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The Comprehensive Process Model of Engagement


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


The American Journal of Geriatric Psychiatry, Volume: 19, No.: 10, Pages.: 859-870

Year of Publication



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. (PsycINFO Database Record (c) 2013 APA, all rights reserved). (journal abstract)

Bibtex Citation

@article{Cohen_Mansfield_2011, doi = {10.1097/jgp.0b013e318202bf5b}, url = {}, year = 2011, month = {oct}, publisher = {Elsevier {BV}}, volume = {19}, number = {10}, pages = {859--870}, author = {Jiska Cohen-Mansfield and Marcia S. Marx and Laurence S. Freedman and Havi Murad and Natalie G. Regier and Khin Thein and Maha Dakheel-Ali}, title = {The Comprehensive Process Model of Engagement}, journal = {The American Journal of Geriatric Psychiatry} }


dementia, engagement, environmental stimulus, medical diagnosis, models, process model engagement, stimuli, various

Countries of Study


Types of Dementia

Dementia (general / unspecified)

Types of Study

Cohort Study

Type of Outcomes

Behaviour, Other


Nursing Homes

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Arts and Music Interventions (including Art and Music Therapy), Other