Definitions and Measurement of Engagement in Persons with Dementia: A Scoping Review

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Journal of Aging and Long-Term Care


Creating meaningful engagement for a person with dementia is recognized as a non-pharmacological approach to enhancing their well-being and decreasing their agitation, anxiety, and depression. However, no standard definition of engagement exists. A scoping review was conducted to examine the current definitions of engagement in persons with dementia and the measurement of engagement. The literature search was conducted using CINAHL/EBSCO and PubMed for the years 2016-2021 using the search terms “dementia AND elderly AND engagement.” A screening process was developed, with articles meeting inclusion criteria independently reviewed by at least two team members. A follow-up of publications of the key authors was conducted alongside a search of the gray literature. Congruent themes of the definitions were identified, and articles were grouped into thematic categories. The two major themes of engagement definitions: were social contact/interaction and response to activity and/or stimuli, and two minor themes, meaningful/ satisfying activity and program/activity attendance, were found in the literature. The measurement of engagement reflected the two major themes of definitions reviewed and was primarily captured through observation. Major components of the three observation-based scales were similar, capturing affect, attitude, and attention in various formats and degrees. A comprehensive definition, combining key aspects of the cited definitions developed by the researchers, follows the Emotional and/or behavioral response generated by introducing stimuli through social or activity-based interactions that are meaningful to the individual and create satisfaction. The current observational approach to capture engagement is impractical for clinical use as it is subjective and time-consuming. This scoping review reveals the need for objective technology-based tools that capture the holistic concept of engagement among persons with dementia.