Engaging persons with dementia in meaningful activities supports well-being; however care staff are challenged to identify activities that are developmentally and generationally appropriate in a group setting. In this study, I compared a randomly assigned treatment group (HT) to a comparison group (traditional activities) on outcome variables, including engagement, affect, and problem behaviors. HT programming was implemented twice weekly at four treatment sites for six weeks, while traditional activities were observed at four comparison sites during that time period. A mixed method assessment was undertaken to examine the processes and outcomes that influenced the observed outcomes and the interrelationships between these dependent variables. Data was gathered from a variety of sources using a range of methods, including structured observational assessments, semi-structured interviews, and a focus group session. Informants included persons with dementia, traditional activity facilitators from the comparison sites, and observational research team members. Nonparametric Mann Whitney-U analyses were used to compare the treatment and comparison groups on behavioral and affective domains, while multiple correspondence analysis (MCA) was used to examine the interrelationships between these outcome variables. Analytic induction and constant comparison enabled the researchers to identify factors that affected the implementation of the intervention and its subsequent impact on the participants. Mann Whitney-U results revealed no statistical differences between the HT and traditional groups on the three affective domains; however, levels of adaptive behavior did differ between the two groups, with the treatment group demonstrating significantly higher levels of active, passive, and other engagement, and the comparison group demonstrating significantly higher levels of self-engagement. MCA analyses indicated that individuals who exhibited high level of active engagement were also likely to display high levels of pleasure and low levels of non-engagement, further supporting the value of active engagement in activities to optimize well-being. Qualitative findings highlighted the importance of simultaneously capturing the participants' responses as well as indicators of the social and physical environment to gain a holistic understanding of the intervention and associated outcomes. Results demonstrated that while HT programming results in positive outcomes for participants, facilitation of therapeutic activities for persons with dementia is a critical element influencing the targeted outcomes. / Ph. D.

There is an evident gap in the research regarding the environmental needs of older adults with Alzheimer's disease and related dementias (ADRD) and the design of therapeutic outdoor spaces for these persons. With the rapid growth of the aging population, appropriate outdoor spaces will become essential to improved quality of life for older adults with ADRD. This study explores nonpharmacological treatment approaches for persons with ADRD that can be facilitated in the outdoor environment. The study presents an examination of the literature, including theoretical frameworks and treatment approaches, interviews with professionals in the fields of landscape architecture and gerontology, and an assessment of case studies. Design guidelines identify the necessary landscape elements that can be incorporated in outdoor environments to reduce maladaptive behaviors and improve positive affect and the overall quality of life for persons with dementia. This study concludes with an example of a prototypical wander garden design that responds to the design guidelines and addresses the physical and mental capabilities of persons with ADRD. / Master of Landscape Architecture