A psychometric study of the Flourishing Scale for people living with dementia

Previous work suggests that well-being in dementia could align with the concept of flourishing-optimized social-psychological well-being-but valid and reliable measurement of flourishing in dementia has not yet been directly explored.The aim of this study was to investigate the psychometric properties of the Flourishing Scale, a brief measure of social-psychological well-being previously validated with older people and cross-culturally, for people living with dementia.We carried out a secondary analysis of baseline data (<i>n</i> = 480) from a previous randomized controlled trial of a self-management psycho-social intervention in dementia (the Journeying Through Dementia trial). Participants were living with early-stage dementia, were predominantly White/British, and 57.8% were male. We utilized Classical Test Theory and Item Response Theory methods to examine the reliability, uni-dimensionality, and validity of the Flourishing Scale as well as item characteristics.Findings indicate the Flourishing Scale is uni-dimensional and has adequate internal consistency and validity for measuring social-psychological well-being in dementia. The scale can discriminate between different levels of well-being in dementia, particularly at lower to moderate levels. Items concerned with active engagement appear most sensitive to measured levels of flourishing overall. People with dementia living alone may be most at risk of lower levels of social-psychological well-being. Levels of flourishing were not correlated with cognitive impairment.The Flourishing Scale measures eudaimonic dimensions of well-being and may be of value in future dementia studies focused on these. The measurement precision of the Flourishing Scale for people with dementia may be best at low-moderate levels and items may vary somewhat in terms of ability to discriminate levels of well-being. Further research should explore optimum item content and response format and investigate how reliable and valid the instrument is longitudinally and for people living with a range of cognitive impairments at different stages of dementia.