The Importance of Engagement for People Living With Dementia

About Juliet Holt Klinger

Senior Director of Dementia Care

Juliet is a passionate advocate for people living with dementia and their families. She is deeply committed to improving the cultural acceptance of those with cognitive differences. As our gerontologist and Senior Director of Dementia Care, Juliet develops person-centered care and programming for Brookdale’s dementia care communities. But if you ask her, Juliet says she continues to learn every day from the true experts, those living with dementia and their care partners. Juliet believes we need to move beyond the concept of caregiving, which implies a one-sided relationship, and embrace the idea of care partnering. Care partnering is about relationships built on cooperation—a two-way street promoting person-centered care and mutual feelings of purpose, where the person living with dementia also plays a strong role in shaping their care and daily routine. We are here to partner, learn and grow with our residents and families to make aging a better experience. After volunteering in nursing homes in high school, Juliet knew she wanted to work with older adults. While working on her bachelor’s degree in social work at the University of Iowa, she completed an Aging Studies Certificate program, before there were formal gerontology programs available. At Iowa, Juliet also had the chance to study with pioneers in the field of dementia care, an opportunity that shaped her passion for caring for those living with dementia. Trained as a gerontologist, with a master’s degree from the University of Northern Colorado, Juliet joined Brookdale in 2004. She is a seasoned senior living executive with more than 30 years of experience designing and executing innovative Alzheimer's and dementia care programs and living environments in both assisted living and skilled settings.

Brookdale resident and associate seated outside

Rita is living with dementia in a Brookdale Clare Bridge community. She is an Elvis lover who relishes her vast collection of makeup, creams and beauty potions. When Ashley, the community’s resident program manager, discovered Rita’s passion for The King and cosmetics, she whipped up the perfect activity.

One morning, Ashley set up a beauty chair in Rita’s bathroom. With Elvis playing in the background, she invited Rita to sit down and enjoy a makeover. As Ashley brushed and curled Rita’s hair, she smiled and reminisced about teaching her own daughter how to apply mascara. Eventually, Rita investigated her lipstick options, selected a shade of pale pink, and applied the tint with the same skill she’d employed for decades.

As Ashley massaged Rita’s hands with lotion, she asked about the senior’s wedding ring and marriage. Rita smiled and said, “love.”

A simple makeover made all of the difference in Rita’s day.

This is engagement. And Brookdale does it well.

Research shows that engagement is vital for people living with dementia. According to the report Engagement in Persons with Dementia: The Concept and Its Measurement, “Engaging older persons with dementia in appropriate activities have been shown to yield beneficial effects such as increasing positive emotions, improving activities of daily living (ADL) and improving the quality of life.”

In fact, positive engagement:

Increases socialization and connectedness
Improves cognitive workouts
Promotes decision making and empowers choice
Gives purpose
Creates meaning and reduces frustration
Improves self-esteem and can return a sense of mastery
Increases joy and general happiness

The same study on engagement found that a lack of engagement “can be particularly detrimental, as it magnifies the apathy, boredom, depression, and loneliness that often accompany the progression of dementia.”

The best engagement comes from person-centered care, which means tailoring activities to the person you are caring for. Ashley’s dedication to learning her residents’ life stories and getting to know their unique interests is a great example. Other residents might not enjoy a makeover, or they may dislike Elvis’s brand of hip-swinging rock-and-roll. But Ashley knew exactly what type of activity would engage Rita.

A study published in the International Journal of Older People Nursing found that person-centered care has the potential to “enable care staff to see the person behind the patient; allow family carers to uphold their relatives’ personhood; enable the voice of the person with dementia to be heard, verbally and non-verbally; be enjoyable for all concerned and enable the person with dementia to feel proud about themselves and their lives.” ?

Whether you are a professional caregiver in a long-term care setting, or you care for your senior loved one at home, here are some engagement ideas to put into practice.

Keep a positive attitude. People living with dementia will notice your energy, which is why interactions should be positive.
Acknowledge every response even if it is incorrect. Meet the person living with dementia where they are. If they answer a question wrong, don’t feel the need to correct them. Acknowledge their response and move on.
Involve ALL the senses when selecting activities.
Use props that engage the senses and are familiar to the person you are caring for.
Add humor and keep your activities light and fun.
Routines and rituals reduce anxiety and help the person living with dementia maintain a sense of normalcy.
Be flexible and do not focus on the end product. You don’t have to finish every activity you start.
Adapt tasks so they appropriately match the person living with dementias remaining skills.

Ashley’s makeover checks almost all of these boxes. She approached the activity with a positive attitude and humor. She engaged Rita’s sense of touch, smell and sight and used her makeup and brushes as props. She acknowledged Rita’s daily makeup routine and adapted tasks to her ability. The outcome was much more than skin deep.

Brookdale is dedicated to providing this level of person-centered care and engagement to every resident. As part of our ongoing Optimum Life Continuing Education series, we are offering a program on “Engaging People with Dementia in Non-Memory Care Settings” this May. I will discuss engagement strategies, the benefits of engagement on symptom management and review standard and cutting-edge tools for engaging people living with dementia.

If you are interested in learning more, or registering for “Engaging People with Dementia in Non-Memory Care Settings” for professional credit, visit Brookdale’s Optimum Life Continuing Education page.