New horizon in improving ageing with improvisational theatre

Cognitive decline, mental health and mindset factors can all affect the autonomy and well-being of older adults. As the number of older adults across the globe increases, interventions to improve well-being are urgently needed. Improvisational theatre (improv) and improv-based interventions are well-suited to address this need. Studies have shown that participation in improv-based interventions has a positive impact on mental health indicators, including depressive symptoms, well-being and social connectedness, as well as cognitive skills such as attention and memory. In addition, improv-based interventions have been beneficial for people with dementia, improving positive affect, self-esteem and communication. In this article, we describe improvisational theatre, or improv, and the reasons it has emerged from a form of spontaneous theatre that involves playfulness and creativity to an important tool to effect behavioural change in individuals and groups. We then review the literature on the effects of improv in ageing populations, with a focus on social, emotional and cognitive functioning. Finally, we make recommendations on designing improv-based interventions so that future research, using rigorous quantitative methods, larger sample sizes and randomised controlled trials, can expand the use of improv in addressing important factors related to autonomy and well-being in older adults.

Exploring the value of multi-sensory aids in co-designing assistive home devices for older adults with cognitive impairment

In this study, we aimed to investigate the benefits of co-design prompts/aids in the development of assistive devices for and with older adults who have cognitive impairment (CI), with the goal of improving their ability to live independently at home. We conducted a series of co-design workshops and utilized eight sets of multi-sensory aids to explore their values and effectiveness in engaging older adults with CI in co-design processes. Our findings revealed that the co-design aids had several benefits, including: (1) increasing the exchange of knowledge and awareness between older adults and designers; (2) eliciting insightful information through multi-sensorial aids, and (3) generating novel assistive design solutions to support seniors' independent living at home. We discuss our findings in relation to the multi-sensorial attributes of co-design aids, which empower older adults with CI to express their opinions and actively participate in co-designing assistive devices that meet their needs/expectations.

'Misdiagnosed and Misunderstood': Insights into Rarer Forms of Dementia through a Stepwise Approach to Co-Constructed Research Poetry

This study investigated co-constructed research poetry as a way to understand the lived experiences of people affected by rarer dementia and as a means to use poetry to convey those experiences to healthcare professionals. Using mixed methods, 71 people living with rarer dementia and care-partners (stakeholders) contributed to co-constructing 27 poems with professional poets; stakeholders' verbatim words were analysed with descriptive qualitative analysis. Stakeholders were also surveyed and interviewed about their participation. Healthcare professionals (n = 93) were surveyed to elicit their responses to learning through poetry and its acceptability as a learning tool. Poems conveyed a shared narrative of different aspects of lived experience, often owing to atypical symptoms, misunderstandings by professionals, lack of support pathways, and a continuous struggle to adapt. Stakeholder surveys indicated it was a valuable experience to both co-create and respond to the poems, whilst group interviews revealed people's experiences of the research poetry were characterised by reflection on lived experience, curiosity and exploration. Healthcare professionals' responses reinforced poetry's capacity to stimulate cognitive and affective learning specific to rare dementia support and prompt both empathy and critical thinking in practice. As the largest poetry-based study that we are aware of, this novel accessible approach of creating group poems yielded substantial information about the experiences and needs of those affected by rarer dementia and how poetry can contribute to healthcare education and training.

Literary, Found and Research Poetry: New Approaches to Representations of Aging and Aged Care

At a time when rapid population aging is producing an emphasis on questions of healthy aging in the public discourse, conditions such as dementia, physical, and other disabilities still too often remain taboo, and this is particularly true in relation to the confronting subjects of aged care, neglect, and failures of care provision. This article considers the transformative potential of 2 different but complementary forms of poetry-research poetry and lyric poetry-to break these silences and represent experiences across the physical and emotional spectrum of aging, including the perspectives of older people and their families whose experiences are neutral, negative, or even distressing, as well as challenge and counter existing negative stereotypes of aging in the public and literary realms. Neither research poetry nor lyric poetry is common in gerontological research; however, they offer the radical potential to offer insight into the lived realities of older people and their loved ones. Research poetry uses the direct words of older people, drawing on transcripts and found texts, and giving voice to people who otherwise would not be heard. Lyric poetry, by contrast, draws more heavily on literary techniques such as metaphor and direct address to evoke sensory and intimate experiences of aging and aged care. This paper presents 2 poems comparing and contrasting the respective processes and techniques of these different poetic forms to represent the imaginary, feared, and hoped-for futures of older people, including those in aged care.

Virtual collaborative creative engagement in a pandemic world: creative connection for older adults with lived experience of dementia

Introduction

Older adults were disproportionately affected by COVID-19, and isolation and loneliness became key risk factors for mental illness and decreased quality of life. Older adults with lived experience of dementia and their care partners experienced isolation, loneliness, anxiety and depression, already heightened due to social stigma. Reduced access to resources was a notable problem.

Objective

This Canadian qualitative study investigates the Raising the Curtain on the Lived Experience of Dementia (RTC) Project's virtual turn in program delivery during the pandemic, asking "How did virtual collaborative creative engagement (CCE) impact well-being for people living with dementia and their care partners?"; and "What are key elements of RTC's unique virtual CCE approach?"

Methods

The study employs reflexive thematic analysis to analyse interviews and focus groups with the project's artist facilitators, researchers, peer collaborators living with dementia, and their care partners. Findings: Themes describe key elements of RTC's unique approach to virtual CCE and include: "Adjusting Expectations and Adapting to Technology"; "Re-imagining Creative Engagement in Virtual Space"; "Sustaining Reciprocal Caring, Learning, and Support"; "Disrupting Stigma and Welcoming a Wider Audience"; and "Supporting Well-being through Empowerment, Community, and Creativity."

Discussion

Findings offer new perspectives on how virtual CCE not only has the potential to decrease loneliness and isolation and associated mental health risks for older adults living with dementia and their care partners, but also can work to disrupt stigmatizing representations of dementia, promote inclusion, and enhance citizenship.

"Sometimers, Alzheimer's? I love that! That's definitely me": Readers' Responses to Fictional Dementia Narratives

This article presents findings from an interdisciplinary project which invited readers to experience the impact of dementia via fictional characters' narratives. Combining methods from critical gerontology and literary linguistics-a field that examines the language of literature-we undertook an empirical reader response study of dementia fiction. We constructed a large corpus of dementia fiction; selecting 12 extracts, each containing first-hand, focalized accounts of fictional characters' experiences of living with dementia. Readers (31) were purposively sampled for 4 separate reading groups-student social workers (9); general public (9); family carers (6); and people with dementia (7). Over 6 weeks they engaged in separate, facilitated, on-line group discussions of extracts. Discussions were independently coded using ATLAS.ti. Although readers from all 4 groups reported that fictional characters drew them into the internal life of someone with dementia, some carers questioned whether fictional characters' experiences were plausible. Readers with dementia recognized themselves in the extracts; viewing fictional characters as eloquent envoys of their lived experiences of diagnosis, social isolation, loss of language, and use of humor. Fictional characters offer an entry point for understanding contrasts in caregiver and care-receiver experiences of dementia. Fictional characters are potentially useful for moving dementia narratives beyond monstrous cultural metaphors and onto a disability-based rights agenda.

"Live Gerontology": Understanding and Representing Aging, Loneliness, and Long-Term Care Through Science and Art

This article proposes an expansive conceptualization of gerontological research by engaging with a "live gerontology" that combines sciences and arts to better understand and represent aging and its diverse meanings and contexts. Borrowing the sociological concept of "live methods," we argue that gerontology can benefit from a "live" approach-not only methodologically, but also conceptually. To guide pathways between artistic and gerontological fields and frame its practices and outcomes, we suggest four propositions for a live gerontology: (1) using multiple genres to artfully connect the whole-interweaving micro-, meso-, and macrolevels to contextualize aging within various sociocultural milieus; (2) fostering the use of the senses to capture more than just what people say-what they do, display, and feel; (3) enabling a critical inventiveness by relying on arts' playfulness to design/refine instruments; and (4) ensuring a constant reflection on ethics of representation and public responsibility. To apply and experiment with a live gerontological approach, we describe collaborations with an award-winning writer and an illustrator. The collaborations drew on qualitative data from a study on lived experiences of loneliness in long-term care through ethnography and interviews with residents of 2 Australian facilities. The writer explored participants' accounts as creative stories, which were then illustrated. Motivated by an ethics of representation, we aimed to represent findings without othering or further marginalizing participants. The creative materials offered more than appealing representations, shining new light on the intricate nature of aging, loneliness, institutionalization, and gerontology research and practice.

Clothing the Clown: Creative Dressing in a Day-center for People with Dementia in the Netherlands

Creatief met clowns is a creative and art-based workshop for people living with dementia that invites participants to join in a collaborative process of creating an outfit and clothing a clown. In this article, I look at what happened in workshop sessions and how this mattered to those involved, including what participants with dementia valued about the activity - by listening to what they had to say, but also by attending to their performative, creative and affective ways of engaging in Creatief met Clowns. To further articulate values that came up in practice, I analyzed my findings in terms of the quality of psychosocial relations, the role of embodiment, material aspects, and playfulness in person-centered care. By combining an ethnographic study of art-based care-practice with a value-sensitive theoretical reflection on empirical findings, my approach offers an alternative to problematic efforts to quantify the value of art in person-centered dementia care.

Effectiveness of creative story therapy for dementia: a systematic review and meta-analysis

OBJECTIVE

To conduct a meta-analysis of the effectiveness of creative story therapy versus routine nursing alone for the treatment of dementia.

METHODS

We manually searched PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), China VIP Database (VIP), China Biomedical Literature Database (CBM), and Wanfang Data up to May 2023. Randomized controlled trials (RCTs) of creative story therapy combined with routine nursing versus routine nursing for the treatment of dementia were included.

RESULTS

A total of 597 participants were enrolled in the 9 RCTs. Among them, 296 were in the creative story therapy group, and 301 were in the routine nursing group. We found statistically significant effects of creative story therapy combined with routine nursing on cognitive function [standardized mean difference (SMD) = 0.99, 95% CI 0.57, 1.41, P < 0.00001], CSDD score [mean difference (MD) =  - 1.71, 95% CI - 3.27, - 0.14, P < 0.00001], quality of life [SMD = 0.97, 95% CI 0.04, 1.90, P = 0.04], and social communication [MD = 0.46, 95% CI 0.17, 0.74, P < 0.00001] between the creative story therapy group and routine nursing groups; no significant difference in change in basic needs communication [MD = 0.09, 95% CI - 0.58, 0.76, P < 0.00001].

CONCLUSION

This meta-analysis shows that creative story therapy combined with routine nursing has significant effectiveness in improving cognitive function and depression in people with dementia. More high-quality RCTs are required to validate these results.

Creativity During COVID-19: Evaluating an Online TimeSlips Storytelling Program for People Living With Dementia During Quarantine in Colombia

BACKGROUND AND OBJECTIVES

Since its first implementation in 1998, evidence has been presented of the positive impact of the TimeSlips storytelling method for people with dementia in long-term care (LTC) settings. This article extends this evidence in important new directions: it is the longest TimeSlips study to date and the first to evaluate the feasibility of online delivery of the method (in response to the coronavirus disease 2019 [COVID-19] quarantine) and the impact of this on the personhood, quality of life, and psychological well-being of Spanish-speaking participants in non-LTC settings in the Global South.

RESEARCH DESIGN AND METHODS

Trained facilitators provided weekly, 1-hr TimeSlips sessions via Zoom over 32 consecutive weeks to 8 participants with dementia. Semistructured interviews of participants and care partners were conducted within 1 week of the final intervention. Thematic analysis evaluated the resultant qualitative data.

RESULTS

This online implementation of the TimeSlips creative expression (CE) method reinforced key facets of participants' personhood (self-expression and self-perception, which led in turn to increased care partner appreciation), had a positive impact on key domains of quality of life (mood, energy levels, and cognitive function), and stimulated a key aspect of psychological well-being (the formation and maintenance of social ties).

DISCUSSION AND IMPLICATIONS

The online delivery of the TimeSlips method to participants who remain in their own homes is feasible and effective. Future research should compare the benefits of online versus face-to-face delivery of this CE method.

Observations on strategies used by people with dementia to manage being assessed using validated measures: A pilot qualitative video analysis

BACKGROUND

Analysis of video data was conducted of validated assessments with people with dementia as part of a feasibility control study comparing a lifelong learning service with other dementia services.

OBJECTIVE

The aim was to provide a new perspective on what occurs during the assessment process when using validated measures in research and explore which strategies people with dementia use to manage their participation.

DESIGN

Video recordings were made of pre- and postintervention assessments of people with dementia. An initial pilot analysis of 10 videos of the pre-assessments was conducted.

SETTING

Lifelong learning services and other dementia services situated in six municipalities in Northern Denmark took part in this study, with 55 people with dementia participating.

RESULTS

The themes identified were: 'State of mind' and 'Mental resources', showing how these aspects influenced the participants' reactions and the strategies they used.

DISCUSSION

The results are discussed in relation to how individual personality traits influence the assessment process and the way a person with dementia will manage the situation.

CONCLUSION

The assessment situation is complex and can be influenced by the strategies adopted by individuals with dementia as they try to manage the assessment process.

PATIENT OR PUBLIC CONTRIBUTION

People with dementia supported the decision-making for the choice of validated measure used within this study.

Library services enriching community engagement for dementia care: The Tales & Travels Program at a Canadian Public Library as a case study

Growing dementia-friendly library services are contributing to community-based dementia care. Emerging community programs in libraries and museums provide notable opportunities for promoting engagement and inclusivity, but these programs have yet to receive in-depth assessments and analyses to guide future research and practice. This paper presents a case study examining a social and storytelling program for people with dementia run by a Canadian public library. It investigates two research questions: How can public library programs contribute to community-based dementia care? And what are public libraries' strengths and challenges in running programs for people with dementia? The study involves participant observations of the program and semi-structured interviews with people with dementia, caregivers, and program facilitators (librarians and Alzheimer Society coordinators). Through thematic analysis of fieldnotes and transcripts, the study reveals how this inclusive platform supports engagement, fosters relationships, helps caregivers, and reaches broader communities. This research further uncovers the librarians' diversified roles as demonstrated through their collaboration with professionals, preparation and research, and facilitation of the sessions. This paper advances librarianship research on enriching community-based dementia care, including furthering inclusivity and engagement and extending accessible library services. By analyzing library programming for the dementia community and assessing its strengths and challenges, the paper highlights librarians' awareness of the community's evolving needs and their collaboration with other professionals. It offers practical insights on useful resources and emerging best practices that will hopefully inspire other initiatives in which information professionals can help improve the well-being of vulnerable populations.

‘Ways of being’ in the domestic garden for people living with dementia: doing, sensing and playing

Domestic gardens represent a site for enacting embodied identity and social relationships in later life, and negotiating tensions between continuity and change. In the context of dementia, domestic gardens have significant implications for ‘living well’ at home, and for wider discussions around embodiment, relational selfhood and agency. Yet previous studies exploring dementia and gardens have predominantly focused on care home or community contexts. In light of this, the paper explores the role of domestic gardens in the everyday lives of people living with dementia and their households, using qualitative, creative methods. This includes filmed walking interviews and garden tours, diaries and sketch methods, involving repeat visits with six households in England. Findings are organised thematically in relation to different ‘ways of being’ in the garden: working in and doing the garden; being in and sensing; and playing, empowerment and agency. These different ‘ways of being’ are situated within relationships with household members, neighbours and non-human actors, including pets, wildlife and the materiality of the garden. Garden practices illustrate continuity, situated within embodied biographies and habitus. However, identities, practices and gardens are also subject to ongoing readjustment and reconstruction. The conclusion discusses implications for extending literature on gardens and later life, describing how social and material relationships in domestic gardens are renegotiated in the context of dementia, while highlighting opportunities for ‘play’, active sensing and agency. We also explore contributions to understandings of dementia, home and place, and implications for garden design and care practice.

What is Intergenerational Storytelling? Defining the Critical Issues for Aging Research in the Humanities

Intergenerational storytelling (IGS) has recently emerged as an arts- and humanities-focused approach to aging research. Despite growing appeal and applications, however, IGS methods, practices, and foundational concepts remain indistinct. In response to such heterogeneity, our objective was to comprehensively describe the state of IGS in aging research and assess the critical (e.g., conceptual, ethical, and social justice) issues raised by its current practice. Six databases (PsycINFO, MEDLINE, PubMed, Scopus, AgeLine, and Sociological Abstracts) were searched using search terms relating to age, intergenerational, story, and storytelling. Peer-reviewed, English-language studies conducted with participants residing in non-clinical settings were included. One thousand one hundred six (1106) studies were initially retrieved; 70 underwent full review, and 26 fulfilled all inclusion criteria. Most studies characterized IGS as a practice involving older adults (> 50 years old) and conventionally-aged postsecondary/college students (17-19 years old). Typical methodologies included oral and, in more recent literature, digital storytelling. Critical issues included inconsistently reported participant data, vast variations in study design and methods, undefined key concepts, including younger vs. older cohorts, generation, storytelling, and whether IGS comprised an intentional research method or a retrospective outcome. While IGS holds promise as an emerging field of arts- and humanities-based aging research, current limitations include a lack of shared data profiles and comparable study designs, limited cross-cultural representation, and insufficiently intersectional analysis of widespread IGS practices. To encourage more robust standards for future study design, data collection, and researcher reflexivity, we propose seven evidence-based recommendations for evolving IGS as a humanities-based approach to research in aging and intergenerational relations.

Intergenerational Theater Workshops as Unique Recreational Activities among Older Adults in Japanese Care Facilities: A Qualitatively Driven Mixed-Methods Multiple-Case Study Design

Intergenerational theater activities have been recently employed in recreation for older adults. We held a series of four intergenerational theater workshops in two older adults' care facilities in Japan and sought the experiences of older participants, younger participants, and the facility managers. With a qualitatively driven mixed-methods multiple-case study design, we obtained data from field observation, interviews with participants, and preworkshop and postworkshop changes on a well-being scale (Ikigai-9) among older participants, and the results of the two sites were compared. "Immediate effects" were seen in older adults because they responded actively and demonstrated surprising faculties during the workshop. Facility staff members and younger participants received "extended effects" because they gained new ideas regarding the remaining skills of older participants and a sense of reuniting with old neighbors through the exercise. In the Ikigai-9 scale, the items measuring "present happiness" significantly improved at Site 1 but not at Site 2. Better results at Site 1 might have been caused by the lower care needs of participants and the inclusion of children. Less support from facility staff members during the activities also might have promoted the voluntary participation of older adults. Involving children and engaging the facility staff in preparation could enhance the quality of activities.

Including formal and informal caregivers in the development of Play Intervention for Dementia: a qualitative study

Background

Play Intervention for Dementia is a practice initiative using play to help people living with dementia (PWD) experience engagements, autonomy, and cognitive stimulation. This program was developed under a participatory paradigm, with extensive contribution from formal and informal caregivers. This article describes how caregivers contributed to the practice principles, materials, and assessment during the development phase of Play Intervention for Dementia through community-based participatory research (CBPR).

Methods

Three service supervisors, 16 formal caregivers and 14 informal caregivers from the community participated in this study. Based on CBPR, the study progressed in a reflexive, iterative and collaborative way. Data were collected from diverse sources, including practice journals, observation notes and reflexive focus group interviews. Two trained qualitative researchers conducted thematic analysis on the data collected, with focus on practical skills, outcomes, and caregivers’ general experience during the intervention.

Results

The therapeutic and liberating power of play was thoroughly discussed by the caregivers. They considered play as an innovative way to understand, engage, and connect with the PWD. Also, improvement in energy level, motivation and communicative capacity was observed among the PWD. The researcher and caregivers collaboratively refined and designed the protocol of Play Intervention for Dementia, adding localized principles and games to the original design.

Conclusion

Caregivers found play to be a meaningful way to engage with PWD, as it provided an equal platform for them. The intervention also enabled them to reflect upon ageing and disease at a deeper level. Caregivers have contributed significantly to the refinement and contextualisation of the intervention. The efficiency of the refined program should be further tested on a larger scale.

"Just ask me what it means to live with dementia" - people with mild dementia's strategies and techniques shared through in-depth qualitative interviews

This article presents results from interviews with twelve persons with mild dementia about how life had changed since they received their diagnosis, exploring their experiences of dementia and how they manage life by using different strategies and techniques. Knowledge about how people with mild dementia experience life is important to explore through their unique perspective, providing clinical practice with knowledge to improve dementia care. Twelve participants were recruited at a Danish school service for people with mild dementia where they receive cognitive stimulation. Semi-structured interviews were conducted, video recorded, transcribed and analysed by using Max Van Manen's five lifeworld existentials: spatiality, corporeality, temporality, relationality and materiality. SRQR checklist was used. Five themes were identified, illustrating the dilemmas and challenges the participants experience, as all existentials are compromised in some way: living a social and active life regardless of difficulties; trying to look at the bright side of life with dementia; it takes time to adapt but at the same time, time is being lost; it is possible to learn, but it is challenging; to try to remember but keep forgetting. The article concludes that all existentials are negatively influenced by dementia, setting the lifeworld of the participants under pressure. However, they still try to live their lives regardless of the difficulties. The study shows it is possible for people with mild dementia to describe their lived experience of dementia and what strategies and techniques they use to manage life. The experienced dilemmas and challenges in the lifeworld of people with mild dementia are of great relevance to be aware of and address in clinical practice. To support people with dementia to identify relevant strategies and techniques, as expressed in the study, that can support them managing life with dementia.

Meaningful Activities and Sources of Meaning for Community-Dwelling People Living with Dementia

OBJECTIVES

To examine how people living with dementia at home engage in meaningful activities, a critical component of quality of life.

DESIGN

Ethnographic study design using semistructured interviews, participant-observation, and ethnographic analysis.

SETTING AND PARTICIPANTS

Home setting. People living with dementia were recruited through 3 geriatrics programs in the San Francisco Bay Area, along with 1 primary live-in care partner for each. Participants were purposively sampled to maximize heterogeneity of dementia severity and life experience.

MEASUREMENTS

We asked participants to self-identify and report meaningful activity engagement prior to dementia onset and during the study period using a structured questionnaire, semistructured dyadic interviews, and observed engagement in activities. Home visits were audio-recorded, transcribed, and inductively analyzed using thematic analysis.

RESULTS

Twenty-one people living with dementia (mean age 84 years, 38% women) and 20 care partners (59 years, 85% women), including 40% professionals, 35% spouse/partners, and 15% adult children. Overarching theme: specific activities changed over time but underlying sources of meaning and identity remained stable. As dementia progressed, meaningful activity engagement took 3 pathways. Pathway 1: Activities continued with minimal adaptation when engagement demanded little functional or cognitive ability (eg, watching football on TV). Pathway 2: care partners adapted or replaced activities when engagement required greater functional or cognitive abilities (eg, traveling overseas). This pathway was associated with caregiving experience, nursing training, and strong social support structures. Pathway 3: care partners discontinued meaningful activity engagement. Discontinuation was associated with severe caregiver burden, coupled with illness, injury, or competing caregiving demands severe enough to impact their ability to facilitate activities.

CONCLUSIONS AND IMPLICATIONS

For people living with dementia at home, underlying sources of meaning and identity remains stable despite changes in meaningful activity engagement. Many of the factors associated with adaptation vs discontinuation over time are modifiable and can serve as targets for intervention.

Synchrony in Old Age: Playing the Mirror Game Improves Cognitive Performance

OBJECTIVES

Studies have shown that synchronized motion between people positively affects a range of emotional and social functions. The mirror-game is a synchrony-based paradigm, common to theater, performance arts, and therapy, which includes dyadic synchronized motion, playfulness, and spontaneity. The goal of the current study is to examine the effects of the mirror-game on subjective and cognitive indices in late life.

METHODS

Thirty-four older adults (aged 71-98) participated in a within-group study design. Participants conducted two sessions of 9-minute movement activities: the mirror-game and the control condition - a physical exercise class. Several measures were taken before and after experimental sessions to assess socio-emotional and attentional functions.

RESULTS

The mirror-game enhanced performance on the attention sub-scale and led to faster detections of spoken words in noise. Further, it enhanced perceived partner responsiveness and led to an increase in positive reported experience.

CONCLUSIONS

Our preliminary findings suggest that the mirror-game, rather than the exercise class, may have an immediate impact on mood and some attentional functions.

CLINICAL IMPLICATIONS

The mirror-game is a novel intervention, with potential benefits of social-emotional and cognitive functioning, which can be easily implemented into the daily routine care of older adults. Future studies should explore the effect of the mirror-game on additional cognitive and socio-emotional aspects.

Resonating moments: Exploring socio-material connectivity through artistic encounters with people living with dementia

In this article, I introduce insights from new material feminist theories into the understanding of connectivity on the basis of an aesthetic analysis of artistic encounters with people living with dementia. I draw on data from a situated art intervention conducted within the Resonance Project at a residential care home in Northern Norway where researchers, artists, health-care professionals, people living with dementia and family members came together in co-creative music sessions. I analyse two resonating moments from the sessions by way of an abductive process, oscillating between theory, written notes, video recordings and my own embodied experiences in the field. I discuss the ways in which materiality, listening and the group matter when it comes to our ability to connect during the sessions. Based on these findings, I conclude that the notion of socio-material connectivity provides an entrance point for studying different ways of relating to people living with dementia and enquiring into relations that matter.

Benefits of Cultural Activities on People With Cognitive Impairment: A Systematic Review

Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.

Dancing With Dementia: Exploring the Embodied Dimensions of Creativity and Social Engagement

Background and Objectives

Dance is increasingly being implemented in residential long-term care to improve health and function. However, little research has explored the potential of dance to enhance social inclusion by supporting embodied self-expression, creativity, and social engagement of persons living with dementia and their families.

Research Design and Methods

This was a qualitative sequential multiphase study of Sharing Dance Seniors, a dance program that includes a suite of remotely streamed dance sessions that are delivered weekly to participants in long-term care and community settings. Our analysis focused on the participation of 67 persons living with dementia and 15 family carers in residential long-term care homes in Manitoba, Canada. Data included participant observation, video recordings, focus groups, and interviews; all data were analyzed thematically.

Results

We identified 2 themes: playfulness and sociability. Playfulness refers to the ways that the participants let go of what is “real” and became immersed in the narrative of a particular dance, often adding their own style. Sociability captures the ways in which the narrative approach of the Sharing Dance Seniors program encourages connectivity/intersubjectivity between participants and their community; participants co-constructed and collaboratively animated the narrative of the dances.

Discussion and Implications

Our findings highlight the playful and imaginative nature of how persons living with dementia engage with dance and demonstrate how this has the potential to challenge the stigma associated with dementia and support social inclusion. This underscores the urgent need to make dance programs such as Sharing Dance Seniors more widely accessible to persons living with dementia everywhere.

Free to be: Experiences of arts-based relational caring in a community living and thriving with dementia

AIM

To present findings about experiences of relational caring at an arts-based academy for persons living with dementia.

BACKGROUND

There is a compelling call and need for connection and relationships in communities living with dementia. This study shares what is possible when a creative arts-based academy for persons living with dementia grounded in relational inquiry and caring focuses on relationships through the medium of the arts.

DESIGN

A qualitative phenomenological methodology (informed by van Manen) was used to answer the research question, "What is it like to experience relational caring at an arts-based academy for persons living with dementia?" We address two research objectives: (1) to explore how relationships are experienced when a relational caring philosophy underpins practice, including arts-based engagements; and (2) to understand the meaning of relationships that bring quality to day-to-day living.

METHODS

Twenty-five participants were recruited from the Academy and interviewed in one-to-one in-depth interviews or small groups. Participants included five persons living with dementia, eight family members, four staff, five artists, one personal support worker, and two volunteers. Participants were asked to describe their experiences of relational caring or relationships in the Academy space.

FINDINGS

Three thematic patterns emerged, which address the research objectives.Relational caring is experienced when:freedom and fluid engagement inspire a connected spontaneous liveliness;embracing difference invites discovery and generous inclusivity; andmutual affection brings forth trust and genuine expression.

CONCLUSIONS

Findings contribute to the growing body of knowledge about both relational caring and arts-based practices that call forth a different ethic of care-one that is relational, inclusive, and intentional. Findings also shed light on what is possible when a relational caring philosophy underpins arts-based practices-everyone thrives.

Co-Composing an Aesthetic Self Through Play: Towards a Transformative Framework for Dementia Care

BACKGROUND AND OBJECTIVES

Aging and deterioration mark a new phase in many older adults' life, highlighting the importance of creativity and imagination. This article introduces the implementation of an innovative program, Play Intervention for Dementia (PID), at a nursing home in Hong Kong, with emphasis on its contribution to the conceptual framework for understanding selfhood of older adults with dementia.

RESEARCH DESIGN AND METHODS

As a community-based participatory action research (CBPAR) project, this study democratized knowledge production by integrating voices of practitioners with diverse backgrounds through video-based methods.

RESULTS

Play, as an activity replete with free expressions and impulsive interactions, is an ideal realm for exploring and establishing selfhood with older adults with dementia. It has been found that "aesthetic self", an alternative self emerging from immediate aesthetic experience and carrying transformative power within the caring relationship, is a necessary element of self-construction in life with dementia.

DISCUSSION AND IMPLICATIONS

Integrating theories and practice, this framework provides a new lens for understanding and responding to selfhood, disease, and life.

Playback theatre in adult day centers: A creative group intervention for community-dwelling older adults

The literature indicates that theatre and drama-based interventions have the potential to improve older adults' well-being and health. The goal of the current study was to characterize the process of a creative group intervention in adult day centers (ADCs), which integrates playback theatre and life-review principles. Our objective was to provide an evidence-informed framework for drama therapy interventions, which would allow older adults to bring up and explore their life-stories in a dramatic creative process in their own community. A total of 27 participants ranging in age from 63 to 91, took part in one of three playback theatre groups. The playback theatre group intervention comprised 12 weekly sessions. All sessions were videotaped to capture the lived experience of the creative process and were analyzed in post-intervention interviews. In addition, focus group meetings were conducted with 13 ADC staff members to decipher further the effects of the participation as perceived by people outside the groups. Three types of potential transformation were identified in the qualitative analysis: the evolution of life stories, evolution of playfulness, and expansion of social engagement. The results indicate the potential of the integrative framework to serve as a creative intervention in ADC communities, as well as its potential to bring about a personal transformation and expand it to enable a person's social engagement in the community. The findings imply the potential benefits of using playback theatre groups to supplement the routine care provided in ADCs.

A complex reminding: The ethics of poetry writing in dementia care

Interest in the potential benefits of poetry writing in dementia care has been increasing. Various practical projects, as well as research articles, have highlighted how poetry can acknowledge the words of persons with dementia, and increase well-being. In this article, the authors present a poetry writing project in dementia care in Norway, and argue for how poetry as a genre involves lyrical as well as ethical aspects. The aim of this article is to show how linguistic and ethical sensibility can illuminate the poetic possibilities of the everyday language of persons with dementia. Through a close reading of selected poems from the poetry writing project, the authors show how poetry writing can give an increased understanding of the resources in the everyday language of persons living with dementia. Poetry can open up alternative forms of expression and agency, and thereby support the narrative citizenship of persons with dementia.

Transforming Undergraduate Student Perceptions of Dementia through Music and Filmmaking

BACKGROUND

With nearly 6 million people with dementia (PWD) in the United States, there is a critical need to build an interprofessional dementia workforce. Among the novel approaches to expanding a new workforce, music and the arts show promise for engaging students and trainees. To understand how and why the arts affect attitudes about and engagement with PWD, we examined a service-learning general education undergraduate course centering on music, filmmaking, and dementia.

METHODS

The undergraduate course curriculum brought students to meet with PWD in dementia care settings, build personalized music playlists, coproduce short films about PWD, and write reflective essays. Two researchers independently completed inductive thematic analysis of the films, essays, and course evaluations. Differences were reconciled by consensus.

RESULTS

A total of 52 students from three classes completed the course; 24 (46%) were majoring in health sciences. Three key themes emerged: (1) Music helps students connect with people living with dementia in meaningful ways; (2) filmmaking offers students the opportunity to share unique, person-centered stories about dementia and music that empower the voices of PWD; and (3) reflective writing enables students to process new experiences and lessons learned. Unexpectedly, 29 students (56%) reported continued engagement with PWD in their careers, families, and communities after course completion.

CONCLUSION

This study identifies reproducible ways in which undergraduate arts courses thematically focused on dementia not only transform student perceptions about dementia but change the ways in which those students choose to engage with PWD following course completion. Arts and music departments may represent an untapped resource for building a geriatrics workforce. J Am Geriatr Soc 68:1083-1089, 2020.

Journey of ethics - Conducting collaborative research with people with dementia

This paper explores some of the ethical considerations of working collaboratively with people with dementia within research based upon the experiences, challenges and learning from three doctoral research studies. Focus is on the research relationship with participants and gatekeepers, the importance of setting and access, the power relations within the research and ways in which people with dementia can be supported to be active and have a voice in research. This sits within an ethical framework of principalist ethics and ethics of care to guide not only how research is planned ethically and with consideration of participants, but also how this can support decisions made in situ. The aim is to share, based upon these three studies, ways of managing and working through some of the ethical consideration to support researchers in their decisions in planning and conducting research with people with dementia as active collaborators.

Caring community and relationship centred care on an end-stage dementia special care unit

BACKGROUND

of the estimated 1.4 million residents of US nursing homes, over half have dementia. In the final stages of dementia, caregiving is complicated by the inability of care recipients to speak intelligibly or express their needs.

AIM

to examine the ways in which a nursing home end-stage dementia special care unit (SCU) functioned as a caring community for people near the end of life.

RESEARCH DESIGN AND METHODS

a qualitative, ethnographic case study was conducted in a highly-regarded SCU. Over 175 hours of scheduled activity observations were completed over 2 years, bolstered by 30 hours of caregiving observations on the end-stage dementia unit and 19 interviews with SCU carers. Inductive coding was completed independently by two researchers, emerging themes reconciled by consensus, and qualitative analysis conducted iteratively until the endpoint of thematic saturation.

FINDINGS

on the SCU, employees and volunteers fostered relationships based upon a model of family. They formed a caring community that included professionals, volunteers, friends and family. Relationships were supported through (1) the use of reminiscence to evoke intact long-term memories, (2) the use of verbal communication long after care-recipients could no longer speak and (3) the use of intentional nonverbal communication, including daily music, pet visits, and sensory stimulation.

CONCLUSIONS

through detailed examination of daily life, this study identified articulated beliefs and observable behaviour through which to develop relationship-centred care in the context of end-stage dementia. The caring community offers primary source data for the development of mid-level theory and the generation of new hypotheses.

Co-creativity: possibilities for using the arts with people with a dementia

Purpose

The purpose of this paper is to explore the concept of co-creativity in relation to artistic practice with people with a dementia. The aim of the discussion is to outline how co-creativity offers fresh approaches for engaging artists and people with dementia, can contribute to less restrictive understandings of “creativity” and above all, expand the understanding of people with a dementia as creative, relational and agential.

Design/methodology/approach

In order to examine current conceptions of co-creativity and to inform the artistic practice, relevant literature was explored and eight expert interviews were conducted. The interviews were thematically analysed and are included here.

Findings

This paper consequently demonstrates that improvisation, structure, leadership and equality are central elements of co-creative processes and outlines how co-creativity can offer fresh insights into the way in which the arts can engage people with a dementia, the relationship between creativity and dementia and the transformative potential of the co-creative arts for those living with a dementia.

Research limitations/implications

The paper discusses some of the difficulties that are inherent a co-creative approach, including power relations and the limitations of inclusivity. Due to ethical restrictions, the paper is limited by not including the perspectives of people living with a dementia.

Practical implications

This paper paves the way for future research into co-creative processes in a variety of different contexts.

Social implications

A more nuanced understanding of co-creativity with people with dementia could challenge the dominant biomedical and social paradigms that associate “dementia” with irretrievable loss and decline by creating opportunities for creative agency.

Originality/value

This exploration of co-creativity with people with dementia is the first of its kind and contributes to the wider understanding of co-creativity and co-creative practice.

Participatory arts programs in residential dementia care: Playing with language differences

This article examines connections between language, identity, and cultural difference in the context of participatory arts in residential dementia care. Specifically, it looks at how language differences become instruments for the language play that characterizes the participatory arts programs, TimeSlips and the Alzheimer’s Poetry Project. These are two approaches that are predominantly spoken-word driven. Although people living with dementia experience cognitive decline that affects language, they are linguistic agents capable of participating in ongoing negotiation processes of connection, belonging, and in- and exclusion through language use. The analysis of two ethnographic vignettes, based on extensive fieldwork in the closed wards of two Dutch nursing homes, illustrates how TimeSlips and the Alzheimer’s Poetry Project support them in this agency. The theoretical framework of the analysis consists of literature on the linguistic agency of people living with dementia, the notions of the homo ludens (or man the player) and ludic language, as well as linguistic strategies of belonging in relation to place.