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The impact of group activities and their content on persons with dementia attending them

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Background: Individuals suffering from dementia and residing in nursing homes often feel lonely and bored. This study examined the engagement and mood of people with dementia in group activities, and how personal characteristics, such as cognitive function, may impact on an individual's responses to group activities. Methods: The study included 102 participants, who took part in group activities while their mood and engagement levels were observed. Participants were invited to attend 10 different types of group activities, each of which was offered twice. Results: Results found improved engagement and mood during group activities as compared to control no-group times. Significant relationships between the type of activity and ratings of engagement and mood were also found. Although participants with higher levels of cognitive functioning manifested greater responsiveness to groups, the pattern of response to different contents did not differ by cognitive function. Conclusions: This study shows the potential utility of group activities for improving quality of life of persons with dementia and demonstrates a methodology that can be used for quality improvement to optimize group contents. Future research should expand the range of contents of group activities in order to enhance the options for improving mood and engagement of individuals with dementia.
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R E S E A R C H Open Access
The impact of group activities and
their content on persons with dementia
attending them
Jiska Cohen-Mansfield
1,2,3
Abstract
Background: Individuals suffering from dementia and residing in nursing homes often feel lonely and bored.
This study examined the engagement and mood of people with dementia in group activities, and how personal
characteristics, such as cognitive function, may impact on an individuals responses to group activities.
Methods: The study included 102 participants, who took part in group activities while their mood and engagement
levels were observed. Participants were invited to attend 10 different types of group activities, each of which was
offered twice.
Results: Results found improved engagement and mood during group activities as compared to control no-group
times. Significant relationships between the type of activity and ratings of engagement and mood were also found.
Although participants with higher levels of cognitive functioning manifested greater responsiveness to groups,
the pattern of response to different contents did not differ by cognitive function.
Conclusions: This study shows the potential utility of group activities for improving quality of life of persons with
dementia and demonstrates a methodology that can be used for quality improvement to optimize group
contents. Future research should expand the range of contents of group activities in order to enhance the options for
improving mood and engagement of individuals with dementia.
Keywords: Dementia, Group activities, Mood, Cognitive impairment
Background
Persons with dementia residing in nursing homes and
long-term care settings are often not engaged in any
activity [1]. Low levels of engagement and understimulation
are problematic because they can result in boredom
and loneliness that may lead to behavior challenges [1].
A potential way to mitigate these issues is to engage
multiple persons with dementia in group activities.
Group activities can provide individuals with dementia
the opportunity to interact with both staff members
and other residents within a social context while being
engaged in an activity. Therefore, it is important to
understand the impact of group activities on engagement
and the possible related outcomes. The Comprehensive
Process Model of Group Engagement serves as a
conceptual framework to understand engagement of
persons with dementia within group activity settings [2].
This model posits that environmental (e.g., physical and
group environments), stimulus (e.g., content of activities),
and personal attributes (e.g., age, cognitive functioning)
impact on the engagement and affect levels of individuals
taking part in the activity, which can, in turn, influence
behaviors of persons with dementia. In particular, stimulus
attributes, such as the content of a specific group activity,
may differentially impact engagement and may also
interact with other attributes, such as characteristics
of group members.
Based on this model, it is possible that certain activities
may be more engaging than others, depending on the
characteristics of the activities. Some insight comes from a
Correspondence: Jiska@post.tau.ac.il
1
Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv
University, P.O.B. 39040, Ramat Aviv, 6139001 Tel-Aviv, Israel
2
Department of Health Promotion, School of Public Health, Sackler Faculty of
Medicine, Tel-Aviv University, P.O.B. 39040, Ramat Aviv, 6139001 Tel-Aviv,
Israel
Full list of author information is available at the end of the article
© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Cohen-Mansfield Alzheimer's Research & Therapy (2018) 10:37
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small descriptive study of 23 individuals who were
diagnosed with dementia [3]thatcomparedtheengage-
ment level in five different types of group activitiesmusic,
art, exercise, cognitive, and functional household activities.
Active participation levels were highest for the exercise,
music, and art groups. Although this study provides
some insight into certain activities that may be more
engaging, in that exercise, music, and art elicited
higher active participation levels than the cognitive
and household activities, no statistical tests comparing
the activities were reported. The small sample size of
higher functioning persons with dementia (who were
able to give their own consent to the study) and the
limited range of activities also make it challenging to
generalize these results to other settings.
A larger study with 107 participants [4] found that
activity interventionssome of which were completed in
groupsengaged residents 84% of the time overall, with
an average engagement duration of 27 min. Examples of
activities that resulted in engagement 9899% of the
time included drama, wine/cheese social, garden, and
dancing activities. These results are encouraging because
they demonstrate that persons with dementia are
capable of showing high engagement levels in different
types of activities. However, this study tailored activities
to each individual, which may have contributed to high
engagement levels. Individualization of activities may
not always be feasible in resource-limited facilities, so
there remains a need for research that compares common
group activities (e.g., exercise, reading) that have not
been individualized.
Other studies have examined different outcomes that
may be related to engagement, such as wellbeing and
affect. For example, one study compared levels of
wellbeing of persons with dementia during reminiscence
group therapy, general activities (e.g., crafts and games),
and unstructured time [5]. Wellbeing was observed to
be lower during unstructured time compared to the
activities. Wellbeing was also higher for reminiscence
therapy than for general group activities. The superiority
of activity over unstructured time was also demonstrated
by Phillips et al. [6], who found significantly more
pleasure during a group storytelling than during an
unstructured control condition.
Other studies have also compared two or three group
activities on outcomes other than engagement, but have
not found significant differences in affect between music
and reading activities [7], or in behavior when compar-
ing a music activity versus general recreational activities,
such as puzzle games and cooking [8], or else they
reported inconclusive or unclear results [9]. The limited
evidence, together with different study methodologies,
makes it difficult to conclude which group activities may
have the most promising impact, and how they compare
to unstructured time. The sample sizes of four of these
studies were small (fewer than 50 participants [3,5,7,9]),
with some consisting of relatively higher functioning
persons with dementia who were capable of making
their own responses on questionnaires (e.g., [7]). Such
limitations make it challenging to provide recommen-
dations for group activities that would be generalizable
to a range of persons with dementia. Thus, there is a
need to clarify the impact of group activities in general
(i.e., in comparison to unstructured time) and to elucidate
the impact of different activities on various outcomes.
To address this research gap, this study measured
the engagement and mood of persons with dementia
with various levels of functioning during 10 group ac-
tivities. The first aim was to compare the engagement
level of participants during group activities to a con-
trol condition consisting of unstructured time. The
hypothesis was that group activities would be more
engaging than unstructured time. The second aim
was to assess whether certain activities were more en-
gaging than others. The general hypothesis was that
certain group activities would be more engaging than
others, but the lack of clear findings in the literature
did not lend itself to specific predictions as to which
these activities would be. The third aim was to exam-
ine whether cognitive level, a personal characteristic
of participants, changes the impact of the different
group activities.
Methods
Participants
Persons with dementia were recruited from nine units at
a geriatric residential facility consisting of a nursing home,
a community adult day program, and an independent
living facility. Inclusion criteria included: a diagnosis
of dementia (derived from the medical chart) and
informed consent. The criteria for exclusion were: a
diagnosis of bipolar disorder; a lifelong diagnosis of
schizophrenia; Cognitive Performance Scale (CPS)
[10] score of 1 or lower (higher scores indicate lower
function), because it is believed that people with
higher levels of cognitive function can articulate their
interests and needs most of the time; no dexterity
movement in either hand; cannot be comfortably
seated in a chair or wheelchair, or cannot be moved
to the location of the group therapeutic recreation;
and never spoke any English. This information was
gathered from computerized charts using Minimum
Data Set (MDS) version 2.0 [11,12]. We purposefully
did not exclude potential participants on the level of
cognitive function, as our aim was to examine the
feasibility and outcomes of group activities for per-
sons with all stages of dementia.
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Ethics, consent, and permissions
This study was approved by the Research Ethics Board
(REB) of Baycrest Health Sciences. We contacted the
persons responsible for making decisions for those
meeting inclusion criteria. Of the 217 contacted, 22
refused and informed consent was obtained for 105
study participants.
Procedure
Once consent was obtained for 1012 eligible participants
for each unit, recruitment was stopped, on the assumption
that 1012 participants would be an appropriate size
for a group. One participant who enrolled in the
study was subsequently excluded due to the onset of
illness prior to the first session. The analyses reported
in this article were conducted with a final sample size
of 104 study participants. Participants were grouped
into nine units, with each unit having between 10
and 13 participants for whom consent was obtained.
Occasionally, group activities were joined by clients
who were not enrolled in the study and dropped in
on the groups. The total group size ranged from 3 to
17 for the group activity sessions, with a mean of 9.2
(SD = 3.1). In total, 102 participants with consent ac-
tually attended groups, and the following text pertains
to them.
Baseline characteristics were collected from the MDS
and medical charts: age, sex, language, education, marital
status, number of children, mobility, vision, hearing,
speech, number of medications, number of diagnoses,
cognitive functioning (via the CPS), and activities of
daily living (via the Activities of Daily Living Long form;
ADL-Long Form, obtained through the MDS [13]). Over
half of the persons with dementia were female (63.7%),
and the average age was 87.20 years (SD = 8.44, ranging
from 59 to 101 years). Cognitive functioning assessed via
the CPS [10] averaged 3.09 (SD = 1.31; range 26; scale,
0=Intactto 6 = Very Severe). ADL-Long Form [13]
performance averaged 16.9 (SD = 18.98, range 028;
scale, 0 = independentto 28 = total dependence).
Participants were invited to participate in two sessions
of each of 10 group activities which had been selected
based on therapeutic recreation (TR) staff expertise and
are considered to be common activities in nursing
homes and long-term care settings: exercise; active
physical games, such as bowling or ring toss; reminiscence
poetry; baking; choral singing; creative storytelling;
reading aloud with discussion; brain games/fitness;
holiday discussion; and holiday newsletter activities
(for additional details see [14]). One group activity
was conducted per session, and each group activity
was conducted twice, in random order, so that each
unit completed 20 sessions of group activities. Over
nine units, this resulted in a total of 180 sessions. Each
unit had one TR who led all the group activities for
that unit, with the exception of one unit in which the
group activities were shared amongst two TRs. Each
session lasted approximately 30 min, and all were
conducted in English. The study took place for
approximately 34 months on each unit and lasted
7monthsoverall.
The control condition consisted of observations of
study participants during one or two visits in their
residential location during unstructured time (i.e.,
when organized activities were not being conducted).
These 35-min observations were scheduled to take
place at a random order with respect to the other
group sessions.
Observations of participants during group activities
were independently made by a trained research assistant,
trained student volunteers, and the TR who had led
the group activity (after its completion). The control
condition sessions were observed by at least one TR
or research staff observer (often both).
Assessments
Outcome measures Observations were collected using
the Group Observational Measurement of Engagement
(GOME) [2] and included outcomes of engagement,
mood, and sleep. These are described in the following.
The construct of engagement was measured by three
variables: engagement,How much of the group was the
participant engaged in the group activity?, rated on a
scale from 0 = none of the time to 5 = most or all of the
time; active participation, To what extent did the
participant actively participate in the group?,rated from
0 = not at all to 4 = very much; and attitude towards
the activity (most of the time), ranging from 1 = very
negative to 7 = very positive.
Active participation and attitude were not measured
in the control observations, since most often there was
no particular stimulus or activity to actively participate
with or to have an attitude toward.
Because the term engagementis used to describe a
group of variables as well as a specific indicator
variable, we will use quotes whenever referring to the
particular observed variable named engagementand
use the term without quotes when we refer to the
general construct of engagement.
Positive mood was measured through observation, with
ratings ranging from 0 = not at all to 4 = very much.
Sleep and sleepiness was rated on the basis of observa-
tion on a scale ranging from 0 = none of the time to 6 = all
of the time.
More detailed descriptions of the variables represent-
ing engagement, mood, and sleep, together with their
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psychometric properties showing good inter-rater
reliability and validity, are presented in [2,15].
Analytical approach
In order to compare ratings during groups to ratings
for control observations, we aggregated all group
observations across the 20 group experiences of each
of the participants and also aggregated the two control
observations for each participant. Paired ttests were
used to compare engagement, mood, and sleep for
each participant during group observations vs control
observations. Effect size for those paired ttests were
calculated as: (mean
diff
/SD
diff
2
.
To address the second goal, of assessing the relative
impact of the different group activities on participants,
we used a mixed model analysis in order to address the
repeated measures in the data, which included two
observations per participant per group topic done by
two different observers. The mixed model analysis also
enabled us to address the missing data resulting from
uneven participation in the groups, which we will examine
in another paper. In order to reduce the number of models
we examined, we used the average of observations by TR
and by the other observer as the dependent variable. In the
mixed model, we included cognitive function as a covariate,
becausewehavefoundittobethemostimportant
personal variable affecting engagement and mood in this
population [16]. Holiday discussion was used as the
reference group to which other groups were compared.
In order to examine the third goal, determining
whether the relative impact of different group topics
varied by cognitive function, we divided the population
into two groups, those of moderate cognitive impairment
(CPS rating of 2 and 3; n= 55) vs advanced cognitive
impairment (CPS ratings of 4, 5, and 6; n=47).Wethen
conducted the same mixed model analysis described for
the second goal within each subgroup and examined these
results for the two subgroups for engagement, active
participation, and positive mood. Due to the small group
sizes, we examined effects with p<0.10inthissection.
Results
Group activities vs control condition
Table 1presents the comparison of the group obser-
vations to the control observations, showing that
during group activities participants were more engaged,
displayed a more positive mood, and spent less time
asleep or displaying sleepiness than during the control
observations. This was found regardless of whether
TR staff or research observations were used, although
effect sizes were larger when using TR ratings.
Comparison of group activities
The mixed model analysis found statistically significant
effects for group topic and for cognitive function in each
of the analyses, with p< 0.001 for ' engagement', active
participation, attitude, and positive mood, and p= 0.018
in the comparison of the different group activities on
sleep and sleepiness (Table 2). The much higher values
for Fstatistics associated with cognitive functioning as
compared to group activities suggest that cognitive
function had a greater impact on the outcome variables
than did the differences among group topics. When
comparing the different activities to the reference group
of holiday discussion, games and choral groups resulted
in significantly more engagement, active participation,
positive attitude, and positive mood, and also in signifi-
cantly less sleepiness; exercise groups resulted in signifi-
cantly more active participation; brain games resulted in
significantly more positive mood; and baking was associated
with significantly more active participation and positive
mood; in contrast, poetry resulted in a worse attitude and
less positive mood, and storytelling resulted in significantly
less engagement, less active participation, and a less
positive attitude (Table 3). The estimated means of the
dependent variables for the different groups (after control-
ling for cognitive function) are displayed in Fig. 1.The
figure shows that the different dependent variables
tended to fluctuate in a similar manner for the different
activities, with sleep naturally showing the mirror
image of the fluctuations and also manifesting smaller
changes among activities.
Table 1 Comparison of mean engagement, mood, and sleep levels during group activities vs during control observations
Variable Rater Group activity Control tdf p(two-tailed) Effect size
Mean SD Mean SD
'Engagement' TR 3.55 1.41 2.72 1.96 4.84 92 0.000 0.71
Observer 3.73 1.35 3.31 1.7 3.43 96 0.001 0.49
Positive mood TR 2.48 1.07 1.76 1.28 6.04 91 0.000 0.89
Observer 1.52 1.07 1.24 1.29 3.12 96 0.002 0.45
Asleep TR 1.14 1.62 1.87 2.15 3.87 89 0.000 0.58
Observer 1.19 1.63 1.48 2.09 1.94 94 0.056 0.28
SD standard deviation, df degrees of freedom, TR therapeutic recreation
Cohen-Mansfield Alzheimer's Research & Therapy (2018) 10:37 Page 4 of 8
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The interaction between group topics and
participantscognitive function
Figure 2displays the means of engagement, active
participation, and positive mood separately for partici-
pants with moderate cognitive impairment and with
advanced cognitive impairment. As expected, higher
levels were observed for those with moderate cognitive
impairment. However, the trends were similar for both
groups, suggesting that for the activities used in this
study, the difference in responsiveness to the groups is a
matter of magnitude of observable response rather than
responsiveness to different types of groups. This is further
supported by other observations: mean engagement
scores were highest for both levels of cognitive function in
the games group and second highest for choral, and they
were lowest for storytelling. Active participation was also
highest in games for both levels of cognitive function
and, again, storytelling had the lowest levels of active
participation regardless of cognitive function. For
positive mood, games had the highest ratings, choral
had the second highest, and poetry had the lowest
ratings regardless of level of cognitive functioning.
Discussion
The results provide relatively clear answers for the three
research aims. Group activities were clearly superior to
control time without such groups. Participantslevels of
engagement, mood, and sleep varied with group content.
While persons with higher level of cognitive function
manifested more positive effects in response to the
groups, the relative responses to the various group
contents did not differ by cognitive function.
The superiority of group activities to control obser-
vations concords with Brooker and Duces[5]and
Phillips et al.s[6] findings that wellbeing was higher
during activities than during unstructured time. In
contrast, our findings of differential effects of groups
based on their contents differ from those of some
previous studies [79]. This could be due to our use
of a larger range of activities, a larger sample size,
different assessments, or the nature of the activities
as described in the following. However, responses for many
Table 2 Mixed model analyses comparing the impact of different
group activities while controlling for cognitive function
Variable Group topic effect CPS effect
'Engagement' F
9, 1097
= 7.03*** F
1,100
= 87.35***
Active participation F
9, 1097
= 14.55*** F
1, 102
= 87.72***
Attitude F
9, 1108
= 11.50*** F
1, 104
= 63.07***
Positive mood F
9, 1100
= 9.16*** F
1,99
= 66.26***
Sleep F
9,1030
= 2.24* F
1,105
= 48.187***
CPS Cognitive Performance Scale
*p0.05, ***p0.001
Table 3 Significant comparisons found as compared to holiday discussions (reference group)
Variable Exercise Games Poetry Baking Choral Storytelling Brain games
'Engagement' 0.44;
t
1100
= 3.83***
0.35;
t
1098
= 3.18**
0.34;
t
1094
=2.92**
Active participation 0.30;
t
1099
= 2.94**
0.74;
t
1101
= 7.29***
0.23;
t
1099
= 2.17*
0.35;
t
1099
= 3.56***
0.22;
t
1095
=2.20*
Attitude 0.38;
t
1113
= 3.96***
0.27;
t
1109
=2.82**
0.45;
t
1109
= 4.79***
0.27;
t
1104
=2.78**
Positive mood 0.44;
t
1104
= 4.26***
0.27;
t
1100
=2.63**
0.30;
t
1101
= 2.81**
0.38;
t
1101
= 3.70***
0.25;
t
1101
= 2.46*
Asleep 0.29;
t
1035
=2.17**
0.31;
t
1031
=2.26*
Cells include effect size and related tstatistic and pvalue
*p0.05, **p0.01, ***p0.001
Fig. 1 Mean impact on different outcomes, after controlling for
cognitive function. Note: different outcome variables are not
comparable, as they involve different scales. Engagement scale,
0 = none of the time to 5 = most or all of the time; active participation,
0 = not at all to 4 = very much; attitude, 1 = very negative to 7 = very
positive; positive mood, 0 = not at all to 4 = very much; sleep scale,
0 = none of the time to 6 = all of the time
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of the group activities in our study did not seem to signifi-
cantly differ from each other, thus also providing partial
agreement with those same studies.
This comparison to previous studies points to a major
strength of this article, in that it uses both a large variety
of activities and multiple outcome measures, which helps
explain some of the negative or inconclusive findings. The
results here clearly show that different activities affect dif-
ferent outcome measures, which supports the use of mul-
tiple outcome measures and the view of engagement as
multidimensional, as specified in the GOME [2].
The most successful group activities were games and
choral singing, whereas the least successful were story-
telling and poetry, with other topics being in between or
having a greater impact on a specific outcome, such as
exercise impacting active participation. This may be
partially due to the observable nature of active participa-
tion in exercise, which is likely greater than in poetry or
reading. There are, however, several caveats that need to
be taken into account in interpreting these findings. The
group activities were conducted on the basis of a pre-
prepared protocol and materials organized in a box, later
labeled activity in a box[14]. For example, for the
reading activity, booklets with short stories were
prepared with large print and high contrast, as well as
fail-free questions for the TR staff to use with the stories;
for holiday discussions, pictures, CDs, texts, and ques-
tions were prepared. The level of success of a group is a
function of both the specific stimulus presented, such as
songs in the choral group, as well as the particular
choice of exemplars used in the activity, such as old
familiar popular songs. For the less successful contents,
it is possible that the particular activity was too difficult
or inappropriate for the population, but it is also
possible that the specifics were not sufficiently devel-
oped. For example, holiday discussion was prepared for
several holidays, but, given the randomized order of the
group content, groups were sometimes conducted with
this topic at a calendar time that did not correspond
with any of these holidays. This was a barrier to the
groups success for some of the participants, and poten-
tially also for the TR staff. Such a barrier can potentially
be addressed by preparing the activity for all holidays
practiced in that part of the world. Similarly, the relative
failure of the poetry activity could be related to the
particular poems used rather than to the use of poetry
for a discussion group.
Another issue encountered relates to positive mood
as an outcome and criterion for success. Sometimes,
participants wished to discuss negative experiences. For
example, one participant always brought up her experi-
ences from the holocaust during a discussion about life
events. She would usually get upset by the memory, as
did some other group members, and yet she clearly
wanted to discuss those experiences. Should this be
counted as a negative outcome for the group activity?
This article focuses on the impact of group activities
and the differences among different contents of group
activities, showing that group activities are beneficial
and that there are statistically significant differences
among different contents of group activities in terms of
their impact. Yet the results show a much greater impact
of participantslevels of cognitive functioning than of
group content on the impact of groups. Indeed, many of
the comparisons among groups were not statistically
different. Thus, despite significant differences among the
groups, the presentation of group activities may be more
crucial than the specific content.
An inherent limitation to this kind of study is the use
of unblinded raters. We countered this to some extent
by using two types of raters: the TR staff who delivered
the intervention as well as research observers who rated
participantsresponses independently. Correlations between
Fig. 2 Impact of group by participantscognitive function
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those raters were high [2], and analyses concerning the
general impact of the group on engagement and mood
were statistically significant for both, yet the effect sizes
obtained by TR ratings were higher than those for
observers (Table 1). This can be explained in two ways.
First, TR staff are experienced with this population and
may be better attuned to nuances in participants' reactions
and behaviors. Alternately, it is possible that they are biased
in wanting to see positive outcomes from their work.
Both of these factors could have contributed to the results.
However, there is no a priori reason to assume that staff
members would be biased toward one activity or another.
Both the strengths and the limitations of the study are
based on this being a clinical field study. It used one
large facility in one location and its TR staff members to
conduct the groups. Although TR staff ratings could be
biased by their wish to see positive effects on their
groups, their results were highly concordant with those
of research observers [2].
Conclusions
Group activities form an important tool in providing
persons with dementia an adequate quality of life and as
a nonpharmacological intervention to prevent behavior
problems in this population. These benefits are based on
activities diminishing boredom and loneliness in this
population. This article provides the first comprehensive
evidence that such groups can significantly impact
engagement and moodas compared to unstructured
time. The article also shows that group content does
matter, in that different contents may result in signifi-
cantly different outcomes, although it appears that good
use of quality groups may be more important than their
content, as many group contents did not differ signifi-
cantly from each other. As such, the findings provide
basic building blocks for forming the science of group
activities for persons with dementia. In addition, the
process presented in this article of immediate assessment
of the impact of group activities provides a timely
feedback for detecting failures in protocols or materials or
in mismatch between those who participate in the groups
and the content of the activities presented. This provides
information allowing for continuous improvement in the
content of activities. This study demonstrated that this
content makes a difference, thus indicating the import-
ance of using such improvement mechanisms in the
selection and design of activities.
Abbreviations
CPS: Cognitive Performance Scale; df: Degrees of Freedom; MDS: Minimum
Data Set; REB: Research Ethics Board; SD: Standard deviation; TR: Therapeutic
recreation
Acknowledgements
This work was made possible by the generous support of the Rotman Family
and the Morris Justein Visiting Scholars Program and by the Minerva Foundation.
Funding
Support from the Rotman Family and the Morris Justein Visiting Scholars
Program and from the Minerva Stiftung.
Availability of data and materials
The datasets used and/or analyzed during the current study are available
from the corresponding author on reasonable request.
Author contribution
The author read and approved the final manuscript.
Ethics approval and consent to participate
This study was approved by the Research Ethics Board (REB) of Baycrest
Health Sciences.
Consent for publication
Not applicable.
Competing interests
The author declares that she has no competing interests.
PublishersNote
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
Minerva Center for the Interdisciplinary Study of End of Life, Tel-Aviv
University, P.O.B. 39040, Ramat Aviv, 6139001 Tel-Aviv, Israel.
2
Department of
Health Promotion, School of Public Health, Sackler Faculty of Medicine,
Tel-Aviv University, P.O.B. 39040, Ramat Aviv, 6139001 Tel-Aviv, Israel.
3
The
Herczeg Institute on Aging, Tel-Aviv University, P.O.B. 39040, Ramat Aviv,
6139001 Tel-Aviv, Israel.
Received: 20 November 2017 Accepted: 7 February 2018
References
1. Cohen-Mansfield J, Marx MS, Werner P. Observational data on time use and
behavior problems in the nursing home. J Appl Gerontol. 1992;11(1):11121.
2. Cohen-Mansfield J, Hai T, Comishen M. Group engagement in persons
with dementia: the concept and its measurement. Psychiatry Res.
2017;251:23743.
3. Kovach CR, Henschel H. Planning activities for patients with dementia: a
descriptive study of therapeutic activities on special care units. J Gerontol Nurs.
1996;22(9):338.
4. Buettner LL, Fitzsimmons S. Activity calendars for older adults with dementia:
what you see is not what you get. Am J Alzheimers Dis Other Demen.
2003;18(4):21526.
5. Brooker DJ, Wellbeing DL. activity in dementia: a comparison of group
reminiscence therapy, structured goal-directed group activity and
unstructured time. Aging Ment Health. 2000;4(4):3548.
6. Phillips LJ, Reid-Arndt SA, Pak Y. Effects of a creative expression intervention
on emotions, communication, and quality of life in persons with dementia.
Nurs Res. 2010;59(6):41725.
7. Cooke M, et al. A randomized controlled trial exploring the effect of music
on quality of life and depression in older people with dementia. J Health
Psychol. 2010;15(5):76576.
8. Vink AC, et al. The effect of music therapy compared with general
recreational activities in reducing agitation in people with dementia: a
randomised controlled trial. Int J Geriatr Psychiatry. 2013;28(10):10318.
9. Rusted J, Sheppard L, Waller DA. multi-centre randomized control group
trial on the use of art therapy for older people with dementia. Group
Analysis. 2006;39(4):51736.
10. Morris JN, et al. MDS cognitive performance scale©. J Gerontol.
1994;49(4):M17482.
Cohen-Mansfield Alzheimer's Research & Therapy (2018) 10:37 Page 7 of 8
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
11. Hawes C, et al. Reliability estimates for the Minimum Data Set for nursing
home resident assessment and care screening (MDS). The Gerontologist.
1995;35(2):1728.
12. Hutchinson AM, et al. The Resident Assessment Instrument-Minimum Dad
Set 2.0 quality indicators: a systematic review. BMC Health Serv Res.
2010;10(166):114.
13. Morris JN, Fries BE, Morris SA. Scaling ADLs within the MDS. J Gerontol A.
1999;54(11):M54653.
14. Cohen-Mansfield J, et al. Activity-in-a-box for engaging persons with
dementia in groups: implications for therapeutic recreation practice.
Am J Recreat Ther. 2016;15(3):818.
15. Cohen-Mansfield J, Dakheel-Ali M, Marx MS. Engagement in persons with
dementia: the concept and its measurement. Am J Geriatr Psychiatry.
2009;17(4):299307.
16. Cohen-Mansfield J. Activity groups for persons with dementia: personal
predictors of participation, engagement and mood. Psychiatry Res.
2017;257:37580.
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... Such activities can ameliorate loneliness, and motivate participants to use their retained skills and abilities. These activities may also reduce behavioral challenges in this population (Cohen-Mansfield et al., 2010), enhance wellbeing, and slow decline (Cohen-Mansfield, 2018;DeVries et al., 2019). ...
... The GOME has been used to examine the relative impact of background characteristics of activity group participants on their response to diverse types of group activities (Cohen-Mansfield, 2017), the impact of environmental variables on their response (Cohen-Mansfield, 2020), and the impact of group activity content on their response (Cohen-Mansfield, 2018). In this article, we report further validation of the GOME within a more heterogeneous sample in Israel, rather than Canada, and examine whether the GOME's individual outcome measures can be combined into one index. ...
... The GOME enables study of impact of group activities according to the lived experience of persons with dementia. Such group activities may improve the wellbeing of this population (Cohen-Mansfield, 2018;, address the social needs of participants (Cohen-Mansfield et al., 2015), and can also decrease challenging behaviors (Cohen-Mansfield et al., 2010). The GOME enables the study of parameters affecting the impact of group processes for persons with dementia, and the comparison of methods to optimize their impact. ...
Article
Full-text available
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.
... CST sessions are designed to stimulate, support the use of cognitive abilities, engage people living with dementia, and provides an opportunity to socialise with peers (Spector et al., 2003). The use of group activities for people living with dementia has been shown to have a positive impact on levels of engagement and mood across a range of cognitive functions (Cohen-Mansfield, 2018). ...
... Outcome measures of CST in relation to cognitive ability, length of admission, changes in behaviours that challenge, quality of life, long term effects, mood, day-to-day functions, and content of the sessions (Cohen-Mansfield, 2018;Chen, 2022;Woods et al, 2023) were not assessed in this evaluation due to time constraints and lack of resources. This paper was based upon client feedback and experience alone. ...
Article
Cognitive Stimulation Therapy (CST) aims to stimulate and support cognitive abilities, as well as engage people living with dementia in a fun and inclusive activity. CST also has a growing evidence base in improving cognitive functioning and quality of life for people living with dementia. A CST group was set up on a dementia inpatient ward to explore if the benefits in previous research could be replicated in an inpatient setting. The CST group ran once a week for approximately one hour which was facilitated by the ward assistant psychologist and activity facilitator. The evaluation of the group indicates services users found the sessions to be inclusive, thought provoking, cognitively stimulating and enjoyable.
... Although dissatisfaction with food and activities are common complaints among NH residents (Simmons et al., 2009), the lack of culturally relevant activities and food (such as properly cooked rice or foods seasoned with familiar spices), may contribute to even worse experiences for BI-POC immigrant NH residents. Similarly, because meaningful activities in the NH can be beneficial to residents QOL (Cohen-Mansfield, 2018;Davila et al., 2022), the inability to participate in group activities due to language barriers may disadvantage residents with LEP. Despite literature on language barriers impacting health care, few studies have examined care for residents with LEP in NHs. ...
Article
Racial disparities in nursing home (NH) quality of life (QOL) are well established, yet, little is understood about actual experiences shaping QOL for Black, indigenous, and people of color (BIPOC) residents in NHs. This gap extends to BIPOC residents with limited English proficiency (LEP). Drawing on Kane’s (2001) and Zubristky’s (2013) QOL frameworks, this case study examined QOL experiences for Hmong NH residents, an ethnic and refugee group from Southeast Asia, in a NH with a high proportion of BIPOC residents. Methods include four months of observation, interviews with eight Hmong residents and five NH staff, and one community focus group. Thematic analysis revealed significant challenges in QOL. Exacerbated by language barriers and racism, many residents reported neglect, limited relationships, lack of meaningful activities, and dissatisfaction with food. These experiences fostered a sense of resignation and diminished QOL among Hmong residents, highlighting the need for additional supports for this group.
... It is possible that participants had more difficulty recognising or remembering each other on screen, or forming relationships, due to the lack of physical contact. Meeting the need for social engagement can improve symptoms of distress in dementia (Cohen-Mansfield, 2018), suggesting that engagement is a relevant factor to consider for improving outcomes. ...
Article
Full-text available
Background and Objectives Cognitive Stimulation Therapy (CST) is an evidence-based group intervention for people with dementia , with benefits for cognition and quality of life when delivered face-to-face. Many people are unable to attend face-to-face groups for reasons including health and transport issues. This study aimed to assess the feasibility and acceptability of online or ‘virtual’ CST (vCST). Research Design and Methods Single-blind, randomised controlled feasibility design with qualitative interviews. 46 people with mild to moderate dementia were randomly allocated to attend either 14 sessions of twice-weekly vCST (n = 24) or treatment as usual (TAU, defined as usual care; n = 22) over seven weeks. Cognition, quality of life and depression were assessed pre and post-treatment. Qualitative interviews (n=16) with participants and carers were analysed using thematic analysis. Results High levels of attendance, adherence, fidelity to the manual and completion of outcomes were recorded. Recruitment appeared feasible although randomisation may not have been acceptable to some. There were no statistical differences noted between vCST and TAU in any of the outcomes evaluated, although both quantitative and qualitative data indicated acceptability, with qualitative reports of improved outcomes including cognition. Discussion and Implications vCST appeared feasible to deliver but did not result in any changes in outcomes, as expected from an underpowered feasibility trial. CST is the main psychosocial intervention delivered for dementia in UK memory services and globally; with many services moving towards virtual CST delivery. Therefore, a fully powered RCT of the effectiveness of vCST is feasible and justified.
Chapter
A recent study [1], which involved interviews with an array of nursing home staff, from CEOs to nursing aids at five Israeli nursing homes, revealed a common complaint: residents’ aggressive behavior. Routine practice in morning care involved nursing aids waking residents starting at 5:30 am in order to shower, dress, and seat them in the dining room by 8:00 am. The staff noted aggression by residents during early morning care, but they did not recognize the association between the residents’ aggressiveness and the staff’s morning care practices. This is, but one example of insufficiently informed care practices and systems that lead to the very problem that all agree needs to be remedied. This chapter (1) summarizes the behavioral challenges of persons with dementia, (2) describes the main conceptual and practical ways to address them without resorting to pharmacological means, and (3) discusses systemic and structural changes needed to improve care-recipients’ and caregivers’ well-being.
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This narrative explores the impact of deinstitutionalization policies on the quality of life and care outcomes for individuals with Alzheimer’s disease and related dementias. We offer a historical perspective on these policies, their implications on dementia care, and the barriers to deinstitutionalization. The potential benefits of deinstitutionalization, such as improved quality of life and access to community-based support and services, are highlighted. Challenges and controversies surrounding safety, caregiver burden, and resource allocation are also examined. Ethical considerations related to the autonomy and decision-making capacity of people living with dementia are discussed. We present best practices and innovative models in dementia care that balance deinstitutionalization with appropriate care. We further put forth recommendations for future research and policy development in dementia care and deinstitutionalization, emphasizing the need for a balanced approach that respects the autonomy and preferences of people living with dementia while ensuring their safety and well-being.
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Objective This study aimed to compare the effects of music therapy with general recreational day activities in reducing agitation in people with dementia, residing in nursing home facilities.Methods In a randomised controlled design, residents with dementia (n = 94) were allocated to either music therapy or recreational activities. Both music therapy and general activities were offered twice weekly for 4 months. Changes in agitation were measured with a modified Cohen-Mansfield Agitation Inventory (CMAI) at four intervals on each intervention day. A mixed model analysis was used to evaluate the effectiveness of music therapy, compared with general activities, on CMAI scores at 4 h after the intervention, controlled for CMAI scores at 1 h before the session and session number.ResultsData were analysed for 77 residents (43 randomised to music therapy and 34 to general activities). In both groups, the intervention resulted in a decrease in agitated behaviours from 1 h before to 4 h after each session. This decrease was somewhat greater in the music therapy group than in the general activities group, but this difference was statistically not significant (F = 2.885, p = 0.090) and disappeared completely after adjustment for Global Deterioration Scale stage (F = 1.500; p = 0.222).Conclusions Both music therapy and recreational activities lead to a short-term decrease in agitation, but there was no additional beneficial effect of music therapy over general activities. More research is required to provide insight in the effects of music therapy in reducing agitation in demented older people.
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This randomized controlled trial investigated the effect of live music on quality of life and depression in 47 older people with dementia using the Dementia Quality of Life and Geriatric Depression Scale. The control/reading group reported higher mid-point feelings of belonging than the music group (F(1, 45) = 6.672, p < .05). Sub-analyses of >or= 50 per cent music session attendance found improvements in self-esteem over time (F(2, 46) = 4.471, p < .05). Participants with scores that were suggestive of increased depressive symptoms had fewer depressive symptoms over time (F(2, 22) = 8.129, p < .01). Findings suggest music and reading activities can improve self-esteem, belonging and depression in some older people with dementia.
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The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 is designed to collect the minimum amount of data to guide care planning and monitoring for residents in long-term care settings. These data have been used to compute indicators of care quality. Use of the quality indicators to inform quality improvement initiatives is contingent upon the validity and reliability of the indicators. The purpose of this review was to systematically examine published and grey research reports in order to assess the state of the science regarding the validity and reliability of the RAI-MDS 2.0 Quality Indicators (QIs). We systematically reviewed the evidence for the validity and reliability of the RAI-MDS 2.0 QIs. A comprehensive literature search identified relevant original research published, in English, prior to December 2008. Fourteen articles and one report examining the validity and/or reliability of the RAI-MDS 2.0 QIs were included. The studies fell into two broad categories, those that examined individual quality indicators and those that examined multiple indicators. All studies were conducted in the United States and included from one to a total of 209 facilities. The number of residents included in the studies ranged from 109 to 5758. One study conducted under research conditions examined 38 chronic care QIs, of which strong evidence for the validity of 12 of the QIs was found. In response to these findings, the 12 QIs were recommended for public reporting purposes. However, a number of observational studies (n = 13), conducted in "real world" conditions, have tested the validity and/or reliability of individual QIs, with mixed results. Ten QIs have been studied in this manner, including falls, depression, depression without treatment, urinary incontinence, urinary tract infections, weight loss, bedfast, restraint, pressure ulcer, and pain. These studies have revealed the potential for systematic bias in reporting, with under-reporting of some indicators and over-reporting of others. Evidence for the reliability and validity of the RAI-MDS QIs remains inconclusive. The QIs provide a useful tool for quality monitoring and to inform quality improvement programs and initiatives. However, caution should be exercised when interpreting the QI results and other sources of evidence of the quality of care processes should be considered in conjunction with QI results.
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The principal aim of this study is to evaluate the immediate and long-term effects of art therapy for older people with dementia, specifically to test the premise that participation in art therapy groups effects significant positive changes in mood and cognition both immediately within sessions and later outside the sessions to impact behaviour in the day care/residential care setting. The broader aim is to provide an evidence-based evaluation about the use of art therapy for older people with dementia. In order to isolate the impact of art therapy we compared art therapy groups with activity groups that do not have emotional expression as a central purpose.
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Although a few papers documented benefits of group therapeutic activities for individuals with dementia, there is a dearth of studies that have investigated the effects of group activities on persons with dementia. This paper introduces a theoretical framework of studying group therapeutic recreational activity, the Comprehensive Process Model of Group Engagement, and an assessment tool, the Group Observational Measurement of Engagement (GOME). We also report the psychometric properties of this assessment. One hundred and four persons with dementia took part in ten different group activities, with each activity conducted twice at random order so that 20 activities were observed for each group of participants. Following each group activity, research and therapeutic recreation staff members used the GOME assessment to independently rate participants on individual-level measures of attendance duration and engagement, and group level measures (e.g., positive and negative interactions among group members). Reliability and validity analyses comparing observer ratings for each group activity on the individual-level measures of attendance and engagement showed good psychometric properties. Different measures collected on a group level differed with respect to their psychometric quality. We present a theoretical framework to understand group engagement and present measures that could be used in future research and practice.
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A within-subjects design was utilized to compare levels of wellbeing demonstrated by 25 individuals with mild to moderate dementia during three types of activity. The first was simple group reminiscence therapy (RT), using objects and photographs; the second was group activities (GA), involving simple goal directed crafts or games; and the third was unstructured time (UT), during which participants were left to their own devices with little staff interaction. These activities were all part of the usual programme of activities within three day hospitals where the study took place. Dementia Care Mapping was used to measure relative levels of wellbeing or illbeing during these three conditions. The results indicated that individuals experienced a greater level of relative wellbeing during RT than GA. The level of wellbeing in both RT and GA was significantly higher than in UT.
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Dependency in activities of daily living (ADLs) is a reality within nursing homes, and we describe ADL measurement strategies based on items in the Minimum Data Set (MDS) and the creation and distributional properties of three ADL self-performance scales and their relationship to other measures. Information drawn from four data sets for a multistep analysis was guided by four study objectives: (1) to identify the subcomponents of ADLs that are present in the MDS battery; (2) to demonstrate how these items could be aggregated within hierarchical and additive ADL summary scales; (3) to describe the baseline and longitudinal distributional properties of these scales in a large, seven-state MDS database; and (4) to evaluate how these scales relate to two external criteria. Prevalence and factor structure findings for seven MDS ADL self-performance variables suggest that these items can be placed into early, middle, and late loss ADL components. Two types of summary ADL self-performance measures were created: additive and hierarchical. Distributional properties of these scales are described, as is their relationship to two external ADL criteria that have been reported in prior studies: first as an independent variable predicting staff time involved in resident care; second as a dependent variable in a study of the efficacy of two programs to improve resident functioning. The new ADL summary scales, based on readily available MDS data, should prove useful to clinicians, program auditors, and researchers who use the MDS functional self-performance items to determine a resident's ADL status.
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Effective nonpharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia. The purpose of this study was to test the effect of a storytelling program, TimeSlips, on communication, neuropsychiatric symptoms, and quality of life in long-term care residents with dementia. A quasi-experimental, two-group, repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly, 6-week TimeSlips intervention group (n = 28) or usual care group (n = 28) at baseline and postintervention at Weeks 7 and 10. Outcome measures included the Cornell Scale for Depression in Dementia, the Neuropsychiatric Inventory-Nursing Home Version, the Functional Assessment of Communication Skills, the Quality of Life-Alzheimer's Disease, and the Observed Emotion Rating Scale (this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group). Compared with the control group, the treatment group exhibited significantly higher pleasure at Week 3 (p < .001), Week 6 (p < .001), and Week 7 (p < .05). Small to moderate treatment effects were found for Week 7 social communication (d = .49) and basic needs communication (d = .43). A larger effect was found for pleasure at Week 7 (d = .58). As expected, given the engaging nature of the TimeSlips creative storytelling intervention, analyses revealed increased positive affect during and at 1 week postintervention. In addition, perhaps associated with the intervention's reliance on positive social interactions and verbal communication, participants evidenced improved communication skills. However, more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes.