Mitigating apathy among older adults with and without dementia across long term care and community settings: A multimethod study

Background: Apathy, characterized by reduced interest in activities and social interaction, is a prevalent yet often underrecognized condition among older adults in long-term care facilities (LTCF) and community settings. It is associated with rapid cognitive decline, functional impairments, and decreased life expectancy. Despite its impact, apathy is frequently misdiagnosed or conflated with other conditions, such as depression and dementia, leading to inadequate intervention strategies. While various non-pharmacological interventions have been proposed, little is known about the effectiveness of eBook clubs as a non-pharmacological option for mitigating apathy. This study seeks to address the overarching research question: "What are the barriers, facilitators, prevalence, and risk factors of apathy among older adults in LTCF and community settings, and how effective is an eBook club intervention in mitigating apathy in these populations?" Methods: This multimethod study employed a series of research designs to explore the multidimensional aspects of apathy and its mitigation guided by the Biopsychosocial Model of Health and Illness and Socioemotional Selectivity Theory. The prevalence and predictors of apathy were analyzed cross-sectionally using the InterRAI Minimum Dataset (MDS 2.0) from the Canadian Institute for Health Information, covering LTCF residents admitted between 2015 and 2019. A pre- and post-quasi-experimental multi methods design was used to assess the effectiveness of an eBook club intervention among LTCF residents and community-dwelling older adults in four rural communities in Northern British Columbia. The intervention’s impact was measured by comparing apathy levels before and after participation. Results: Findings highlight key barriers to apathy care, including the lack of a standardized definition, limited awareness, symptom overlap with other disorders, and methodological challenges in clinical trials. Facilitators that promote effective apathy management include caregiver involvement, professional training, and the adoption of innovative screening and intervention methods. Apathy was prevalent in 12.5% of newly admitted LTCF residents (N = 157,596) and 13.1% of those with Alzheimer’s disease and related dementias (N = 97,789). Cognitive impairment was identified as the strongest predictor of apathy among the general LTCF population, while depression was the most significant risk factor among residents with dementia. The eBook club intervention demonstrated positive effects, leading to improved social engagement, cognitive stimulation, and emotional well-being among LTCF residents and community-dwelling older adults. Conclusion: Understanding the barriers, facilitators, prevalence, and risk factors of apathy are essential for developing effective interventions. The findings suggest that structured, accessible, and low-cost programs, such as eBook clubs, have the potential to mitigate apathy in both LTCF and community settings. This study underscores the need for enhanced screening, targeted interventions, and policy-driven efforts to improve apathy care and promote well-being of residents in LTCF and community dwelling older adults.