Designing Engagement in Dementia Care: Embodied Participation, Situated Adaptation, and Co-Design-In-Practice.

This study explores how a tactile and play-based intervention, the Colorful Counting Brickers, fostered emotional and social engagement among older adults with dementia in a Taiwanese long-term care setting informed by relationally grounded care practices. Grounded in person-centered care and theories of embodied selfhood, the research employed a four-phase design process including rapid ethnographic immersion, iterative design development, expert consultation, and in-situ implementation. Thematic analysis of observations, caregiver interviews, and written reflections revealed that engagement was not a fixed behavioral response, but an emergent and relational process shaped by sensory interaction, peer reciprocity, and caregiver facilitation. Three key dimensions emerged. First, embodiment was evident as residents engaged through tactile exploration, affective responses, and gestural interaction. Second, relationality enabled peer reciprocity, including imitation, turn-taking, and spontaneous assistance. Third, immediacy was apparent as caregivers adjusted facilitation strategies in real time through emotional attunement and embodied familiarity. The study introduces the concept of co-design-in-practice to describe these situated and informal design contributions enacted by caregiving staff. This research contributes to the field of dementia care by reframing caregiving as a form of design agency and by emphasizing the relational and culturally embedded nature of engagement. It advocates for a shift from designing isolated products to designing with and through everyday care practices. This perspective informs a more inclusive and practice-sensitive model of participatory dementia innovation that recognizes the experiential expertise of caregivers and the lived realities of those they support.