Unlocking the benefits of montessori-based reading activities in nursing home: A multiple baseline study on groups of individuals with severe dementia

OBJECTIVE

Group activities are commonly offered to residents of nursing homes, and increasingly with a person-centred care approach. The aim of this study is to compare the impacts of a Montessori-based reading activity with a more traditional reading activity.

METHOD

A multiple baseline design was used, with 3 groups of 5 older adults with moderate to severe dementia. All sessions were videorecorded and analysed by independent judges, blinded to our hypotheses and conditions. Impacts of the type of activity (storytelling or Montessori-based reading) on verbal interactions, engagement level, affect and behavioural aspects were estimated with both visual analyses and statistical analyses using the between-case standardised mean differences method.

RESULTS

Significant differences were found in favour of the Montessori-based activities with regard to the number of verbal interactions, constructive and passive engagement and positive affect expressed, with moderate to large effect size (from 0.46 to 1.66).

CONCLUSION

The Montessori-based reading group activity really seems to be preferable to a more traditional storytelling activity, with multiple benefits for residents. Depending on the preserved abilities and interests of the participants, it can also be aimed at people with severe dementia.

How to Measure Human-Dog Interaction in Dog Assisted Interventions? A Scoping Review

Human-dog interaction is the working tool through which the therapeutic, educational and recreational goals of dog-assisted interventions (DAIs) are achieved. A better understanding of the characteristics of this interaction could improve the effectiveness of DAIs. This scoping review addresses the question: how has the human-dog connection been measured in the context of DAIs? After searching the Web of Science and Scopus platforms, only peer-reviewed, primary research studies reporting measures of therapy dog-human interaction, relationship and bond were included. A total of 70 included articles provided information on what was measured (interaction, relationship or bond) and how, as well as the general context (DAIs or experimental situations with therapy dogs). While the majority of the articles identified use behavioural analysis methods to analyse the interaction between the participant/recipient and the therapy dog during DAIs, it was possible to identify some more structured tools that assess the participant/recipient's interaction, relationship or bond with the therapy dog, as well as tools that consider the animal's perspective or focus on the dog-handler dyad, indicating growing areas of research. The tools and methods identified can be used by both practitioners and researchers to further explore aspects of human-dog interaction in the field of DAIs.

A scoping review on the psychosocial interventions used in day care service for people living with dementia

BACKGROUND

Adult Day care centres provide an important aspect of care provision through all phases of the dementia illness from diagnosis to the end of life (Dabelko HI 2008) supporting the well-being of both older people living with dementia and their care partners. Services within adult day care settings are designed to provide biopsychosocial health benefits to participants as well as care partner respite.

OBJECTIVE

To examine research studies, literature reviews and grey literature and identify and map the literature on psychosocial interventions used in day care services for older people living with dementia and chart their use, evaluation and outcomes. The research review question is "what are the psychosocial interventions used in day care service for older people living with dementia?" Psychosocial interventions are important non-pharmacological interventions which support people's wellbeing.

METHODS

Inclusion/Exclusion criteria were identified and guided the search strategy. Participants were people aged 60 years and over living with dementia attending day care services. The use of psychosocial interventions for this cohort was the focus of the review. Databases were searched (Cochrane Reviews, CINAHL, Embase, Medline EBSCO, Medline Ovid, Medline PubMed, PsycINFO, Scopus, Open Grey, Lenus and WHO Global Index Medicus databases) using keywords/terms with Boolean operators from 2011 to 2023. Rayyan was used to extract and manage the data.

RESULTS

The findings present a narrative and charting of the data from the 45 papers that met the review criteria, and this data is mapped onto the five objectives. Within this review, interventions were grouped into five broad types: nature (n = 6 papers), memory/cognitive (n = 11 papers), social (n = 17 papers), animal (n = 4 papers), or physical/sensory (n = 7 papers) based interventions.

CONCLUSIONS

This review has illustrated the wide variety in the types, range and facilitation of psychosocial interventions within adult day care services. This review highlights the potential benefits of these interventions. However, findings must be considered in the context that many were provided as brief intervention studies with little evidence of continuation after the study and further research is required given the complex and diverse range of interventions. Results will be of interest to practitioners planning to implement or evaluate psychosocial interventions used in day care services for older people living with dementia.

Roles and usages of neuro service dogs for caregivers living at home with persons with dementia: An exploratory comparative case study

The goal of the present study was to examine how canine assistance may support family caregivers and persons with dementia and to document and compare two modalities of home care support. An exploratory comparative case study research design was conducted. Three cases correspond of dyads of a caregiver, a person with mild to moderate dementia, and either a neuro service dog (NSD), a companion dog or no dog. Hypotheses are formulated to capture differences between cases. Recruitment was done in a service dog organisation, through Canadian Alzheimer associations and in records of a hospital. Data were collected through 45-60 minutes telephone interviews that included completion of the Caregiver's Burden Scale and sociodemographic questions. We used an inductive approach with qualitative data. There were five caregivers (mean age 54.8 years) who had an NSD, 28 caregivers (63.6 years) who had a companion dog, and 23 caregivers (63.8 years) without dog. In the category of roles and usages of the dog, 'Socialisation' and 'Help with a sense of direction' were the most addressed roles for dyads with the NSD. For dyads with companion dog and without dog, 'Engagement-and-meaning of life' as well as 'Physical activity with the dog' were the most discussed roles. The 'Sleep or wake up' role was the least discussed role across three cases. In the other categories, they were seven advantages and 10 inconvenients that were mentioned for canine assistance. For home care support, the presence of NSD has more positive impacts on both the person with dementia and their caregiver compared to the presence of a companion dog; the presence of a NSD results in the person with dementia accessing more indoor and outdoor public sites than with a companion dog; and dyads with a dog are informally socially engaged more frequently than those with no dog.

Animal-assisted and robotic animal-assisted interventions within dementia care: A systematic review

BACKGROUND

Animal-assisted interventions and robotic animal interventions are becoming increasingly popular to support the care of people with dementia and may have the potential to improve a range of psychosocial outcomes. This review aims to identify, describe, and compare animal-assisted and robotic animal interventions delivered to people with dementia, their characteristics, effectiveness, and the proposed mechanisms underlying any potential impact.

METHODS

A systematic literature search was conducted in MEDLINE, AMED, EMBASE, PsycINFO, OVID Nursing, PubMed, CINAHL and Web of Science. Random-effects meta-analyses of randomised controlled trials (RCTs) were conducted to summarise studies that evaluated common outcomes (agitation, depression, quality of life). A narrative approach was used to synthesise other findings.

RESULTS

Fifty-one studies were included: 18 RCTs; 12 non-randomised trials, 13 cohort studies, 7 qualitative studies and one mixed-methods study. Meta-analyses were conducted for a small number of RCTs, with effectiveness of animal-assisted interventions demonstrated for agitation. Narrative findings suggested animal-assisted and robotic animal interventions may be promising in improving depression, agitation, and quality of life. Three potential mechanisms of action were identified for both animal-assisted and robotic animal interventions, namely enhancing social connections, providing engaging and meaningful activities, and the affect-generating aspect of the human-animal bond. A fourth mechanism was identified for animal-assisted interventions only: promoting physical activity. Robotic animals appear to have a place in complex human-animal relationships, but a greater understanding of robotic animal interventions is required to harness the benefits that may be derived from their use.

CONCLUSION

Delivering these interventions appear promising in improving psychosocial outcomes for people with dementia. As most included studies had methodological limitations, these findings are preliminary, but contribute to the body of evidence providing an understanding in terms of intervention characteristics and mechanisms of action. When developing intervention guidance, attention should be given to potential mechanisms and fundamental characteristics such as session content, delivery format and facilitator role.

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

INTRODUCTION

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

METHODS

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

FINDINGS

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

CONCLUSION

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

Handlers’ Representations on Therapy Dogs’ Welfare

Simple Summary

Most research about Animal-Assisted Interventions (AAI) has focused on the benefits on human health. In contrast, very little has been made on the impact of this work on therapy dogs, although it is part of the ethics of the practice to ensure their welfare. This study aimed to contribute to the knowledge on the welfare of therapy dogs by interviewing 111 handlers through an online questionnaire. The qualitative assessment of handlers’ representations underlined that the welfare of therapy dogs is multidimensional and can be impacted by various variables. Its consideration is important for the quality and safety of the sessions, both for the dog and for the beneficiaries involved. Handlers have a central role in the welfare of their therapy dog and must be trained on stress-related behaviors. Research needs to focus on the impact of interactions on therapy dogs.

Abstract

While research on the benefits of animal-assisted interventions is beginning to build a significant body of work, studies on the well-being of therapy dogs are still in their infancy. Since handlers are the people responsible for their therapy dog’s welfare, we interviewed 111 French handlers through an online questionnaire. Our results underlined that (i) therapy dogs’ welfare is multidimensional when physical and psychological welfare, a balance between work and dog life and the settings and interactions of sessions are all taken into consideration. (ii) The response of our handlers emphasized that considering therapy dog welfare is important for the quality and safety of AAI. (iii) Three categories of risks factors were highlighted: the spatio-temporal framework (planning and environment), the interactions with beneficiaries and the handler themselves. It is particularly important that handlers talk about the negative impact of interactions with beneficiaries since they are at the heart of AAI, however there are few studies focusing on interactions as a stressor for dogs in this practice. Moreover, since there is a potential for positive bias in the handlers’ representations, it is important that they be trained to identify and manage the stress in their dogs. Future research is particularly needed on the impact of interactions during sessions on therapy dog welfare.

Activity Preferences Among Older People With Dementia Residing in Nursing Homes

The study aimed to examine the influence of personal characteristics on activity preferences using decision tree analysis and examine the effects of the variables using conventional approaches (logistic regression analysis). A descriptive study was conducted with 251 nursing home residents with dementia in Korea (76.9% female) to examine the relationship between their personal characteristics and activity preferences. Decision tree analysis was used to classify participants’ activity preferences, and preference levels were examined using logistic regression analysis. Activities were classified as either physical and social activities or cognitive and affective activities. This model showed an accuracy rate of 85.7% for positively predicting physical and social activity preference and 30.3% for positively predicting cognitive and affective activity preference. Gender was the strongest determinant of activity preference. The odds of preferring physical and social activities were 3.179 times higher among women, while the odds for preferring cognitive and affective activities were 0.412 times higher among men. Notably, cognitive and affective activity preference increased to 58.8% for married male participants. This study’s findings can contribute to the development of programs to decrease behavioral and psychological symptoms among older people with dementia residing in nursing homes and provide scientific evidence for integrating these activities into long-term services for this population.

Animal-Assisted Interventions for Dementia: A Systematic Review

Behavioral and psychological symptoms of dementia (BPSD) can be devastating for people who have dementia and their families. More than 5 million Americans are living with dementia, and approximately 97% of these individuals have BPSD, including agitation, aggression, anxiety, depression, apathy, sleep disturbances, wandering, and disinhibition. Animal-assisted interventions (AAI) have increasingly been used to treat these symptoms in individuals with dementia and constitute an optimal nonpharmacological treatment strategy. The current review aims to explore the literature regarding AAI in treating BPSD. Of 3,573 publications reviewed, 15 articles met inclusion criteria. All studies included a type of AAI exploring BPSD within individuals with dementia. The systematic review unveils AAI may be beneficial for those with dementia; however, further research is necessary to address limitations in the existing literature. [Research in Gerontological Nursing, 14(6), 317-324.].

Assisted Living Residents with Dementia: Being Out in the World and Negotiating Connections

BACKGROUND AND OBJECTIVES

Persons living with dementia, including long-term care residents, and their care partners emphasize the importance of meaningful engagement and stress the need for activity and opportunities to go outdoors or offsite. Yet, little is known about getting out in this population. Here, our objectives are to: 1) identify residents' opportunities for, and experiences with, getting out; 2) understand the significance of getting out; and 3) explain influential factors.

RESEARCH DESIGN AND METHODS

Guided by grounded theory methods, we analyzed qualitative data collected over a one-year period in four diverse assisted living communities. We followed 33 residents with dementia and their care partners. Data include detailed fieldnotes capturing 1,560 observation hours, 114 interviews with residents (where possible), assisted living staff, family members, and other visitors, and record review.

RESULTS

We identified the centrality of "being out in the world and negotiating connections," which characterizes residents' experiences with the outside world as a process of 'working out' engagement with nature, others, and the community. Being out in the world was consequential to well-being and quality of life. Most residents got out at least occasionally; some lacked opportunities. Among residents who got out, most benefitted from ensuing connections. Yet, not all experiences were positive. Being out in the world varied over time and by individual-, convoy-, AL community-, and neighborhood-level factors.

DISCUSSION AND IMPLICATIONS

We discuss the implications of our findings for research and practice surrounding meaningful engagement among persons with dementia, including during crises such as the pandemic.

Dog visits in nursing homes - increase complexity or keep it simple? A randomised controlled study

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: F_1,85 = 5.17, P < 0.05) and talking to it directly (period 1: F_1,90 = 4.60, P < 0.05; period 3: F_1,87 = 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: F_1,89 = 7.89, P < 0.01; period 2: F_1,97 = 6.76, P = 0.01; period 3: F_1,92 = 13.57, P < 0.001) and talking about the activities (period 1: F_1,89 = 13.78, P <0.001; period 2: F_1,88 = 3.27, P = 0.07; period 3: F_1,86 = 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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The Smiles of Older People through Recreational Activities: Relationship between Smiles and Joy

Recreational activities are found to increase people's smiles, arising joy in older people, but there is limited research on this topic within the Japanese context. This cross-sectional study aimed to measure the quality and frequency of smiles in older people living in rural settings using a smile analysis application. The participants comprised 13 females aged over 65 years who lived in Unnan City, Japan, and regularly attended recreational meetings. In this study, the recreational activity that the participants joined was a game called Mattoss. A video camera captured the participants' faces, while a smile assessment application assessed their facial expressions for smiles and joy. A total of 2767 smiles were recorded. For validity, we calculated the Spearman's rho score between smile and joy, which was 0.9697 (p < 0.001), while for reliability, we determined the Spearman's rho score for each participant, which exceeded 0.7 (p < 0.001). Surges of smiles were induced by one's own mistakes, successes, and big mistakes in the game and by severe or mild judgments by the referee. High validity and reliability of smile evaluation were demonstrated. The study found that smiling increased during recreational activities. Therefore, recreational activities can be encouraged for older people living in rural communities.

Effects of non-facilitated meaningful activities for people with dementia in long-term care facilities: A systematic review

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Most activity interventions for people with dementia in long-term care are facilitated.

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Non-facilitated meaningful activities included music/stimulated family presence, animal-like social robot, lifelike dolls.

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Some beneficial effects for agitation, emotional wellbeing, feelings of pleasure, engagement and sleep quality.

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Future research into the potential benefits of non-facilitated meaningful activities is needed in rigorously designed RCTs.

This systematic review sought to evaluate the effectiveness of non-facilitated meaningful activities for older people with dementia in long-term care facilities. Searches were conducted in PubMed; CINAHL; EMBASE; Web of science; PsycINFO; Cochrane; ProQuest; and ClinicalTrials.gov to identify articles published between January 2004 and October 2019. A total of six studies were included. Results implied that current randomised controlled trials or controlled trials about non-facilitated meaningful activities for people with living dementia in long-term care facilitates are limited, but those included in this review were of adequate methodological quality. Meaningful non-facilitated activities, such as music, stimulated family presence, animal-like social robot PARO/plush toy and lifelike dolls, may have beneficial effects on agitation, emotional well-being, feelings of pleasure, engagement, and sleep quality. However, there remains a lack of conclusive and robust evidence to support these psychological and physiological effects of non-facilitated meaningful activities for older people with dementia living in long-term care facilities by care staff.

Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis

OBJECTIVE

To comprehensively review studies on dog-assisted interventions (DAIs) among older people in residential long-term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality.

METHOD

We searched 18 electronic databases to identify English articles (published January 2000-December 2019) reporting on well-defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta-analyses.

RESULTS

Forty-three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low-quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random-effects meta-analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21-1.11; I²  = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI.

IMPLICATIONS FOR PRACTICE

The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence-base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults.

Exploring the perceptions of people with dementia about the social robot PARO in a hospital setting

New technology, such as social robots, opens up new opportunities in hospital settings. PARO, a robotic pet seal, was designed to provide emotional and social support for older people with dementia. We applied video-ethnographic methods, including conversational interviews and observations with video recording among 10 patient participants while they were using the robot. We also conducted semi-structured individual interviews and focus groups with nursing staff to gain contextual information. Patient and family partners were actively involved in the study as co-researchers. This study reports our findings on the perceptions of 10 patients with dementia about their experiences with PARO in a hospital setting. Thematic analysis yielded three substantive themes: (a) ‘it’s like a buddy’ – the robot helps people with dementia uphold a sense of self in the world, (b) ‘it’s a conversation piece’ – the baby seal facilitates social connection and (c) ‘it makes me happy’ – PARO transforms and humanizes the clinical setting. Our findings help provide a better understanding of the perspectives of patients with dementia on the use of social robots.

Effectiveness of the dog therapy for patients with dementia - a systematic review

BACKGROUND

Dementia represents a mental and economic burden for both patients and their caregivers. Therefore, the aim of this study is to explore the effectiveness of animal assisted therapy (AAT) with special focus on canis therapy among people with dementia, specifically Alzheimer's disease.

METHODS

The key method of this review study is a systematic review of the research studies detected in the Web of Science, Scopus and PubMed. The search was conducted for the studies dating from 2016 till 31 August 2018 because several review studies were published before. Eventually, only six studies were involved into the final analysis.

RESULTS

The findings of this review, based on significant effect sizes, reveal that AAT may work as a beneficial and effective complementary treatment, especially in the area of behavioral and psychological symptoms, for patients with different degree of dementia severity if AAT is targeted at their specific needs and interests.

CONCLUSIONS

More research in the area of methodology for the implementation of AAT is necessary, and more research should be conducted with respect to the use of AAT for the improvement of cognitive functions in people with dementia.

Effectiveness of a Combined Intervention on Psychological and Physical Capacities of Frail Older Adults: A Cluster Randomized Controlled Trial

BACKGROUND

Older adults experience physical and psychological declines affecting independency. Adapted and structured combined interventions composed of cognitive stimulation and physical exercise contribute to comorbidities' reduction. Methods: Multicenter single-blinded two-arm cluster randomized controlled trial conducted to assess effectiveness of a combined intervention (CI), composed of a cognitive stimulation program (CSP) and a physical exercise program (PEP), on psychological and physical capacities of frail older adults as to on their activities of daily living. Were recruited 50 subjects from two elderly end-user organizations. Of these, 44 (65.9% females, mean age of 80.5 ± 8.47 years) were considered eligible, being randomly allocated in experimental (EG) or control group (CG). Data collected at baseline and post-intervention. EG received CI three times a week during 12 weeks. CG received standard care. Non-parametric measures were considered. Results: At baseline, groups were equivalent for study outcomes. The comparison of pre- and post-intervention data revealed that subjects receiving CI reduced depressive symptomatology and risk of fall based on gait and balance, and improved gait speed. Simultaneously, in the CG a significant decline on activities of daily living was observed. Significant results were found among biomechanical parameters of gait (BPG). EG' effect size revealed to be small (0.2 ≤ r < 0.5). CG' effect size was also small; but for activities of daily living there was an evident decrease. Conclusion: The CI is effective on managing older adults' psychological and physical capacities.

Attendance in Recreational Groups for Persons With Dementia: The Impact of Stimulus and Environmental Factors

OBJECTIVES

Participation in group activities can benefit persons with dementia, alleviating boredom, improving affect, maintaining function, and decreasing problematic behaviors.

METHODS

We describe patterns of attendance of residents with dementia at nursing home activity groups and investigate stimulus and environmental factors that may affect attendance.

RESULTS

Residents participated in 60.8% of the activities, with reasons for nonattendance including refusal (9.7%), not being on the unit (7.8%), being asleep (6.8%), and being involved in activities of daily living and other activities (8.3%). On average, 3.5 other residents not recruited for the study chose to participate in each group session. Group attendance was significantly related to group topic.

IMPLICATION

The need for activities was evident by the attendance of both invited and other residents. Understanding the factors that affect attendance is the first step toward developing procedures to maximize participation in activities in order to decrease loneliness and boredom in this population.

Understanding Engagement in Dementia Through Behavior. The Ethographic and Laban-Inspired Coding System of Engagement (ELICSE) and the Evidence-Based Model of Engagement-Related Behavior (EMODEB)

Engagement in activities is of crucial importance for people with dementia. State of the art assessment techniques rely exclusively on behavior observation to measure engagement in dementia. These techniques are either too general to grasp how engagement is naturally expressed through behavior or too complex to be traced back to an overall engagement state. We carried out a longitudinal study to develop a coding system of engagement-related behavior that could tackle these issues and to create an evidence-based model of engagement to make meaning of such a coding system. Fourteen elderlies with mild to moderate dementia took part in the study. They were involved in two activities: a game-based cognitive stimulation and a robot-based free play. The coding system was developed with a mixed approach: ethographic and Laban-inspired. First, we developed two ethograms to describe the behavior of participants in the two activities in detail. Then, we used Laban Movement Analysis (LMA) to identify a common structure to the behaviors in the two ethograms and unify them in a unique coding system. The inter-rater reliability (IRR) of the coding system proved to be excellent for cognitive games (kappa = 0.78) and very good for robot play (kappa = 0.74). From the scoring of the videos, we developed an evidence-based model of engagement. This was based on the most frequent patterns of body part organization (i.e., the way body parts are connected in movement) observed during activities. Each pattern was given a meaning in terms of engagement by making reference to the literature. The model was tested using structural equation modeling (SEM). It achieved an excellent goodness of fit and all the hypothesized relations between variables were significant. We called the coding system that we developed the Ethographic and Laban-Inspired Coding System of Engagement (ELICSE) and the model the Evidence-based Model of Engagement-related Behavior (EMODEB). To the best of our knowledge, the ELICSE and the EMODEB constitute the first formalization of engagement-related behavior for dementia that describes how behavior unfolds over time and what it means in terms of engagement.

Animal-Assisted Intervention and Dementia: A Systematic Review

This review discusses the relationship between animal-assisted interventions (AAI) and behavioral and psychological symptoms of dementia (BPSD). A systematic search was conducted within CINAHL, Web of Science CAB Abstracts, PubMed, Abstracts in Social Gerontology, Google Scholar, and PsycINFO for primary research articles. A total of 32 studies were included in the final review. Variation was noted in study designs and in study setting. Twenty-seven of 32 studies used dogs as the intervention. Agitation/aggression showed a significant decrease in nine of 15 studies. Eleven of 12 studies demonstrated increased social interaction with AAI. Mood had mixed results in nine studies. Quality of life was increased in three of four studies. Resident activity and nutritional intake were each increased in two studies. Animal assisted activities/interventions showed a strong positive effect on social behaviors, physical activity, and dietary intake in dementia patients and a positive effect on agitation/aggression and quality of life.

Activity groups for persons with dementia: Personal predictors of participation, engagement and mood

This study examined the relationship between personal characteristics and attendance, engagement, sleep, and mood outcomes of persons with dementia participating in group activities. The purpose of this study is to examine which persons with dementia benefit most from group interventions. Sixty-nine persons with dementia were observed by research and therapeutic recreation staff during 10 types of group activities (reading aloud with discussion, choral-singing, baking, creative storytelling, brain games, active games, exercise, reminiscence poetry, holiday newsletter, and holiday discussions) on multiple outcomes (attendance duration, sleep, engagement, active participation, attitude, and positive mood). Correlations between these outcomes and personal characteristics (demographics, functional and medical characteristics, personal preferences for group activities) were conducted. Variables with significant correlations were then entered into regression analyses. Many of the personal characteristics were significantly correlated with the outcomes. Cognitive function was the most consistent predictor of all outcomes. Personal characteristics, particularly cognitive function, can predict the responses of persons with dementia during group activities.

Group engagement in persons with dementia: The concept and its measurement

Although a few papers documented benefits of group therapeutic activities for individuals with dementia, there is a dearth of studies that have investigated the effects of group activities on persons with dementia. This paper introduces a theoretical framework of studying group therapeutic recreational activity, the Comprehensive Process Model of Group Engagement, and an assessment tool, the Group Observational Measurement of Engagement (GOME). We also report the psychometric properties of this assessment. One hundred and four persons with dementia took part in ten different group activities, with each activity conducted twice at random order so that 20 activities were observed for each group of participants. Following each group activity, research and therapeutic recreation staff members used the GOME assessment to independently rate participants on individual-level measures of attendance duration and engagement, and group level measures (e.g., positive and negative interactions among group members). Reliability and validity analyses comparing observer ratings for each group activity on the individual-level measures of attendance and engagement showed good psychometric properties. Different measures collected on a group level differed with respect to their psychometric quality. We present a theoretical framework to understand group engagement and present measures that could be used in future research and practice.