2025 CEAL@UNC Research Award Summary
Cognitive/Dementia
2026 Alzheimer’s Disease Facts and Figures
The National Dementia Workforce Study: The Plan for Organization Sample Frames and Data Collection
The National Dementia Workforce Study was designed to improve our understanding of the individuals and systems who care for people with dementia, but designing and implementing such a study is challenging due to the large number of patient care organizations, clinical and direct care roles, and locations in which care is provided. Specifically, developing a […]
The National Dementia Workforce Study: The Plan for Organization Sample Frames and Data Collection
The National Dementia Workforce Study was designed to improve our understanding of the individuals and systems who care for people with dementia, but designing and implementing such a study is challenging due to the large number of patient care organizations, clinical and direct care roles, and locations in which care is provided. Specifically, developing a […]
The National Dementia Workforce Study: Development of Questionnaires for Home Care, Assisted Living, and Nursing Home Settings
The growing aging population and rising prevalence of dementia are driving increased demand for long-term care services and supports in the United States. People with dementia require substantial support and care, often from direct care workers in private homes, assisted living communities, and nursing homes. Despite their crucial role, these workers receive highly variable training, […]
The National Dementia Workforce Study: Development of Questionnaires for Home Care, Assisted Living, and Nursing Home Settings
The growing aging population and rising prevalence of dementia are driving increased demand for long-term care services and supports in the United States. People with dementia require substantial support and care, often from direct care workers in private homes, assisted living communities, and nursing homes. Despite their crucial role, these workers receive highly variable training, […]
The National Dementia Workforce Study: Perspective From the National Institute on Aging
As the population of individuals living with Alzheimer’s disease and related dementias (AD/ADRD) continues to grow, so does the need for a well-prepared and stable dementia care workforce. The National Dementia Workforce Study (NDWS) represents a significant investment to understand the demographics, experiences, and magnitude and scope of challenges faced by the professional and direct […]
The National Dementia Workforce Study: Perspective From the National Institute on Aging
As the population of individuals living with Alzheimer’s disease and related dementias (AD/ADRD) continues to grow, so does the need for a well-prepared and stable dementia care workforce. The National Dementia Workforce Study (NDWS) represents a significant investment to understand the demographics, experiences, and magnitude and scope of challenges faced by the professional and direct […]
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
Background and objectives: Home and community-based services (HCBS) intend to allow individuals to age in their home or a home-like environment. The relationship between receiving specific types of HCBS and person-reported HCBS quality remains unclear. Research design and methods: We linked data on HCBS quality from 1413 respondents of the 2018 Minnesota National Core Indicators-Aging […]
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
Background and objectives: Home and community-based services (HCBS) intend to allow individuals to age in their home or a home-like environment. The relationship between receiving specific types of HCBS and person-reported HCBS quality remains unclear. Research design and methods: We linked data on HCBS quality from 1413 respondents of the 2018 Minnesota National Core Indicators-Aging […]
Recruiting Sexual and Gender Minority Older Adults With and Without Dementia in Long-Term Care: Overcoming Barriers and Lessons Learned
Sexual and gender minority (SGM) older adults, including those in long-term care and living with cognitive impairment, are underrepresented in research. This study explored barriers and facilitators to recruiting SGM older adults using long-term services and supports (LTSS) into research. As part of a broader project on SGM policies in LTSS, we conducted qualitative interviews […]
Recruiting Sexual and Gender Minority Older Adults With and Without Dementia in Long-Term Care: Overcoming Barriers and Lessons Learned
Sexual and gender minority (SGM) older adults, including those in long-term care and living with cognitive impairment, are underrepresented in research. This study explored barriers and facilitators to recruiting SGM older adults using long-term services and supports (LTSS) into research. As part of a broader project on SGM policies in LTSS, we conducted qualitative interviews […]
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 study explored stakeholder perspectives on how information is collected, shared, and used to support person-centered dementia care in low-resource long-term care settings. This qualitative study was conducted in four long-term care settings situated in federally designated medically underserved areas (two rural, two urban). In-depth semi-structured interviews were conducted with administrative leaders (n = 7), […]
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 study explored stakeholder perspectives on how information is collected, shared, and used to support person-centered dementia care in low-resource long-term care settings. This qualitative study was conducted in four long-term care settings situated in federally designated medically underserved areas (two rural, two urban). In-depth semi-structured interviews were conducted with administrative leaders (n = 7), […]
The Influence of Physical, Social, and Organizational Environments on Recreational Activities in Long-Term Care for Residents With Dementia: A Scoping Review
Background: This scoping review explores how physical, social, and organizational factors influence recreational activity engagement for residents with dementia in long-term care settings. Methods: A literature search in AgeLine, PsycINFO, CINAHL, Medline, and Web of Science identified studies on environmental factors affecting recreational activities for long-term care residents with dementia. A narrative approach was used […]
The Influence of Physical, Social, and Organizational Environments on Recreational Activities in Long-Term Care for Residents With Dementia: A Scoping Review
Background: This scoping review explores how physical, social, and organizational factors influence recreational activity engagement for residents with dementia in long-term care settings. Methods: A literature search in AgeLine, PsycINFO, CINAHL, Medline, and Web of Science identified studies on environmental factors affecting recreational activities for long-term care residents with dementia. A narrative approach was used […]
Care Refusal by Older Adults With Dementia Receiving Professional Care: A Scoping Review
Care refusal behaviors by institutionalized older adults with dementia pose significant challenges for professional caregivers in residential care settings. This scoping review mapped the determinants and effects of care refusal in this population. A systematic search of five databases identified 19 studies published between 2013 and 2023. The findings indicated that personal, relational, environmental, and […]
Care Refusal by Older Adults With Dementia Receiving Professional Care: A Scoping Review
Care refusal behaviors by institutionalized older adults with dementia pose significant challenges for professional caregivers in residential care settings. This scoping review mapped the determinants and effects of care refusal in this population. A systematic search of five databases identified 19 studies published between 2013 and 2023. The findings indicated that personal, relational, environmental, and […]
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.
Staffing Patterns in Nursing Homes, Assisted Living Communities, and Memory Care Units: Variation Across Shifts
WHAT THIS MEANS FOR YOU: This study used observational data from 678 nursing staff at NHs and 432 nursing staff at AL communities in Ohio to assess their direct care nursing staffing patterns. Both NHs and AL communities had better daytime staffing ratios than overnights, although NH staffing ratios were superior to those in AL communities. In AL and NH memory care units, staffing patterns were similar. As acuity increases in AL communities, more nursing staff will likely be required, especially on overnight shifts.
Staffing Patterns in Nursing Homes, Assisted Living Communities, and Memory Care Units: Variation Across Shifts
WHAT THIS MEANS FOR YOU: This study used observational data from 678 nursing staff at NHs and 432 nursing staff at AL communities in Ohio to assess their direct care nursing staffing patterns. Both NHs and AL communities had better daytime staffing ratios than overnights, although NH staffing ratios were superior to those in AL communities. In AL and NH memory care units, staffing patterns were similar. As acuity increases in AL communities, more nursing staff will likely be required, especially on overnight shifts.
