{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T10:50:04Z","timestamp":1791456604776,"version":"4.3.4"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>This study examines interactions in residential care for people with dementia and severe challenging behavior. Approaching dementia as contextualized, lived experience, it explores how meaningful encounters can be fostered for residents and those directly involved in their life and care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research Design and Methods<\/jats:title>\n                    <jats:p>A phenomenological design informed by Todres\u2019 embodied enquiry was employed. Data were collected through intensive shadowing observations (35\u2009hr) over a 2-week period in a Dutch closed long-term care facility accommodating 16 residents. The daily work of 18 paid care workers was observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Meaningful interaction emerged as a delicate balancing process, described as walking a tightrope, requiring continuous attunement to both pleasant and distressing dimensions of lived experience. Care workers fostered at-homeness, togetherness, and shared memories, while also acknowledging disorientation, loneliness, grief, and sadness. This balancing act unfolded across four interconnected dimensions: (1) at-homeness versus uncanniness in space, (2) togetherness versus loneliness in relationships, (3) continuous recalibration in embodied attunement, and (4) joy versus sorrow in personal narratives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Implications<\/jats:title>\n                    <jats:p>While previous research has emphasized the importance of connectedness for meaning in life, this study underscores another crucial perspective: genuine well-being requires sincere engagement with life\u2019s darker dimensions, not merely positive reassurance. Meaningful interaction depends on care workers\u2019 capacity to remain present with both affirming and unsettling aspects of life. This calls for a relational approach to care that acknowledges distress alongside positive experience, supports agency through doing-with, and employs inclusive, non-corrective communication practices that flexibly integrate clinical and humanistic perspectives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/geront\/gnag175","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T11:58:01Z","timestamp":1786017481000},"source":"Crossref","is-referenced-by-count":0,"title":["Walking a tightrope: meaningful encounters in the care for people with dementia and severely challenging behavior"],"prefix":"10.1093","volume":"66","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2940-9163","authenticated-orcid":false,"given":"Els","family":"Van Wijngaarden","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center , Nijmegen,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debby","family":"Gerritsen","sequence":"additional","affiliation":[{"name":"Department of Primary and Community Care, Radboud University Medical Center , Nijmegen,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"2026100805571786000_gnag175-B1","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.1177\/1471301217714654","article-title":"Behavioural changes in dementia and their impact on professional caregivers: A grounded theory approach","volume":"18","author":"Appleton","year":"2019","journal-title":"Dementia (London, England)"},{"key":"2026100805571786000_gnag175-B2","doi-asserted-by":"publisher","first-page":"57","DOI":"10.4324\/9781351153683-3","volume-title":"Interpersonal Development","author":"Baumeister","year":"2017"},{"key":"2026100805571786000_gnag175-B3","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1177\/1471301215581081","article-title":"Dementia grief: A theoretical model of a unique grief experience","volume":"16","author":"Blandin","year":"2017","journal-title":"Dementia (London, England)"},{"key":"2026100805571786000_gnag175-B4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1007\/s11089-009-0264-0","article-title":"The trauma and complicated grief of ambiguous loss","volume":"59","author":"Boss","year":"2010","journal-title":"Pastoral Psychology"},{"key":"2026100805571786000_gnag175-B5","volume-title":"Loving someone who has dementia. How to find hope while coping with stress and grief","author":"Boss","year":"2011"},{"key":"2026100805571786000_gnag175-B6","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1177\/0969733011408049","article-title":"Sustaining citizenship: People with dementia and the phenomenon of social death","volume":"18","author":"Brannelly","year":"2011","journal-title":"Nursing Ethics"},{"key":"2026100805571786000_gnag175-B7","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1111\/j.1365-2702.2008.02748.x","article-title":"Developing relationships in long term care environments: The contribution of staff","volume":"18","author":"Brown Wilson","year":"2009","journal-title":"Journal of Clinical Nursing"},{"key":"2026100805571786000_gnag175-B8","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1080\/0968759032000127344","article-title":"Improving service approaches and outcomes for people with complex needs through consultation and involvement","volume":"18","author":"Clare","year":"2003","journal-title":"Disability & Society"},{"key":"2026100805571786000_gnag175-B9","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1177\/1533317517703478","article-title":"Rethinking psychosis in dementia: An analysis of antecedents and explanations","volume":"32","author":"Cohen-Mansfield","year":"2017","journal-title":"American Journal of Alzheimer\u2019s Disease and Other Dementias"},{"key":"2026100805571786000_gnag175-B10","volume-title":"Reflective lifeworld research","author":"Dahlberg","year":"2008"},{"key":"2026100805571786000_gnag175-B11","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1093\/geront\/gnaa206","article-title":"Continuing to participate in the dance of life as oneself: The lived experience of meaning in life for older adults with Alzheimer\u2019s disease","volume":"61","author":"Dewitte","year":"2021","journal-title":"The Gerontologist"},{"key":"2026100805571786000_gnag175-B12","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1017\/s1041610218002338","article-title":"Meaning in life matters for older adults with Alzheimer\u2019s disease in residential care: Associations with life satisfaction and depressive symptoms","volume":"31","author":"Dewitte","year":"2019","journal-title":"International Psychogeriatrics"},{"key":"2026100805571786000_gnag175-B13","doi-asserted-by":"publisher","first-page":"igad049","DOI":"10.1093\/geroni\/igad049","article-title":"Supporting persons with dementia: Perspectives from certified nurse\u2019s assistants","volume":"7","author":"Dokos","year":"2023","journal-title":"Innovation in Aging"},{"key":"2026100805571786000_gnag175-B14","doi-asserted-by":"crossref","DOI":"10.7208\/chicago\/9780226206868.001.0001","volume-title":"Writing ethnographic fieldnotes","author":"Emerson","year":"2011"},{"key":"2026100805571786000_gnag175-B15","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1080\/02650530802396650","article-title":"Identity and relationships: on understanding social work with older people suffering from dementia","volume":"22","author":"Emilsson","year":"2008","journal-title":"Journal of Social Work Practice"},{"key":"2026100805571786000_gnag175-B16","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1177\/1471301211418161","article-title":"Creating relationships with persons with moderate to severe dementia","volume":"12","author":"Ericsson","year":"2013","journal-title":"Dementia (London, England)"},{"key":"2026100805571786000_gnag175-B17","doi-asserted-by":"publisher","first-page":"676","DOI":"10.1111\/jocn.15589","article-title":"\u2018You become their advocate\u2019: The experiences of family carers as advocates for older people with dementia living in residential aged care","volume":"30","author":"Fetherstonhaugh","year":"2021","journal-title":"Journal of Clinical Nursing"},{"key":"2026100805571786000_gnag175-B18","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1016\/j.jamda.2019.01.148","article-title":"The difficulty with studying challenging behavior","volume":"20","author":"Gerritsen","year":"2019","journal-title":"Journal of the American Medical Directors Association"},{"key":"2026100805571786000_gnag175-B19","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1177\/1471301214539690","article-title":"Dementia and well-being: A conceptual framework based on Tom Kitwood\u2019s model of needs","volume":"15","author":"Kaufmann","year":"2016","journal-title":"Dementia (London, England)"},{"key":"2026100805571786000_gnag175-B20","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/gnae077","article-title":"Learning from people with dementia what works well for well-being: Interviews and focus groups","volume":"64","author":"Kloos","year":"2024","journal-title":"The Gerontologist"},{"key":"2026100805571786000_gnag175-B21","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1016\/j.jamda.2021.09.013","article-title":"Dutch long-term care in transition: A guide for other countries","volume":"23","author":"Koopmans","year":"2022","journal-title":"Journal of the American Medical Directors Association"},{"key":"2026100805571786000_gnag175-B22","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s10728-010-0161-9","article-title":"Care for nurses only? Medicine and the perceiving eye","volume":"19","author":"Martinsen","year":"2011","journal-title":"Health Care Analysis: HCA: Journal of Health Philosophy and Policy"},{"key":"2026100805571786000_gnag175-B23","volume-title":"Care and vulnerability","author":"Martinsen","year":"2006"},{"key":"2026100805571786000_gnag175-B24","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1080\/13607863.2011.628980","article-title":"The relationship between care providers\u2019 relational behaviors and residents mood and behavior in long-term care settings","volume":"16","author":"McGilton","year":"2012","journal-title":"Aging & Mental Health"},{"key":"2026100805571786000_gnag175-B25","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1177\/1471301218800122","article-title":"Understanding public-stigma and self-stigma in the context of dementia: A systematic review of the global literature","volume":"19","author":"Nguyen","year":"2020","journal-title":"Dementia (London, England)"},{"key":"2026100805571786000_gnag175-B26","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1111\/j.1365-2702.2004.00926.x","article-title":"Beyond \u2018person-centred\u2019care: A new vision for gerontological nursing","volume":"13","author":"Nolan","year":"2004","journal-title":"Journal of Clinical Nursing"},{"key":"2026100805571786000_gnag175-B27","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1017\/s0714980822000253","article-title":"Relational care, dementia, and communication challenges in long-term care: A meta-ethnography","volume":"42","author":"Novy","year":"2023","journal-title":"Canadian Journal on Aging\u2009=\u2009La Revue Canadienne Du Vieillissement"},{"key":"2026100805571786000_gnag175-B28","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.3233\/jad-180647","article-title":"Severe agitation in dementia: An explorative secondary data analysis on the prevalence and associated factors in nursing home residents","volume":"66","author":"Palm","year":"2018","journal-title":"Journal of Alzheimer\u2019s Disease: JAD"},{"key":"2026100805571786000_gnag175-B29","volume-title":"The emotional journey of the Alzheimer\u2019s family","author":"Santulli","year":"2015"},{"key":"2026100805571786000_gnag175-B30","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1177\/1468794114550439","article-title":"Anonymising interview data: Challenges and compromise in practice","volume":"15","author":"Saunders","year":"2015","journal-title":"Qualitative Research"},{"key":"2026100805571786000_gnag175-B31","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1177\/1533317517689876","article-title":"Roles of communication problems and communication strategies on resident-related role demand and role satisfaction","volume":"32","author":"Savundranayagam","year":"2017","journal-title":"American Journal of Alzheimer\u2019s Disease and Other Dementias"},{"key":"2026100805571786000_gnag175-B32","doi-asserted-by":"publisher","first-page":"530","DOI":"10.1177\/1533317515622291","article-title":"Resident reactions to person-centered communication by long-term care staff","volume":"31","author":"Savundranayagam","year":"2016","journal-title":"American Journal of Alzheimer\u2019s Disease and Other Dementias"},{"key":"2026100805571786000_gnag175-B33","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.jamda.2012.09.027","article-title":"The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: A systematic review","volume":"14","author":"Selb\u00e6k","year":"2013","journal-title":"Journal of the American Medical Directors Association"},{"key":"2026100805571786000_gnag175-B34","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1177\/1363459316677626","article-title":"Interaction and common ground in dementia: Communication across linguistic and cultural diversity in a residential dementia care setting","volume":"21","author":"Strandroos","year":"2017","journal-title":"Health (London, England: 1997)"},{"key":"2026100805571786000_gnag175-B35","doi-asserted-by":"crossref","DOI":"10.1057\/9780230598850","volume-title":"Embodied enquiry: Phenomenological touchstones for research, psychotherapy and spirituality","author":"Todres","year":"2007"},{"key":"2026100805571786000_gnag175-B36","doi-asserted-by":"publisher","first-page":"1566","DOI":"10.1177\/1049732308324249","article-title":"Being with that: The relevance of embodied understanding for practice","volume":"18","author":"Todres","year":"2008","journal-title":"Qualitative Health Research"},{"key":"2026100805571786000_gnag175-B37","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"International Journal for Quality in Health Care: Journal of the International Society for Quality in Health Care"},{"key":"2026100805571786000_gnag175-B38","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1007\/s11019-012-9456-y","article-title":"Giving voice to vulnerable people: The value of shadowing for phenomenological healthcare research","volume":"16","author":"van der Meide","year":"2013","journal-title":"Medicine, Health Care, and Philosophy"},{"key":"2026100805571786000_gnag175-B39","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1007\/s11019-015-9621-1","article-title":"Participating in a world that is out of tune: Shadowing an older hospital patient","volume":"18","author":"van der Meide","year":"2015","journal-title":"Medicine, Health Care and Philosophy"},{"key":"2026100805571786000_gnag175-B40","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1080\/13607863.2025.2465780","article-title":"Patient characteristics, behavior, and discharge locations of patients with dementia and very severe challenging behavior","volume":"29","author":"van Voorden","year":"2025","journal-title":"Aging & Mental Health"},{"key":"2026100805571786000_gnag175-B41","doi-asserted-by":"publisher","first-page":"2482","DOI":"10.1080\/13607863.2023.2169248","article-title":"Well-being, multidisciplinary work and a skillful team: Essential elements of successful treatment in severe challenging behavior in dementia","volume":"27","author":"van Voorden","year":"2023","journal-title":"Aging & Mental Health"},{"key":"2026100805571786000_gnag175-B42","doi-asserted-by":"publisher","first-page":"S34","DOI":"10.1002\/hast.4990","article-title":"Unfolding hidden narratives: Glimpses of an ethos of senses in a dementia-care facility","volume":"55 Suppl 1","author":"van Wijngaarden","year":"2025","journal-title":"The Hastings Center Report"},{"key":"2026100805571786000_gnag175-B43","doi-asserted-by":"publisher","first-page":"323","DOI":"10.1007\/s12062-021-09331-9","article-title":"The darker side of ageing: Towards an ethics of suffering that emphasises the primacy of witnessing","volume":"14","author":"van Wijngaarden","year":"2021","journal-title":"Journal of Population Ageing"},{"key":"2026100805571786000_gnag175-B44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0214724","article-title":"\u2018The eyes of others\u2019 are what really matters: The experience of living with dementia from an insider-perspective","author":"van Wijngaarden","year":"2019","journal-title":"PLoS One"},{"key":"2026100805571786000_gnag175-B45","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s11019-025-10253-y","article-title":"Concepts of self in dementia research: Towards theoretical integration","volume":"28","author":"van Woerkum-Rooker","year":"2025","journal-title":"Medicine, Health Care, and Philosophy"},{"key":"2026100805571786000_gnag175-B46","doi-asserted-by":"publisher","first-page":"1339","DOI":"10.1016\/j.jagp.2017.08.002","article-title":"Nursing home residents with dementia and very frequent agitation: A particular group","volume":"25","author":"Veldwijk-Rouwenhorst","year":"2017","journal-title":"The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry"},{"key":"2026100805571786000_gnag175-B47","doi-asserted-by":"publisher","first-page":"838","DOI":"10.1080\/13607863.2023.2280673","article-title":"Transferring people with dementia to severe challenging behavior specialized units: An in-depth exploration","volume":"28","author":"Verhees","year":"2024","journal-title":"Aging & Mental Health"},{"key":"2026100805571786000_gnag175-B48","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1177\/1471301216682880","article-title":"Developing the senses framework to support relationship-centred care for people with advanced dementia until the end of life in care homes","volume":"18","author":"Watson","year":"2019","journal-title":"Dementia (London, England)"},{"key":"2026100805571786000_gnag175-B49","doi-asserted-by":"publisher","first-page":"1102","DOI":"10.1080\/09687599.2017.1321225","article-title":"Conversation takes two: Understanding interactions with people with dementia","volume":"32","author":"Webb","year":"2017","journal-title":"Disability & Society"}],"container-title":["The Gerontologist"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/gerontologist\/advance-article-pdf\/doi\/10.1093\/geront\/gnag175\/70544806\/gnag175.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/66\/10\/gnag175\/70544806\/gnag175.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/gerontologist\/article-pdf\/66\/10\/gnag175\/70544806\/gnag175.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T09:57:24Z","timestamp":1791453444000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/gerontologist\/article\/doi\/10.1093\/geront\/gnag175\/8756718"}},"subtitle":[],"editor":[{"given":"Tonya J","family":"Roberts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":49,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9,10]]}},"URL":"https:\/\/doi.org\/10.1093\/geront\/gnag175","relation":{},"ISSN":["0016-9013","1758-5341"],"issn-type":[{"value":"0016-9013","type":"print"},{"value":"1758-5341","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,8,7]]},"article-number":"gnag175"}}