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Individuals with dementia often face barriers accessing meaningful engagement, contributing to issues like agitation, loneliness and depression. Engaging activities have shown promise in alleviating these negative symptoms and enhancing overall quality of life. Past research has explored various approaches such as recreational activities, sensory stimulation and music therapy. However, meeting the individualized needs of residents in long-term care dementia programs remains challenging, particularly for those in late-stage dementia who may struggle with group activities due to communication barriers.

One-to-one interactions are often preferable but can be difficult to implement due to staffing constraints. Reading has emerged as a potential individualized activity for persons with dementia, with some evidence suggesting its positive impact on well-being. The Reading Buddies Program (RBP), facilitated through a partnership with an occupational therapy graduate program, provides personalized reading sessions for veterans with late-stage dementia. In this study, we explored the effectiveness of reading sessions in engaging persons with dementia and investigated how various factors such as interaction dynamics, environmental conditions, attention, attitude and activity levels influenced engagement. Our primary measure was the engagement percentage, calculated by comparing the duration of the person's engagement with the book to the duration of the reading session. We hypothesized that increased reading duration and positive interaction parameters would lead to higher engagement levels. Additionally, we examined the impact of environmental factors on engagement.

The engagement of individuals with dementia in meaningful activities has garnered significant attention due to its potential to mitigate negative symptoms and enhance quality of life. Dementia is commonly associated with difficulties in accessing and participating in activities, often leading to feelings of agitation, loneliness and depression among affected individuals [1]. It indicates that engagement in various activities, such as recreational pursuits, sensory stimulation, music therapy and pet visits, can positively impact the well-being of persons with dementia [2]. However, meeting the individualized needs of residents in long-term care settings, particularly those with late-stage dementia, presents a considerable challenge, as traditional group-based activities may not always be feasible due to communication barriers and other limitations [3]. In light of these challenges, one-to-one interactions have emerged as a promising approach to address the unique needs of individuals with dementia [4]. Reading, in particular, has garnered attention as a potential individualized activity for persons with dementia, with some evidence suggesting its positive impact on quality of life and wellbeing [5]. The Reading Buddies Program (RBP) represents one such initiative that capitalizes on academic partnerships to provide personalized reading sessions for veterans with late-stage dementia. This program enables occupational therapy graduate students to engage in one-to-one interactions with residents, fostering meaningful engagement through shared reading experiences. In the present study, the effectiveness of reading sessions in engaging persons with dementia was investigated, along with the influence of various factors on the level of engagement observed. Utilizing the Observational Measurement of Engagement (OME) form adapted for the RBP, observers recorded data on engagement behaviors during reading sessions. Factors such as interaction parameters, environmental conditions, attention, attitude and activity levels were examined to determine their impact on engagement levels [6]. The primary outcome measure, the engagement percentage, was calculated by comparing the duration of the person's engagement with the book to the total duration of the reading session [7]. Hypotheses were formulated to assess the relationship between reading duration, attention, attitude, activity levels and overall engagement. Statistical analysis, including weighted Analysis of Variance (ANOVAs), was conducted to explore the influence of these variables on engagement outcomes. A conservative bonferroni correction was applied to account for multiple statistical tests, ensuring robustness in the findings. Overall, the study provides valuable insights into the efficacy of individualized reading interventions for persons with dementia and underscores the importance of tailored approaches to address the diverse needs of this population [8-10]. By elucidating the factors that contribute to engagement during reading sessions, the findings contribute to the growing body of literature on person-centered care for individuals with dementia in long-term care settings. Future research may further explore the potential benefits of reading interventions and inform the development of evidence-based practices to enhance the quality of life for persons living with dementia [11,12].

In this comprehensive study, we delved into the intricacies of the reading buddies program to evaluate its effectiveness in engaging inpatient residents with dementia during book reading sessions. Our exploration extended beyond mere program evaluation, encompassing a multifaceted analysis of interaction dynamics, environmental conditions and individual parameters such as attention and attitude to elucidate the nuanced factors influencing the observed level of engagement.

As anticipated, our findings substantiate the existence of a robust positive correlation between the duration of reading sessions and the level of engagement exhibited by residents. This correlation aligns with existing evidence, suggesting that individuals in the late stages of dementia tend to engage for shorter durations and may require additional prompting compared to those in earlier stages. This insight underscores the importance of tailoring reading interventions to accommodate the specific needs of residents at different stages of dementia, recognizing the varying attention spans and responsiveness within the population.

Our exploration into interaction parameters revealed intriguing patterns. Transferring residents during sessions was associated with increased engagement, emphasizing the potential impact of physical interactions on residents' participation in reading activities. Conversely, interruptions from students during other activities were found to decrease engagement, highlighting the necessity of providing sufficient transition time between activities, particularly for individuals with advanced dementia who may be sensitive to abrupt changes.

Surprisingly, instances of being interrupted by someone else or initially refusing the book did not significantly impact overall engagement levels. This intriguing finding suggests that residents with dementia may still engage in activities even after an initial refusal, emphasizing the significance of patience and persistence in offering stimulating experiences to this population.

Environmental factors, while not significantly impacting engagement levels in our study, revealed a trend wherein a moderate number of people present seemed to slightly decrease engagement. This warrants further exploration in future research to determine the optimal environmental conditions that facilitate engagement during reading sessions.

Additionally, our study affirmed expected associations between higher levels of attention, attitude and activity and increased engagement. However, it is crucial to note that the correlational nature of these findings prevents us from establishing causality. Future studies could enhance their design by incorporating baseline measures of these parameters to better understand their interplay with engagement outcomes following reading interventions.

In conclusion, our extensive investigation into the reading buddies program sheds light on the efficacy of personalized reading interventions for individuals facing late-stage dementia. Our meticulous examination of interaction dynamics, environmental factors and individual parameters reveals the intricate influences on engagement levels during reading sessions. Emphasizing the importance of tailored approaches to address the diverse needs of those in institutional settings, particularly those in advanced stages of dementia, our study underscores the potential of one-to-one interactions, specifically through shared reading experiences, in enhancing residents' quality of life. By pinpointing key factors such as attention, attitude and activity levels contributing to increased engagement, our research establishes a foundation for evidence-based practices in optimizing dementia care programs. These insights not only advance our understanding of effective interventions but also offer guidance for healthcare professionals and caregivers to customize their approaches based on individual needs. Looking forward, our call for continued research aims to deepen the understanding of the benefits of reading interventions and explore strategies for sustaining engagement over time in individuals living with dementia. This ongoing exploration holds the promise of refining and expanding our knowledge, contributing to the advancement of compassionate and effective dementia care practices.

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