Meaningful Engagement and Quality of Life among Assisted Living Residents with Dementia

项目概要/摘要 有意义的参与是与艾滋病毒/艾滋病患者一起生活的人的护理质量和生活质量的一个关键方面。 痴呆广泛定义为参与个人和团体活动，参与对以下方面有影响： 幸福，心理健康，认知和身体功能，并显示出作为一种非药理学 解决焦虑、抑郁和行为表达的策略。对于辅助生活（AL）的居民， 对于痴呆症患者来说，这是一个越来越受欢迎的护理环境，参与也可以防止或推迟 搬迁到昂贵和不太喜欢的养老院设置，但代表着一个重大的挑战。虽然 我们的工作表明，大多数AL居民都嵌入了由正式和 非正式的护理伙伴谁支持他们的日常活动，有意义的参与机会，既不是 普遍或持续可用，特别是对痴呆症患者。证据表明， 对痴呆症患者进行有意义的参与，但也要消除潜在的障碍。增速出现明显 公共卫生，实践和政策影响，未知的是什么是有意义的参与，以及如何 以最好地促进它作为跨痴呆类型和功能能力的水平。这项五年研究的总体目标是 确定最佳护理实践，旨在识别，创造和保持最佳的有意义的 为痴呆症患者提供参与机会，提高他们的生活质量。我们的具体目标是：1） 了解什么是对老年痴呆症患者的生活有意义的参与，包括如何 是由护理伙伴感知和协商; 2）了解促进和 限制AL中痴呆症患者生活中有意义的参与机会和经验; 和3）确定促进有意义的参与机会和经验的战略， 痴呆症患者。本研究将使用人种志方法，包括参与者观察， 非正式和正式的面试，并在12个AL设置不同的关键个人，居住地， 和当地社区一级的因素，收集数据，在三个为期一年的时期，涉及4个网站。七十五 患有不同类型痴呆和不同功能能力水平的居民，性别，年龄， 种族和民族，社会经济地位，将有目的地选择和研究沿着， 非正式和正式的护理伙伴。扎根理论方法将指导数据收集和分析， 为居民提供有意义的参与机会和体验，包括 与生活质量的联系。这项研究将支持国家阿尔茨海默氏症计划及其优化护理的呼吁 通过提高对痴呆症患者及其护理伙伴的认识， 参与，包括如何评估其在痴呆症背景下的质量，并确定最佳护理实践 这将使痴呆症患者获得最佳的有意义的参与。

PROJECT SUMMARY/ABSTRACT Meaningful engagement is a critical dimension of quality of care and quality of life for persons living with dementia. Defined broadly as participation in individual and group activity, engagement has implications for well-being, mental health, and cognitive and physical function and shows promise as a non-pharmacological strategy for addressing anxiety, depression, and behavioral expressions. For residents in assisted living (AL), which is an increasingly popular care setting for persons with dementia, engagement also can prevent or delay relocation to costly and less-preferred nursing home settings, but represents a significant challenge. Although our work shows that most AL residents are embedded in care convoys (i.e. networks) comprised of formal and informal care partners who support their daily activities, opportunities for meaningful engagement are neither universally nor consistently available, especially for those with dementia. Evidence points to the importance of meaningful engagement for persons living with dementia, but also to potential barriers. Despite the significant public health, practice, and policy implications, unknown is what constitutes meaningful engagement and how to best promote it as across dementia type and level of functional ability. The overall goal of this five-year study is to identify best care practices aimed at recognizing, creating, and maintaining optimal meaningful engagement opportunities for persons with dementia that enhance their quality of life. Our specific aims are: 1) To learn what constitutes meaningful engagement in the lives of AL residents with dementia, including how it is perceived and negotiated by care partners; 2) To understand the intersecting factors that promote and constrain meaningful engagement opportunities and experiences in the lives of persons with dementia in AL; and 3) To determine strategies that promote meaningful engagement opportunities and experiences for persons living with dementia. This study will use ethnographic methods, including participant observation, informal and formal interviewing, and record review in 12 AL settings that vary by key individual-, residence-, and local community-level factors, collecting data in three 1-year periods involving 4 sites each. Seventy-five residents with different types of dementia and of varying levels of functional ability and diverse in gender, age, race and ethnicity, and socioeconomic position, will be purposively selected and studied along with the informal and formal care partners. Grounded Theory Method will guide data collection and analysis, which will provide significant insight into residents’ meaningful engagement opportunities and experiences, including connections to quality of life. The study will support the National Alzheimer’s Plan and its call to optimize care quality and support persons living with dementia and their care partners by advancing knowledge of engagement, including how to assess its quality in the dementia context, and identifying best care practices that lead to optimal meaningful engagement among persons with dementia.