ArticleLiterature Review

Enjoyable, engaging and individualised: A concept analysis of meaningful activity for older adults with dementia

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Aim: The term "meaningful activity" is widely used in policy, practice and the research literature. However, definition and use of the term is unclear and inconsistent. A concept analysis was conducted to explore the fundamental attributes that make an activity meaningful for older adults with dementia and propose a conceptual model for understanding "meaningful activity" in this population. Methods: This study followed Walker and Avant's method of concept analysis. Searches were conducted in the Scopus, MEDLINE, CINAHL, PubMed, Academic Search Elite and Web of Science databases for literature using the term "meaningful activity." Papers published before 1996 were excluded. Results: Twenty-nine papers concerned with "meaningful activity" were analysed. This analysis identified five attributes that make activities meaningful for people with dementia: (a) enjoyable; (b) suited to the individual's skills, abilities and preferences; (c) related to personally relevant goals; (d) engaging; and (e) related to an aspect of identity. The conceptual model illustrates how individual and opportunity factors influence participation in "meaningful activity" and the consequences of this participation as discussed in the existing literature. Conclusion: The findings of this concept analysis provide insight into what characteristics make an activity meaningful. Specific activities that are meaningful are different for each person and participation in personally 'meaningful activities' has the potential to positively impact the lives of people with dementia. Implications for practice: This understanding of 'meaningful activity' can be used by those involved in research, planning or delivery of services and care for people with dementia to encourage and support participation in activities that are meaningful to individuals.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... Roberts and Bannigan (2018) conducted a meta-analysis and found that fulfilment, identity, restoration, social, cultural, and intergenerational connection were common dimensions of personal meaning. A more recent concept analysis of meaningful activities identified five attributes of meaningfulness: (a) enjoyable; (b) suited to the individual's skills, abilities and preferences; (c) related to personally relevant goals; (d) engaging; and (e) related to an aspect of identity (Tierney and Beattie, 2020). This study included research of adults in general and elderly with dementia and translated these attributes to people with dementia since research has shown that attributes of meaning in adults have a striking resemblance to findings of people with dementia (Phinney et al., 2007). ...
... To decide whenever a study activity was meaningful for the participant, a framework was used with attributes of meaning. After a comprehensive literature search, the authors agreed on using the concept-analysis of Tierney and Beattie (2020) which includes five attributes to make an activity meaningful. We chose these attributes because they are intuitive, clear, and can be efficiently applicate in the articles without asking the participants. ...
... Thematic analysis to define the level of meaningfulness in the studied activities Thematic analysis discussed the degree of meaningfulness for the participant in the study activity. Based on the attributes of Tierney and Beattie (2020), the studies were grouped together. ...
Article
Full-text available
Introduction Engaging in meaningful activities contributes to health and wellbeing. Research identifies meaningfulness by analysing retrospective and subjective data such as personal experiences in activities. Objectively measuring meaningful activities by registering the brain (fNIRS, EEG, PET, fMRI) remains poorly investigated. Methods A systematic review using PubMed, Web of Science, CINAHL, and Cochrane Library. Findings Thirty-one studies investigating the correlations between daily activities in adults, their degree of meaningfulness for the participant, and the brain areas involved, were identified. The activities could be classified according to the degree of meaningfulness, using the attributes of meaningfulness described in the literature. Eleven study activities contained all attributes, which means that these can be assumed to be meaningful for the participant. Brain areas involved in these activities were generally related to emotional and affective processing, motivation, and reward. Conclusion Although it is demonstrated that neural correlates of meaningful activities can be measured objectively by neurophysiological registration techniques, “meaning” as such has not yet been investigated explicitly. Further neurophysiological research for objective monitoring of meaningful activities is recommended.
... Meaningful activities contribute to an older adult's sense of identity. 24 When autonomy is expressed in the form of engagement in meaningful activities, there is a positive impact on one's psychosocial and physical well-being. 24,25 People's interests, needs, identity, and, inevitably, their autonomy are shaped by their relation to others. ...
... 24 When autonomy is expressed in the form of engagement in meaningful activities, there is a positive impact on one's psychosocial and physical well-being. 24,25 People's interests, needs, identity, and, inevitably, their autonomy are shaped by their relation to others. 26 It is within these relationships and social conditions that one's autonomy emerges. ...
Article
Full-text available
The global pandemic expedited the adoption of AgeTech solutions that aim to help older adults maintain their autonomy and independence. This article examines the negative impact of the Western worldview of autonomy and independence on older adults. Negative impact can manifest as ageism and may be compounded by intersections of identities with race, gender, and culture. We propose an inclusive framework for health leaders, one that is not binary or categorical, but instead, on a continuum: (1) relational autonomy which assumes that relationships form one’s identity; therefore, no one is autonomous to the exclusion of others, and (2) interdependence which proposes that one’s lifestyle choice is supported by interreliance with aspects of one’s environment. We examine two examples of AgeTech from the perspective of relational autonomy and interdependence and discuss how health leaders can use this inclusive framework to ensure that their services do not discriminate against older adults.
... The definition and use of the term meaningful activity are unclear and inconsistent [18] and are interpreted differently across disciplines such as psychology, nursing, and occupational science. However, significant progress has been made in understanding the attributes that make activities meaningful for people living with dementia. ...
Article
Full-text available
Background Everyday life in residential long-term care is widely portrayed as boring. However, empirical evidence on this topic remains limited, particularly for the vulnerable group of people living with dementia. A better understanding of everyday life and the associated experiences of boredom could facilitate the development of practical strategies to reduce boredom in this target group. The aim of this study is therefore to analyse everyday activities, daily routines and the frequency and types of boredom in people living with dementia in residential long-term care. Data and methods In five long-term care facilities, participants were observed for two days in 20-minute time slots (from 7 am to 7 pm) using the Maastricht Electronic Daily Live Observation Tool. Semi-structured interviews were conducted with people living with dementia about their daily routines and experiences of boredom. Qualitative content analysis based on Mayring was applied, using the five boredom types from Goetz et al. as deductive categories. Observational data was analysed descriptively and merged with qualitative data on daily routines. In all, 46 people living with dementia (average age: 84.65 ± 7.15 years, 89.13% female, average DSS: 6.50 ± 3.15) were observed at 2760 time points. Of these, 17 participants took part in the interviews. Results The residents spend 47.5% of their day doing nothing and follow a routine that is strongly determined by communal meals. 62.5% of participants are bored, with 18.5% describing boredom as a constant/prevalent condition in their everyday lives. All five types of boredom are reflected in the interviews, with apathetic boredom being the most common. Conclusions Although people living with dementia follow almost the same daily routine in residential long-term care, they experience everyday life very differently, ranging from no boredom, to feelings of pleasant relaxation when bored to strongly negative feelings such as hopelessness and frustration. These findings suggest that interventions to prevent or reduce boredom need to be personalised in order to effectively combat the highly individual nature of boredom. Person-centred dementia care provides a valuable intervention strategy to meet this requirement. Clinical trial number Not applicable.
... Engagement in meaningful activities decreased agitation and other dementia-related behaviors (Tierney & Beattie, 2020). Adverse drug reactions are more common in PWD due to the vulnerable, impaired brain (Pendelton & Schultz-Krohn, 2018). ...
... The absence of meaningful activities and a lack of social interaction can lead to loneliness in older adults in nursing homes [1,2]. Meaningful activities are defined as those that hold personal significance or offer enjoyment to individuals, aligning with their present and past interests, routines, habits, and roles [3,4]. In the context of nursing homes, a meaningful activity could include household tasks like cooking, which older adults may no longer be able to do on their own. ...
Article
Full-text available
Background Virtual reality (VR) group activities can act as interventions against inactivity and lack of meaningful activities in nursing homes. The acceptance of VR among older adults has been explored from different perspectives. However, research on the impact of older adults’ individual characteristics on the acceptance of VR group activities in nursing homes is necessary. Objective This study investigates the impact of individual characteristics (eg, psychosocial capacities) on VR acceptance among older adults in nursing homes, as well as this group’s perceptions of VR after participating in a VR intervention. Methods In this pre-post study conducted in nursing homes, we applied a VR group intervention with 113 older adult participants. These participants were categorized into two groups based on their naturalistic choice to join the intervention: a higher VR acceptance group (n=90) and a lower VR acceptance group (n=23). We compared the two groups with respect to their sociodemographic characteristics, psychosocial capacities, and attitudes toward new technologies. Additionally, we examined the participants’ perceptions of VR. Results The results show that those with lower acceptance of VR initially reported higher capacities in organizing daily activities and stronger interpersonal relationships compared to older adults with higher VR acceptance. The VR group activity might hold limited significance for the latter group, but it offers the chance to activate older adults with lower proactivity. Openness to new technology was associated with a favorable perception of VR. After the VR intervention, the acceptance of VR remained high. Conclusions This study investigates the acceptance of VR group events as meaningful activities for older adults in nursing homes under naturalistic conditions. The results indicate that the VR group intervention effectively addressed low proactivity and interpersonal relationship issues among older adults in nursing homes. Older adults should be encouraged to experience VR if the opportunity to participate is offered, potentially facilitated by caregivers or trusted individuals.
... Meaningful activities are defined as "physical, social, and leisure activities tailored to the needs and preferences of the individual" [6]. Further conceptual analysis of meaningful activities reveals five attributes: a) enjoyable, b) appropriate for personal skills, abilities, and preferences, c) relevant to personally relevant goals, d) engaging, and e) related to aspects of identity [7]. Thus, meaningful activities are interpreted as activities that reflect the subjective viewpoint of "for the individual" [8]. ...
Article
Full-text available
Purpose The purpose of the study was to investigate the effects of satisfaction with meaningful activities and their performance on the memory function among community-dwelling older adults 3 years later. Methods A longitudinal analysis was conducted on 288 community-dwelling older adults aged 65 years and more who had completed the survey in 2019 and 2022 as participants in the Tarumizu Study. Meaningful activities were assessed in 2019 using the Aid for Decision-Making in Occupation Choice for activities. Satisfaction with and performance of meaningful activities were assessed, and the bottom 25% were classified into two groups: low satisfaction and low performance. Memory function was assessed using the National Center for Geriatrics and Gerontology-Functional Assessment Tool in 2019 and 2022. Changes in memory function over 3 years were analyzed by satisfaction and performance of meaningful activities. Results Two-way analysis of variance with group (satisfaction with and performance of meaningful activities) and time (2019 and 2022) as factors showed no statistically significant group-time interaction for memory in the satisfaction with meaningful activities group ( F = 1.4, p = 0.24). Meanwhile, a statistically significant group-time interaction was observed for memory in the meaningful activity performance group, indicating that high performance of meaningful activities may play a protective role against memory decline ( F = 7.4, p = 0.007). Conclusion Higher performance of meaningful activities may protect against age-related changes in memory. A careful assessment of meaningful activities, and engagement that enhances performance may be useful in designing health support against memory decline.
... It is necessary that they are tailored to the current needs and preferences of the resident and to the nurse caring for that resident. In a concept analysis on meaningful activities, Tierney et al. con rmed that activities are only meaningful if they relate to an aspect of the person's identity and are individually targeted to the person's preferences, skills, abilities, and goals [50]. A review by Lee et al. on personcentered care for persons with dementia found immediate effects on challenging behaviors [51]. ...
Preprint
Full-text available
Background: People with dementia often receive care in dementia special care units of nursing homes. The concept of these units vary considerably. Knowledge about the effects and mechanisms of action of dementia special care units is limited. The aim of the study was to evaluate a specific care concept of a dementia special care unit in long-term care. In this paper, we present the results of the evaluation study in the form of a revised program theory. The aim was to describe the components of the care concept, its context as well as its mechanisms of impact and outcomes for persons with dementia and the nursing staff members. Methods: We conducted a theory-driven evaluation resulting in a revised program theory. The revision was based on an initial program theory and the findings of the outcome/process evaluation. The primarily data-driven revision is enriched by theory and further literature. Data analysis followed a two-step process: evaluation of the original program theory and construction of the revised program theory, consisting of an action and a change model. Results: The action model describes interventions, context, target groups and implementers. The change model details how the program generates outcomes. Structural, organizational and educational elements promote a shared person-centered understanding of care among nurses. A unified understanding of care favors engagement in meaningful activities and social interactions. It also supports early interventions addressing challenging behavior. Mutually reinforcing interventions create positive experiences and maintain the residents’ personhood. The success of the program is largely based on a workplace culture and a leadership style facilitating person-centered ways of working. Conclusion: The revised program theory highlights the positive effects of the dementia special care unit care concept on staff and residents. It provides starting points for future practice development. Considering the interdependence of interventions, increased promotion of meaningful activities and social interactions seem advisable. Future research should explore whether the mechanisms of action developed for a specific care concept are transferable to a broader program theory for specialized dementia care. Trial registration: DRKS00011513
... Activity which is individually tailored has been shown to be particularly effective (Sauer et al., 2016;Tierney & Beattie, 2020;Travers et al., 2015), and this is in line with the suggestion that what makes meaningful activities so important is the opportunity for personal meaning-making, value-seeking, and the expression of personal preference and choice that they provide (Chung et al., 2017;Strick et al., 2021). However, these idiosyncrasies can mean the evidence base is complicated, with a recent review concluding that the certainty of evidence is low and variable across outcomes including reducing challenging behaviour, and improving the QoL, affect and engagement of PLWD (Möhler et al., 2020). ...
Article
Full-text available
Supporting ageing in place, quality of life, and activity engagement are public health priorities for people with dementia. The importance of maintaining opportunities for meaningful activities has been widely acknowledged for those with dementia in long-term care, but little is known about what makes activities meaningful for, and how they are experienced by, people with different types of dementia in their own homes. This study used focussed ethnographic methods to explore the motivations and meanings of everyday activity engagement within the homes of 10 people with memory-led Alzheimer’s disease and 10 people with posterior cortical atrophy. While participants’ interactions with their everyday environments were challenged by their diagnoses, they were all finding ways to continue meaning-making via various activities. The main findings are encapsulated in three themes: (1) The fun and the function of activities; (2) Reciprocities of care, and (3) The constitution and continuity of (a changing) self. Ongoing engagement with both fun and functional activities offered participants living with different dementias opportunities to connect with others, to offer care and support (as well as receive it), and to maintain a sense of self and identity. Implications are discussed regarding the development and delivery of tailored interventions and support to enable continued engagement in meaningful activities for people with different types of dementia living in the community.
... For people living in residential aged care, including the large proportion living with dementia, there is a need for suitable interventions that offer opportunities for engagement in activities that are personally meaningful and promote cognitive stimulation, physical activity and social connection (D'Cunha et al., 2020;O'Rourke et al., 2018;Tierney & Beattie, 2020). An increase in social isolation and restrictions in physical activity may increase neuropsychiatric symptoms, feelings of loneliness, poorer quality of life and cognitive function for older people with dementia living at home but particularly for older people living in residential aged care (Curelaru et al., 2021;Lion et al., 2022). ...
Article
Full-text available
Intergenerational programs in residential aged care may improve well-being and combat loneliness and social isolation in older people with cognitive impairment. This pilot study investigated the effects of a semi-structured intergenerational group, including children from a co-located early learning centre and people living in residential aged care with cognitive impairment. This 9-week study used a mixed methods pre- and post-program design. Sessions were designed and delivered once per week by Occupational Therapists and took into account residents’ interests and children’s developmental needs and interests, identified in pre-program interviews. Nine older people with cognitive impairment and 13 children participated. The program was well attended despite disruptions and complications caused by COVID-19 and weather conditions. Older people valued the opportunity to engage with the children. Children were observed to gain confidence in communicating and forming friendships with older people with different levels of ability. There did not appear to be any change in loneliness or neuropsychiatric symptoms. The intergenerational program benefited participants and received strong support from family members and staff of the early learning centre and aged care home.
... These motivators sharpen the 'individual tailoring/personalized PA' [41] by suggesting that specific activities are suited for people with dementia, such as gardening, dog walking, mountaineering or duo-cycling [34]. Providing preferred activities related to everyday life can contribute to the sense of doing meaningful activities, which can increase the well-being and quality of life of people with dementia [76]. Furthermore, having a meaningful purpose for PA encourages people with dementia to participate in PA [38,56,63]. ...
Article
Full-text available
Physical activity (PA) has positive effects on the physical and cognitive functioning of people with dementia. Knowledge about what limits and stimulates people with dementia to participate in PA is essential to promote effective PA implementation and enhance PA levels. Previous reviews primarily included opinion-based studies, using data from interviews, focus groups or dyads. By including implementation studies, we aimed to elaborate on previous reviews by identifying new barriers to PA and new facilitators and motivators for PA. We conducted systematic searches in Pubmed, PsychInfo and Web of Science for studies published up to the 21st of September 2021. Search terms were related to the population of people with dementia, PA interventions and implementation outcomes. Studies were included if PA participation was investigated during actual PA implementation. No restrictions were made regarding study design, date of publication, PA type or outcome measures. Studies not implementing PA or not evaluating the implementation were excluded. Based on 13 empirical studies, we identified 35 barriers, 19 facilitators and 12 motivators. Of these, 21 barriers, 11 facilitators and 4 motivators were not identified by previous reviews. New factors are related to the support for people with dementia from informal and formal caregivers, e.g., revealing the importance of a trusting relationship. Furthermore, support for staff from the institution or an external party is needed to overcome doubts about PA, for example, related to safety and effects. New factors also suggested specific recommendations for the content and organization of the PA intervention, for instance, related to how to give instructions. Overall, factors affecting PA identified with opinion-based or implementation studies are complementary. Our extended overview shows the complexity of PA implementation and may help to personalize PA, develop implementation strategies, facilitate actual PA implementation and free up resources needed for effective implementation.
... Health is an important contributor to both older adults' emotional well-being and meaningful engagement (Tierney & Beattie, 2020). Even after controlling for health, the protective effect of between-person meaningful engagement was still significant. ...
Article
Full-text available
Background and Objectives Extremely hot temperature affects psychological well-being negatively, especially for older adults with lower socioeconomic status (SES). The objectives of this study are to examine: (a) the impact of hot instantaneous temperature on older adults’ emotional well-being and (b) whether meaningful engagement could reduce the above impact, particularly for those of lower SES. Research Design and Methods We conducted a quantitative time-sampling study during hot-weather months (May–September) in 2021 and 2022. The sample comprises 344 participants aged 60 years or older (Mage = 67.15, SDage = 5.26) living in urban areas of Hong Kong, where hot days (daily maximum temperature ≥33°C) accounted for 23% of the study days. Participants reported positive and negative affect, and engagement in meaningful activities, three times a day over a 10-day period, and wore sensors that tracked the instantaneous temperature of their immediate environment. Multilevel modeling was employed to examine the impacts on affect from temperature, SES, and meaningful activity engagement. Results Hotter instantaneous temperature predicted greater momentary negative affect and less positive affect immediately afterwards. Meaningful engagement significantly buffered against the affective impacts of hotter temperature, and this buffering effect was more salient among older adults of lower SES. Discussion and implications This study highlights the role of meaningful engagement in reducing the impact of hotter instantaneous temperature on older adults’ emotional well-being, particularly for those of lower SES. Meaningful activity engagement may be capitalized on, as a strategy, to reduce climate-related social inequality.
... Similar concepts include valued activity [46], leisure activity [36], individualized activity [86], and purposeful activity [61]. Activities are meaningful when they are enjoyable, suited to individual preferences, and related to personally relevant goals [83]. However, the perception of 'meaningfulness' in activity can vary across age and gender groups, and there are individual diferences even within small groups [37]. ...
... This includes daily living activities (e.g., dressing and eating) as well as leisure activities, such as reading, singing, gardening or arts and crafts [5]. According to Tierney and Beattie [6], there are five attributes that make an activity meaningful for a person: being enjoyable, suited to the individual's skills, abilities and preferences, related to personally relevant goals, engaging, and related to an aspect of identity. Dementia is a progressive condition that gradually challenges people's ability to perform activities due to cognitive and behavioural changes as well as the ability of family members and care partners to effectively support active engagement in leisure activities [7]. ...
Article
Full-text available
Many people are keen to be actively involved in social life and activities, but even at an early stage, dementia can have a negative impact on social participation and access to leisure activities. As part of the IDoService project, this study has investigated people’s needs and wishes, barriers and facilitators to identify opportunities for improving access to meaningful activities. Individual and focus group interviews were conducted with 5 people living with mild to moderate dementia, 2 familial and 2 professional care partners, as well as 12 people working in the field of dementia and/or community activities. Thematic analysis has highlighted the benefits of participating in meaningful activities, such as empowerment and pride, social contacts, and feeling useful to others. A number of barriers to participation relating to individual and environmental factors were reported. Even where participants praised dementia-friendly activities and facilities, they advocated activities inclusive for all and mentioned that some people might be reluctant to participate in dementia-labelled activities because they may not be suitable for their needs. These results indicate the need for developing tailored opportunities for people with mild to moderate dementia and provide valuable insights for researchers, service providers, policymakers and charities wanting to improve access.
... The literature suggests the examples of apps that are considered to provide meaningful activity for people with dementia; however, the utility of compiling a list of 'meaningful activities' is limited, as the meaning ascribed to specific activities and reasons for participating in them will vary between individuals. 69 It is, therefore, more useful to understand what makes an activity meaningful for the person. This will encourage a more person-centred approach to identifying 'meaningful activities' and supporting the involvement of people with dementia. ...
Article
Full-text available
Objective Researchers have used various theories and models to understand technology adoption, however, with the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing the adoption of digital health applications for people living with dementia and add to the current literature on this topic. Methods Searches were conducted in CINHAL, Web of Science, Psych Info, ProQuest Health and Medical, IEEE Xplore and Scopus. Citation searching and handsearching were used in the identification of other studies. Results Following an assessment of relevancy, nine studies remained and are included within this review. Methodological quality was assessed using The Mixed Methods Appraisal Tool (MMAT). A thematic analysis was used for the data synthesis of included studies. Each study reported on different types of apps. Conclusion From the synthesis of included studies, four analytic themes were identified; Theme 1: Personal and contextual factors; Theme 2: Perceived value and benefit; Theme 3: Design and content of app; and Theme 4: Digital Literacy and Confidence. People are diverse and so are their reasons for the adoption of apps. These findings provide an insight into the range of factors that impact the adoption of apps for people living with dementia. Understanding the factors that impact the adoption of mobile applications is critical to their success. These findings can be beneficial for app developers and for people living with dementia and their carers.
... Meaningful and pleasurable activities are those that provide emotional, creative, intellectual, and spiritual stimulation. These activities can include physical, social, and leisure activities that are tailored to individual needs and interests (8). Although engaging in meaningful activities is an important part of person-centered nursing practice (9); however, this need is often not given the attention it deserves (10). ...
Article
Full-text available
Objectives To translate 20-item Meaningful and Enjoyable Activities Scale into Chinese and evaluate its psychometric properties amongst Chinese with mild dementia. Methods A cross-sectional study of 450 people with mild dementia recruited from a memory disorders clinic was conducted with the C-MEAS. Raw data were randomly divided into two parts for exploratory factor analysis and confirmatory factor analysis, to evaluate the construct validity. Content validity and reliability were tested by content validity index and Cronbach’s α coefficients, respectively. Results Adaptation results showed that the Chinese version of the scale is adequate for linguistic and content validation. Confirmatory factor analysis indicated a significantly good fit for a three-factor model. Cronbach’s alpha coefficient was 0.84 for the overall scale. Conclusion The C-MEAS for people with mild dementia is a reliable and valid instrument with satisfactory psychometric properties. Future studies should recruit a more representative sample of people with mild dementia in China to verify the applicability of the scale.
... Therefore, individuals' impetus to maintain such activities may also be a form of coping related to selfmaintaining and self-adjusting responses, whereby the threat to self is managed (Clare, 2003). 'Meaningful activity' has been linked to both expressing and maintaining identity (Han et al., 2016;Tierney and Beattie, 2020), with Strick et al. (2021) linking 'meaningful occupation' in dementia to past as well as evolving identity. However, much previous research has focused on loss of or persistence of the self, particularly in relation to autobiographical memory rather than on adaptation and change (Caddell and Clare, 2010), when shifts in identity may be important to 'live well' with dementia (Wolverson et al., 2016). ...
Article
Full-text available
The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE (Identifying and Mitigating the Individual and Dyadic Impact of COVID-19 and Life Under Physical Distancing on People with Dementia and Carers) component of the IDEAL (Improving the Experience of Dementia and Enhancing Active Life) cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic within the context of the ‘post-vaccine’ period and the national lockdowns in England and Wales; and to determine perceived challenges to and facilitators of ‘living well’ during the COVID-19 pandemic and beyond as restrictions were eased. In addition, the study findings are considered in relation to understandings of identity in dementia which the broader accounts of living through the pandemic have highlighted. Seven people with mild-to-moderate dementia were interviewed and themes were derived using framework analysis. Themes suggest interviewees' stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world. Interviewees managed threats to social identity by striving to maintain social and emotional connections, where the importance of a shared, social identity, particularly for people with young-onset dementia, was also apparent. Unlike in previous studies during the pandemic, the relevance of occupation for identity was observed, where maintaining previous or new activities or occupations was important to facilitate identity as well as to keep a sense of purpose. Therefore, as well as supporting people with dementia as the pandemic eases, future research into occupation and identity in dementia is of potential value.
... We propose an analytical method derived from the psychological and linguistic understanding of communication that quantifies complex affective and behavioral outcomes of engagement. These outcomes of engagement may be used to assess the impact of a range of psychosocial interventions and meaningful activities (Tierney and Beattie, 2020) on people in residential care. The proposed multidimensional approach is important as it will be able to determine the impact of interventions on older adults where there are idiosyncratic characteristics of engagement. ...
Article
Full-text available
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.
... A great challenge for both formal and informal caregivers of people with dementia, however, is how to support people with dementia in maintaining a programme of meaningful activities and experiences on a daily basis. While a considerable number of studies have focussed on meaningful activities for people with dementia, a recurring problem in this literature is the lack of a precise definition or position of what meaningful activity entails, often generalizing the meaningfulness of certain activities across the entire population of people with dementia [155,156]. However, what constitutes meaningful activity will differ between individuals. ...
Chapter
Dementia is increasingly being recognised as a public health priority and poses one of the largest challenges we face as a society. At the same time, there is a growing awareness that the quest for a cure for Alzheimer's disease and other causes of dementia needs to be complemented by efforts to improve the lives of people with dementia. To gain a better understanding of dementia and of how to organize dementia care, there is a need to bring together insights from many different disciplines. Filling this knowledge gap, this book provides an integrated view on dementia resulting from extensive discussions between world experts from different fields, including medicine, social psychology, nursing, economics and literary studies. Working towards a development of integrative policies focused on social inclusion and quality of life, Dementia and Society reminds the reader that a better future for persons with dementia is a collective responsibility.
... Meaningful activity encompasses experiences that are enjoyable, engaging, responsive to individuals' abilities, needs and preferences, and express and reinforce identity (Tierney & Beattie, 2020). Music, reminiscence, family and social activities that are meaningful for people with dementia living in residential-aged care (RAC; herein residents) (Harmer & Orrell, 2008), add to growing support for inclusion of music and music interventions to promote person-centred care McDermott et al., 2013). ...
Article
Background Despite growing support for the benefits of music interventions in dementia care, the perspectives of people with dementia, their families and carers are often missing from the research. This study explored multiple perspectives and first-person experiences of group music interventions delivered within a large cluster randomised controlled trial examining the effectiveness of group music therapy (GMT) and recreational choir singing (RCS) with people with dementia living in residential-aged care (RAC) settings. Methods Focus group and individual interviews with residents with dementia (n = 4), family members (n = 5) and care home staff (n = 15) were conducted following completion of the 6-month GMT and/or RCS intervention and analysed using inductive thematic analysis. Findings Three main themes were identified as follows: (1) direct and indirect intrapersonal benefits, (2) direct and indirect interpersonal benefits and (3) therapeutic music interventions versus entertainment. GMT and RCS supported residents' mood, enjoyment, engagement and connectedness to self and others within and post-sessions, with flow-on effects to family members, care staff and the care home environment. Participants differentiated GMT and RCS from other forms of music engagement in the RAC facilities and described feelings of post-programme loss, highlighting ongoing meaning in active therapeutic music interventions. Conclusion This research highlights the need for increased access to sustainable and meaningful activities, such as purposefully designed therapeutic music interventions in RAC. Improving knowledge about the distinct benefits of therapeutic music interventions compared with other forms of music engagement in RAC may assist nursing staff to make appropriate treatment planning decisions regarding therapeutic music programmes to meet the complex needs of residents with dementia.
... A great challenge for both formal and informal caregivers of people with dementia, however, is how to support people with dementia in maintaining a program of meaningful activities and experiences on a daily basis. While a considerable number of studies have focused on meaningful activities for people with dementia, a recurring problem in this literature is the lack of a precise definition or position of what meaningful activity entails, often generalizing the meaningfulness of certain activities across the entire population of people with dementia [155,156]. However, what constitutes meaningful activity will differ between individuals. ...
... Activities presumed to be meaningful for the individual increase engagement, regardless of cognitive function, whereas work-related activities are more engaging for residents with moderate compared to severe dementia [41]. This shows that the type and content of the activity is indeed important and should be appropriate with regard to the cognitive as well as physical abilities of the individual [44,45]. With the results from the present study, and general knowledge about participation in nursing home activities, the next step is to tailor dog visits, taking into account the different needs and abilities of residents with varying cognitive impairment levels. ...
Article
Full-text available
Objective To compare the immediate response of nursing home residents to dog visits with or without an activity, and the impact of cognitive ability. Methods In a randomly controlled trial, 174 nursing home residents were allocated to 12 bi-weekly 10-minute visits: either ordinary dog visits (D, n = 57, 49 analysed), dog visits with an activity (DA, n = 56, 48 analysed), or visits with activity but no dog (A, n = 61, 54 analysed). We recorded frequency and duration of residents’ verbal and physical interactions with the dog and persons. Data were analysed in three periods of four visits (period 1–3) as binomial variables (generalised linear models) or durations (non-parametric statistics). Results Both visit type and impairment level affected the likelihood of interacting with the dog (D and DA). In some periods increased cognitive impairment lowered odds of touching the dog in DA visits (period 1: F1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F1,90 = 4.60, P < 0.05; period 3: F1,87 = 5.34, P < 0.05). Throughout, residents talked less to persons during DA visits compared to D and A (P = 0.01–0.05), and level of cognitive impairment correlated negatively with talk duration (P < 0.001). Generally, high cognitive impairment level lowered odds of interacting with (period 1: F1,89 = 7.89, P < 0.01; period 2: F1,97 = 6.76, P = 0.01; period 3: F1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F1,89 = 13.78, P <0.001; period 2: F1,88 = 3.27, P = 0.07; period 3: F1,86 = 3.88, P = 0.05). Conclusion Visits without specific activities stimulated residents to interact with the dog, whereas increasing the complexity of dog visits by adding activities resulted in less interaction with the dog for severely impaired residents. The optimal dog visit for the less cognitively impaired residents could include activities and thereby a possibility to interact with the dog in different ways, whereas for severely impaired residents, just being with the dog seems more appropriate.
Chapter
This is the first book to analyze empirically supported treatments by using the newest criteria from the American Psychological Association's Society of Clinical Psychology, Division 12. Clinicians, scholars, and students all need to stay updated on the treatment research, and this book goes beyond providing updated treatment information by pointing readers to other useful treatment manuals and websites for continuing to stay up-to-date. The chapters, all written by prominent experts, highlight the best available evidence for specific disorders by breaking treatments down into credible components. With an emphasis on treatments for adults, chapters also share information about treatments for youth. Other variables that influence treatment are discussed, including assessment, comorbidity, demographics, and medication. Each chapter also corresponds with a chapter in the companion book, Pseudoscience in Therapy, presenting a full picture of the evidence base for common treatments.
Article
Full-text available
The challenges of simultaneously experiencing depressive disorders and autism spectrum conditions pose a significant threat to the well-being of young adult women. Previous research reports indicate that engagement in meaningful activities, specifically analysed in occupational therapy, can not only increase the effectiveness of the activities performed, but also have a positive impact on overall life satisfaction and mental health. The purpose of this study was to demonstrate the relationship between the severity of autistic traits, involvement in meaningful activities and depression in women. The following tools were used in the study: Short Autism Spectrum Quotient Test (AQ-10), Engagement in Meaningful Activities Scale (EMAS) and Beck Depression Inventory (BDI). The study involved 237 women aged 18 to 35 years (M = 21.1; SD = 1.93), who were divided into two subgroups based on AQ-10 indicators. The results revealed a linear relationship between the severity of autistic traits and involvement in meaningful activities and depressive symptoms. Additionally, a correlation was found between engagement in meaningful activities and depression. It was also identified that the intensification of autistic traits significantly differentiated the level of engagement in meaningful activities but did not differentiate the level of depression.
Article
Background Internationally, person-centred care (PCC) is embedded in the language of regulations and mandated to be practised in residential aged care (RAC). Despite this, PCC has not been fully adopted in RAC in Australia and internationally, and concerns about the quality of care persist. Over the past 2 decades, Montessori for dementia and ageing has been introduced in RAC to support and inform a cultural change towards PCC. This study aimed to examine the intersection between the goals and approaches of Montessori and PCC in RAC. Methods This qualitative descriptive study reports on a secondary analysis of qualitative data from focus groups (FGs) and interviews with residents, family-members, staff, and volunteers from eight RAC homes in Victoria, Australia. Sixteen FGs and 36 interviews were conducted. A qualitative deductive approach using researcher-developed Montessori for dementia and ageing framework for data analysis was applied. Results Findings provide support for the intersection between PCC and Montessori with participants’ descriptions of PCC aligning with many of the goals and approaches of Montessori. Participants most commonly described Montessori approaches of engagement in daily tasks with purposeful roles and promoting cognitive abilities through multi-sensory stimulation. Least frequently-described approaches included focusing on residents’ strengths/abilities, maintaining function, using familiar objects, and guided repetition. Conclusions Findings have important implications for practice to use Montessori as a vehicle that supports and upskills the workforce to deliver care that is person-centred. Future research must examine the resources required to support the implementation and sustainability of Montessori as a vehicle for PCC.
Article
The purpose of this manuscript is to describe the protocol for an Alzheimer's Association‐funded cluster randomized trial that focuses on engaging assisted living residents with dementia in meaningful activity to help address their behavioral symptoms of distress using a theoretically based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC‐4‐BSD). The development of MAC‐4‐BSD was based on the Social Ecological Model and Social Cognitive Theory. The MAC‐4‐BSD intervention includes the following four steps: (1) Assessment of the assisted living physical environment and policies to facilitate meaningful activity; (2) Education of staff about implementation of meaningful activity; (3) Assessment of resident preferences and goals for meaningful activity; (4) Mentoring and motivating staff and residents to facilitate engagement in meaningful activity. The overall aim of this study will be to determine the feasibility and preliminary efficacy of implementing the MAC‐4‐BSD intervention and test whether it will improve residents' engagement in meaningful activity, behavioral symptoms of distress, and quality of life as well as the environment and policies to promote meaningful activity in assisted living.
Article
Full-text available
Background: Dignity, an abstract and complex concept, is an essential part of humanity and an underlying guiding principle in healthcare. Previous literature indicates dignity is compromised in people with dementia (PwD), but those PwD maintain the capacity to live with dignity with appropriate external support. Alzheimer’s disease and related dementias (ADRDs) lead to progressive functional decline and increased vulnerability and dependence, leading to heightened risks of PwD receiving inappropriate or insufficient care that diminishes dignity. Considering the increased disease prevalence and the continuously escalating costs of dementia care, establishing a productive value-based guideline may prevent suffering, maximize dignity, and thus promote quality of life (QoL). Aim: The goal of this project is to identify actionable targets for integrating dignity harmoniously and practically into care planning and management for PwD. Research Design: We conducted a concept analysis using Walker and Avant’s eight-step process. A comprehensive literature search was conducted (PubMed and CINAHL) with the keywords “dignity,” “dementia,” “Alzheimer’s disease,” and “dementia care.” Results: A total of 42 out of 4910 publications were included. The concept of dignity in PwD is operationalized as the promotion of worthiness and the accordance of respect that allows the presence and expression of a person’s sense of self, regardless of physical, mental, or cognitive health. The concept has two subdimensions: absolute dignity which encompasses the inherent self and relative dignity characterized by its dynamic reflective nature. Worthiness and respect are the two main attributes, while autonomy is an underlying component of dignity. Specific antecedents of dignity in PwD are empowerment, non-maleficence, and adaptive environmental scaffolding. As a consequence of facilitating dignity in PwD, QoL may be enhanced. Conclusion: As a foundational and necessary humanistic value, incorporating dignity into dementia care can lead to efficient and effective care that optimizes QoL in PwD throughout their disease progression.
Article
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.
Article
Full-text available
Background In addition to illness, inactivity is a risk factor for high mortality in nursing homes. Using innovative technology, such as virtual reality (VR), for meaningful group activities could provide new opportunities for solving this problem. VR interventions have already been approved as a promising method for enhancing the health of older adults. Objective In this study, we examined whether VR-based group activities can have a positive impact on activity level and group interaction among older adults living in nursing homes. Methods We conducted a longitudinal study and provided VR interventions as a group activity once a week for 4 consecutive weeks in nursing homes. Participants were recruited based on the experience of the nursing staff members and the natural decisions of the older adults. Within a virtual cottage, designed according to the needs of the target group, older adults were able to perform daily tasks that they were no longer able to do in real life, such as gardening and making pizza. Overall, 2 psychologists measured the psychosocial capacities, activities of daily life, and well-being before and after the interventions using standardized instruments. Results The results focus on a total of 84 older adults from 14 nursing homes who completed at least 3 VR interventions. The results indicate that several psychosocial capacities among the older adults improved, including adherence to regulations (P<.001; η²=0.122), flexibility (P<.001; η²=0.109), and group integration (P<.001; η²=0.141). Problems related to competence also showed a slight decrease (P=.04; η²=0.039). In addition, the VR intervention promoted their proactivity (P<.001; η²=0.104) and mobility (P=.04; η²=0.039). During the VR group intervention, older adults’ well-being could be maintained at a high level. The results highlight the beneficial effects of VR intervention as a meaningful activity in nursing homes, showcasing the potential of VR applications in this setting. Conclusions This study provides a novel and naturalistic perspective, offering new insights into the use of VR in nursing homes. The VR intervention was well accepted and fulfilled the aim of enhancing capacity and well-being. It could be a meaningful group activity in nursing homes to improve social group interaction. To provide stronger evidence, randomized controlled trials are necessary.
Article
Introduction: With the growing interest and availability of mobile applications (apps) for people living with dementia, it is desirable to have a broader insight into how technology adoption may be further improved. This paper aims to explore the factors influencing adoption of mobile applications for people living with dementia. Methods: The recruitment of participants was facilitated through a dementia advocacy group of people living with dementia. A focus group design was applied to elicit discussion and to explore divergent views on the topic. The data was analysed using thematic analysis. Findings: The 15 individuals who participated in this study comprised of seven women and eight men within the age range of 60-90 years. This study reports key findings pertaining to the views and experiences of using mobile apps. Data analysis revealed the following four distinct themes; (Theme 1: Living with dementia)-"That's the difficulty there even with apps or anything else." (Theme 2: Motivation)- "It makes me feel good. I feel a little with it [laughs], that its not all gone in there" (Theme 3: Fears and Concerns)- "Can somebody else get into your personal memories?" (Theme 4- Support)- "So it's important that we have that support". Together these themes encapsulate the most influential aspects, as highlighted by the participants influencing the acceptance and adoption of apps. Conclusion: This paper explores the barriers and facilitators to app acceptance and adoption. This includes the importance of "feel good moments" and positive experiences, challenges associated with living with dementia, the importance of ongoing support, and security of the user's information. This study adds to what is already known by capturing the views and experiences of people living with dementia in relation to the factors influencing the adoption of apps.
Article
Background: Participation and active engagement in meaningful activities support the emotional and physical well-being of older adults. In 2020, the onset of the COVID-19 pandemic altered lives, including the ability to participate in meaningful activities. This study compared meaningful activity engagement before and at the beginning of the COVID-19 pandemic in a nationally representative, diverse sample >65 years between 2015 and 2020. Methods: We described the proportions and characteristics of National Health and Aging Trends Study participants and their engagement in four activities: visiting friends or family, attending religious services, participating in clubs/classes/other organized activities, and going out for enjoyment. We used mixed effects logistic regressions to compare probabilities of activity engagement before 2020 and in 2020, adjusting for age, sex, functional status, income, geographic region, anxiety-depression, and transportation issues. Results: Of 6815 participants in 2015, the mean age was 77.7 (7.6) years; 57% of participants were female; 22% were Black, 5% Hispanic, 2% were American Indian, and 1% were Asian; 20% had disability; and median income was $33,000. Participation in all four activities remained consistent between 2015 and 2019 and declined in 2020. Significant differences existed in attending religious services (p < 0.01) and going out for enjoyment (p < 0.001) by race and ethnicity, before and after the start of COVID-19. Black and Hispanic participants experienced the largest decline in attending religious services (-32%, -28%) while Asian and White participants experienced the largest decline in going out for enjoyment (-49%, -56%). Conclusions: Potential quality of life tradeoffs should be considered to a greater extent in future pandemic emergencies.
Article
For this study, we examined whether engaging in meaningful activities at home is associated with subjective well-being (SWB) in older adults with long-term care needs according to their preference for going out. We distributed a self-administered questionnaire to long-term care facilities in Japan and performed a linear mixed-effects model regression analysis of the responses. The dependent variable was SWB, and the independent variables were the number of meaningful home activities, preference for going out, and the interaction between them. In our survey (n = 217), we found that both number of meaningful home activities (B = 0.43; 95%CI: 0.17, 0.70) and its interaction with preference (B = −0.43; 95%CI: −0.79, −0.08) were associated with SWB. These results suggest the importance of engaging in meaningful activities at home for older adults who do not prefer going out. We should encourage older adults to participate in activities that match their preference.
Article
Rationale: Veterans living with dementia in long-term care have complex needs, with variable manifestation of symptoms of dementia that interact with their lived experience. Best practice dementia care prioritises nonpharmacological interventions; of which few have strong evidence. Implementation of evidence is complex, with evaluation of outcomes and processes necessary. Aims and objectives: This paper details the evaluation of implementation, at veteran and organisational level, of the Weaving Evidence into Action for Veterans with Dementia (WEAVE) programme. Methods: A Type 2 hybrid effectiveness-implementation design was used, underpinned by the Implementation Framework for Aged Care (IFAC). Programme intervention incorporated music therapy, exercise, reminiscence therapy and/or sensory modulation, offered over a 24-week period. Evaluation components included: (1) programme effectiveness for veterans with dementia for responsive behaviour, physical wellbeing, cognitive status, emotional state, medications and falls (at baseline, 8-week, 16-week and 24-week); and (2) implementation outcomes of reach and adoption, feasibility and acceptability, fidelity (via interviews) and a preliminary cost analysis. Results: Thirty-eight veterans participated in the 24-week programme, with high levels of engagement in interventions of their choice. Statistically significant improvements were seen across all veteran-level outcome measures, for functional capacity and reduced neuro-psychiatric and depressive symptoms. Ten staff members were interviewed, highlighting co-designed core elements were feasible and acceptable, and the momentum generated by resident and staff enthusiasm. Cost analysis included costs of programme set-up and running the 24-week intervention. Conclusion: Key components of programme success were the therapeutic leaders, adherence to core elements of programme design, and veterans' choice in meaningful activity. Cost analysis supports deliberations for upscale across further care homes.
Article
Aim: This thesis presents nine of my published papers based around a common theme of meaningful activity in dementia. The papers and the accompanying text will explore the concept of meaningful activity and whether it is relevant to dementia; the use of meaningful activities for people living with dementia in various settings; and the experiences of people with dementia participating in such activities. Background: An overview of the published literature regarding four areas of meaningful activity is presented in Chapter 2. These areas, which reflect topics of the included papers, comprise: access to the outdoors; exercise and other group activities; dementia and the arts; and involving people with dementia in mindful design. Chapter 3 is a critical discussion of the concept of meaningful activity. Meaningful activity is a concept with considerable limitations but remains useful in psychosocial research and practice in dementia. Methods: The methods of each study are described in each of the nine included papers but the overall methodological approach is summarised in Chapter 4. In general, the approach is exploratory and qualitative, and places a strong emphasis on the voices and experiences of people living with dementia. Results: As with the methods, the detailed results are included in each study. Chapter 5 provides an overall summary of the results, and combines results from those papers with similar methods. Altogether, over 100 people living with dementia have contributed to the data, either as study participants or in the process of co-design. The nine papers included appear in Chapter 6, with the abstract as published and a commentary on each one. The full texts of the papers are reproduced in Appendices 2 to 10. The nine papers fall into four broad groups: Paper 1 is about outdoor access; Papers 2 to 5 concern exercise and other group activities; Paper 6 to 8 are studies of arts interventions; and Paper 9 is about design for and with people living with the dementia. The individual papers are as follows: Paper 1 is an invited editorial that argues for improved access to outdoor space for all people with dementia, whether resident in their own homes or in care homes. This argument is based upon a human rights perspective. Paper 2 reports a qualitative study of a community based sports and exercise group for men with young onset dementia. Four main themes were identified, with enjoyment, anticipation and the creation of a ‘dementia-free’ environment, set alongside less positive themes of loss and lack of other appropriate resources. Paper 3 is a qualitative study of using multisensory boxes as the basis for a storytelling group intervention for care home residents with dementia. The themes generated in our analysis included engagement, curiosity about the contents of the boxes, and the opportunity for self-expression. Paper 4 describes a qualitative study of a Boccia (modified indoor bowls) group for people with dementia. Four main themes were identified, three of them positive: the family nature of the group, the characteristics of Boccia as a sport, and the sense of equality and freedom from dementia in the group. Paper 5, another qualitative study, investigated a weekly swimming group for people with dementia. Themes included the impact of dementia, the pleasure of swimming, and how the group created a sense of equality or being ‘all in the same boat’. Paper 6 reports two case studies of arts interventions for care home residents that were provided as part of a larger arts project. The case studies explored the perceptions of the artists and care home staff and draws attention to the crucial role of care home activity co-ordinators. Paper 7 includes more than one individual study (focus groups and case study) that were used to create a taxonomy of arts interventions in dementia. The paper presents a striking visual model with twelve descriptive dimensions, thus providing a common language for description and future research. Paper 8 is a single case study of a person with advanced dementia and her interaction with a visual art installation in an exhibition, using video analysis. The study was an exploration of capturing the in the moment experience of the participant but also as to whether a person with profound disability could engage with visual art. Paper 9 is a report on a European programme of work around mindful design with and for people with dementia, which provides a background to the work, a description of the models and the approach to co-design that were used, and concludes with a series of design guidelines for different stakeholder groups. Discussion and Conclusions: The main findings and the contribution of the work as a whole are presented and discussed in the final chapter of the thesis. Collectively, the papers present several positive findings. Participation in groups providing exercise or stimulating activities is enjoyed and valued by those taking part. Under the right circumstances, such activities have powerful effects, such as levelling things up for people with dementia, creating equality between group members, and reducing the sense of ‘us and them’ (that is, people with and without dementia). These effects act to enhance the dignity and confidence of participants and reduce the stigma of dementia. In addition, establishing meaningful collaboration with people with lived experience of dementia requires attention to several elements: how and why people are approached initially; how the invitation to participate is framed; observing relevant rights, permissions and consent; creating an equitable and inclusive working environment; and accessible communication and participatory activities that include everyone. There is much common ground across the nine papers, which may be described as an overriding theme of rights, empowerment, liberty and activity, all of which aim at enjoyment and social interaction. The studies included in this thesis have certain strengths, which include the exploratory nature of the studies, the collection of data in naturalistic surroundings, and the emphasis on recording the experiences of the participants with dementia. Possible limitations include the relatively small sample sizes and lack of quantitative data, though it is argued that these are not really required in exploratory studies looking at people’s personal experiences. As a body of work, the nine papers in this thesis make a significant contribution to research and scholarship in the area of meaningful activity in dementia. Future research will need to explore the mechanisms by which interventions ‘work’ and to continue exploration of studying in the moment experiences. Involvement of people living with dementia is essential in order to design products or activities that they may value, and in order to ascertain that allegedly meaningful activities actually do have personal significance.
Article
Most residential aged care facilities support residents to participate in activities and the importance of activities that are suited to individual preferences and abilities is widely acknowledged. Participating in activities, including those considered to be ‘meaningful’ has the potential to improve residents’ quality of life. However, what makes activities meaningful for people living with dementia in residential aged care facilities is unclear. The aim of this study was to understand the key characteristics of ‘meaningful activity’ in residential aged care facilities and the perceived value of residents participating in these activities. Using a qualitative study design, this study explored ‘meaningful activities’ from the perspectives of people living with dementia in residential aged care facilities, their family members and staff. Across four residential aged care facilities, residents (n = 19) and family members (n = 17) participated in individual interviews while staff (n = 15) participated in focus group interviews. Interviews were recorded, transcribed and analysed using a qualitative content analysis approach. Participant responses suggest that the meaning of an activity is subjective, varying over time and between individuals. Key characteristics of an activity that makes it meaningful include being enjoyable, social and engaging, aligning with the persons’ interests, preferences, and abilities. To be considered meaningful, activities need to do more than occupy the person. The activity needs to be linked to a personally relevant goal and an aspect of the individuals’ identity. Participating in ‘meaningful activities’ was perceived as valuable to encourage participation and socialising, provide a sense of normality for residents and improve their wellbeing. The findings of this study further our understanding of the concept of ‘meaningful activity’ for people living with dementia in residential aged care facilities. Understanding the key attributes of ‘meaningful activity’ can also provide practical guidance for those supporting people with dementia to participate in these types of activities.
Article
Full-text available
In this reflection essay, the authors explore how meaning is represented in occupational therapy literature. A review of occupational therapy and occupational science literature uncovers framings of meaning, meaningful, and meaningfulness that are almost exclusively ‘positive’. Positioning of occupations as inherently ‘positive’ and assuming universal experiences of positive meanings for all members of society, overlooks individual and collective diversities. To perpetuate framings of occupations as inherently and exclusively ‘positively meaningful’ effectively silences experiences that do not conform to dominant assumptions and perspectives. Approaching concepts of ‘meaning’ more broadly may allow occupational therapists and scholars to better comprehend what people do and do not do, and why, better situating the profession to promote the espoused goals of equity, justice, and rights. Neglecting nuanced understandings of meaning may forfeit more complex examinations of occupation to other disciplines, thereby undermining disciplinary claims of expertise in the realm of occupation.
Preprint
Full-text available
The continuing COVID-19 pandemic and social restrictions have impacted on the cognitive decline and mental health of people with dementia. Social isolation and loss of activities due to social restrictions may also have implications as to sense of identity for people with dementia. As part of the INCLUDE component of the IDEAL cohort study, the overall aim of this subtle realist qualitative study was to explore the perspectives of people with dementia on living through the COVID-19 pandemic in England and Wales during the post-vaccine time period; also with focus on the study findings in relation to understandings of identity in dementia. Seven people with mild-to-moderate dementia were interviewed, and themes derived using framework analysis. Themes suggest interviewees’ stoic acceptance of the pandemic and social restrictions but also fear of decline related to the temporality of their condition as well as loss of self-confidence to re-engage with the world, and loss of social connections. Under threat due to lack of access to dementia groups, the importance of a shared, social identity, particularly for people with young-onset dementia, was apparent. With valued activities also prevented or reinvented during the pandemic, the relevance of occupation for identity is discussed. Although under continued pressure, services must consider how people with dementia and their family caregivers can best be supported during the ongoing pandemic.
Article
Full-text available
Both demands of stability and efficiency constitute the gargantuan barriers of perovskite solar cells (PSCs), hampering the academic communities and industrial production. Herein, it is demonstrated that, after depositing optimized CdS shell layers on TiO2 nanorod arrays (NAs) by a simple and rapid chemical bath method at room temperature, the efficiency and stability of PSCs are simultaneously enhanced. The PSCs based on TiO2/CdS core–shell NAs achieve higher power conversion efficiency up to 17.71%, compared to 15.93% of the pristine TiO2 NAs‐based cells. Especially, the stability of the PSCs is prominently improved after optimized CdS layer modification without encapsulation. The significant enhancement of both efficiency and stability are mainly ascribed to that the type‐II structure of TiO2/CdS coaxial nanorods can suppress recombination, and the oxygen vacancies on TiO2 surfaces are not directly contacted with perovskite layers. The surface modification on TiO2 NAs opens up an alternative approach toward improving the performance and stability of PSCs. A facial and efficient method is demonstrated to simultaneously improve the efficiency and stability of the perovskite solar cells (PSCs) based on TiO2 nanorod arrays by inserting uniform CdS shells. After optimizing the CdS shells, the PSCs achieve power conversion efficiency up to 17.71%, with current density of 22.36 mA cm−2, V oc of 1.05 V, and FF of 0.75.
Article
Full-text available
BACKGROUND: People with dementia who are being cared for in long-term care settings are often not engaged in meaningful activities. Offering them activities which are tailored to their individual interests and preferences might improve their quality of life and reduce challenging behaviour. OBJECTIVES: ∙ To assess the effects of personally tailored activities on psychosocial outcomes for people with dementia living in long-term care facilities.∙ To describe the components of the interventions. ∙ To describe conditions which enhance the effectiveness of personally tailored activities in this setting. SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's Specialized Register, on 16 June 2017 using the terms: personally tailored OR individualized OR individualised OR individual OR person-centred OR meaningful OR personhood OR involvement OR engagement OR engaging OR identity. We also performed additional searches in MEDLINE (Ovid SP), Embase (Ovid SP), PsycINFO (Ovid SP), CINAHL (EBSCOhost), Web of Science (ISI Web of Science), ClinicalTrials.gov, and the World Health Organization (WHO) ICTRP, to ensure that the search for the review was as up to date and as comprehensive as possible. SELECTION CRITERIA: We included randomised controlled trials and controlled clinical trials offering personally tailored activities. All interventions included an assessment of the participants' present or past preferences for, or interests in, particular activities as a basis for an individual activity plan. Control groups received either usual care or an active control intervention. DATA COLLECTION AND ANALYSIS: Two authors independently checked the articles for inclusion, extracted data and assessed the methodological quality of included studies. For all studies, we assessed the risk of selection bias, performance bias, attrition bias and detection bias. In case of missing information, we contacted the study authors. MAIN RESULTS: We included eight studies with 957 participants. The mean age of participants in the studies ranged from 78 to 88 years and in seven studies the mean MMSE score was 12 or lower. Seven studies were randomised controlled trials (three individually randomised, parallel group studies, one individually randomised cross-over study and three cluster-randomised trials) and one study was a non-randomised clinical trial. Five studies included a control group receiving usual care, two studies an active control intervention (activities which were not personally tailored) and one study included both an active control and usual care. Personally tailored activities were mainly delivered directly to the participants; in one study the nursing staff were trained to deliver the activities. The selection of activities was based on different theoretical models but the activities did not vary substantially.We found low-quality evidence indicating that personally tailored activities may slightly improve challenging behaviour (standardised mean difference (SMD) -0.21, 95% confidence interval (CI) -0.49 to 0.08; I² = 50%; 6 studies; 439 participants). We also found low-quality evidence from one study that was not included in the meta-analysis, indicating that personally tailored activities may make little or no difference to general restlessness, aggression, uncooperative behaviour, very negative and negative verbal behaviour (180 participants). There was very little evidence related to our other primary outcome of quality of life, which was assessed in only one study. From this study, we found that quality of life rated by proxies was slightly worse in the group receiving personally tailored activities (moderate-quality evidence, mean difference (MD) -1.93, 95% CI -3.63 to -0.23; 139 participants). Self-rated quality of life was only available for a small number of participants, and there was little or no difference between personally tailored activities and usual care on this outcome (low-quality evidence, MD 0.26, 95% CI -3.04 to 3.56; 42 participants). We found low-quality evidence that personally tailored activities may make little or no difference to negative affect (SMD -0.02, 95% CI -0.19 to 0.14; I² = 0%; 6 studies; 589 participants). We found very low quality evidence and are therefore very uncertain whether personally tailored activities have any effect on positive affect (SMD 0.88, 95% CI 0.43 to 1.32; I² = 80%; 6 studies; 498 participants); or mood (SMD -0.02, 95% CI -0.27 to 0.23; I² = 0%; 3 studies; 247 participants). We were not able to undertake a meta-analysis for engagement and the sleep-related outcomes. We found very low quality evidence and are therefore very uncertain whether personally tailored activities improve engagement or sleep-related outcomes (176 and 139 participants, respectively). Two studies that investigated the duration of the effects of personally tailored activities indicated that the intervention effects persisted only during the delivery of the activities. Two studies reported information about adverse effects and no adverse effects were observed. AUTHORS' CONCLUSIONS: Offering personally tailored activities to people with dementia in long-term care may slightly improve challenging behaviour. Evidence from one study suggested that it was probably associated with a slight reduction in the quality of life rated by proxies, but may have little or no effect on self-rated quality of life. We acknowledge concerns about the validity of proxy ratings of quality of life in severe dementia. Personally tailored activities may have little or no effect on negative affect and we are uncertain whether they improve positive affect or mood. There was no evidence that interventions were more likely to be effective if based on one specific theoretical model rather than another. Our findings leave us unable to make recommendations about specific activities or the frequency and duration of delivery. Further research should focus on methods for selecting appropriate and meaningful activities for people in different stages of dementia.
Article
Full-text available
Purpose To understand activity in dementia care, we examine relationships of disease stage with types and characteristics of meaningful activities (cueing needs, help with initiation, and recommended engagement time) provided in a home-based intervention trial designed to reduce behavioral symptoms. Design and Methods Data involved 158 activity prescriptions or written documents detailing prescribed activities, cueing needs, and engagement goals designed by occupational therapists for 56 families. Activities were categorized as arts and crafts, exercise/physical, cognitive, music/entertainment, manipulation/sensory/sorting, family/social/ reminiscence, and domestic/homemaking. Bivariate correlations examined relationships of activity categories and characteristics with disease stage (mild, moderate, or severe). Kruskal–Wallis H tests examined differences among disease stages and frequency of type of activities prescribed, recommended cues, and engagement time. For significant Kruskal–Wallis tests, pairwise comparisons utilized the Mann–Whitney U test. Results Activity categories and instructions for set up were significantly related to cognitive and functional levels. Persons with mild dementia were most often prescribed complex arts and crafts and cognitive activities. Persons with moderate dementia were most often prescribed music/entertainment. Persons with severe dementia were most often prescribed simple physical exercises and manipulation/sensory/sorting activities. Average time prescribed for activities was less for those in severe (15min) versus moderate (24min) and mild (28min) stages. The severe group required more assistance with activity initiation and cueing/redirection. Implications Type of activity, recommended cueing, and engagement time differed by dementia stage. Findings provide guidance as to how to use and set up activities across the dementia trajectory.
Article
Full-text available
Purpose of the study: Engagement in meaningful activities is associated with positive outcomes for persons with dementia, yet studies demonstrating quantitative evidence for which activities can be considered meaningful are lacking. We investigated MemPics(™), a program designed to promote meaningful activity for individuals with dementia through engagement and cognitive stimulation. It was compared with other recreation activities offered in U.S. long-term care facilities to determine whether MemPics(™) was rated as having more meaningful activity from both the perspectives of participants and recreation staff. Design and methods: Long-term care residents with mild to moderate dementia that met eligibility criteria were randomly assigned to an activity group (treatment, control). Participants completed 2 sessions of either the experimental or control group activity with facility recreation staff. Both participants and staff rated each activity in terms of meaningfulness following each session. Results: Of the enrolled participants (N = 126), study analyses were based on the 94 participants (n = 48 treatment and n = 46 control; M age = 82.98±9.63) who completed the activity sessions. Compared to the control group activities, MemPics(™) had significantly higher participant and staff ratings of meaningfulness. Scores between the 2 rater types were significantly different, with staff reporting higher meaningful activity than participants. Further support for MemPics(™) was found in exit survey responses from participating staff. Implications: We discuss the merits and shortcoming of this study, the utility of MemPics(™) for providing meaningful engagement in long-term care residents with mild to moderate dementia, and ideas for future research.
Article
Full-text available
Providing quality care for people with dementia to meet the growing demand for services is a significant challenge to Australia and globally. When it comes to planning for current and future care needs, limited information is available on what people living with dementia and their family members consider the meaning of “quality” in residential care services.
Article
Full-text available
Purpose: To understand how adults living in a low-income, public housing community characterize meaningful activity (activity that gives life purpose) and if through short-term intervention, could overcome identified individual and environmental barriers to activity engagement. Methods: We used a mixed methods design where Phase 1 (qualitative) informed the development of Phase 2 (quantitative). Focus groups were conducted with residents of two low-income, public housing communities to understand their characterization of meaningful activity and health. From these results, we developed a theory-based group intervention for overcoming barriers to engagement in meaningful activity. Finally, we examined change in self-report scores from the Meaningful Activity Participation Assessment (MAPA) and the Engagement in Meaningful Activity Survey (EMAS). Results: Health literacy appeared to impact understanding of the questions in Phase 1. Activity availability, transportation, income and functional limitations were reported as barriers to meaningful activity. Phase 2 within group analysis revealed a significant difference in MAPA pre-post scores (p =0.007), but not EMAS (p =0.33). Discussion: Health literacy should be assessed and addressed in this population prior to intervention. After a group intervention, participants had a change in characterization of what is considered healthy, meaningful activity but reported fewer changes to how their activities aligned with their values.
Article
Full-text available
Qualitative studies were synthesized to describe perspectives of people with dementia regarding meaningful activities. Themes of connectedness were identified using a meta-ethnography approach. The theme of being connected with self encompasses engagement for continuity, health promotion, and personal time. The theme of being connected with others includes being with others not to feel alone, doing an activity with others, and meaningful relationships. The theme of being connected with the environment encompasses being connected to one's familiar environment, community, and nature. This synthesis suggests that connectedness is an important motivation for engagement in daily activities. Findings indicate that identifying the underlying motivation for an individual with dementia to engage in different activities is important for matching a person with activities that will be satisfying. This review may inform the development of interventions for engaging people with dementia in meaningful, daily activities and creating connectedness to self, others, and the environment. © The Author(s) 2015.
Article
Full-text available
Dementia threatens the capacity to engage in activity, suggesting meaningful activity may be helpful for persons with dementia (PWDs). This study explores the concept of meaningful activity, as defined by caregivers of PWDs. Family caregivers of PWDs, who provide 3 hours of care over 3 days/week, were interviewed after 6 months of cholinesterase inhibitors (ChEIs) therapy. Caregiver responses (N = 906) to the open-ended question What do you believe getting involved in activities outside the home means for someone with dementia are assessed. The themes are analyzed in terms of content, frequency, co-occurrence, and dementia severity. Caregivers emphasize the benefits of social connectedness, physical health, and mental stimulation. Activity is also viewed as respite, difficult, and has no meaning for care recipient. The implications of activity for self- and social-identity in PWD and caregiver are discussed. The benefits of activity varied by stage of disease. This knowledge indicates areas for improved activity provision and health care support. © The Author(s) 2015.
Article
Full-text available
The purpose of this study was to explore the change and continuity in the engagement in life of people with advanced dementia. The idea of meaningful activities is commonly used in nursing research, but few studies have been performed on what makes activities meaningful. This study aims to shed light on the meaning of activities in a life course context, changes in activity patterns due to dementia disease, and the significance of narratives told by close relatives. The 11 stories of activities were analyzed using thematic narrative analysis with Leontyev's activity theory as a theoretical framework. The findings revealed several types of changes: slow and abrupt changes in everyday and physical activities, changes in the person's level of awareness, and changes in habits in new care settings and environments. The meaningfulness of activities was connected to a person's background, his/her motives, lifestyle and identity, and the contextuality of activities. Through the narratives, nursing care personnel could acquire a nuanced picture of the person and his/her engagement in life. These narratives are vital to helping people who have dementia to keep up with meaningful activities and enhance their quality of life, especially when the person has deficiencies in communication. © The Author(s) 2014.
Article
Full-text available
The author of this study proposed and examined a theoretical model in which meaningful activity fulfills basic psychological needs and contributes to meaning in life. Hypotheses derived from the Meaningful Activity and Life Meaning model and tested within this study included: (1) meaningful activity will be associated with meaning in life, (2) meaningful activity will be associated with basic psychological needs, and (3) basic psychological needs will partially mediate the relationship between meaningful activity and meaning in life. Structural equation modeling with latent variables was used to test the study hypotheses. A total of 591 undergraduate and graduate students completed the Engagement in Meaningful Activities Survey, the Basic Psychological Needs Scales (i.e., autonomy, competence, and relatedness), and the Presence subscale of the Meaning in Life Questionnaire. Results from the study were in full support of each hypothesis and indicate the important role meaningful activity may serve in fostering meaning in life.
Article
Full-text available
Objectives: This randomized controlled study tested the effectiveness of individualized activities, led by certified nursing assistants (CNAs), to increase positive and reduce negative affect and behavior among nursing home residents with dementia. Method: Nursing home residents with mild to advanced dementia (N = 180) were randomly assigned to usual care (UC, n = 93) or 1 of 2 experimental conditions. Residents in the attention control group (AC, N = 43) participated in standardized one-to-one activities with their CNAs. Individualized Positive Psychosocial Intervention (IPPI) participants (n = 44) received a CNA-led activity matched to their interests and ability. Outcomes were residents' positive and negative affect and verbal and nonverbal behavior. Results: The IPPI and AC groups experienced similar benefits-more pleasure, alertness, engagement, positive touch, and positive verbal behavior-compared with UC. The AC group displayed more anger, uncooperativeness, and very negative verbal behavior than UC or IPPI. Discussion: This study demonstrates the value of individualized activities for nursing home residents with dementia. In a stringent test, residents were happier and less angry during a customized intervention compared with a standardized intervention. Even brief individualized CNA-led activities bring pleasure to nursing home residents and constitute an effective strategy to enhance positive affect and engagement in persons with dementia.
Article
Full-text available
The Engagement in Meaningful Activities Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002) demonstrated sufficient psychometric properties in a sample of 122 adults. The EMAS was found to have adequate test-retest (r = .71) and internal consistency (α = .88) reliability; significant positive correlations between the EMAS and the subscales of the Basic Psychological Needs Scale and the Sources of Meaning Profile and negative zero-order correlations were found with short form versions of the Boredom Proneness Scale and the Depression, Anxiety, and Stress Scales. Step-wise multiple regression analysis results showed the Sources of Meaning Profile, Boredom Proneness Scale, and Competence subscale of the Basic Psychological Needs scale best predicted the EMAS. These results lend additional construct validity evidence in support of the EMAS as a brief measure of meaningful activity participation.
Article
Full-text available
A hypothesized relationship between engagement in meaningful activities and quality of life was tested for thirty-two individuals attending a community mental health agency's programs. They completed the Lehman Quality of Life Interview; the Derogatis Symptom Checklist-90-Revised, and the Engagement in Meaningful Activities Survey (EMAS), constructed for this study. It measures 12 facets of the meaningfulness of activities and includes some open-ended questions. Its test-retest reliability and Cronbach Alpha were .69 and .84, respectively. Participants were involved in a wide range of activities that were most lacking in providing appropriate challenge and a sense of control. Engagement in meaningful activities was significantly correlated with satisfaction with life as a whole (p < .05), but depression accounted for most of the variance. Some support is provided for the theorized value of meaningful activity engagement and recommends strategies to increase the meaningfulness of activities. Findings alert clinicians to the importance of treating depression.
Article
Full-text available
The complexities of defining what appears to be the relatively simple concept of resilience are widely recognized. This paper analyses the concept of resilience from a range of disciplinary perspectives and clarifies a definition in order to inform research, policy and practice. The work takes a life course approach to resilience, examining evidence derived from research across the lifespan. It incorporates the methods of systematic review, concept analysis and consultation through face-to-face meetings. The synthesis of methodological approaches enables a clear identification of the antecedents, defining attributes and consequences of resilience, validated with stakeholder partners. Through this process, resilience is defined as the process of effectively negotiating, adapting to, or managing significant sources of stress or trauma. Assets and resources within the individual, their life and environment facilitate this capacity for adaptation and 'bouncing back' in the face of adversity. Across the life course, the experience of resilience will vary. A large proportion of resilience research is routed within the discipline of developmental psychology, and has mainly been developed with children and adolescents. A major contribution to resilience research could be made through more multi-disciplinary studies that examine the dynamics of resilience across the lifespan, its role in healthy ageing and in managing loss, such as changes in cognitive functioning.
Article
Full-text available
Objective: This study evaluated the measurement characteristics of the Engagement in Meaningful Activities Survey (EMAS) in an age-diverse sample. Method: The sample included 154 older adults and 122 college students (age range = 18-100 yr). A Rasch-Andrich rating scale model was used to evaluate the EMAS. Analyses addressed rating scale design, person and item fit, item hierarchy, model unidimensionality, and differential item functioning. Results: Category functioning was improved by reducing the EMAS item responses to four categories. Adequate person response validity was established, and all but one EMAS item demonstrated an ideal fit to the Rasch measurement model. After establishing the item hierarchy, I found the EMAS to be a unidimensional measure. Differential item functioning was not detected using Bonferroni-adjusted statistical criteria. Conclusion: The results confirm the potential to validly measure subjective qualities of meaningful activity participation. The EMAS can be used to evaluate processes and outcomes central to occupational therapy practice and to aid in the design of therapeutic occupations.
Article
Full-text available
This study evaluated the psychometric properties of the Engagement in Meaningful Activities Survey (EMAS) (Goldberg, Brintnell, & Goldberg, 2002) in a sample of older adults living in the greater Los Angeles area. The EMAS evidenced moderate test-retest reliability (r = .56) and good internal consistency (α = .89). Exploratory factor analysis (principal components) discerned a two-component structure within the EMAS, indicative of Personal-Competence and Social-Experiential meaning. The EMAS demonstrated theoretically predicted zero-order correlations with measures of meaning and purpose in life, depressive symptomology, life satisfaction, and health-related quality of life. Regression analyses discerned that purpose and meaning in life consistently predicted the EMAS and its components. Furthermore, persons reporting greater levels of Social-Experiential relative to Personal-Competence meaning had the lowest levels of physical health-related quality of life. This study offers initial evidence in support of the EMAS as a valid measure of meaningful activity in older adults.
Article
Full-text available
The term person-centered care (PCC) has been frequently used in the literature, but there is no consensus about its meaning. This article uses Walker and Avants's method of concept analysis as a framework to analyze PCC. A literature search was completed and data were collected using several search engines (CINAHL, Medline, PubMed, and Cochrane Review). The key words used were "individualized-care," "person-centered care," "patient-centered care," "client-centered care," and "resident-centered care." Attributes, antecedents, and consequences of PCC were identified. Empirical referents were provided to measure PCC from the perspective of the person receiving care and finally, a model case provides an exemplar of the concept.
Article
Full-text available
To test the main and interactive effects of activities derived from the Need-Driven Dementia-Compromised Behavior model for responding to behavioral symptoms in nursing home residents. Randomized double-blind clinical trial. Nine community-based nursing homes. One hundred twenty-eight cognitively impaired residents randomly assigned to activities adjusted to functional level (FL) (n=32), personality style of interest (PSI) (n=33), functional level and personality style of interest (FL+PSI) (n=31), or active control (AC) (n=32). Three weeks of activities provided twice daily. Agitation, passivity, engagement, affect, and mood assessed from video recordings and real-time observations during baseline, intervention, random times outside of intervention, and 1 week after intervention. All treatments improved outcomes during intervention except mood, which worsened under AC. During intervention the PSI group demonstrated greater engagement, alertness, and attention than the other groups; the FL+PSI group demonstrated greater pleasure. During random times, engagement returned to baseline levels except in the FL group in which it decreased. There was also less agitation and passivity in groups with a component adjusted to PSI. One week after the intervention, mood, anxiety, and passivity improved over baseline; significantly less pleasure was displayed after withdrawal of treatment. The hypothesis that activities adjusted to FL+PSI would improve behavioral outcomes to a greater extent than partially adjusted or nonadjusted activities was partially supported. PSI is a critical component of individualized activity prescription.
Article
Full-text available
The current study investigated the nature of the flow state among older adults. Flow is a pleasurable experiential state that occurs during full-capacity engagement in which an individual is performing at a level that is matched with the demands of the task. Each participant completed a scale assessing dimensions of flow in a particular activity selected by the participant. More cognitively demanding activities elicited higher levels of flow for those with higher fluid ability, but lower levels of flow for those with lower fluid ability. This pattern was reversed for activities that were low in demand. Our data highlight the potential importance of considering motivational states such as flow in understanding cognitive optimization in adulthood.
Article
Full-text available
The concept empowerment is difficult to understand, define and translate into different contexts. Therefore, the purpose of this paper was to analyze the empowerment concept in the midwifery context, focused on the childbearing period, aimed at clarifying its meaning in order to enable comprehension and use in clinical practice, education and research. Semi structured interviews and written text. Prenatal clinics, delivery and maternity wards in western Sweden. Nine midwives and 12 couples. A concept analysis was undertaken according to the hybrid model which consists of the theoretical, fieldwork and analytical phases. After a literature review, the concept was empirically elucidated in the fieldwork phase. The final step was to describe criteria and attributes, illustrative cases, antecedents and consequences of the concept. The following tentative criteria and attributes of empowerment in the midwifery context are described: developing a trustful relationship; starting an awareness process, making it possible to reflect on the changing situation; acting based on the parents' situation on their own terms, getting them involved and able to make informed choices; confirming the personal significance of becoming parents. Finally, empowerment in the midwifery context was redefined. Midwives use empowerment in education and research as well as strategies on both the micro and macro levels in practice. Empirical findings from the concept analysis confirm the concept's relevance in the midwifery context.
Article
Full-text available
The Meaningful Activity Participation Assessment (MAPA), a recently developed 28-item tool designed to measure the meaningfulness of activity, was tested in a sample of 154 older adults. The MAPA evidenced a sufficient level of internal consistency and test-retest reliability and correlated as theoretically predicted with the Life Satisfaction Index-Z, the Satisfaction with Life Scale, the Engagement in Meaningful Activities Survey, the Purpose in Life Test, the Center for Epidemiologic Studies Depression Inventory and the Rand SF-36v2 Health Survey subscales. Zero-order correlations consistently demonstrated meaningful relationships between the MAPA and scales of psychosocial well-being and health-related quality of life. Results from multiple regression analyses further substantiated these findings, as greater meaningful activity participation was associated with better psychological well-being and health-related quality of life. The MAPA appears to be a reliable and valid measure of meaningful activity, incorporating both subjective and objective indicators of activity engagement.
Book
Over 4,500 entries This dictionary is the most wide-ranging and comprehensive of its kind, covering the essential vocabulary for everyday archaeological work in the English language. There is coverage of principles, theories, techniques, artefacts, materials, people, places, monuments, equipment, and descriptive terms. The dictionary focuses especially on Europe, the Old World, and the Americas, and covers legislation relating to the United Kingdom and the USA, though this third edition does add a fair number of entries relating to the Near East and Asia. These include Angara Style , Donghulin Culture , Hasanlu , Samarra Culture , and Tel Tsaf , as well as a new appendix listing Chinese rulers and dynasties. Written by a leading authority, the dictionary’s detailed but clear entries provide an essential reference source for students, teachers, professionals, and enthusiasts alike.
Article
Background: People with moderate to advanced dementia living in residential care are at risk of occupational deprivation. Person-centered care has been adopted as a guiding principle in the provision of residential care for older adults with dementia. In this context, there has been shift in occupational therapy practice from addressing occupational performance towards focusing on meaningful engagement. While both meaningful engagement and person-centered care have been well researched the relationship between the two concepts is poorly understood. Aim: A critical interpretative synthesis was conducted to determine how principles of person-centered care inform occupational therapy practice in relation to promotion of meaningful engagement among residents with moderate to advanced dementia. Methods: A systematic search of research addressing meaningful engagement of people with moderate to advanced dementia identified 26 papers. Results: Papers were classified as theoretical papers and empirical research. Two overarching constructs emerged, namely promoting a culture of collaborative care and understanding the resident as a person with a past, present and future. Conclusions: Occupational deprivation prevails and person-centered care is not fully addressed if opportunities for growth and engagement for residents with moderate to advanced dementia is not extended beyond their life history. Significance: Creating continued opportunities for building agency of residents with dementia could promote occupational justice in residential care.
Article
Objectives The aims of this study are (1) to describe the types of leisure activities preferred by persons with dementia in the past and present, as reported by family members and therapeutic recreation staff members, and (2) to examine the influence of demographic and functional abilities variables on the perceived current interest of persons with dementia. Method Family members of persons with dementia and therapeutic recreation staff involved in the care of those persons completed an activities preference assessment concerning the persons with dementia. Participants were recruited from a nursing home and a senior day center. Family members completed the assessment for the past and present, and staff members completed the assessment for the present. Results For present preferences, music was the most often preferred activity according to both family and staff, followed by reminiscence and reading, while the least desirable activity was cooking/baking according to family and trivia games according to the staff. Current preferences were significantly related to past preferences. Gender was also related to preference for some activities. A significant reduction in preference from the premorbid past to the present was found for music, reading, and cooking. Additionally, the number of activities persons preferred as reported by both caregiver groups was affected by dementia. Family members tended to report lower preference levels for the activities in the present in comparison to the staff, and they were also more likely to report not knowing the present level of preference than therapeutic recreation staff members. Conclusion The assessments by both therapeutic recreation staff members and family members shed light on leisure preferences of persons with dementia, while the varying reports reflect a possibly different perspective of the two caregiver groups.
Article
Most individuals with dementia develop significant behavioral problems, which present enormous challenges for caregivers. Given that there is no imminent cure in sight and pharmacotherapy is ineffective, it is critical to identify interventions that minimize behavioral disturbances, improve quality of life, and lessen caregiver burden. As activity-based interventions have shown great promise, we examined relationships of dementia disease stage (mild, moderate, severe) with types and characteristics of meaningful activities (cueing needs, help with initiation, recommended engagement time) provided in a home-based behavioral intervention trial. We found that type of activity, recommended cueing, and engagement time were significantly related to dementia stage. Findings provide guidance as to how to use and set up activities across the dementia trajectory and show that persons with even advanced dementia benefit from a wide range of meaningful activities with appropriate set-up. This study represents an important step towards developing guidelines for activities in dementia care.
Article
Aim There is a lack of conceptual clarity around ‘respite’ as it relates to people with dementia and their carers. This study provides clarification on the use and meaning of the term and considers the concept in relation to the dominant care paradigm in dementia, i.e. person-centred care. Methods Rodgers’ (1989) evolutionary framework was employed. A systematic search was conducted on the Pubmed/MedLine, Embase, Cinahl, PsychInfo, Scopus, Web of Science and Cochrane databases (1980–2016, English) with fixed search terms relating to ‘respite’ and ‘dementia’. Papers with primary qualitative data and literature reviews were included. This search was supplemented with snowballing techniques (back/forward searching, generic search engines). Data were analysed thematically, through an iterative process of constant comparison. Results Respite is understood both as a service that provides a physical break for the carer and as a psychological outcome, i.e. a mental break for the carer, which can be facilitated by formal services, under certain conditions. The conceptual model outlines how client factors (dyadic relations, recognising/accepting need, carer psychosocial issues, restorative occupation, and stigma) and service factors (model/characteristics, care quality, staff expertise, meaningful occupation for people with dementia and communication and support), interact to influence a respite outcome. The key antecedent for a positive respite experience is that the carer perceives that mutual benefit is garnered from service use. Conclusion The term respite can be interpreted as both a service and an outcome. However, it is clear that ‘respite’, as currently understood, acknowledges the relational experience of the carer only; it is, therefore, potentially damaging to the planning and delivery of person-centred dementia care. We suggest ‘restorative care’ as a potential alternative nomenclature to respite care, thereby highlighting the importance of providing mutual, personalised health and social care services that serve to enhance care relationships rather than diminish them.
Article
Aims: Dementia is being increasingly recognised as a major public health issue for our ageing populations. A critical aspect of supporting people with dementia is facilitating their participation in meaningful activities. However, research to date has not drawn on theories of ageing from developmental psychology that would help undergird the importance of such meaningful activity. For the first time, we connect existing activity provision for people with dementia with developmental psychology theories of ageing. Method: We reviewed the literature in two stages: first, we narratively searched the literature to demonstrate the relevance of psychological theories of ageing for provision of meaningful activities for people with dementia, and in particular focused on stage-based theories of adult development (Carl Jung and Erik Erikson), gerotranscendence (Tornstam), selective optimisation with compensation (Baltes and Baltes), and optimisation in primary and secondary control (Heckhausen and Schulz). Second, we systematically searched PubMed and PsycINFO for studies with people with dementia that made use of the aforementioned theories. Results: The narrative review highlights that activity provision for people with dementia goes beyond mere pleasure to meeting fundamental psychological needs. More specifically, that life review therapy and life story work address the need for life review; spiritual/religious activities address the need for death preparation; intergenerational activities address the need for intergenerational relationships; re-acquaintance with previously conducted leisure activities addresses the need for a sense of control and to achieve life goals; and pursuit of new leisure activities addresses the need to be creative. The systematic searches identified two studies that demonstrated the utility of applying Erikson's theory of psychosocial development to dementia care. Conclusion: We argue for the importance of activity provision for people with dementia to help promote wellbeing among an increasing proportion of older people.
Article
The 2006 activity revision provides important opportunities to advance the value of culture change in LTC settings. Developing and maintaining successful, person-appropriate activity programs for individuals with dementia relies on the cooperation and assistance of all team members, a basic working knowledge of dementia processes, and a sound knowledge of innovative, evidence-based activities that are matched to the interests and abilities of individual residents. Ongoing training and education of LTC staff, including but not limited to programs like the NEST and the CD-based Dementia Training programs, is a necessary first step in building facility-based, interdisciplinary teams that share responsibility for ensuring ongoing involvement in person-appropriate, meaningful activities for residents with dementia.
Article
Lack of occupation can lead to boredom, apathy, social exclusion and solitude. Occupation should incorporate meaningful activities. The aim of this study is to describe how Spanish Nursing Home residents experienced and made sense of meaningful activities. A qualitative phenomenological approach was followed. Data were collected over an 18-month period between 2012 and 2014. Purposeful sampling was conducted with Spanish residents in nursing homes in Madrid. Data were collected using unstructured and semi-structured interviews. The data were analyzed using the Giorgi proposal. Thirty-eight residents (20 female and 18 male) participated. Three main themes describing the significance of meaningful activity in nursing homes emerged from the data: Feeling the passage of time, Seeking an occupation, and Living with restrictions. Nursing homes should strive to develop diverse and meaningful activity programs for residents in order to occupy their time and provide them with a greater sense of purpose.
Article
The study of engagement in people with dementia is important to determine the effectiveness of interventions that aim to promote meaningful activity. However, the assessment of engagement for people with dementia in relation to our current work that uses social robots is fraught with challenges. The Video Coding - Incorporating Observed Emotion (VC-IOE) protocol that focuses on six dimensions of engagement: emotional, verbal, visual, behavioral, collective and signs of agitation was therefore developed. This paper provides an overview of the concept of engagement in dementia and outlines the development of the VC-IOE to assess engagement in people with dementia when interacting with social robots.
Article
This systematic review describes the benefits of individualized leisure and social activity interventions for people with dementia (aim 1), how these interventions were individually tailored (aim 2), and what recommendations or suggestions can be made for these interventions and further studies (aim 3). A total of 32 included studies were organized into four categories based on how the intervention was individually tailored. These categories include: 1) performance factors; 2) self-identity; 3) music preference; and 4) life experiences and past memories. The authors discuss benefits by synthesizing the finding of the included studies in each category and suggestions.
Article
Introduction Refugees experience a number of difficulties when settling in the United Kingdom and may be faced with occupational injustice due to their restricted occupational engagement. This study explores the value of an allotment group for refugees of working age, aiming to explore the role of horticulture and the social environment on health, wellbeing and social inclusion. Method This was an exploratory study using qualitative methodology based on ethnographic principles. Data collection included observation of the group, semi-structured interviews with five participants, with four of these participants also taking part in photo-elicitation interviews. Data analysis involved using a ‘framework’ approach to produce three themes and associated sub-themes. Findings Analysis identified firstly gardening as a meaningful activity; secondly, the importance of the social environment and, lastly, the value of occupational engagement for refugees. Further theoretical analysis led to the conclusion that these themes linked to the dimensions of occupation: doing, being, belonging and becoming. Conclusion The findings identify how occupational engagement can have a positive impact on the health and wellbeing of refugees, specifically with the use of social and therapeutic horticulture.
Article
Contents: Preface Acknowledgments Continuity Theory How Did Continuity Theory Arise? Continuity Theory as Theory Elements of Continuity Theory Development versus Aging in Later Adulthood Case Examples Internal Continuity Continuity of the Self Self-Confidence Emotional Resilience Personal Goals Beliefs about the Effects of Retirement Summary External Continuity Living Arrangements, Household Composition,and Marital Status Income Adequacy Modes of Transportation Patterns of Activity: Stability, Continuity, and Change over Time How Activities Fit Together to Form Lifestyles Summary Adaptive Capacity Proactive Coping and Motivation for Continuity How Did Respondents Cope? Coping with Specific Changes: Retirement, Widowhood, and Functional Limitations Functional Limitation and the Self Patterns of Coping withFunctional Limitations General Patterns of Adaptation Factors Linked to Negative Outcomes in Later Life Summary Goals for Developmental Direction Continuity of Personal Goals Disposition toward Continuity Spiritual Development The Theory of Gerotranscendence The Study of Goals for Developmental Direction in Later Life Conclusion Assessing Continuity Theory Evidence on the Assumptions and Propositions of Continuity Theory Continuity Strategies Are Generally Effective Methodological Issues Related to the Study of Continuity Theory Future Research Using Continuity Theory Appendixes A. Tables B. The Ohio Longitudinal Study of Aging and Adaptation C. The 1995 Study Questionnaire D. Worksheets Used to Examine Longitudinal Patterns References Index
Article
In the light of recent research it is now possible to gain considerable insight into the subjective world of dementia. The uniqueness of each individual's experience, which is related to personality and defence processes, must always be taken into account. Six 'routes to understanding' are discussed, and the array of evidence is used to build up an overall picture of the domain. Comments are made on the psychological needs of people with dementia. Finally, a speculation is offered about the subjective consequences of those needs being met.
Article
Abstract Social interaction and participation in leisure activities are positively related to the health and well-being of elderly people. The main focus of this exploratory study was to investigate elderly peoples' perceptions and experiences of social interaction and leisure activities living in a residential aged care (RAC) facility. Six residents were interviewed. Themes emerging from discussions about their social interactions included: importance of family, fostering friendships with fellow residents, placement at dining room tables, multiple communication methods, and minimal social isolation and boredom. Excursions away from the RAC facility were favourite activities. Participants commonly were involved in leisure activities to be socially connected. Poor health, family, the RAC facility, staffing, transportation, and geography influenced their social interaction and participation in leisure activities. The use of new technologies and creative problem solving with staff are ways in which residents could enhance their social lives and remain engaged in leisure activities.
Article
This study explored how nursing staff promote person-centeredness in long-term care settings. The study used an anthropological free-listing approach to data collection and qualitative content analysis to analyze written self-report descriptions from a convenience sample of Swedish long-term care staff (N = 436). The analyses resulted in four themes that illuminate how nursing staff promote person-centeredness: Promoting Decision Making, Promoting a Meaningful Living, Promoting a Pleasurable Living, and Promoting Person-hood. The study contributes to the literature by providing concrete descriptions of how person-centeredness was facilitated by staff in their everyday practice and contributes to move person-centeredness from the philosophical, policy, and conceptual domains toward clinical implementation. The study also suggests that promoting pleasure for residents is a dimension central to person-centeredness and to health-promoting gerontological nursing, and that "small talk" is an emerging nursing phenomenon that deserves more research attention. [Journal of Gerontological Nursing, xx(x), xx-xx.].
Article
Article
Despite continuing interest in the physical activity-mental health relationship, few studies have recently been published concerning the effects of exercise for men with serious mental illness. This study helps fill this gap through an interpretive approach that explores how sport and exercise can contribute to recovery from mental illness. Case studies of two men's experiences are presented that illustrate two distinct roles sport and exercise can play. In the first case, sport and exercise are central to the participant's identity and fundamental to his sense of self. For this individual, returning to sport and exercise following remission of psychotic symptoms represents a return to intrinsically meaningful activities. In the second case, sport and exercise are used as a tool or vehicle for desired outcomes that facilitate personally meaningful vocational activities. For this individual, sport and exercise represent a fresh start and a worthwhile use of time.
Article
Background: Providing everyday activities is central to high quality residential aged care, but further research is needed on the association between activity participation, person-centred care and quality of life. Aims and objectives: To explore the point-prevalence of participation in everyday activities for residents with dementia within a national sample of Swedish residential aged care units and to explore if residents participating in everyday activities lived in more person-centred units and/or had higher quality of life as compared to residents not participating in everyday activities. Design and methods: A cross-sectional design was used to collect valid and reliable questionnaire data on activity participation, unit person-centredness and quality of life in a sample of residents in residential aged care (n = 1266). Results: Only 18% of residents participated in everyday activities such as making coffee, setting or clearing the table, cleaning or watering plants, 62% participated in outdoor walks, 27% participated in parlour games, and 14% and 13% participated in excursions and church visits, respectively. Those residents who had participated in everyday activities lived in more person-centred units, had significantly higher quality of life and higher cognitive scores as compared to those residents who had not participated in everyday activities. Conclusions: Even though the prevalence of resident participation in everyday activities was low, resident participation was significantly associated with unit person-centredness and resident quality of life. It seems that everyday activities that are routine and commonplace to residential aged care can be potent nursing interventions for promoting resident quality of life.
Article
This study aimed to clarify the concept of productive engagement as it applies to older adults. The concept analysis was based on Walker and Avant's eight-step method. A literature review of articles published in English between 1990 and 2011 (n = 37) was conducted, using an electronic search of multiple sources. Results revealed that four defining attributes for productive engagement include continuing to work either paid or unpaid, caring for others, engaging in social activities, and growing spirituality. The antecedents of productive engagement are sociocultural factors as well as individual and institutional capacities. Meanwhile, the consequences are increased feelings of usefulness, improved health and well-being, aged successfully, and enhanced quality of life. Model, borderline, and contrary cases are presented to illustrate the concept's defining attributes. Defining the concept of productive engagement provides a basis for nurses and other health professionals to better understand productive engagement in older adults, thus effective strategic plans or programs for promoting productive roles among older adults can be further developed.
Article
In recent years, researchers have investigated the psychological effects of exercise for people with mental health problems, often by focusing on how exercise may alleviate symptoms of mental illness. In this article I take a different tack to explore the ways in which exercise contributed a sense of meaning, purpose, and identity to the life of one individual named Ben, a runner diagnosed with schizophrenia. Drawing on life history data, I conducted an analysis of narrative to explore the narrative types that underlie Ben's stories of mental illness and exercise. For Ben, serious mental illness profoundly disrupted a pre-existing athletic identity removing agency, continuity, and coherence from his life story. By returning to exercise several years later, Ben reclaimed his athletic identity and reinstated some degree of narrative agency, continuity, and coherence. While the relationships between narrative, identity, and mental health are undoubtedly complex, Ben's story suggests that exercise can contribute to recovery by being a personally meaningful activity which reinforces identity and sense of self.
Article
The term person-centred care has become all-pervasive on the UK dementia care scene. It has been suggested that it has become synonymous with good quality care. It seems that any new approach in dementia care has to claim to be pc (person-centred) in order to be P.C. (politically correct). The term is used frequently in the aims and objectives for dementia care services and provision in the UK and the US, although what lies behind the rhetoric in terms of practice may be questionable.
Article
This paper presents a conceptual framework for person-centred practice with older people. The research from which the framework was developed was guided by hermeneutic philosophy and integrated processes of conversation analysis and reflective conversation in data collection and analysis. The research findings suggested that nurses need to be able to particularize the person that the patient is, the relationship that exists between them and the patient, and the understandings and expectations implicit in the relationship. From these findings a conceptual framework for person-centred practice was developed. In the framework, person-centredness is premised on the concept of authentic consciousness and is operationalized through five imperfect duties. The factors that enable person-centredness to operate in practice are identified as the patient's values, the nurse's values and the context of the care environment. Considerations for implementing the model in practice are highlighted.
Article
A number of studies have sought to establish the social psychological factors involved in the maintenance of active lifestyles during long-term unemployment. The aim of this study was to describe and account for the development and maintenance of different patterns of activity, with reference to their perceived meaningfulness. This was undertaken with a sample of Birmingham's inner city, long-term unemployed population recruited from three inner city Jobcentres, including men and women, and White, Asian and African Caribbean participants (N = 24). Interviews were conducted using a semi-structured interview guide. Using the qualitative software program, NUD.IST, the data were analysed according to the principles of the grounded theory approach. Activities were characterized as: domestic; educational; work-like; socializing; and none. A model of meaningful activity in the context of formal unemployment was developed. The main components of the model were: features of formal employment that inhibited participants' engagement in it; the requirements for personal meaningful activity (challenging activity, effort and commitment, and being valued by others); the consequences of meaningful activity (opportunities for self-determination and self-development, and achievement, competence, and confidence) and consolidating factors (social comparison, self-appraisal, religious and political beliefs, and social support). Theories of unemployment of Jahoda, Warr, and Fryer are considered in the light of the present findings. Copyright © 2002 John Wiley & Sons, Ltd.