5 Engagement in Dementia Cameron J. Comp, Ph.D. ‘Michael J. Skrajner, M.A. Gregg. Gorzelle, BA. The study ofengagement sa necessary foundation fo the development of nenparmaceog- al ntersenons for persons th denent wheter the eventos ales prs tiation, apathy, ltt, or borer Cohen Mansfield, Dake Al fe Mare (2009, p.298) ABSTRACT: Engagement isthe key to successful nonpharmacological treatment of tehavioral symptoms of dementia Persons with dementia who are pesitively en ‘gaged with their physical and social environments are able to decrease problematic ‘or undesirable responsive behaviors, display positive affec, and enjoy a better qual- ity of life. The Menorah Park Engagement Scale (NPES) isa “low-tech” means of sireetly documenting the presence anc general duration of various facets of engage- rent, as well en afer: altruism, and the presence or absence of problematic beha fore chuerved during activities designed fo engage persons with dementia. While a ‘more complex form can and has been used in research projects, asimpliied version tan be used by staff of long-term care residences or by families to dacumert the e!- fect of activities provided to persons with dementia, Both versions are presented inthis chapter, along with a detailed account of the scoring system used with the MPES, For ingpirioe rogerding the use of MPES, please contact Dr. Cameron Camp at Cameronitcendard com or visit www.cendard com, Keywords:engagenent, positive aft, quality of lif, bduviors, scale, nonpharmacoogice lreatment, actisties documentation {Engagement isa requisite for quality of life for persons with dementia and for persons without denentia). The concept of engagement involves interaction with stim, gen rally locaied within the external environment. In dementia care, engagement willy involves interaction through activities designed to capture the atention and (ideally) to promote positive inteactions fer perscns with dementia We define positive meractons as {hose "in which participants are engaged with each other in a socally appropriate and/or ltruistic manner.” Exampleo include a long term care resident making eye contact with peers, saying “hello” to peers, and reading aloud to a resident who is blind. A resident(56 Ament Solr Aine De serving 38 a leader fora small groupactvity during ashift change (a time when agitation ‘among residents can be high) would aleo be considered a positive interaction. Negatioe interacts would inelade situations in which participants are acting in socially inappro- Priate ways (eg, yelling at peersor anxiously moving away from the group) and/or when the person isnot interacting at all (eg, sleeping or paying atention tootker things). ‘Cohen-Mansfield, Dakheel-Ali, and Marx (2009) describe a conceptual model of engagement called the Comprehensive Process Model of Engagement (CPME). In this ‘mod, engagement is affected by the atrbutes of the porsan, the stimulus (material of the activity), and the environment. To the extent that an activity can engage 2 person ina ‘positive manner, affect will in turn be influenced positively. Mest importantly, positively engaging a person with dementia decreases problematic responsive bebaviors such 38 latempting to excape or repetitive actions. in addition, the ablty to engage is a prerequi- ‘so fer involving persone with purposeful activity, which in tum can sigaficantly impact ‘quality of life (Mak, 2011; Mast, Shouse, & Camp, in press). Thus, the ability to docu ‘ment that interventions positively engage persons with dementia (or do not) i exitical for ensuring the development and use of successful ronpharmacological interventions t0 decrease problematic of undesirable responsive behaviors. Development ofthe Menorah Park Engagement Scale "The Menorah Park Engagement Seale (MPES) was developed in conjunction with the de velopment of Montestori Based Dementia Programming® (MEDP) (Camp, 2006; Camp, 2010) MBDP isan actvity-based intervention based on the Montessori method of educr- tion. During the development of MPES, we wished to determine the effects of providing ‘mearingful activites 10 persons with dementia based on rehabilitation principles and a Philosophy of showing all peraons sespect and digraty. It soon became clear that rather than simply reducing or eliminating disruptive or challenging behaviors, we also were producing immediate and positive effects. We decided to focus on engagement asa con ‘cept that best exemplified the effects produced by MBDP. Fist, we examined the amount ‘time that a person with dementia wasnt engaged with an aclivily oF with hisor her en vironment (eg, sleeping staring fixedly into space) during « scheduled activity to learnif MIBDP. applied to intergenerational programming, signiicantly reduced nonengagement (Camp etal, 1997), Then, we began to test ways of examining postive forms of engage- ‘ment (Camp, Judge, Orsulic-eras, & Schneider, 2000; Judge, Camp, & Orsulic-eras 2000; COrsulic-eras, Judge, & Camp 2000, Orsulle-Jeras, Schneider, 8 Camp 2000). Thus, the measure of engagement began to determine the level of succees in activity programming implemented with persons with dementia. ‘When using the MPES, a key assumption is that successful activities are ones in which partidpants are actively or passively engaged. During unsuccessful activities, per- sons typically pay attention to other things or fal asleep It is also assumed that successful activities will generally rerult in increased positive emotions, manifested by smiling oF laughing. as well as decreased negative emotions. We also began to note whether persons ‘with dementia would assis others in group activities This led, in turn, to esearch exam- {ing the ability of persons with dementia to run activities fr cur persons with dernen- tia inlong,-term caze, and to effectively engage those resents in these activities (Camp & Skrajncr, 2004; Skrajner & Camp, 2007; Skrajner etal, 2014). ‘The MPESiis a measure ofthe proximal efecs ofan intervention (effects that are ‘obtained when an actwvity ot intervention is being used). A minimum requirement of 2 ‘successful intervention for persons with ementi i that i is successful at the moment it{sbeing usod, We assume that other long-term bonofits, which we call “distal effects” are “only possible ifwhen the activity has positive proximal effects. The Observational Measurement of Engagement Assessment (Cohen-Mansfield and her colleagues (Coher-Manseld, Dakheel-Ak, Jensen, Mar. & “Then, 2012, Cohen-Mansfild, Mars, Regier, & Dakneel-Ali, 2008) have develope the Observational Measurement of Engagement Assessment (OME), a valdated measure specifically developed to asses he ievls of engagement of persos with intellectual ds- slilites (Cohen ManaSeldetal,200) thats based onthe CPME mods! described earlier (OME data are gathered through direct observation and entered onto a handheld com= pter with special software developed fortis purpose. Outcome vatiables nthe OME Include the following: + Ducaton: The time (seconds) thatthe participants engaged! with the stimulus, starting after presentation ofthe engagement stimulus and ending at 13 minutes tr whenever the paticipant iene longer engaged with the stimuli + Attention the simslue Bsamples include oye tracking: visual scanning: acl, ‘motor or verbal fedbuckeve contact and touching te stimulus. Measred or 24 point scale not attentive, somewhat attentive, atentive, and very attentive + Attitude tothe stimulus: Examples include positive or negative facial expressin, verbal contri, and physical movement toward the stimulus. Measured on 3 poi scale, any from very negative 1 very positive Refusal rates for activities abo are measured, Imer-rater reliability of the OME was 38- sessed by sie dyads of research setae’ ratings ofthe engagement menrures during (8 engagement sessions with long-term care residents. Intra-classcomeltion (alpha vals) veraged 0.78 forthe engagement osteome variables, MPES Approaches and Scoring ‘The MPES is an 1I-item measure used to asses the eifects of activities on levels of en- ‘gegement with the environment The MPES looks primarily t four types of engagement: Constructive engagement, passive engagement, nonengagement, and other engagement In addition there are tems involving a edident refusing to pastcipate and/or leaving an activity. MPES items are scored as 0 (never seen) I (seen up to half the activity time), oF 2 (seen more than haf the activity time). These scoring decisions were made to increase ‘researchers’ capacity to obtain reliable observations and to enable nonsesearch staff to cefiecivey use the MIS for data gathering in real-world setings in order to assess the tffces of acivity programming. inter-rater relibilty forthe MPES was established. Thirty S-minute observation ses- sions were conducied during activity programming for persons with dementia on special ‘are units. A eniterion of 80% or greater perfect agreement for each ofthe 11 MPES items ‘was used to determine the scales inter-rater cellbilty. Periodic comparisons of ratings by differentataf are conducted within any specific study tocncure that rater “drift” dees ‘not take place, and when questions arise about scoring a specific tem, they are resolved by consensus. 7 “ter rter reliability is maintained by using the following approac: Persons being trained on the scale must match the trainer atleast 47% of the time on each item. To ac ‘complish this, we conduct a minimem of 30 taining observations, where the trainee must(08 Asozinent Scie forAdonced Demat agree with the trainer at least 80% of the time for each tem before allowing staff to use Uheacaleon their own. lease note that this a the bare minimum often overall reliability ie in the mid-o-high 90% range, In addition, researchers take part in refresher training observations atleast once every 6 monthsto ensure that they are continuing to code obser- vations properly. Fially, when unusual things occur out inthe field, researchers discuss {heir odservaons and Make a decision based upen the best interpretation of the facts. This decision is shared and documented with the ret of the team to ensure thal everyone codes the same way in the ture ‘The MPES uses direct observation of different forms of engagement, along with measures of affect, refusal, and helping behavior. Cbservation windows can vary in length, with S-minute windows being used mest frequently in research. Specitic MES items involving engegement each represent a distinct expect or typeof engagement (C5 . constructive engagement. passive engagement, engagement in something other than the target activity, noneagagement) Affect is measured as a general negative or positive var lence, Presence or absence of disruptive or inappropriate behavior aso is documented. ‘OME and MPES Comparison Unlike the OME, the MPES does not require either hardware or specialized software to obtain data In addition, the MPES focuses on different forms or aspects of engagement fand thus can track traritions in engagement. For instance, one might watch a person transition from intially being aslep to being awake but not focused on a target activity, to watching a target activity, to eventually taking an active part ina target activity. While duration of engagement isnot as detailed in the MPES as in the OME, we have found that the MPES is sensitive to the proximal eects of quality acivity programming, especially in settings such a long term eare facilites, where activity programming, can be minimal land isnot always effective at engaging large numbers of residents for substantial periods In addition, the MPES captures the act of helping others (altruism) in persons with de- ‘mentia during activities and documents the presence or absence of problematic behaviors uringactvites, MPES Versions We have developed two versions of the MPES, cach designed fo meet different needs: 1) the general MPES form, designed tobe used in research prejcts, and 2) Te brief MPES. form, designed to be used by staff members of programs or residences serving persons with dementia The brief MPES form enables staff to easily document the effects of act ties provided to residents or cen’. The general MES should be used in research proj- cts targeted to explore nonpharmacclogical interventions for problematic or undecrable responsive behavior, ae well ae 19 document proximal and distal effects of producing positive engagement Using the MPES, projects designed to evaluate individualized, carefully structured actwvities could be compared with generic approaches. The MPES could be used to evalu- ate the efficacy of specie interventions, such as Bright Eyes the systematic stimulation Of the sense of smell, followed by kinestheticimovement (gross motor activity) touch. vi- sion, hearing, and finally the sense of taste (Trudeau, 1999), or Snoezelen, another sensory imulation intervention focusing on one or mare series tha is controled by the person with dementia rather than a therapist (Brown, 1999) The MPES also could be used to eval- tate overall approaches to care, such as providing assistance with activities of daily living bbased on previous lifestyle preferences (Simard, 1999). If the MPES had been availableErgogennt Donate 60 ‘when our team was planning to evaluate Simulated Presence (Woods & Ashley, 1995) we ‘would have included! engagement as.an important outcome variable “There are very few scales that measure positive concepts (eg,, emotions, behaviors, fractions) in persors with advanced dementia and the MPES has filed this need. When a ‘brief version ofthe MPUS is availabe fr lineal staff to use, direct caregivers have a tool toevaluate their approaches to caring for persons withadvanced dementia, with potential ‘outcomes of improved care for residents and empowered caregivers. ‘Cameron J. Camp, PhD., i a psychologist who specializes in appliod research in geror- tology. He currently serves as Direcior of Research forthe Center for Applied Research in Dementia in Solon, Ohio. Dr, Camp conducts workshops internationally on designing cognitive and behavioral interventions for dementia, These interventions are all designed to reduce challenging behaviors and increase the level of functioning of persons with clementia He has co-authored thee callege textbooks and published more than 100 peer reviewed articles. ‘Michae! J Skrajner, M.A, isDirecior of Research and Innovation at Hearthstone Alzheimer ‘Care in Woburn, MA. He has been conducting federally and privately funded research ‘on nonpharmacslogical interventions for persons with dementia for more than 13 years. He alzo tains people across the United States and internationally on how toimplement cevidenced-based approaches to working with persons with dementia, Gregg J. Gorzelle, BA, ia Associate Director of Resoarch at Hearthstone Alzheimer Caro in Webum, MA. He has spent the past 15 years focused on creating and researching non- pharmacological interventions for persons with dementia His current focus ison improv {ng quality of care and quality of lifefor home heath clients with dementia References. ‘Brown, (95). oer Int oli, oom Chart Ed, Enhancing he iyo if aon Tinta ta as, Pai oer rei Camp’) 0b) Motes Basel Denceta Programming! inkong-erm cae Aca study of disersns- ina iervnton tx peor wit rcaie RoR hater & Lye (a5) Can! pl Cola 12 renin Lem Caro 295-34, New Yak Spies cog Bi il ramen deen i Parc Thr iene Camp Clee KS. Be CA. Fon KM. Bowen | el, Metal (987) An inrgenertinal program fer saci denen sing Monts ethos" Cesiugy37 680-, calc Jcge es Ora rae Schrier NM. G10), Mason ae acti in dul ay cam. "Aint Diecion Garey fr Alhener an er Dement atin 11-8 Camp, Cfo roc MON, Fence amie Monier propmaning (RAMD™) Tning psoas idea serve grap sty der. Te eros fo ‘cohen Cubical Ak Re Ns Ms (0) Engageben persons wih dees The concept i neasurmant Aver ao of Grae Te). 28-307 ‘cohen Manet Dealt M eae, By Mate MS, They K: 212, An aaa fe reition- “Spanner pe ovr nse ining eins heme ro oe Pera 40 ‘Coen Mansel as Meet NG, k Dike AX, M09, The impact of pend caraceesen gegement ran ems nettwih dermenta. ert oral Crit Paar 2) 78-73. Judge £8 Camps ChE Out fes§ (20), Ue of Monet ed ate for ets wih Sementa wl a efron arene oon one i dementia ua Goo Svc Sens SR 770 Asin Sol bor Akonced Demeia seo, ec re eee ergata Srp ction eh at areca Fogo Sieriaeeiee ee ane SE nents eter ‘hanced deme Electr a ale. The ft #1 rsa eae Shiner Nie & Camp C1 200 ints olongeem care residents Se ne Ouccory and lnplont or pri ein Tesi Cora Reb, 1, i sc om singapore el ura meh Ant one Be Reet Slur Secs 9 swirl a Rect ce pr Ta a Te, ek eae es nae ence ce afield Beat ersces hr mae cra acu Fee eat say des mans aod om th EAB roel Dene 0G "cr, bee rau ies ei 6 nent des Adsond Demetr p19), Piadlpi Tylor & Franc vw aly (Sima rec ay Ug ots mee me rien "ethionine Cone uring, 60, 9-16Instructions for Using the Menorah Park Engogement Scale (MPES) et is Prosadure: The MPES ix dexgnad fo dacoment engagement of persors wih dementia for ole dsailiis) during otvtos ‘ands ved by researches of care providers, such os actly sto in longterm core or edt day heath cones Typical, thot administering the scale observe single individuals daring focused acivites,athough itis eso posible to obsarve ‘ngagenert ond afec foro goup. Observation time frames can vay. Wypiclly we hare used the MPES in ‘Sine, 1Ominse, or 30-minute observation peiods. As wi ny ebservatorel meosee, ts be! oy We be as unable Sve 28 possble during the abuarvetion,olhough he cbeeva: should be abla to hace the perzor'srxpontat ard vio fil ‘pressions ond molo actrty, Obwerers should be cb fo cemonstteilearceliabilty oft last 80% fro Hams ct {2 minimum of 30 obsewation windows before gahering date iniviual Scoring Criteria: Scoring I cordced hrcuah die! obsevason, Observers should have obtoieed int-roter relies of at los! 80% for @mininure of 30 observtion windows befor recording doa. Observers can be sof menbes, research. tr, © evan fonily manlben oF ober iformal caregivers. In exteme citeomsances, a person who has conducted on axtiviy fon record observations ofthe end of he activity, The MFES is designed as «hesrstc meosoreto be vied in eokword or prosica cieunetonces os @ means of debrmiing ond documenting lens end pes ofengegenen ond dled produced by oatvties In most intone, tens ore scored os eiher yes or no, or on a Spoink sale. For types of engagemed and fect, items ara ‘ated 0s either not present, mirimaly present the minutes cbsorved, or majorly preser inthe mints obverved. This done fortwo rears: make easy vilze the MPES in reabworl cicunstaces ond to lnceaseinersaterreliabil {cr the insremant. fo edeion, sve rtaorch shins hove ound hat ha MPES i sanatvn enaugh to datect be alc of highqueliy acvily pregranming compared to standard ectvlyprogrommirg for persons with dementia, ‘Nate thot eoch item represents c reltvely nique cspoc oF monifestaion of engopentnt or affect. Tus, rather thon tracing a compose score, individual iten scares are gaercied fron on observation. For example, if on inde con- srucivey fekes pot in an activity for os of he observation ond then shops fo the wary las segient of he observation, {is woud be shown by a sore 072" on tere 4 ontrdve engogemenl scars of 70" forums 5 (passive engagement) and 6 belt /otor engaaerent, ond a score of "I" fer item ? fnonergagement) There would be o diferer scoring profile lore person wo shops lor mest o he aciviy then wokes up at he very end ard makes an appropriat coment about the activity. This person would havea score of “1" for it 4 (crsinctve engagement), scres of "D" for tems 5 [pasive engogener| ort 6 (hater engogemen), and a score of 2" fr ter 7 ponengogemert). general, mos analyss ‘sing the MPES hove token seers averaged foreach Hem across mutiplecbzervaton and compared individual on on inmby-tem bass. 1. Allover, excep for intarces of conducive engagemen, mutt oct frat aot 3 eaconde afore they ore coded. Inthe case of cansrocive engegemer, you coun! every insonce of fe behovio: For example, if oresdert picked up ‘an objec related othe org activity but only hal th objec for 2 saconds before puting I back down, is instonce ‘would sil be coded af “di/commented on target activity.” However, i resident momentarily listed tothe orget ‘elvty for 2 seconds, his woud rot be coded as passive engagement because te instance wos not 3 seconds in ‘dovaton a resden! ie cbvavved touching hit oho hot fron «acon of «second, the absarva shuld aot count ths 8 “der atended things other han the target ety” becouse, onan, the action wos nt 3 seconds in oration 2. Foritens 4 {consnctie ergageman), 5 [pose engogemen) 6 [sl/other engagement), and 7 (nonengagemeny}, ‘he folowing guidelines opply (0, Comiucve engagement {doing oF conmentirg upon an actiy| takes precedence over I) passive engogemont [isenng or wahing) 2) doing someting ctl han the octty, and 3) norengagemet (deeping/eleuing tes/serng Ino spe) So, fa parson ie doing an ectvly e.9singing a song) but ao watching the acivty coordina, you shold code “di/conmented on orget activity” he rlevan! behavior. Also forest is [boking fcugh her purse while singing a song, you shoud code “did/commented en txge!ocviy” os the relevant ‘bohowo. Final fa resident Fos his o ee eyes closed while sinullenscusl plying o pioro ding amuse ‘etapy session, you shoud code “did/conmented on org! activity" ashe elvan! behavior. Amn i Ahead Conia b Laser Vln nd Jo aly omni 8 BTS Hoos Maan Hearne Kp saned ww bpp con! ».Fasive engogement string or watching) ckes precedence overdoing something other thon the acy So, if resident i watching oher resides tango buts oso alaying wit the buttons on his or her sweater. you should code “Tisened o/watched target cctv" ho rlavont behavior «Finally, doing something cher thon the activ toes precedence over nonengogement isleping/cosing yes/ ‘esing int space). So, @ residents hxng bis her hair end fhe fesidents eyes are closed, “did or ahendd fo things the than the forget aciviy" shoul be coded os the oleant behavior For toms 4, 5,6, and 7, you can ony code one *2" (more han ha of he acy) on given observation. This i because mare thon ore “2" (more than haf af the activi) would toil move thon 5 minute, In other mores, Hone hype oF engogenent occurs mor than hal of he fme, all other ypes must be up to half the time or nota al. For tens € (pleaswe) and 9 (ancty/sodnest, he following guidelines apply: ©. Be sur only to code abvious end clecly observable dislays of hese enotons. For item B, look fo sing laughing, cr verbaizatons tht clearly indicate pleasure. For ten 9, ook for crying or verelizations hat clea Indicate sodnes. For rxiety, bok for ansious verblzatons ot movements e.g, honduieging} combined wih ‘ansious fil displays. Never assime a aiden! x experiencing one of ess emotions. Always Kok fr on ove? sign of hese enotions. Observers should net make inferences ost howe vsident lel: hey show only docomen) ihe behavies they con elec see, 6. tis posible to see both anxiety/sodness ad pleasure being expressed during he same observation pared, though enemely unusual. Be coral when you cade fr thse Bems, Again, you re only coding fo obvious signs of hese emotions ord wot mokng gueises abut how a resident ebing =: Athough iis possible alo enswol fo ee eter pleosure or anxiety sane for more han ha the activity Lareaterthon 2.5 min). Although you may soe resident sling mony tines tveughout he observation, dees ‘he foto moun offme he or se wos smiling (or sxprastng sodness/anriety) equal greater hon 25 inves? Most chen the answer is no This is © common error the many people mak, 20 be mindful ofthis when you comet coding © "2" (more thon half the aciviy for these ems. copys 8355 ts eos she ipa aed PaaSmee poe3 8) [MPES Scoring Hirorchy: The folowing MPES hieroichy helps researchers determine which behavior lo cde when Wo ore cccrting simulionoush, When observing wo bekawiors af th soma time, researchers code the behavior that higher on the followin “ladder,” ince the purporeo the MES i to document he highest lve oF engagement that perian with ‘Renta is capobie o displaying This oppreach may be useful in demonstatirg fo sa members ond cher ha the peion vith derenta ismore capable of engaging in activites ard accomplishing tesks han negative ereatypes abet demenio, righ sugges. MPES Hierarchy Ladder “eae “iceon thence pron she cy barb isn any (exptcaing ce pe orn ne ipso cedars” ‘ote Stns ha wou cae Score te nae ac) ‘assy ce ron Dart yay Ye an Ans ay Connit 8203 by en rasan fom, he Avner meas comeso) lem Definitions: 1. Participated in trget acy A gastcipont participates in on tiv ‘The portcipent it constrctvely engaged ding the obrraten (i, tem number 4 ceded “1° 0°27 AND/OL 1m The porizipent is posivaly engaged during on obtovation fe, am number 3 is coded “1 02°) 2. ‘ied fe leave on own ‘A portcipont testo leave on activity on his or her own if: ‘a The portipent is making « concerted fr Yo leave the activi = De net code “yes” unos iti obvious that he resident is ying o leave ~ py special atenion o residents in wheelchairs or hose who cannot move wihou asistonce They may no! fete he trergthor nebltyto physically make an atemptio leave bu moy sil verbxly expres the deste Teloore. they expres he desire fo leave bt connot do se becaure of maby dice, sil eonsder the verbal expression on erp fo bave = Chon pasicipan wl sy thal they ae ying t Inova, 0 st closely for such verbliztions, = Do no eae “yes” fa aa member i ryng treme the resident fem the oxy. — EXANPLE. A resident says she ie bowed with exercising. gets up from hac chair, rd leaves the room. 3. etry alone o with stelt ‘A porfcipan!leoves en ccivy it 1A sof memiver removes the poriciprt frm the ctv oR 18 The portcizant acl leaves the ctvity om is er her own |. id the forget oxivity ond commented en the avy (conructve engagement) ‘Consretve engogemen curs ifthe participant is 1 Using mateo rloted io fe target activi EXAMPLE 1 Playing the pteno during © mac therapy session ~ EXAMPLE 2: Drowing @ pleure wih @ rayon during et eropy 18 Holding onto matric related io trgetoxviy (but oot moving tem Holding is more thon jut esting one's ands onthe moter; means tat he ptcpant is chiching ent the motel — EXAMPLE 1 Holding a bingo chip in one's howd — EXAMPLE 2: Holding @ maraca without shoking it during « msicel performonce ‘= Specking Is vxpanse fo ferge! acti — EXAMPLE 1 Anewering a tvie question — EXAMPLE 2: Diseusing a sory oF reminiscing about ene's chron 18 Costing in Response to target tv: — EXAMPIE 1 Topping ove'sfoc fo music — BAMPIE 2: Clapping hands cera performance — FXAMPIE 3: Shakirg one's hod ia agreomert wih the group leoder Asmsnes ct fy hc Oui by aan lat nd i Mey omy SSTSiy heals Nomen fem Kii red ww eae con5. Usted to and/or watched target actly (pessive engogemant | Ponive engagement occun if he portzipant | Uitened to ard/er watched forget activi: t — “Assume the individual iting in on or watching he target cctv if he porcipat is looking athe acy coordinate, ober poricipan’s, or meterils elated I the fxget activity = Ininstonces wher is dificult to determine wheter the ooricipant s possirely poticpatng ave the paticipon! the betel ofthe doubt, the parcipontis alert and looking in the general defen ofthe aciviy fssume hoor shes lisening in or walching. = EXAMILE 1: Facing the oxiviy coordnaor ison olen manver during bingo = EXAMILE 2: Laoking in the general dracon ofthe performers ring a musical performance. {6 Did or attended to thiogs other then the target acivityfoher/selhengogement) ‘Other engagement occurs ifthe paticpont is 1m Using merc rt relted tothe target actinty ~ BXAMILE: Painting ding « musical performance = EXAMPLE: Fumbling trough his er her purse during exercise 1 Geasping ont materilsnotrlcted othe trge acy — EXAMPLE: Holding a sutfed nial during binge '= Speaking in response o something other thon the forget activity — EXAMPLE: Conplimerting a nurse on her hairdo dunno gol ctwy 1 Gestring in esponse fo something other thon the target city = EXAMPLE: Ponting 10.0 dog durieg valley 1 Usenng/ watching someting chor han he frye! octry = EXAMPLE: Watching 1. during © group reminiscing actvity Sellengogementcccuts when the partcipan: 1m Atendsspecticaly to his or er body, ewe, or cates: = EXAMPLE: Playing wit the batons of his or her shit dung binge — EXAMPLE: Ring his or er fot ching ors ond cafe = EXAMPLE: Fiding wih the decorative pin os his or er shit 7. Sept/kept eyes dlsed/ tered inte space nowengogement) Nonengagement cccucs fhe portcipant is Closing eyes = Sleeping ~ Since ‘looping the nly exception tothe MPES hirerchy, i i ispoant to distinguish deaging rom coring ‘om's ayes — look for clad aye clang with deop breath oF sexing. Oton resident's head wil droop forword er the person my actualy ul he ox her head down of the fable, 1m Staring into pce — Storing ino space cor be defined os either completely losing focus onthe immo environment or beceming So caught up the ervirenment hot one stores blankly stan object. Ths may appeor as though the portcipont {5 octaly looking “hough he objec rs If he or he ising to se something that smiles ava. This onlly alia ecomponias hyo lock of chonging ast Thie paticuar tem is somtimes refered 0% "zoning ‘out o "the thousand yard tre.” _~ PXANPIE: Sterng blankly athe ceiling o the floor and does not seem to be oer conics onson oa Hogi ta wueopcen8. Plesure > esisre occurs the participants & Lovghing = smiog = A participant ust be deal sniling. you have quelions abou whether he pacpos is smting, de no! code thabohavier or pleasure. Av general guide, we cetme a pars sailing i we sae eth for guns '= Cxpreing pleasure trough vrbalzaion EXAMPLE: Soying "This civil 0 fon ond mane me happy!” 9. Anaiety/sodness Sodhess occurs the partipont Crying ‘5 Exproming todnase trough conversation — EXAMFLE: Saying “Lan 20x03" er "Lam doprosied” Ansatycceirs Fhe pertcpan ie 1 Exibting an anous facil expression fog, «rowed brow) IN COMBINATION WITH 1m Avsous bohavior — Winging of hens = Rocking bock and forth resected ~ Repetive vcalzeionsleonstomly asking "Whee wil be going homet") 100. Helped others Halping others scars 1m The portcipom ithelping athe player wih somehing related tothe activity = EXAMILE: Poiting ou! an answer on ancther person's game cord ‘The porticipat ishelaing the lecder with something relood othe acy EXAMPLE: Sirightnieg ve the pile of bingo cards al the end of the octvity Ob, Helped sthers frequen) Frequency s determined by: ‘m= Couning the nunber of mes the particiort helps during the cbservaon, = lFoperson offers asstonce more thon orce ir the same issue (els. o player hice thal hey hove 818 during bingo. hs ony count sone instanceof helping, In rdar'o cade for mare than ene instanceof helping, he ‘events mut be unelated elping ogain once NS i called, 11. Aced inappropriately A participant ccs inogproprictely i 1m He orshe behaves oggrsstly toward ancther person or objec = EXAMPLE: Throwing © game cord — EXAMPLE: Curing ot anchor resort 1m He or she doss something that srpts he oct. — EXAMPLE: Pouring apple [uce ot the bor (actviy coordinator mst sp the activity ote Yo thot revit 1m He orshe does somthing sacaly inappropriate. ~ EXAMPLE: Teling a dey phe during bingo = EXAMPLE: Begining foke ff ise her lth Asian Ses Adri Oty ad Wx oc na ony S183 iytesh fase Khas wsbyonm omMenorah Park Engagement Scale (MPES) aeiewiiin Oberon ein 0 Date: PoricipensD Foctotr None oocy - 10 of prs fing out fr: Iypeofdbwevcion: 1 Boing 2 Trnctnent Time of doy: 1AM. oF 2PM, kre one} Observation length ints 1. Pointed in target cv either consrately ox passive} Didhe/she take pet inthe acti? (O=No chart engogementon ters and 7) 1 =Yesichor engrgenenton items 4,56, ond 7) 22. Tod toleove on own oot inched who remaved the cook Didhe/she ny leave he act O-No Teer 3. Leftoctirityon own or wth stall Didhe/she octal Soo he city? O=No Ve Ye Code ne mere hon one "2 for items 4, 5, 6, ond 7. 4. id the toretctvtyend/orcommerted on he ocviy. How log cid te/she partial inthe avy by mcking comments answering questions, talking about memories, dicuse- Ing dees, nokng gesies in rexpons othe act, or physealy manipucing the metrics [Do net incude looking and lsening 0 =Notat a 1-Uptohol tthe sbewvetion = Morethan half ofthe abservotion 5 listed o and/or watted target activity (code er 3 seconds, bt donot code if leeping) How long the potkipant remain general let ord spend tine fering aad watching the forget actin O=Noter al V=Uptohal cfhecbservaion 2 = Moreshar haf ofthe observation 6 Dido eterded to hings ther thon target ach (code cer 3 seconds, but do not code if eoping| How org oid ha/se ated fo something beside the orgs tv Ince istening, watching, conmentig, gesting, ‘ling. or physical manpulting any hem not cuocened wih to acy. chide slfengogene's Gctre, such os 00- or fngetpping,pointest manipulation of clhirg or ater belngitgs. eI he cients iteing to ec wotcing the Soret activity whi manipling an fem nc associated wits he ivy fe, a walker, boa, or shit sleeve code fer ited t/ watched tage aetiy. O=Notot all 1= Up tohalofihe obseration 2 « Mare han half ofthe observation 7. Slgt/kapt eyes dosed/stored ito space (code ofr 3 second) How log cid the participant hsp or keep his/her eyes closed during the cbsaration® = Notat ol 1 Uptoholl ofthe observation 2 = More thor hal ol he observation Coppin 21Sby Hea okason hom: Alghero omee ae Code co more then ore * for items 8 ond 9. 8. rane How lang dd hehe expres pleasure llough or sis) daring th obsorotien® O- Net atall 1 Up hal ethe cbvenation = More thon hal the akaaratin 9. Anxiety sadness How lang dl b/s display sey ox dns ding he cbse? lndude obvious diplys of ses: tough meres, Conversion, or deol abmreble deprened cle Arxity sous be coded fr dems rch a hand winging, dking, ansous ‘ccolition, 2 oer paydianator civil son in combination with on wus foci ply. = Neratall 1 = Up te haf othe obseresion 2= Morethor ha lhe observesion 10, Helped here How lang di b/s help onoter player rng th okzenation? Include havior such ox pointing ou answoson acta ployer ead, osising wh he covering mechanism of he cardhole, giving cues to anche layer (you hove he werd MOON") hing he ployer ead his/her cord, ok. O=Netatall 1 = Up hal ofthe sbseneion 2 Norethan ho ofthe cbservaton Frequing: 0-0 Tel? 203 11, Aetedineppropraty How lng did he/she nyo do someting nore, cpiv. or aggrssie dorrg the observation? D+ Net otal 1 = Up tal ofthe sbseveon 2 = More thon haf oh obuaetion ‘sew den yo a Com ere 207, eo rene eat bd “kes Prong on tngapnent rig ioe Betis th Done, ‘weve con/ gta ppM= 1333 pri 8301S by Haws Pac Pc: Kg mv ow llpopsomASSESSMENT SCALES for ADVANCED DEMENTIA by Ladislav Volicer, M.D., Ph.D., FAN, FGSA Ann C. Hurley, RLN., D.N.Sc., FAN Forwards by &S3HPP O05 i fn Fe Babimore# landen * Sycaoy