Resident Engagement and Loneliness
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One of the most common problems for residents in assisted living and nursing home facilities is loneliness. It is paradoxical that so many residents, both those with and without dementia (but especially those with dementia) feel loneliness even as they live in social communities.  The experience of so many residents can be described as “feeling alone in a crowd.”

Why is this?  There are many contributory factors, some of which are resident internal factors while some are environmental.  The need for engagement with peers and others can be intensified when people experience important losses – to their social support systems, their places of residence, health statuses (including cognition), and occupational roles.  Of course, the association between these losses and loneliness can be compounded when the social environment fails to provide enough opportunities for true engagement for residents.

One of the initiatives we have at the BCAT Research Center is to investigate and create optimal programs that encourage resident engagement.  These programs are based on two central assumptions: (1) that both peer-to-peer and staff-to-peer engagement is important in promoting psychological well-being; and (2) optimal engagement should be person-centered. That is, the quality and quantity of engagement differs from person to person, and facilities, if they are to be true communities, must create programs with this in mind.

We define resident engagement in terms of a three-level approach.  Each level should be integrated not only in formal activity or recreation programs, but should also be part of routine staff-resident interactions (during personal care, dining, dispensing medications).  These levels fall on a continuum of meaningfulness for the individual resident.  There can be overlap in the experiences of these levels. We define them as:

  • Meaningful engagement – These are interactions and activities that the resident experiences as meaningful to her.  The content tends to activate old memories, and tap into former roles and interests (jobs, hobbies).  These interactions are relatable for the resident. An example of a tool designed for promoting meaningful engagement is the BCAT MemPics® books series.
  • Purposeful engagement – These interactions and activities are about action and participation, though they are not intended to be truly meaningful for the resident.  They are doable. The emphasis in on active participation. Certainly they should be fun or enjoyable. Examples are physical exercise and brain games.  (Keep in mind that a purposeful engagement interaction for one resident may be a meaningful for another resident.)
  • Passive engagement – These are interactions and activities in which the resident has very little active participation.  From the standpoint of promoting well-being and reducing loneliness, passive engagement has the lowest value.  Examples are “parking” a resident at an activity in which she cannot really participate, providing personal care with a minimum of social interaction and engagement.

Unfortunately in most assisted living and nursing facilities, the majority of activities and interactions are passive engagements, especially for those who have dementia. There is ample evidence that when facilities instead create opportunities for purposeful and meaningful engagement, residents well-being and physical health improves; and instances of behavioral agitation decrease. Therefore, a clear premium should be put on the training of staff and the implementation of these higher-quality activities and interactions.

Understanding specifically how much meaningful and purpose engagement is necessary is to reduce loneliness and improve health outcomes is unclear, and remains an important research focus for the BCAT Research Center.  The devil may be in the details, but ultimate success begins with a commitment to the assumptions underlying resident engagement.

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