Background: People with dementia in institutional settings lack engagement in meaningful occupations, which may cause decreased quality of life. Although many researchers and professionals have proposed approaches to engage people with dementia in these occupations, an overview seems to be missing. Aim: This scoping review provides an overview by categorizing and describing the characteristics of the approaches. Material and method: A thorough literature search in nine databases identified the studies on approaches. We included 54 studies, and extracted bibliometric data. A content analysis revealed the characteristics of the approaches. Results: Four categories of approaches were uncovered. First, the literature defined the concept of meaningful occupation in various ways. Second, a category of approaches provided theoretical knowledge of meaningful occupations. The third category focussed on specific themes, such as certain methods. The final described comprehensive multilevel approaches. Conclusion: This review contributes to knowledge of the diversity of approaches to engage people with dementia in meaningful occupation within institutional settings. Significance: We suggest that occupational therapy researchers and practitioners consider how the concept of meaningful occupation is embedded in the theoretical landscape. Furthermore, activity programming requires reflexive decision-making at the policy and practice level, as engagement in meaningful occupations is complex.