Meaningful Engagement in Advance Dementia (MEAD) – Co-producing a digital tool in long-term care
Parallel 4
18 November, 2026 12:00 – 1:10 pmCo-producing Activity and Engagement in Care Homes
Arlene Astell
Professor of Cyberpsychology
Northumbria University
Amelia Greenwood
Head of Specialist Services
Orchard Healthcare Group
Summary
Background
People living with dementia who have lost speech face reduced opportunities for meaningful engagement. Adaptive Interaction is an approach to nonverbal communication that equips caregivers to connect but they lack a structured way to assess meaningful engagement. This four-part study is co-producing an evidence-based digital measure to promote ongoing meaningful engagement for people living with advanced dementia who are nonverbal.
Method
The first part comprised a systematized review to identify engagement characteristics in existing measurement approaches. The second part descriptive qualitative study identified key indicators of engagement in video recordings based on Adaptive Interaction. The third part conducted two rounds of co-production workshops with 19 family and professional caregivers examining their understanding of meaningful engagement in advanced dementia. These informed development of a prototype video-based observational prototype tool for Measuring Engagement in Advanced Dementia (MEAD). In part four, the prototype measure was developed and field tested to examine feasibility for capturing meaningful engagement during interactions in real care environments.
Results
The first part identified 21, predominantly observational dementia engagement measures, focusing on behaviour, social environment, and personal interaction. In the second part, video analysis of Adaptive Interaction sessions identified that engagement is reciprocal and mainly nonverbal and evolves within dyads. The caregiver workshops confirmed engagement as a relational, observable, and non-verbal concept. The field testing with 9 dyads over 7 sessions each (N=63) showed that the MEAD measure was feasible and acceptable, supported attention to non-verbal behaviours, strengthened caregiver confidence in engaging non-verbal residents, and the quality of interactions.
Conclusions
The first three parts demonstrated that engagement in dementia is approached as an observable experience in both research and care. Field testing the prototype MEAD tool demonstrated a positive impact on the confidence of formal caregivers and their ability to engage nonverbal people living with advanced dementia. Based on these findings and a third round of co-production workshops, Version 2 of the MEAD tool is currently in development. This will be evaluated in long-term care, alongside caregiver training and implementation variables to embed the measure in routine care.