Engaging in meaningful activities outside of care settings: What’s the impact on people with dementia?

The Bottom Line

  • Among older adults diagnosed with dementia, 33% of those under 80 years of age and 42% of those over 80 years of age live in long-term care homes.
  • Preliminary research shows that engaging in meaningful activities outside of care home settings can improve psychological well-being in older adults with dementia.
  • People with dementia and/or their caregivers should engage in discussions about their desire or their loved one’s desire to participate in activities outside of aged care settings, as well as assess the ability of care facilities to provide such an offering.   

Dementia is a progressive condition, meaning it worsens as time goes on. These days, there is a great deal of support for aging in place, and with adequate resources, this can certainly be achieved. However, for some folks diagnosed with dementia, there may come a time when their needs can no longer be met at home. This can lead to the transition to a residential aged care facility, such as a long-term care home, nursing home, or assisted-living facility (1;2). In Canada, it is estimated that 33% of older adults diagnosed with dementia who are under 80 years of age reside in a long-term care home, and this number increases to 42% among those over 80 years of age who are diagnosed with dementia (1).

People with dementia who live in long-term care homes face many challenges. For instance, 40% are severely cognitively impaired, 50% exhibit aggressive behaviours, 31% show signs of depression, 82% require assistance in completing activities of daily living (e.g., bathing, eating, getting dressed), and 59% demonstrate some indication of health instability (e.g., changes in their health) (1). As such, this population is in need of complex interventions that address multiple factors related to health and well-being.

Models of care that aim to create positive and respectful environments that prioritize people’s interests, wishes, habits, and unique abilities have garnered a lot of support recently when it comes to caring for those with dementia and cognitive impairment (2-4). These strategies advocate for the participation of those with dementia in meaningful activities, and research suggests that this can hold health benefits for people with dementia living in residential aged care facilities (2;3;5). What is a meaningful activity? It can be anything from engaging in art to gardening. However, for those residing in care facilities, these activities often occur indoors, and when they are outdoors, they are generally conducted within the grounds of the care facility.

Research is now looking at whether engaging in meaningful activities outside of one’s residential aged care facility—in other words, activities that allow someone to leave the grounds of their facility—has positive effects in people with dementia? One systematic review tackles this question and will hopefully provide some more considerations around what to look for when choosing a long-term care facility (2).

What the research tells us

This is the first review to evaluate the impact of meaningful activities outside of care homes among people with dementia.

The review reported that positive effects may occur on psychological health, namely improved well-being and mood, and reduced depressive and behavioural symptoms. Swimming, wheelchair cycling, intergenerational mentorship, art gallery visits, horse riding, walking, and outdoor gardening are examples of some of the meaningful activities that folks participated in. Unfortunately, due to differences amongst the studies included in the review—such as the activities and outcomes they investigated—no conclusions can be made about what activity is best for enhancing psychological health overall. In the future, high-quality studies with greater numbers of participants are needed to better understand the effectiveness of this strategy (2).

Key considerations

For folks with dementia, the decision to transition to a residential aged care facility can be a difficult one to make. The same can be said for caregivers involved in the decision-making process. However, finding the right facility that meets the needs of all parties can help ease this transition. Patients and/or caregivers can consider the following questions to help identify needs and choose an appropriate aged care facility:

  1. Is engaging in activities outside of their aged care facility important to the patient and something that they wish to participate in?
  2. Does the aged care facility offer this intervention as an option to patients?
  3. Does the aged care facility have the capacity to successfully and safely plan and execute such an intervention? For instance, does the facility employ a sufficient number of staff and the needed knowledge and expertise, do they conduct assessments to determine whether the patient is physically and cognitively able to participate in such activities, and are transportation services available when needed (2)? 

If a person with dementia is already living in a care facility but has yet to broach this topic, these questions can also be used to guide discussions and next steps.

Living meaningfully is something we all desire. Engaging in activities that bring us joy and excitement and allow us to use our talents, follow our passions, and investigate our interests, both inside and outside of an aged care facility, is one small step towards living life in a way that is meaningful to us. 

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  1. Canadian Institute for Health Information. Dementia in long-term care. [Internet] 2022. [cited April 2022]. Available from https://www.cihi.ca/en/dementia-in-canada/dementia-care-across-the-health-system/dementia-in-long-term-care   
  2. D'Cunha NM, Isbel S, McKune AJ, et al. Activities outside of the care setting for people with dementia: A systematic review. BMJ Open. 2020; 10:e040753. doi: 10.1136/bmjopen-2020-040753.
  3. McDermott O, Charlesworth G, Hogervorst E, et coll. Psychosocial interventions for people with dementia: A synthesis of systematic reviews. Aging Ment Health. 2019; 23:393-403. doi: 10.1080/13607863.2017.1423031.
  4. Sidani S, Streiner D, Leclerc C. Evaluating the effectiveness of the abilities-focused approach to morning care of people with dementia. Int J Older People Nurs. 2012; 7:37-45. doi: 10.1111/j.1748-3743.2011.00273.x.
  5. Nordhausen T, Langner H, Fleischer S, et coll. [Improving psychosocial health of nursing home residents: a systematic review of interventions for prevention and health promotion]. Z Evid Fortbild Qual Gesundhwes. 2019; 147-148:7-19. doi: 10.1016/j.zefq.2019.09.005.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.