach to capitalize on a PWD's retained capabilities as opposed to compensating for disabilities associated with dementia. We hope this model will provide a framework for caregivers to understand what factors impact mealtime participation in PWD and provide appropriate means on intervention.

Barriers and facilitators of meaningful engagement among older migrants living with dementia in residential aged care facilities: A mixed studies systematic review

BACKGROUND

Migrants with dementia living in residential care may be at risk of disengagement.

OBJECTIVE

To synthesize research relating to the meaningful engagement of migrants with dementia who are living in residential care.

METHOD

Mixed studies systematic review following PRISMA guidelines. Nine electronic databases were searched for relevant studies. Studies were eligible for inclusion if they reported original research relating to meaningful engagement of migrants with dementia living in residential aged care and were published in English. Two independent reviewers screened the title and abstracts, full texts of eligible studies and conducted a quality appraisal of included texts. A convergent qualitative synthesis approach was used.

RESULTS

From 1460 articles, 14 papers representing 12 studies were included. Facilitators of meaningful engagement included: the presence of cultural artefacts in the care environment, the use of multimodal communication and a shared but flexible understanding of residents' culture. Barriers were the absence of a common language and a task-orientated approach to care.

CONCLUSIONS

Migrants with dementia who are living in residential care are at increased risk of disengagement. Our review highlights the need for culturally congruent residential care to go beyond issues of language and to consider how occupations can be tailored to support ongoing participation and engagement.

Photo-elicited conversations about meetings with a therapy dog as a tool for communication in dementia care: An observational study

INTRODUCTION

It is well-known that people with dementia living in residential care facilities spend most of their time not engaged in meaningful activities. Being involved in activities can improve their quality of life. Animal-assisted therapy is an activity that can evoke engagement and joy. Another way to create engagement and promote communication between people with dementia and caregivers is to use photos.

METHODS

In this observational study, the researchers combined animal-assisted therapy and photobooks in order to explore whether photos of people with dementia who were engaged in animal-assisted therapy could be used as a tool for communication in dementia care. Ten persons (4 men and 6 women; aged 72-92) with dementia were video recorded during photo-elicited conversations with a dog handler/assistant nurse. The recordings were conducted in two residential care facilities in Sweden during 2017-2018. Each participant was video recorded 2-4 times. The recordings were analysed using The Observed Emotion Rating Scale and The Observational Measurement of Engagement-OME Modified. In addition, the video recordings were interpreted from a hermeneutic perspective.

FINDINGS

The findings showed that the most frequently observed effects were pleasure and general alertness, and the participants were observed to be attentive most of the time. The most common attitude during the conversations was 'somewhat positive'. The hermeneutic interpretations were grouped into four themes: Conveys a structure for the conversation with an inherent beginning and ending; An opportunity to recognise oneself and recall a sense of belonging; Awakens emotions and creates fellowship and Entails confirmation and revitalises their identity.

CONCLUSION

Photobooks can be used by caregivers as a tool for meaningful and joyful communication with people with dementia, even those with severe dementia.

Guys and dolls: Two case reports of spontaneous interactions with dolls in male veterans with dementia

Prior studies have described positive behavioral, emotional, and social responses to dolls in persons with dementia (PWD), but most have examined formal doll therapy in institutional settings and primarily included women. This study describes two cases of spontaneous doll interactions in male veterans who were participating in a research study of a gentle group movement program at an adult day center. A doll was present at the study site, and two participants chose to interact with it. Researchers analyzed class videos and thematically coded behavioral, emotional, and social responses to the doll. Mr. B was a 90-year-old World War II-era veteran with moderate Alzheimer's disease. Behavioral responses (n = 83) toward the doll included gazing, holding, and caressing. Emotional responses (n = 46) included chuckles, smiles, and laughter. Social responses (n = 59) involved conversations about the doll in which his ability to communicate verbally was markedly improved. Mr. C was a 68-year-old Vietnam veteran with mild Lewy body dementia. He also exhibited frequent behavioral (n = 10), social (n = 11) and emotional (n = 8) responses toward the doll. In addition, he reported having an intense, cathartic dream about the doll, crying "it brings me back to holding my son or my daughter." These case studies add to the literature supporting the benefits of doll use by PWD by describing the effects of spontaneous doll use in two male veterans. Results suggest that having dolls available and providing a nonjudgmental environment where doll use is encouraged and supported may have profound beneficial effects to diverse populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Clinical utility of an assessment scale for engagement in activities for patients with moderate-to-severe dementia: additional analysis

BACKGROUND

We developed the assessment scale for engagement in activities (ASEA), an assessment tool used to quantify engagement in therapeutic activities for patients with moderate-to-severe dementia. In this study, we report additional analyses to confirm the viability of ASEA as a reliable measurement scale.

METHODS

This study included 195 patients with moderate-to-severe dementia in a psychiatric acute-phase hospital. Additional analyses based on the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist were as follows: (i) exploratory and confirmatory factor analysis; (ii) standard error of measurement (SEM), minimal detectable change (MDC) and limit of agreement (LOA); (iii) short change score from baseline to 2 weeks; and (iv) correlation to the facial expression analysis system.

RESULTS

Exploratory factor analysis yielded two factors. This two-factor model of ASEA exhibited an acceptable and validated model fit (comparative fit index = 0.954, Tucker Lewis index = 0.936, goodness-of-fit index = 0.927, adjusted goodness-of-fit index = 0.873, root mean square error of approximation = 0.091, standardised root mean square residual = 0.045) by confirmatory factor analysis. SEM and MDC were 1.29 and 3.80, respectively. The Bland-Altman plot for examining LOA showed no apparent fixed bias. From baseline to 2 weeks later, 129 participants were retested. The mean ASEA total score improved significantly (Wilcoxon signed-rank test; P < 0.01, effect size = 0.25) from baseline (14.30 ± 2.63) to 2 weeks later (15.00 ± 2.73). The correlation between each emotion value was calculated using Kokoro sensor, which is an affect analysis based on human facial expression data using deep learning. For the 36 video data samples, the total score and domains of arousal, interaction, and affect in ASEA were statistically significantly correlated with the emotion value of joy, engagement, and valence (Spearman rank correlation; P < 0.05).

CONCLUSIONS

Among the few evaluation methods specific to severe dementia, ASEA is a useful scale for quantifying and evaluating the state of engagement in therapeutic activities.

Design and development of a social assistive robot for music and game activities: a case study in a residential facility for disabled people

Cognitive disability strongly reduces people's autonomy in performing desired as well as daily activities. The use of Social Assistive Robots (SARs) for cognitive rehabilitation therapy for disabled people could be a valuable gateway for the residential facility of the future. In this work, we design and develop a SAR that can be used for cognitive therapy proposing music and game activities. The results confirm that participants were positively engaged during the proposed activities and satisfied by the robot, despite the low perception of its usability. Professional caregivers noticed and confirmed the high level of engagement and the positive acceptance of the robot within the session, suggesting future tasks for SAR. Clinical Relevance- The results suggest the potential use of SAR also with disabled people proposing cognitive games as a part of the cognitive rehabilitation program.

A simulated experiment to explore robotic dialogue strategies for people with dementia

Introduction

Persons with dementia (PwDs) often show symptoms of repetitive questioning, which brings great burdens on caregivers. Conversational robots hold promise of helping cope with PwDs’ repetitive behavior. This paper develops an adaptive conversation strategy to answer PwDs’ repetitive questions, follow up with new questions to distract PwDs from repetitive behavior, and stimulate their conversation and cognition.

Methods

We propose a general reinforcement learning model to interact with PwDs with repetitive questioning. Q-learning is exploited to learn adaptive conversation strategy (from the perspectives of rate and difficulty level of follow-up questions) for four simulated PwDs. A demonstration is presented using a humanoid robot.

Results

The designed Q-learning model performs better than random action selection model. The RL-based conversation strategy is adaptive to PwDs with different cognitive capabilities and engagement levels. In the demonstration, the robot can answer a user’s repetitive questions and further come up with a follow-up question to engage the user in continuous conversations.

Conclusions

The designed Q-learning model demonstrates noteworthy effectiveness in adaptive action selection. This may provide some insights towards developing conversational social robots to cope with repetitive questioning by PwDs and increase their quality of life.

SAR-Connect: A Socially Assistive Robotic System to Support Activity and Social Engagement of Older Adults

Multi-domain activities that incorporate physical, cognitive, and social stimuli can enhance older adults' overall health and quality of life. Several robotic platforms have been developed to provide these therapies in a quantifiable manner to complement healthcare personnel in resource-strapped long-term care settings. However, these platforms are primarily limited to one-to-one human robot interaction (HRI) and thus do not enhance social interaction. In this paper, we present a novel HRI framework and a realized platform called SAR-Connect to foster robot-mediated social interaction among older adults through carefully designed tasks that also incorporate physical and cognitive stimuli. SAR-Connect seamlessly integrates a humanoid robot with a virtual reality-based activity platform and a multimodal data acquisition module including game interaction, audio, visual and electroencephalography responses of the participants. Results from a laboratory-based user study with older adults indicates the potential of SAR-Connect that showed this system could 1) involve one or multiple older adults to perform multi-domain activities and provide dynamic guidance, 2) engage them in the robot-mediated task and foster human-human interaction, and 3) quantify their social and activity engagement from multiple sensory modalities.

Montessori mealtimes for dementia: A pathway to person-centred care

PURPOSE

This study examined the impact of a Montessori mealtime intervention for people living with dementia to support the mealtime experience of residents and mealtime care practices of staff in a memory support unit. The mealtime intervention was part of a broader culture change project.

METHOD

An observational research design was used to evaluate changes in the mealtime experience and care practices across three time points (baseline, post-implementation, maintenance), spanning 30 months. Five video recordings of the lunch time service (range: 19-32 min) were analysed. The coding protocol comprised pre-determined indicators related to accepted dimensions of person-centred care. Resident and staff behaviours were quantified across four categories: providing choice and preferences, promoting the social side of eating, supporting independence and showing respect towards residents. Staff behaviours that reflected personal enhancing actions and personal detractors were also coded during each mealtime service.

RESULTS

A significant increase in staff providing residents with the opportunity for choice and a subsequent significant increase in residents demonstrating choice behaviours was evident. Staff and residents both significantly increased their interactional behaviours, with greater social interaction between staff and residents. Staff further demonstrated greater support for mealtime independence that reached and maintained significance during the final two sampling points. Significant gains observed post implementation were largely maintained and, on specific measures, further increased over time. A significant increase in staff use of personal enhancing actions during mealtime care was also evident. Variability in individual staff and resident behaviour highlighted the complexity of mealtime care and culture change processes.

IMPLICATIONS

The study provides novel evidence to support the use of a Montessori mealtime intervention to achieve more person-centred mealtime care, and which resulted in a more respectful, enabling and social dining experience. Clinical implications and direction for future research are presented to build on these findings.

Predicting Activation Liking of People With Dementia

Physical, social and cognitive activation is an important cornerstone in non-pharmacological therapy for People with Dementia (PwD). To support long-term motivation and well-being, activation contents first need to be perceived positively. Prompting for explicit feedback, however, is intrusive and interrupts the activation flow. Automated analyses of verbal and non-verbal signals could provide an unobtrusive means of recommending suitable contents based on implicit feedback. In this study, we investigate the correlation between engagement responses and self-reported activation ratings. Subsequently, we predict ratings of PwD based on verbal and non-verbal signals in an unconstrained care setting. Applying Long-Short-Term-Memory (LSTM) networks, we can show that our classifier outperforms chance level. We further investigate which features are the most promising indicators for the prediction of activation ratings of PwD.

Use of robots to encourage social engagement between older adults

We designed a robotic architecture system within a commercially available socially assistive robot to engage pairs of older adults in multimodal activities over 3 weeks for 6 sessions. The study took place in two assisted living facilities. Seven pairs (14 individuals) completed the experiment. Ages ranged from 70 to 90 years with a mean age of 83.0 (± 6.1). Most were women (79%). Three adults were screened as having normal cognition, 10 had mild cognitive impairment, and 1 adult self-reported a diagnosis of Alzheimer's disease. All sessions were video recorded and analyzed using Noldus Observer XT. Individuals demonstrated high levels of both human-human interaction and human-robot interaction, but the activity influenced the type of interaction. Engagement measures (visual, verbal, behavioral) also varied by type of activity. Future studies will focus on further development of activities that can engage older adults with varying levels of cognitive impairment and apathy.

Perceived Service Quality in HRI: Applying the SERVBOT Framework

Services are intangible in nature and as a result, it is often difficult to measure the quality of the service. In the service literature, the service is usually delivered by a human to a human customer and the quality of the service is often evaluated using the SERVQUAL dimensions. An extensive review of the literature shows there is a lack of an empirical model to assess the perceived service quality provided by a social robot. Furthermore, the social robot literature highlights key differences between human service and social robots. For example, scholars have highlighted the importance of entertainment value and engagement in the adoption of social robots in the service industry. However, it is unclear whether the SERVQUAL dimensions are appropriate to measure social robot's service quality. The paper proposes the SERVBOT model to assess a social robot's service quality. It identifies, reliability, responsiveness, assurance, empathy, and entertainment as the five dimensions of SERVBOT. Further, the research will investigate how these five factors influence emotional engagement and future intentions to use the social robot in a concierge service setting. The model was tested using student sampling, and a total of 94 responses were collected for the study. The findings indicate empathy and entertainment value as key predictors of emotional engagement. Further, emotional engagement is a strong predictor of future intention to use a social robot in a service setting. This study is the first to propose the SERVBOT model to measure social robot's service quality. The model provides a theoretical underpinning on the key service quality dimensions of a social robot and gives scholars and managers a method to track the service quality of a social robot. The study also extends on the literature by exploring the key factors that influence the use of social robots (i.e., emotional engagement).

Assessing Momentary Well-Being in People Living With Dementia: A Systematic Review of Observational Instruments

Optimizing the possibility to lead good lives is at the core of treatment and care for people with dementia. This may be monitored by assessing well-being and quality of life. However, cognitive impairment following dementia may complicate recall-based assessment with questionnaires, and proxy-ratings from family-caregivers do not correspond well to self-reports. Thus, using observational measures represents a potentially advanced option. Systematic reviews evaluating measurement properties, interpretability and feasibility of observational instruments assessing well-being in people living with dementia are lacking. Thus, this review performed systematic searches to find peer reviewed validated instruments of relevance in the databases MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL and ProQuest. Twenty-two instruments assessing well-being were included for evaluation of measurement properties based on the systematic approach of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The evaluation included risk of bias on study level, and assessment of measurement properties on instrument level including content validity, construct validity, structural validity, internal consistency, measurement invariance, cross-cultural validity, measurement error and inter-rater/intra-rater/test-retest reliability and responsiveness. Additionally, the feasibility and interpretability of the measures were evaluated. No single instrument could be recommended based on existing publications. Thus, we provide general recommendations about further assessment and development of these instruments. Finally, we describe the most promising instruments and offer guidance with respect to their implementation and use in clinical and research contexts.

Context-Enhanced Human-Robot Interaction: Exploring the Role of System Interactivity and Multimodal Stimuli on the Engagement of People with Dementia

Engaging people with dementia (PWD) in meaningful activities is the key to promote their quality of life. Design towards a higher level of user engagement has been extensively studied within the human-computer interaction community, however, few extend to PWD. It is generally considered that increased richness of experiences can lead to enhanced engagement. Therefore, this paper explores the effects of rich interaction in terms of the role of system interactivity and multimodal stimuli by engaging participants in context-enhanced human-robot interaction activities. The interaction with a social robot was considered context-enhanced due to the additional responsive sensory feedback from an augmented reality display. A field study was conducted in a Dutch nursing home with 16 residents. The study followed a two by two mixed factorial design with one within-subject variable - multimodal stimuli - and one between-subject variable - system interactivity. A mixed method of video coding analysis and observational rating scales was adopted to assess user engagement comprehensively. Results disclose that when additional auditory modality was included besides the visual-tactile stimuli, participants had significantly higher scores on attitude, more positive behavioral engagement during activity, and a higher percentage of communications displayed. The multimodal stimuli also promoted social interaction between participants and the facilitator. The findings provide sufficient evidence regarding the significant role of multimodal stimuli in promoting PWD’s engagement, which could be potentially used as a motivation strategy in future research to improve emotional aspects of activity-related engagement and social interaction with the human partner.

Conversational System as Assistant Tool in Reminiscence Therapy for People with Early-Stage of Alzheimer's

Reminiscence therapy is a non-pharmacological intervention that helps mitigate unstable psychological and emotional states in patients with Alzheimer’s disease, where past experiences are evoked through conversations between the patients and their caregivers, stimulating autobiographical episodic memory. It is highly recommended that people with Alzheimer regularly receive this type of therapy. In this paper, we describe the development of a conversational system that can be used as a tool to provide reminiscence therapy to people with Alzheimer’s disease. The system has the ability to personalize the therapy according to the patients information related to their preferences, life history and lifestyle. An evaluation conducted with eleven people related to patient care (caregiver = 9, geriatric doctor = 1, care center assistant = 1) shows that the system is capable of carrying out a reminiscence therapy according to the patient information in a successful manner.

Can a humanoid social robot stimulate the interactivity of cognitively impaired elderly? A thorough study based on computer vision methods

Social Assistive Robotics is increasingly being used in care settings to provide psychosocial support and interventions for the elderly with cognitive impairments. Most of these social robots have provided timely stimuli to the elderly at home and in care centres, including keeping them active and boosting their mood. However, previous investigations have registered shortcomings in these robots, particularly in their ability to satisfy an essential human need: the need for companionship. Reports show that the elderly tend to lose interests in these social robots after the initial excitement as the novelty wears out and the monotonous familiarity becomes all too familiar. This paper presents our research facilitating conversations between a social humanoid robot, Nadine, and cognitively impaired elderly at a nursing home. We analysed the effectiveness of human-humanoid interactions between our robot and 14 elderly over 29 sessions. We used both objective tools (based on computer vision methods) and subjective tools (based on observational scales) to evaluate the recorded videos. Our findings showed that our subjects engaged positively with Nadine, suggesting that their interaction with the robot could improve their well-being by compensating for some of their emotional, cognitive, and psychosocial deficiencies. We detected emotions associated with cognitively impaired elderly during these interactions. This study could help understand the expectations of the elderly and the current limitations of Social Assistive Robots. Our research is aligned with all the ethical recommendations by the NTU Institutional Review Board.

Engagement in purposeful activities and social interactions amongst persons with dementia in special care units compared to traditional nursing homes: An observational study

Background

Persons with dementia spend most time of their day not engaging in activities or social interactions. A care concept of a dementia special care unit that promotes activities and social interaction through a household‐like design and individualised stimuli is studied.

Aim

To evaluate the main outcomes of the care concept of a dementia special care unit, namely, engagement in activities and social interactions.

Methods

We conducted an observational study as part of a theory‐driven evaluation. The Maastricht Daily Life Observation Tool was used to collect momentary assessments multiple times per participant, including engagement in activity, type of activity, engagement in social interaction, interaction partners, location, agitation and mood. Thirty‐three residents of the dementia special care units that implemented the care concept and 54 residents with dementia of two traditional nursing homes participated in the study, resulting in 2989 momentary assessments.

Results

Residents of both settings did not engage in activities or social interaction in approximately half of the observations. Compared to residents of traditional nursing homes, residents of special care units had a significantly higher chance for engagement in activities and social interaction in the afternoon but not in the morning or evening.

Conclusion

The care concept of the special care unit facilitated engagement but had its limitations. Further research is needed to develop and evaluate appropriate interventions to enhance engagement of persons with dementia.

Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia

Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care.

Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE.

Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals.  However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings.

Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.

Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia

Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals.  However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.

Development of the Video Analysis Scale of Engagement (VASE) for people with advanced dementia

Background: The current study sought to develop a valid, reliable and unobtrusive tablet computer-based observational measure to assess engagement of people with advanced dementia. The Video Analysis Scale of Engagement (VASE) was designed to enable the rating of moment-by-moment changes in engagement during an activity, which would be useful for both future research and current residential care. Methods: An initial version of the VASE was tested. Face validity and content validity were assessed to validate an operational definition of engagement and develop an acceptable protocol for the scale. Thirty-seven non-professional and professional volunteers were recruited to view and rate level of engagement in music activities using the VASE. Results: An inter-class coefficient (ICC) test gave a high level of rating agreement across professionals and non-professionals.  However, the ICC results of within-professionals were mixed. Linear mixed modelling suggested that the types of interventions (active or passive music listening), the particular intervention session being rated, time period of video and the age of raters could affect the ratings. Conclusions: Results suggested that raters used the VASE in a dynamic fashion and that the measure was able to distinguish between interventions. Further investigation and adjustments are warranted for this to be considered a valid and reliable scale in the measurement of engagement of people with advanced dementia in a residential care setting.

Development of an assessment scale for engagement in activities for patients with moderate to severe dementia

BACKGROUND

Various types of therapy, including occupational therapy, are utilised for the treatment of moderate to severe dementia. In order to determine the optimal rehabilitation strategy for such patients and examine the treatment efficacy, an assessment scale for engagement in various group activities that can be easily applied in clinical situations is required. We herein report the development of the Assessment Scale for Engagement in Activities (ASEA) and its clinical utility.

METHODS

The ASEA was developed by nine occupational therapists and a psychiatrist with experience in developing measures for dementia, in accordance with the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) checklist. This assessment comprises 10 items covering four domains: Engagement in the Activity, Interaction, Arousal, and Affect. Participants with moderate to severe dementia who resided in a psychiatric acute phase hospital in Japan were assessed in terms of engagement in activities using the ASEA and Todai-shiki Observational Rating Scale (TORS), and in terms of cognitive function using the Mini-Mental State Examination (MMSE). We examined the internal consistency, inter- and intra-rater reliability, content validity, and concurrent validity of the ASEA.

RESULTS

Cronbach's alpha of the ASEA was 0.889. The overall inter-rater reliability was 0.937 (Spearman rank correlation, P < 0.001), and the intraclass correlation (ICC) for each item was 0.490-0.965 (P < 0.018-0.001). The overall test-retest reliability was 0.778 (Spearman's rank correlation, P < 0.001), and the ICC for each item was 0.498-0.863 (P < 0.023-0.001). The test-retest correlations were significant for almost all items, aside from 'Interaction with others' (P = 0.051). The concurrent validity, examined using the TORS and MMSE, was 0.920 and 0.304 (Spearman's rank correlation, P < 0.001-0.006).

CONCLUSIONS

The ASEA has confirmed reliability and validity, aside from 'Interaction with others' regarding test-retest reliability. Generally, this assessment tool has clinical utility and allows the evaluation of activity engagement among patients with moderate to severe dementia.

Promoting Quality of Life in Advanced Dementia Care: Reading Buddies Program as Service-learning

The Reading Buddies Program was developed as a service-learning component of an Occupational Therapy Practice with Older Adults course as a collaboration between Tufts University and the VA Bedford Health Care System. The purpose of this service-learning program was to challenge graduate students' implicit biases and improve communication skills when working with older adults with significant cognitive impairments. Through this collaboration, occupational therapy students provided individualized, activity-based care to Veterans with advanced dementia. In this qualitative study, a total of 55 guided reflection papers submitted by students were analyzed using NVivo. Four major themes emerged: "I was a fish out of water," "I finally took a risk," "And then I thought, maybe I should give myself a little credit," and, "I am still experimenting with how I feel," illustrating student outcomes and perceived benefits of participation in the Reading Buddies Program. Each theme reflected the development of clinical reasoning which was the targeted impact. Outcomes confirm service-learning as an effective tool and suggest further use for academic programs, emphasizing the potential of creative partnerships to meet educational goals while providing valuable programming to vulnerable populations.

Using touchscreen tablets to support social connections and reduce responsive behaviours among people with dementia in care settings: A scoping review

The use of touchscreen tablets, such as the iPad, offers potential to support the person with dementia staying in a care setting, ranging from a long-term care home to an adult day programme. Although electronic devices are used among people with dementia, a comprehensive review of studies focusing on their impact and how they may be used effectively in care settings is lacking. We conducted a scoping review to summarize existing knowledge about the impact of touchscreen tablets in supporting social connections and reducing responsive behaviours of people with dementia in care settings. Our research team consists of patient partners and family partners, physicians, nurses, a medical student and an academic professor. A total of 17 articles were included in the review. Our analysis identified three ways in which touchscreen tablets support dementia care: (1) increased the person's engagement, (2) decreased responsive behaviours and (3) positive effect on enjoyment/quality of life for people with dementia. Lessons learned and barriers to the use of touchscreen tablets in the care of people with dementia are described. Overall, only a few studies delineated strategies that helped to overcome barriers to technology adoption in care settings. Knowledge translation studies are needed to identify effective processes and practical tips to overcome barriers and realize the potential of assistive technology in dementia care.

Evaluation of the Montessori-Inspired Lifestyle® as the Foundation of Care in Assisted Living Memory Care

The Montessori-Inspired Lifestyle^® (MIL) was implemented as the foundation of care in several assisted living memory care (ALMC) neighborhoods to enhance meaningful social roles, engagement, and focus on residents' remaining capabilities. The purpose of this quality improvement project was to evaluate the outcomes regarding resident levels of engagement and prescribed antipsychotic medications before and after MIL implementation. A total of 85 residents were observed for 10-minute periods seven times during 1 day to ascertain the level of engagement during meals and planned and unplanned activities. Positive engagement minutes increased after MIL implementation for activities and meals. Outcomes of this project support the MIL as a foundation of care for ALMC residents and have raised the awareness for addressing diverse cognitive abilities. The need for reoccurring training for the sustainability of this model of care was recognized. [Journal of Gerontological Nursing, 46(5), 40-46.].

Robotic Telemedicine for Mental Health: A Multimodal Approach to Improve Human-Robot Engagement

COVID-19 has severely impacted mental health in vulnerable demographics, in particular older adults, who face unprecedented isolation. Consequences, while globally severe, are acutely pronounced in low- and middle-income countries (LMICs) confronting pronounced gaps in resources and clinician accessibility. Social robots are well-recognized for their potential to support mental health, yet user compliance (i.e., trust) demands seamless affective human-robot interactions; natural 'human-like' conversations are required in simple, inexpensive, deployable platforms. We present the design, development, and pilot testing of a multimodal robotic framework fusing verbal (contextual speech) and nonverbal (facial expressions) social cues, aimed to improve engagement in human-robot interaction and ultimately facilitate mental health telemedicine during and beyond the COVID-19 pandemic. We report the design optimization of a hybrid face robot, which combines digital facial expressions based on mathematical affect space mapping with static 3D facial features. We further introduce a contextual virtual assistant with integrated cloud-based AI coupled to the robot's facial representation of emotions, such that the robot adapts its emotional response to users' speech in real-time. Experiments with healthy participants demonstrate emotion recognition exceeding 90% for happy, tired, sad, angry, surprised and stern/disgusted robotic emotions. When separated, stern and disgusted are occasionally transposed (70%+ accuracy overall) but are easily distinguishable from other emotions. A qualitative user experience analysis indicates overall enthusiastic and engaging reception to human-robot multimodal interaction with the new framework. The robot has been modified to enable clinical telemedicine for cognitive engagement with older adults and people with dementia (PwD) in LMICs. The mechanically simple and low-cost social robot has been deployed in pilot tests to support older individuals and PwD at the Schizophrenia Research Foundation (SCARF) in Chennai, India. A procedure for deployment addressing challenges in cultural acceptance, end-user acclimatization and resource allocation is further introduced. Results indicate strong promise to stimulate human-robot psychosocial interaction through the hybrid-face robotic system. Future work is targeting deployment for telemedicine to mitigate the mental health impact of COVID-19 on older adults and PwD in both LMICs and higher income regions.

"It Makes You Feel That You Are There": Exploring the Acceptability of Virtual Reality Nature Environments for People with Memory Loss

Aim: To report on the acceptability of virtual reality (VR) nature environments for people with memory loss at memory cafes, and explore the experiences and perceptions of carers and staff. Methods: A qualitative study was conducted between January and March 2019. Ten adults with memory loss, eight carers and six volunteer staff were recruited from two memory cafes, located in Cornwall, UK. There were 19 VR sessions which were audio recorded and all participants were interviewed at the end of the sessions. Framework analysis was used to identify patterns and themes in the data. Results: During the VR experience, participants were engaged to varying degrees, with engagement facilitated by the researcher, and in some cases, with the help of a carer. Participants responded positively to the nature scenes, finding them soothing and evoking memories. The VR experience was positive; many felt immersed in nature and saw it as an opportunity to ‘go somewhere’. However, it was not always positive and for a few, it could be ‘strange’. Participants reflected on their experience of the VR equipment, and volunteer staff and carers also shared their perceptions of VR for people with dementia in long-term care settings. Conclusions: The VR nature experience was an opportunity for people with memory loss to be immersed in nature and offered the potential to enhance their quality of life. Future work should build on lessons learned and continue to work with people with dementia in developing and implementing VR technology in long-term care settings.

Technology-driven solutions to prompt conversation, aid communication and support interaction for people with dementia and their caregivers: a systematic literature review

Background

The impact of dementia for communication skills can result in difficulties in social interactions between people with dementia and their conversation partner, as initiating and maintaining conversations becomes increasingly challenging. The role of technology in enhancing social health and participation for people with dementia is increasing, but the use of technological devices to support social interactions and aid communication quality is still in its infancy. The objective of this literature review is to provide a comprehensive description of technology-driven interventions for people with dementia and their conversation partners to prompt communication and facilitate positive social interactions.

Methods

A systematic search was conducted using PubMed, CINAHL and PsycINFO, with titles and abstracts independently screened by two researchers. Quality appraisal of the included studies was assessed using the Mixed Methods Appraisal Tool.

Results

Of the 18 papers included, the technology most commonly used to facilitate communication and interactions was tablet-computers (n = 7), social robots (n = 5) and computers systems (n = 4). By analyzing the impact of the device(s) for social interaction and communication, four major themes emerged: i) breaking the ice; ii) increased interaction; iii) better understanding of the person with dementia; and iv) reduced pressure for the conversation partner.

Conclusion

While the majority of the included studies are small-scale, they indicate promising findings for the potential of technology to promote interaction in a way that relieves strain on the caregiver, enhances relationships and engages people with dementia in social activities. Rigorous investigation using standard, comparable measurements is needed to demonstrate the effects of technological solutions, as well as to explore and address barriers and potential adverse outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02105-0.

Meaningful Engagement Among Assisted Living Residents With Dementia: Successful Approaches

Meaningful engagement is an important dimension of quality of life and care for persons living with dementia, including the growing number who reside in assisted living communities. This report presents preliminary findings from an ongoing qualitative study aimed at identifying best care practices to create and maintain meaningful engagement among persons with dementia. Over a 1-year period, we conducted interviews, residents' record review, and participant observations in four diverse care communities. Our analysis identified four approaches that successfully promote meaningful engagement: (a) knowing the person, (b) connecting with and meeting people where they are, (c) being in the moment, and (d) viewing all encounters as opportunity. Incorporation of these approaches in care routines and adoption by all care partners can promote meaningful engagement, including during crises such as COVID-19.

Examining the Utility of the DESCARTE Model for Case Study Research

The DESCARTE model aims to guide health care researchers on the design, conduct, and reporting of case studies. The current article critically appraises the utility of the model and provides an example of its application to a multiple case study that examined the effect of MARIO, a social robot, on the resilience of people with dementia. The DESCARTE model is explained, and its strengths and the challenges encountered during its application are discussed. DESCARTE provides a structured framework that promotes quality in case study research by requiring the researcher to articulate philosophical cohesiveness, ethical considerations, reflexivity, and the strategies used during data integration and throughout data analysis. However, the model does not prompt the development of research questions or methods to promote rigor and reflexivity throughout the case study. A task list and additional guiding questions are provided to address these deficits and to improve the utility of the DESCARTE model. [Research in Gerontological Nursing, 14(2), 60-68.].

Field Testing of Ro-Tri, a Robot-Mediated Triadic Interaction for Older Adults

Older adults residing in long term care (LTC) settings commonly experience apathy, a neuropsychiatric condition with adverse consequences of increased morbidity and mortality. Activities that combine social, physical and cognitive stimuli are most effective in engaging older adults with apathy but are time consuming and require significant staff resources. We present the results from an initial pilot field study of our socially assistive robotic (SAR) system, Ro-Tri, capable of multi-modal interventions to foster social interaction between pairs of older adults. Seven paired participants attended two sessions a week for three weeks. Sessions consisted of robot-mediated triadic interactions with three types of activities repeated once over the 3 weeks. Ro-Tri gathered quantitative interaction data, head pose, vocal sound, and physiological signals to automatically evaluate older adults' activity and social engagement. Ro-Tri functioned smoothly without any technical issues. Older adults had > 90% attendance and 100% completion rate and remained engaged with the system throughout the study duration. Participants' visual attention toward the SAR system and their partners increased 7.2% and 4.7%, respectively, with their interaction effort showing an increase of 2.9%. Older adults and LTC staff had positive perceptions with the system. These initial results demonstrate Ro-Tri's ability to engage older adults, encourage social human-to-human interaction, and assess the changes using quantitative metrics. Future studies will determine SAR's impact on apathy in LTC older adults.