Social interaction of people living with dementia in residential long-term care: an ecological momentary assessment study

Background: The importance of social health is increasingly recognized in dementia research. For most people living with dementia, their social environment changes as the disease progresses, especially when they move into a long-term care facility. However, maintaining social interactions in the new living environment contributes significantly to health and quality of life. Staff and other residents are the most readily available interaction partners to provide this. The aim of this study is to investigate the frequency, contexts, partners and influencing factors (personal and contextual) of social interactions of people living with dementia in residential long-term care.

Methods: Participants were observed for two days in 20-min slots (from 7 am to 7 pm) in 12 long-term care facilities in Germany. The Maastricht Electronic Daily Live Observation Tool (MEDLO-tool) was used for ecological momentary assessment. Age, gender, functional status, cognitive status and length of stay at the facility were recorded. Generalized linear mixed-effect models were used for the data analysis.

Results: In all, 106 people living with dementia (average age: 85.16 ± 7.42 years, 82.9% female) were observed at 6134 time points. No social interaction take place in 71.9% of the observations. The place where the participants spend their time influences the occurrence of social interaction (p < 0.001), with a significantly higher probability of social interaction in communal spaces. Most frequently, interaction takes place with staff (43.4%), closely followed by other residents (40.9%), with the context (location, p < 0.001; time of day, p < 0.001) and functional status (care level, p < 0.001) influencing which of the two groups people living with dementia interact with.

Conclusion: A better understanding of the context of social interactions and its influencing factors provide a basis for more targeted interventions. As the increasing staff shortage will further limit the opportunities for social interaction with staff, future concepts should focus on other residents. Meaningful activities that enable people living with dementia to co-operate and share responsibility can provide a stimulating framework for this. In addition, social assistance robots and the application of peer-mentoring/leading represent promising approaches for creating a socially interactive environment.