The comprehensive process model of engagement

Jiska Cohen-Mansfield*, Marcia S. Marx, Laurence S. Freedman, Havi Murad, Natalie G. Regier, Khin Thein, Maha Dakheel-Ali

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

64 Scopus citations


Background: Engagement refers to the act of being occupied or involved with an external stimulus. In dementia, engagement is the antithesis of apathy. OBJECTIVE:: The Comprehensive Process Model of Engagement was examined, in which environmental, personal, and stimulus characteristics impact the level of engagement. Methods: Participants were 193 residents of 7 Maryland nursing with a diagnosis of dementia. Stimulus engagement was assessed via the Observational Measure of Engagement, measuring duration, attention, and attitude to the stimulus. Twenty-five stimuli were presented, which were categorized as live human social stimuli, simulated social stimuli, inanimate social stimuli, a reading stimulus, manipulative stimuli, a music stimulus, task and work-related stimuli, and two different self-identity stimuli. Results: All stimuli elicited significantly greater engagement in comparison to the control stimulus. In the multivariate model, music significantly increased engagement duration, whereas all other stimuli significantly increased duration, attention, and attitude. Significant environmental variables in the multivariate model that increased engagement were: use of the long introduction with modeling (relative to minimal introduction), any level of sound (especially moderate sound), and the presence of between 2 and 24 people in the room. Significant personal attributes included Mini-Mental State Examination scores, activities of daily living performance and clarity of speech, which were positively associated with higher engagement scores. CONCLUSIONS:: Results are consistent with the Comprehensive Process Model of Engagement. Personal attributes, environmental factors, and stimulus characteristics all contribute to the level and nature of engagement, with a secondary finding being that exposure to any stimulus elicits engagement in persons with dementia.

Original languageEnglish
Pages (from-to)859-870
Number of pages12
JournalAmerican Journal of Geriatric Psychiatry
Issue number10
StatePublished - Oct 2011


FundersFunder number
National Institute on AgingR01AG021497


    • Dementia
    • engagement
    • environment
    • nursing home residents
    • personal characteristics
    • stimuli


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