An international study of social engagement among nursing home residents.

METHOD data using the Resident Assessment Instrument (RAI) from nursing home populations in five countries (Denmark, Iceland, Italy, Japan, USA) were assembled from 396277 residents. The distribution of a new quality of life measure, 'social engagement', embedded in the RAI and found to be reliable and valid in the USA, was examined and compared in the international samples. RESULTS in all five countries' nursing home populations engagement was highest among residents with adequate functioning in activities of daily living (ADL) and cognition, but the level of social engagement differed considerably by country among residents with poor ADL functioning, who had adequate cognition. The lowest scores were in Italy and Japan. The amount of time residents spend in activities stratified by ADL and cognition reveal the same pattern cross-culturally--cognitively impaired residents are least actively involved. CONCLUSIONS the Minimum Data Set measure of social engagement is stable across types of residents and across nations and can serve as a marker of nursing home quality.