Differing Realities Among Assisted Living Residents With Dementia: Understanding Care Partner Responses

Persons living with dementia can experience confusion in terms of orientation to time, place, and scenario. The ways care partners respond are apt to shape quality of life and care experiences. With a focus on assisted living (AL) residents with dementia, we seek to: (1) examine differing realities and care partner responses and (2) identify influential resident and care partner factors, other contributing contextual conditions, and response outcomes.

We present analysis of qualitative data gathered from a grounded theory (GT) study involving 8 diverse AL communities each studied for a 1-year period between 2019 and 2023. Researchers followed 73 residents with dementia and 103 care partners (family, friends, AL staff, external workers, volunteers), conducting interviews (n = 236) and participant observation (980 visits and 2,676 hr), and reviewing resident participants' AL records. Guided by principles of GT, analysis was iterative, involved initial, axial, and selective coding, and led to the identification of the core category, "reality management."

Most residents experienced dementia-related confusion. In response, care partners engaged in a process of "reality management," which involved strategies that invalidated or validated realities and emotions; these included ignoring, dismissing, correcting, redirecting, and joining. The nature, types and expression of confusion, and resident and care partner characteristics and capacities, influenced responses and outcomes.

Findings reinforce the value of person- and situation-specific responses and have implications for practice and underscore the need for additional research.