The structure of well-being in dementia

The nature and structure of the concept of well-being, both in general psychological research and in relation to dementia, is reviewed. Well-being is important in understanding subjective emotional experience and life satisfaction, and central to the concept of 'quality of life'.;The research between the structure of well-being in dementia and in wider research is explored, bringing together work from the United States and Tom Kitwood's theory of dementia care.;The principal hypothesis investigated relates to this body of work: specifically whether 'well-being' in people-with-dementia can be understood as one- or more than one factor.;Subsidiary hypotheses concerning well-being in dementia and other variables are also investigated.;Seven point rating scales were used to measure indicators of well-being used in 'Dementia Care Mapping'. A pilot study was used to develop a rater's manual, to test acceptability, and to obtain feed-back for improvements in method. A reliability study measured inter-rater reliability on fifteen indicators of well-being. Further data was gathered to produce data on ratings of indicators of well-being in 102 persons with dementia. Additional data on demographic characteristics and cognitive functioning were collected.;Findings indicate that indicators of well-being in people-with-dementia can be reliably measured using observation.;The research findings support a two-factor model of well-being in dementia, comprising a factor of 'Social engagement/Pleasure', and a factor of 'Negative affect vs. Relaxed calm'. These factors are uncorrelated.;Investigation of subsidiary hypotheses reveals evidence of a negative correlation between cognitive impairment and the 'Social engagement/Pleasure' factor, but no correlation between cognitive impairment and 'Negative Affect'. No gender differences in factor scores are found for well-being or ill-being, although gender differences for indicators of ill-being not included in the factor analysis are found.;The theoretical, service, policy and clinical implications for the above findings are discussed. Suggestions for future research are made.