Promoting wellbeing for individuals living with dementia in care homes by improving opportunities for engagement in meaningful activities.

Abstract

Rationale: Research highlights that people living with dementia have identified the opportunity to engage in activities as important to their wellbeing. However, evidence suggests that individuals living with dementia in care homes spend the majority of their time in a state of passivity and inactivity. This thesis considers how it might be possible to improve the wellbeing of people with dementia living in care homes by improving opportunities to engage in positive and meaningful activities. Research Design: This thesis draws upon the approaches of ethnography and action research and seeks to examine the lived experience of thirteen people with dementia living in a care home with a rich and varied programme of activities. Dementia Care Mapping, unstructured observations, conversations and a focus group were the principal methods used to gather data with particular reference to participants’ mood and engagement, their activity preferences and the effect that engagement had upon their wellbeing. In addition, the researcher worked in partnership with care workers during staff workshops to co-create a strategy to improve opportunities for resident engagement within the context of everyday care. This study was designed to be conducted over four phases comprising three cycles of action research. This predominantly qualitative data was analysed using thematic analysis. Findings: Within this research, residents reported a wish to take part in activities and were clear about the type of activities they wanted to engage in. However, this thesis found that despite residents’ wishes and the programme of activities offered within the home, individuals living with dementia spent the majority of their time in behaviours associated with passivity and disengagement and consequently experienced a fairly neutral mood. One of the reasons for this appeared to be that residents were not supported to engage in activities beyond the activity programme and that the programme could only support engagement for a relatively short period. The findings of this thesis suggest that an activity programme alone may not be the best way to sufficiently engage people living with dementia in care homes. Therefore, careful consideration should be given to identifying how to improve the opportunities for residents to engage throughout the day within the context of everyday care. This thesis identified seven factors that might facilitate or act as a barrier to engagement. These were cognitive and physical limitations, the physical environment, the activity programme, care workers’ perception of their role, individual care workers, the culture of care and care workers’ time constraints. With these factors in mind, care workers were asked to develop a strategy to improve opportunities for resident engagement throughout the day. Within this strategy they suggested that it might be possible to engage residents in quick activities that were simple to set up and in activities as part of their everyday care routine. Recommendations: This thesis demonstrates that to improve opportunities for resident engagement, activity provision needs to be woven into everyday care rather than seen as a separate sphere of care facilitated by dedicated staff; supporting activities need to be part of the role and responsibility of every member of the care team. It is acknowledged, however, that achieving this is no easy task and that to increase opportunities for residents to engage in activities, a wider shift in the culture of care and a reconceptualisation of the role of the care worker is necessary.