Personal care interactions can provide important opportunities for caregivers to engage with a person living with advanced dementia but may also prove to be a difficult experience; why this so is not completely understood. We aimed to examine the person’s engagement and refusals of care in personal care interactions and identify both successful and difficult interpersonal dynamics to enable learning from each setting to inform educational resources.

One-off video-recorded observations of personal care interactions between caregivers (care-home staff or family carers) and people with advanced dementia in the UK (total observation time 03:01:52). Observations were analysed using the Menoh Park Engagement Scale (MPES) (Camp et al., 2015) and the Resistance-to-Care scale (RTC-DAT) (Mahoney, 2015) to score 5-minute video sections, and inductively with qualitative content analysis.

Active engagement of people with dementia was observed in 66% of observations. Refusals of care were present in 32% of observation time. Generally, caregivers emanated a nurturing attentiveness and people with dementia were focused and engaged throughout care activities. Rare difficult interactional components were characterised by the person with dementia appearing to show uneasiness and caregivers being flustered and uncertain. However, caregivers from both family and care-home settings were predominantly attuned to the person and skilled in effortlessly supporting them through the care activity.

Findings provide real-world empirical evidence which reenergises the concept of person-centredness in dementia care. Personal care activities typically created opportunities of engagement, rather than sites of conflict, for people with advanced dementia. The findings provide much needed insight into ways to improve care experiences for people with advanced dementia. Appropriate training/guidance for care-home staff and family carers could support more engaged and pleasurable care experiences for people with dementia.