Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Oct;19(10):859-70.
doi: 10.1097/JGP.0b013e318202bf5b.

The comprehensive process model of engagement

Jiska Cohen-Mansfield  1 , Marcia S Marx, Laurence S Freedman, Havi Murad, Natalie G Regier, Khin Thein, Maha Dakheel-Ali
Affiliations

The comprehensive process model of engagement

Jiska Cohen-Mansfield et al. Am J Geriatr Psychiatry. 2011 Oct.

Abstract

Background: Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy.

Objective: The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement.

Methods: : Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli.

Results: All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores.

Conclusions: Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
The Comprehensive Process Model of Engagement
See this image and copyright information in PMC

References

    1. Burgio LD, Scilley K, Hardin JM, et al. Studying disruptive vocalization and contextual factors in the nursing home using computer-assisted real-time observation. J Gerontol B Psychol Sci Soc Sci. 1994;49(5):230–239. - PubMed
    1. Cohen-Mansfield J, Marx MS, Werner P. Observational data on time use and behavior problems in the nursing home. J Appl Gerontol. 1992;11(1):111–121. - PubMed
    1. Buettner L, Lundegren H, Lago D, et al. Therapeutic recreation as an intervention for nursing home residents with dementia and agitation: an efficacy study. Am J Alzheimers Dis. 1996;11(5):4–12.
    1. Engelman KK, Altus DE, Mathews RM. Increasing engagement in daily activities by older adults with dementia. J Appl Behav Anal. 1999;32(1):107–110.
    1. Cohen-Mansfield J, Dakheel-Ali M, Marx MS. Engagement in persons with dementia: The concept and its measurement. Am J Geriatr Psychiatry. 2009;17(4):299–307. - PMC - PubMed

Publication types