Promoting and Highlighting Research in Assisted Living to Inform Practice and Policy
Cognitive/Dementia
2025 CEAL@UNC Research Award Summary
2026 Alzheimer’s Disease Facts and Figures
The National Dementia Workforce Study: The Plan for Organization Sample Frames and Data Collection
This article outlines the plan for developing organization sample frames and data collection methods for the National Dementia Workforce Study (NDWS). Since no national sampling frames for this workforce exist, a two-stage sampling framework was developed: stage 1 involved identifying organizations, inviting them to participate in a survey, and asking them to provide staff information; and stage 2 involved recruiting individual staff for the NDWS survey.
The National Dementia Workforce Study: The Plan for Organization Sample Frames and Data Collection
This article outlines the plan for developing organization sample frames and data collection methods for the National Dementia Workforce Study (NDWS). Since no national sampling frames for this workforce exist, a two-stage sampling framework was developed: stage 1 involved identifying organizations, inviting them to participate in a survey, and asking them to provide staff information; and stage 2 involved recruiting individual staff for the NDWS survey.
The National Dementia Workforce Study: Development of Questionnaires for Home Care, Assisted Living, and Nursing Home Settings
This report describes the design of the National Dementia Workforce Study (NDWS) initial questionnaire. The process involved integrating literature reviews, validated questionnaire items, expert consultations, and cognitive interviews to ensure reliability and validity. The resulting data from the NDWS will be available to researchers to better understand the workforce serving people living with dementia.
The National Dementia Workforce Study: Development of Questionnaires for Home Care, Assisted Living, and Nursing Home Settings
This report describes the design of the National Dementia Workforce Study (NDWS) initial questionnaire. The process involved integrating literature reviews, validated questionnaire items, expert consultations, and cognitive interviews to ensure reliability and validity. The resulting data from the NDWS will be available to researchers to better understand the workforce serving people living with dementia.
The National Dementia Workforce Study: Perspective From the National Institute on Aging
This article discusses the goals, data collection, and data release of the National Dementia Workforce Study (NDWS), a longitudinal study that will help track workforce changes over time in community-based medical practices, nursing homes, AL communities, and home care. The NDWS is the first nationally representative study of this workforce, including information on knowledge, skills, experiences, challenges, job retention, and financial struggles.
The National Dementia Workforce Study: Perspective From the National Institute on Aging
This article discusses the goals, data collection, and data release of the National Dementia Workforce Study (NDWS), a longitudinal study that will help track workforce changes over time in community-based medical practices, nursing homes, AL communities, and home care. The NDWS is the first nationally representative study of this workforce, including information on knowledge, skills, experiences, challenges, job retention, and financial struggles.
The Relationship Between Home and Community-Based Services Utilization and Self-Reported Quality of Life for Community-Dwelling and Assisted Living Residents with and without Dementia
This study of 1413 respondents from the 2018 Minnesota National Core Indicators-Aging and Disability survey examined the relationship between specific home and community-based services and quality of life. On average, respondents with dementia reported lower quality of life scores than respondents without dementia. Using personal care assistants was most significantly correlated with increased quality of life, while services such as home health care and adult day services were not significantly associated with quality of life.
The Relationship Between Home and Community-Based Services Utilization and Self-Reported Quality of Life for Community-Dwelling and Assisted Living Residents with and without Dementia
This study of 1413 respondents from the 2018 Minnesota National Core Indicators-Aging and Disability survey examined the relationship between specific home and community-based services and quality of life. On average, respondents with dementia reported lower quality of life scores than respondents without dementia. Using personal care assistants was most significantly correlated with increased quality of life, while services such as home health care and adult day services were not significantly associated with quality of life.
Recruiting Sexual and Gender Minority Older Adults With and Without Dementia in Long-Term Care: Overcoming Barriers and Lessons Learned
This qualitative study of 20 AL and nursing home administrators explored the barriers and facilitators of recruiting sexual and gender minority (SGM) residents for research projects. Three key themes emerged: challenges identifying SGM residents, a need to address discrimination, and special considerations for SGM residents who also have cognitive impairment. These findings can guide researchers trying to recruit SGM residents more ethically and effectively.
Recruiting Sexual and Gender Minority Older Adults With and Without Dementia in Long-Term Care: Overcoming Barriers and Lessons Learned
This qualitative study of 20 AL and nursing home administrators explored the barriers and facilitators of recruiting sexual and gender minority (SGM) residents for research projects. Three key themes emerged: challenges identifying SGM residents, a need to address discrimination, and special considerations for SGM residents who also have cognitive impairment. These findings can guide researchers trying to recruit SGM residents more ethically and effectively.
Collecting, Sharing, and Using Information for Person-Centered Dementia Care: Perspectives of Residents, Care Partners, and Staff in Low-Resource Long-Term Care Settings
This qualitative study explored the perspectives of 59 administrative leaders, direct care staff, residents, and care partners in 4 long-term care communities in medically underserved areas about how collecting and sharing information can be used to support person-centered care. Effective communication strategies included communication logs, leaving notes, and verbal reports, and, to support person-centered care, interdisciplinary collaboration, engaging care partners, and peer mentorship. These strategies can improve information collection and sharing in long-term care.
Collecting, Sharing, and Using Information for Person-Centered Dementia Care: Perspectives of Residents, Care Partners, and Staff in Low-Resource Long-Term Care Settings
This qualitative study explored the perspectives of 59 administrative leaders, direct care staff, residents, and care partners in 4 long-term care communities in medically underserved areas about how collecting and sharing information can be used to support person-centered care. Effective communication strategies included communication logs, leaving notes, and verbal reports, and, to support person-centered care, interdisciplinary collaboration, engaging care partners, and peer mentorship. These strategies can improve information collection and sharing in long-term care.
The Influence of Physical, Social, and Organizational Environments on Recreational Activities in Long-Term Care for Residents With Dementia: A Scoping Review
This scoping review of 28 studies examined how physical, social, and organizational factors influence activity engagement for residents with dementia in long-term care (LTC) settings. Factors such as small house-like environments, familiar routines, and closer staff-resident relationships can increase participation, highlighting the importance of using inclusive and person-centered approaches to improve activity planning in LTC settings.
The Influence of Physical, Social, and Organizational Environments on Recreational Activities in Long-Term Care for Residents With Dementia: A Scoping Review
This scoping review of 28 studies examined how physical, social, and organizational factors influence activity engagement for residents with dementia in long-term care (LTC) settings. Factors such as small house-like environments, familiar routines, and closer staff-resident relationships can increase participation, highlighting the importance of using inclusive and person-centered approaches to improve activity planning in LTC settings.
Care Refusal by Older Adults With Dementia Receiving Professional Care: A Scoping Review
This scoping review examined 19 studies to understand determinants and effects of care refusal by long-term care residents living with dementia. Factors such as cognitive impairment, communication challenges, elderspeak, unfamiliar environments, and task-oriented care were identified as determinants of care refusal, while megative effects included compromised health outcomes, disrupted provision of care, and increased neuropsychiatric symptoms, highlighting factors that could be addressed to reduce care refusal.
Care Refusal by Older Adults With Dementia Receiving Professional Care: A Scoping Review
This scoping review examined 19 studies to understand determinants and effects of care refusal by long-term care residents living with dementia. Factors such as cognitive impairment, communication challenges, elderspeak, unfamiliar environments, and task-oriented care were identified as determinants of care refusal, while megative effects included compromised health outcomes, disrupted provision of care, and increased neuropsychiatric symptoms, highlighting factors that could be addressed to reduce care refusal.
Understanding Digital Literacy of Persons With Dementia and Their Caregivers: A Scoping Review and an Evolutionary Concept Analysis of Empirical Studies
WHAT THIS MEANS FOR YOU: This scoping review of 22 studies examined digitial literacy for people with dementia and their caregivers across settings and aimed to understand antecedents, attributes, and consequences of digital literacy. Support systems, and individual and sociodemographic characteristics were identified as antecedents; technological and critical thinking skills are attributes; and technology acceptance, psychosocial impacts, and digital equity were consequences. These concepts could guide the development and implementation of digital interventions for people with dementia and their caregivers.
Understanding Digital Literacy of Persons With Dementia and Their Caregivers: A Scoping Review and an Evolutionary Concept Analysis of Empirical Studies
WHAT THIS MEANS FOR YOU: This scoping review of 22 studies examined digitial literacy for people with dementia and their caregivers across settings and aimed to understand antecedents, attributes, and consequences of digital literacy. Support systems, and individual and sociodemographic characteristics were identified as antecedents; technological and critical thinking skills are attributes; and technology acceptance, psychosocial impacts, and digital equity were consequences. These concepts could guide the development and implementation of digital interventions for people with dementia and their caregivers.
Artificial Intelligence in Assisted Living and Memory Care: Enhancing Care or Increasing Exposure?
WHAT THIS MEANS FOR YOU: This editorial uses data from the CAN Aging Servces Claim Report to examine how artificial intelligence (AI) can alter care, liability, and decision-making in assisted living and memory care settings.
Artificial Intelligence in Assisted Living and Memory Care: Enhancing Care or Increasing Exposure?
WHAT THIS MEANS FOR YOU: This editorial uses data from the CAN Aging Servces Claim Report to examine how artificial intelligence (AI) can alter care, liability, and decision-making in assisted living and memory care settings.
Empowering Family Care Partners to Optimize Delirium Care for Persons Living with Dementia
WHAT THIS MEANS FOR YOU: This qualitative study interviewed twelve family care partners from an assisted living community in Virginia and a memory care clinic in Georgia to gain insight into intervention development for delirium superimposed on dementia (DSD). Themes such as education, proactive strategies, and empathetic communication emerged as relevant for improving outcomes for people with DSD. The study highlights the need for interventions targeting education and the mental and emotional needs of care partners.
Empowering Family Care Partners to Optimize Delirium Care for Persons Living with Dementia
WHAT THIS MEANS FOR YOU: This qualitative study interviewed twelve family care partners from an assisted living community in Virginia and a memory care clinic in Georgia to gain insight into intervention development for delirium superimposed on dementia (DSD). Themes such as education, proactive strategies, and empathetic communication emerged as relevant for improving outcomes for people with DSD. The study highlights the need for interventions targeting education and the mental and emotional needs of care partners.
Differing Realities Among Assisted Living Residents With Dementia: Understanding Care Partner Responses
WHAT THIS MEANS FOR YOU: This analysis of 73 residents with dementia and 103 care partners from eight assisted living communities in the Atlanta area examined differing realities of residents with dementia and their care partners' responses. A qualitative analysis revealed most residents experienced confusion, which led to reality management strategies deployed by care partners. These strategies ranged from ignoring or dismissing to correcting, redirecting, or joining the resident in their reality. Factors such as type of confusion and resident/care partner characteristics influenced which strategy was deployed.
Differing Realities Among Assisted Living Residents With Dementia: Understanding Care Partner Responses
WHAT THIS MEANS FOR YOU: This analysis of 73 residents with dementia and 103 care partners from eight assisted living communities in the Atlanta area examined differing realities of residents with dementia and their care partners’ responses. A qualitative analysis revealed most residents experienced confusion, which led to reality management strategies deployed by care partners. These strategies ranged from ignoring or dismissing to correcting, redirecting, or joining the resident in their reality. Factors such as type of confusion and resident/care partner characteristics influenced which strategy was deployed.
Two New Positive Psychosocial Measures for Persons Living with Dementia
WHAT THIS MEANS FOR YOU: Two pilot studies created and tested two new instruments for evaluating wellbeing for people living with dementia, the Living Well Inventory for Dementia (LWI-D) and the Quality of Day Scale (QODS). Seventeen individuals with early-stage dementia tested the LWI-D, and 30 care dyads tested the QODS. Both measures were supported for acceptability and feasibility, with initial support for reliability and validity; further testing of the instruments is recommended.
Two New Positive Psychosocial Measures for Persons Living with Dementia
WHAT THIS MEANS FOR YOU: Two pilot studies created and tested two new instruments for evaluating wellbeing for people living with dementia, the Living Well Inventory for Dementia (LWI-D) and the Quality of Day Scale (QODS). Seventeen individuals with early-stage dementia tested the LWI-D, and 30 care dyads tested the QODS. Both measures were supported for acceptability and feasibility, with initial support for reliability and validity; further testing of the instruments is recommended.
Considerations for Use of the Cornell Scale for Depression in Dementia Among Assisted Living Residents: Factor Analysis Results
WHAT THIS MEANS FOR YOU: This study tested the Cornell Scale for Depression in Dementia (CSDD) with 511 residents from 85 assisted living (AL) communities in three states to understand if it is an appropriate scale for assessing depression in AL residents. Measure-related analysis led to three items being removed from the scale and a five-factor model showed a better fit than the four-factor model, although both showed poor fit. Although a modified CSDD is partially supported for use with this population, future research should explore more appropriate measures for measuring depression in AL residents.
Considerations for Use of the Cornell Scale for Depression in Dementia Among Assisted Living Residents: Factor Analysis Results
WHAT THIS MEANS FOR YOU: This study tested the Cornell Scale for Depression in Dementia (CSDD) with 511 residents from 85 assisted living (AL) communities in three states to understand if it is an appropriate scale for assessing depression in AL residents. Measure-related analysis led to three items being removed from the scale and a five-factor model showed a better fit than the four-factor model, although both showed poor fit. Although a modified CSDD is partially supported for use with this population, future research should explore more appropriate measures for measuring depression in AL residents.
What Happens Behind Closed Doors? Investigating Care Practices in Nursing Home and Assisted Living Memory Care Units
WHAT THIS MEANS FOR YOU: This study investigated care practices in memory care units using data from the 2021 Biennial Survey of Ohio Long-Term Care Facilities. Analysis revealed that about 20% of nursing homes and AL communities had memory care units, and that physician monitoring, staffing, and adoption of practices and policies were similar in both settings, but that psychotropic medications were used more frequently in NH memory care units. This analysis indicates that improving memory care may require different interventions in NH vs. AL settings.
What Happens Behind Closed Doors? Investigating Care Practices in Nursing Home and Assisted Living Memory Care Units
WHAT THIS MEANS FOR YOU: This study investigated care practices in memory care units using data from the 2021 Biennial Survey of Ohio Long-Term Care Facilities. Analysis revealed that about 20% of nursing homes and AL communities had memory care units, and that physician monitoring, staffing, and adoption of practices and policies were similar in both settings, but that psychotropic medications were used more frequently in NH memory care units. This analysis indicates that improving memory care may require different interventions in NH vs. AL settings.
Understanding Urinary Incontinence and Urinary Tract Infections as Key Contributors to Falls in Assisted Living and Memory Care Communities
WHAT THIS MEANS FOR YOU: This editorial examined how urinary incontinence (UI) and urinary tract infections (UTIs) are contributors to falls for assisted living and memory care residents. Impacts on balance, stability, confusion, and fatigue all contribute to the increased risk. Future falls prevention approaches should consider UI and UTIs, structured toileting, and caregiver training to reduce risk.
Understanding Urinary Incontinence and Urinary Tract Infections as Key Contributors to Falls in Assisted Living and Memory Care Communities
WHAT THIS MEANS FOR YOU: This editorial examined how urinary incontinence (UI) and urinary tract infections (UTIs) are contributors to falls for assisted living and memory care residents. Impacts on balance, stability, confusion, and fatigue all contribute to the increased risk. Future falls prevention approaches should consider UI and UTIs, structured toileting, and caregiver training to reduce risk.
The Meaningful Engagement Assessment for Residents with Dementia in Assisted Living Settings
WHAT THIS MEANS FOR YOU: This study tested the Meaningful Engagement Assessment (MEA) tool with 31 residents with mild to severe dementia in two assisted living communities. The MEA is designed to create individualized care plannning for residents. With brief training, this pilot study revealed that the tool can feasibly be used by staff to promote meaningful activity for AL residents.
The Meaningful Engagement Assessment for Residents with Dementia in Assisted Living Settings
WHAT THIS MEANS FOR YOU: This study tested the Meaningful Engagement Assessment (MEA) tool with 31 residents with mild to severe dementia in two assisted living communities. The MEA is designed to create individualized care plannning for residents. With brief training, this pilot study revealed that the tool can feasibly be used by staff to promote meaningful activity for AL residents.
Assisted Living, Residential Care, and Memory Care Staffing Level Dynamics: Oregon, 2017-2023
WHAT THIS MEANS FOR YOU: This longitudinal study examined staffing levels, as measured by care hours per resident per day, from 535 long-term care communities in Oregon between 2017-2023. There was an increase in staff immediately after the pandemic and staffing levels were, on average, 28 minutes higher in 2023 than 2017. However, there was significant variation among AL communities' staffing levels, likely due to organizational-level factors like resource allocation, resident case mix, and operational structures.
Assisted Living, Residential Care, and Memory Care Staffing Level Dynamics: Oregon, 2017-2023
WHAT THIS MEANS FOR YOU: This longitudinal study examined staffing levels, as measured by care hours per resident per day, from 535 long-term care communities in Oregon between 2017-2023. There was an increase in staff immediately after the pandemic and staffing levels were, on average, 28 minutes higher in 2023 than 2017. However, there was significant variation among AL communities’ staffing levels, likely due to organizational-level factors like resource allocation, resident case mix, and operational structures.
The Impact of Enhanced Group Activity Kits (EGAKs) on Well-being of Persons with Dementia
WHAT THIS MEANS FOR YOU: This study examined 123 people living with dementia (PLwD) from 6 nursing centers and 4 adult day units in Israel to investigate the impact of group activities and whether group activity kits (EGAKs) enhanced activity quality. Use of EGAKs significantly improved resident well-being compared to activities without EGAKs, and participating in no activities at all significantly lowered well-being, supporting possible implementation of EGAKs to improve group activities for residents.
The Impact of Enhanced Group Activity Kits (EGAKs) on Well-being of Persons with Dementia
WHAT THIS MEANS FOR YOU: This study examined 123 people living with dementia (PLwD) from 6 nursing centers and 4 adult day units in Israel to investigate the impact of group activities and whether group activity kits (EGAKs) enhanced activity quality. Use of EGAKs significantly improved resident well-being compared to activities without EGAKs, and participating in no activities at all significantly lowered well-being, supporting possible implementation of EGAKs to improve group activities for residents.
The Efficacy of a Mobile-Based Multidomain Program on Cognitive Functioning of Residents in Assisted Living Facilities
WHAT THIS MEANS FOR YOU: This study of 20 AL residents who scored in the range of mild cognitive impairment on the MoCA was designed to test the efficacy of a mobile-based program on cognitive functioning (the Silvia program). The intervention group received the mobile program's lifestyle intervention for 50-60 mins, twice weekly, for 12 weeks. The intervention group showed significant improvement in MoCA scores (23.6 vs. 24.3) while the control group declined (22.0 vs. 21.7).
The Efficacy of a Mobile-Based Multidomain Program on Cognitive Functioning of Residents in Assisted Living Facilities
WHAT THIS MEANS FOR YOU: This study of 20 AL residents who scored in the range of mild cognitive impairment on the MoCA was designed to test the efficacy of a mobile-based program on cognitive functioning (the Silvia program). The intervention group received the mobile program’s lifestyle intervention for 50-60 mins, twice weekly, for 12 weeks. The intervention group showed significant improvement in MoCA scores (23.6 vs. 24.3) while the control group declined (22.0 vs. 21.7).
Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia
WHAT THIS MEANS FOR YOU: This study used data from 3 AL communities over one year to examine deviations from scheduled activity programming, identify influential factors, and understand the outcomes on residents. The analysis showed general adherence to calendars, but deviations did occur. Staffing, capacity, programming guidance and support, staff attitudes, and unforeseen circumstances all influenced these deviations. Cancellations of programming were more detrimental to resident well-being than substitutions.
Examining Engagement Calendar Deviations in Assisted Living: A Focus on Residents With Dementia
WHAT THIS MEANS FOR YOU: This study used data from 3 AL communities over one year to examine deviations from scheduled activity programming, identify influential factors, and understand the outcomes on residents. The analysis showed general adherence to calendars, but deviations did occur. Staffing, capacity, programming guidance and support, staff attitudes, and unforeseen circumstances all influenced these deviations. Cancellations of programming were more detrimental to resident well-being than substitutions.
