Quality of life for people with dementia living in long-term care is often reduced because they participate in too few activities.
Staff and family members frequently underestimate the ability of people with dementia to engage in leisure and social activities, according to a large national study examining quality of life in residential aged care.
The research, conducted by the Dementia Collaborative Research Centre in partnership with Griffith University, was presented by Professor Wendy Moyle from Griffith’s Menzies Health Institute Queensland at the 11th Gold Coast Health and Medical Research Conference.
The study evaluated activity participation in 53 residential aged care facilities across Australia. Researchers measured resident involvement across 15 leisure activities (five indoor and ten outdoor items). Among the 191 residents who were able to rate their own participation, the average activity score was 11.4 out of a possible 30, with 0 indicating no participation and 30 indicating the highest participation level.
Staff perceptions of resident activity were lower: the 435 staff members who completed the survey gave an average score of 9.6. Family members were the most pessimistic, rating their relatives’ participation the lowest with an average score of 7.
The study also assessed cognitive impairment and found an important distinction: the residents’ own reports of their activity levels did not correlate with their degree of cognitive impairment. In contrast, staff and family ratings were strongly and negatively associated with cognitive decline, meaning that residents with more advanced dementia were perceived as less active even when self-reports did not show the same relationship.
Professor Moyle highlights this discrepancy, noting that care staff and relatives may assume people with late-stage dementia cannot or should not take part in activities, which can lead to missed opportunities for engagement.
Importantly, the study found a clear link between depressive symptoms and activity participation across all three respondent groups. Residents who rated themselves as more depressed also reported lower levels of activity. Staff assessments showed a large difference by mood: residents judged to have no depression averaged activity scores of 10.9, while those perceived as severely depressed averaged 6.4.
Low activity participation in residential aged care has practical consequences for quality of life. Leisure activities are strongly associated with emotional well-being, cognitive stimulation and social connection. When people with dementia are left with limited opportunities for engagement, their cognitive function may decline further and unmet needs can present as behavioural and psychological symptoms—such as agitation or wandering—often resulting in increased reliance on medication.
The study’s findings point to several actionable implications for improving quality of life in long-term care. Increasing the quantity and quality of structured and meaningful leisure activities should be a priority. That requires adequate staffing levels to plan, facilitate and support activities tailored to residents’ abilities and interests. Professor Moyle recommends considering higher staff-to-resident ratios and integrating trained volunteers to broaden the range and frequency of activities offered in care homes.
Training for staff and education for families are also important so that assumptions about ability based solely on cognitive diagnosis do not limit opportunities for participation. Regular assessment of activity needs and mood can help identify residents who would benefit from adapted leisure programs, personalised engagement strategies or additional social support.
Maintaining and improving activity participation in residential aged care is a practical and evidence-based approach to enhancing quality of life for people with dementia. Given that there is currently no cure for most forms of dementia, optimizing daily engagement, social connection and purposeful leisure should remain central to care planning and policy for long-term care settings.
About this Alzheimer’s disease research
Source: Louise Durack – Griffith University
Image Source: The image is in the public domain
Original Research: The research was presented at the 11th Gold Coast Health and Medical Research Conference in Queensland, December 3–4, 2015