Early in our longitudinal qualitative study on meaningful engagement and quality of life among assisted living (AL) residents with dementia, researchers observed differences between the activities scheduled on monthly engagement calendars and those taking place. Yet, we were unable to identify any research examining such deviations or their implications. Thus, drawing on data from three diverse AL communities studied over a one-year period, we aim to: 1) examine deviations in scheduled engagement programming; 2) identify influential factors; and 3) understand resident outcomes. Our analysis identified general adherence to calendars but also deviations involving cancellations and substitutions. Factors influencing deviations included staff and staffing, engagement capacity, programming guidance and support, care staff attitudes and beliefs, and unforeseen circumstances. Cancellations typically meant resident inactivity and sometimes boredom, disappointment, and anxiety; substitutions appear less detrimental. This analysis has implications for research and practice and underscores the significance of engagement among persons living with dementia.
AbbottK. M.HeidA. R.KlebanM.RovineM. J.Van HaitsmaK. (2018). The change in nursing home residents' preferences over time. Journal of the American Medical Directors Association, 19(12), 1092–1098. https://doi.org/10.1016/j.jamda.2018.08.004
2.
BenderA. A.HalpinS. N.KempC. L.PerkinsM. M. (2021). Barriers and facilitators to exercise participation among frail older African American assisted living residents. Journal of Applied Gerontology, 40(3), 268–277. https://doi.org/10.1177/0733464819893923
3.
BurgessE. O.KempC. L.BenderA. A. (2022). “It’s going to be different for everyone”: Negotiating quality of life and care priorities within care convoys. Journal of Aging and Health, 34(4-5), 602–613. https://doi.org/10.1177/08982643211052367
4.
CiofiJ. M.KempC. L.BenderA. A. (2022). Assisted living residents with dementia: Being out in the world and negotiating connections. The Gerontologist, 62(2), 200–211. https://doi.org/10.1093/geront/gnab113
5.
Cohen-MansfieldJ.Dakheel-AliM.MarxM. S. (2009). Engagement in persons with dementia: The concept and its measurement. American Journal of Geriatric Psychiatry, 17(4), 299–307. https://doi.org/10.1097/JGP.0b013e31818f3a52
6.
Cohen-MansfieldJ.MarxM. S.WernerP. (1992). Observational data on time use and behavior problems in the nursing home. Journal of Applied Gerontology, 11(1), 111–121. https://doi.org/10.1177/073346489201100109
7.
DienerWirtzD.TovW. (2010). New measures of well-being: Flourishing and positive and negative feelings. Social Indicators Research, 39(1), 247–266. https://doi.org/10.1007/s11205-009-9493-y
8.
DobbsD.MunnJ.ZimmermanS.BoustaniM.WilliamsC.S.SloaneP.S.ReedP.S., (2005). Characteristics Associated With Lower Activity Involvement in Long-Term Care Residents With Dementia, The Gerontologist,Volume 45, Issue suppl_1, Pages 81–86, https://doi.org/10.1093/geront/45.suppl_1.81
9.
DysS.CarderP. C.ElliottS. (2018). Online marketing practices of assisted living communities in Oregon. Seniors Housing and Care Journal, 26(1), 74–82.
10.
FazioS.PaceD.MaslowK.ZimmermanS.KallmyerB. (2018). Alzheimer’s Association dementia care practice recommendations. The Gerontologist, 58(suppl_1), S1–S9. https://doi.org/10.1093/geront/gnx182
HanA.RadelJ.McDowdJ. M.SabataD. (2016). Perspectives of people with dementia about meaningful activities: A synthesis. American Journal of Alzheimer's Disease and Other Dementias, 31(2), 115–123. https://doi.org/10.1177/1533317515598857
13.
HeidA. R.AbbottK. M.RovineM. J.EshraghiK.MadrigalC.CrumbieV.Van HaitsmaK. (2022). The stability of nursing home residents’ ratings of importance of recreation preferences over one year. Journal of Applied Gerontology, 41(8), 1942–1951. https://doi.org/10.1177/07334648221089239
KempC. L.BallM. M.HollingsworthC.LeporeM. J. (2010). Connections with residents: “It’s all about the residents for me. In BallM. M.PerkinsM. M.HollingsworthC.KempC. L. (Eds.), Frontline workers in assisted living (pp. 147–170). Johns Hopkins University Press.
16.
KempC. L.BallM. M.PerkinsM. M. (2013). Convoys of care: Theorizing intersections of formal and informal care. Journal of Aging Studies, 27(1), 15–29. https://doi.org/10.1016/j.jaging.2012.10.002
17.
KempC. L.BenderA. A.CiofiJ.Craft MorganJ.BurgessE. O.DuongS.EppsF. R.HillA. M.ManleyP. R.SeaseJ.PerkinsM. M. (2021). Meaningful engagement among assisted living residents with dementia: Successful approaches. Journal of Applied Gerontology, 40(12), 1751–1757. https://doi.org/10.1177/0733464821996866
18.
KempC. L.BenderA. A.MorganJ. C.BurgessE. O.EppsF. R.HillA. M.PerkinsM. M. (2023). Understanding capacity and optimizing meaningful engagement among persons living with dementia. Dementia, 22(4), 854–874. https://doi.org/10.1177/14713012231162713
19.
KempC. L.Craft MorganJ.BenderA. A.HillA. M.AnglinE.BurgessE. O.EppsF.PerkinsM. M. (2024). “Just join them”: Improv and dementia care. Journal of Applied Gerontology, 43(3), 302–309. https://doi.org/10.1177/07334648231203195
20.
MansbachW. E.MaceR. A.ClarkK. M.FirthI. M. (2017). Meaningful activity for long-term care residents with dementia: A comparison of activities and raters. The Gerontologist, 57(3), 461–468. https://doi.org/10.1093/geront/gnv694
21.
MorganJ. C.KempC. L.BarmonC.FitzroyA. F.BallM. M. (2021). Limiting and promoting resident self-care in assisted living. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 76(8), 1664–1672. https://doi.org/10.1093/geronb/gbab016
22.
NojabaeeA.SalehmoghaddamA. R.MazlomS. R.AsgharipourN.MohajerS. (2018). Effect of flourishing promotion program on social health in the elderly. Evidence Based Care, 8(2), 39–48. https://doi.org/10.22038/ebcj.2018.30277.1749
23.
OfficeE. E.RodensteinM. S.MerchantT. S.PendergrastT. R.LindquistL. A. (2020). Reducing social isolation of seniors during COVID-19 through medical student telephone contact. Journal of the American Medical Directors Association, 21(7), 948–950. https://doi.org/10.1016/j.jamda.2020.06.003
24.
ParkE. Y.KimJ. H. (2022). Activity preferences among older people with dementia residing in nursing homes. Frontiers in Psychology, 12(1), Article 799810. https://doi.org/10.3389/fpsyg.2021.799810
PlysE. (2019). Recreational activity in assisted living communities: A critical review and theoretical model. The Gerontologist, 59(3), e207–e222. https://doi.org/10.1093/geront/gnx138
27.
SandhuN. K.KempC. L.BallM. M.BurgessE. O.PerkinsM. M. (2013). Coming together and pulling apart: Exploring the influence of functional status on co-resident relationships in assisted living. Journal of Aging Studies, 27(4), 317–329. https://doi.org/10.1016/j.jaging.2013.07.001
28.
ScalesK.LeporeM. J. (2020). Always essential: Valuing direct care workers in long-term care. Public Policy and Aging Report, 30(4), praa022. https://doi.org/10.1093/ppar/praa022
29.
SenguptaM.ZimmermanS.Harris-KojetinL. (2019). Activity engagement in residential care settings: Findings from the national survey of residential care facilities. Journal of Housing for the Elderly, 33(2), 120–139. https://doi.org/10.1080/02763893.2018.1534178
30.
Van HaitsmaK.AbbottK. M.ArbogastA.BangerterL. R.HeidA. R.BehrensL. L.MadrigalC. (2020). A preference-based model of care: An integrative theoretical model of the role of preferences in person-centered care. The Gerontologist, 60(3), 376–384. https://doi.org/10.1093/geront/gnz075
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