Who benefits most? Intervention-induced changes in the social networks of people living with dementia

This is a preprint that has not yet been peer-reviewed.For most people living with dementia, their social network shrinks as the disease progresses, especially when they move into a care home. Many experience major barriers to build social relationships in the new living environment and additionally there is a lack of effective interventions to promote social contacts between residents. Considering this, the aim of the present study is twofold: (1) to investigate the effect of two interventions (physical activity [PA] vs. PA plus social component [PAS]) on the social networks of people living with dementia in long-term care facilities using an ordinal mixed-effects model, and (2) to identify the participants who benefit most from these interventions through descriptive profile analysis. Sociocentric networks of the intervention groups were assessed before and after the respective 12-week interventions. Photographs served as a facilitative tool, enabling participants to identify their social contacts and evaluate the quality of these relationships, categorizing them as positive regard, casual friend, or true friend. Loneliness, the importance of friendships within the facility and the attitude towards peer residents were assessed in interviews. 46 people living with dementia (87.1±7.3 years, 82.6% female) from six care homes participated in the interventions. In five out of six social networks, both graph density and weighted graph density increased. The average graph density across the PA groups increased by 14.8% and by 153.3% in the PAS groups. The results of the ordinal regression analysis confirm a significant positive time effect across both intervention types (β = 2.29, 95% CI = [1.36; 3.86]) as well as for each intervention type separately. Evident interaction effects (β = 5.76, 95% CI = [2.87; 11.57]) indicate that the time effect in the PAS groups (β = 10.68, 95% CI = [6.11; 18.69]) was significantly higher than in the PA groups (β = 2.61, 95% CI = [1.47; 4.63]). The profile analysis indicates that a higher level of cognitive functioning in particular contributes to greater benefit. The observed results fit in well with the current state of research and at the same time underline the benefits and necessity of using social network analysis approaches in research with people living with dementia in the long-term care setting.