Interventions to Foster Resilience in Family Caregivers of People with Alzheimer's Disease: A Scoping Review

The family caregiver of a person with Alzheimer's disease still experiences, in most cases, negative consequences in their biopsychosocial environment, which are related to the acquisition of this role. However, it has been observed that this fact is not universal in this type of population since benefits can be obtained in the act of caring through the development of resilience. Given this possibility and given that nurses are the health professionals who support people in this illness process, there is an urgent need to identify which non-pharmacological interventions could improve or promote resilience in family caregivers of people with Alzheimer's disease. Therefore, our overall objective was to determine which interventions are useful in promoting resilience in family caregivers of people with Alzheimer's disease through a scoping review. The data were analysed using an adapted version of Arksey and O'Malley's methodological framework, after critically reading the articles with the CasP and MMAT tools. Nine articles were included (five analytical experimental, two quantitative and two mixed). Three types of interventions related to promoting resilience in family caregivers of people with Alzheimer's disease were identified: meditation, multicomponent psychoeducation and creative art; nurses participated as co-therapists in the last two.

Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review

Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.

Living well with dementia: The role volunteer-based social recreational programs in promoting social connectedness of people with dementia and their caregivers

Objectives: This evaluation study was designed to examine the factors that contribute the promotion of social connectedness among people with dementia and their caregivers through social recreational programs; develop an understanding of volunteer's impact on program success; and identify the barriers and facilitators to improve the volunteer-based programs to promote social connectedness.Method: A qualitative descriptive research design was used to explore the study participants' lived experiences of social recreational programs from Alzheimer's Society of Durham Region (ASDR) in Ontario, Canada. A final sample of 31 participants was recruited including people with dementia, informal caregivers, and community volunteers. Qualitative data was collected through face-to-face semi-structured interviews. Emerging themes were derived from the qualitative descriptive data using thematic analysis.Results: The qualitative interviews highlighted the impact of social recreational programs on people with dementia, caregivers and volunteers in the promotion of social connectedness, as well as the examination of barriers and facilitators to identify opportunities for the future improvement of ASDR programs that would benefit the dementia populations. The study findings revealed that the project 'Living Well with Dementia' has been able to successfully foster social connectedness through its volunteer-led social recreational programs by promoting the physical and mental well-being of people with dementia and their caregivers.Conclusion: Our study findings underscored the critical roles of volunteers who contributed to the success of community-based programs. Future research is needed to identify the opportunities to address current gaps in services and to strengthen the social recreational programs using evidence-based practices and client-centered approaches.Supplemental data for this article can be accessed online at http://doi.org/10.1080/13607863.2021.1950614.

A conceptual model of the impact of including carers in museum programmes for people with dementia

BACKGROUND

Research has highlighted a need for more theoretical work in arts interventions, including the role of the dyad. This study aimed to test theories from a literature review on the impact of including carers in museum programmes for people with dementia, and develop a model which can be used in other programmes to consider the impact of including carers more broadly.

METHODS

Using a realist evaluation approach, theory was developed through interviews and participant-observation at six museums in the UK.

FINDINGS

The impacts of including carers fell into seven broad areas - caring responsibility, session function, controlling access, preventing engagement, comparisons and losses, long-term impact of in-the-moment activities, and reducing social isolation and opening up the museum.

CONCLUSIONS

Including carers may have both unanticipated benefits and negative consequences, and greater attention is needed on how both carers and people with dementia can be supported in shared sessions. Carers should be viewed as participants of programmes, and can even be the main beneficiaries, even where the programme is ostensibly 'for' the person with dementia - it's not simply that carers are the enablers of, or barriers to, the impacts on the person with dementia.

Systematic review of group-based creative arts interventions in support of informal care-givers of adults: a narrative synthesis

Informal care-givers play an important role, with health-care systems relying on the billions of hours of care they provide. Care-givers experience high levels of psychological distress and isolation; however, the efficacy of what support is the best for care-givers is unclear. The primary aim of this systematic review is to determine the effect of group creative arts interventions on informal care-givers of adults. The secondary aim is to understand the impact of group type, the primary outcomes and how they are measured. Given the heterogeneous nature of the included studies, a narrative synthesis approach was taken. Database searches identified 2,587 studies, 25 of which met the full inclusion criteria. Studies included group creative arts interventions for either care-givers only (N = 8) or for care-giver/cared-for dyads (N = 17). The majority of the participants in the studies were older Caucasian females. Group creative arts interventions are beneficial for care-givers and for the person being cared for; however, benefits differ depending on whether the group is for care-givers only or for care-giver/cared-for dyads. Future research will benefit from care-givers being involved in the design of the creative arts intervention to provide input regarding group type and relevant outcome measures. Future research should consider targeting their intervention to care-givers with a low baseline score to increase the ability of the study to demonstrate a significant difference.

A Brief Report on Reviews of Existing Creative Art-Based Interventions in Dementia Care From 2010-2020

The following brief report provides an overview of previously published reviews in the context of creative arts-based interventions for persons with dementia. A total of 22 review articles were identified and summarized. Next steps are suggested for future studies that may wish to a) develop a new review, or b) create new studies filling in the gaps identified by the authors in this report.

The effect of a performing arts intervention on caregivers of people with mild to moderately severe dementia

OBJECTIVES

This study aimed to determine the feasibility and acceptability of a multi-modal performing arts intervention (MPAI) for caregivers of people with mild to moderately severe dementia. The secondary objective was to examine how MPAI might change caregiver burden, caregiver resiliency, and perceived quality of life (QoL) for care recipients.

METHOD

The study features a mixed-methods design. Caregivers (N = 32) completed the Zarit Burden Interview (caregiver burden) Brief Resilience Scale (resiliency) and Quality of Life-Alzheimer's disease measure (care recipient QoL) at five study timepoints. Semi-structured interviews (N = 15) documented the intervention's acceptability and caregivers' subjective experiences. Feasibility was indexed through withdrawal and attendance analysis. Braun and Clarke (2006) thematic analysis guided the qualitative analysis.

RESULTS

Caregiver burden significantly declined from baseline through final follow-up. Caregiver resiliency and care recipient QoL were not significantly changed but trended up during the intervention until it dropped at the end of the program. Qualitative data suggests the reversal in resiliency and QoL may be explained by caregivers' increased anxiety as the program ended. Acceptability data indicated caregivers were unanimously highly satisfied with the intervention, desiring to continue participation. Feasibility findings provide recommendations for intervention improvements.

CONCLUSION

MPAI could reduce caregiver burden and increase resilience for informal caregivers of a person with dementia. Effects drop off quickly at the end of the program, indicating the need for ongoing interventions that provide social support, a respite from the pressures of care recipients' dependency, and the relief that caregivers experience when they perceive benefits to their care recipient's well-being.

Bringing Art to Life: Social and Activity Engagement through Art in Persons Living with Dementia

OBJECTIVES

The Bringing Art to Life (BATL) program was created as an art therapy intervention to increase social engagement, intergenerational engagement, and creative expression among persons living with dementia (PWD) in an adult day service. This is an evaluation of BATL program efficacy.

METHODS

A modified behavioral observation tool was used to quantify meaningful engagements as recorded in ethnographic field notes and test the hypotheses that: 1) engagements increase across art therapy sessions, and 2) engagements were more social than activity or art related.

RESULTS

The increase in engagement across session was not significant. However, social engagements (M = 9.61, SD 4.6) were more prevalent than art engagements (M = 5.23, SD = 3.1) in each session (t(99) = 9.52,). A thematic analysis of social interactions recorded in the ethnographic field notes revealed themes related to reminiscence.

CONCLUSIONS

The quantitative and qualitative data supported the BATL program as effective in engaging participants in social interaction and art activities. Specifically, quantitative data showed participants were engaged in conversations around reminiscence and discussion of creative expression with students.

CLINICAL IMPLICATIONS

Intergenerational social interaction between PWD and college students is a critical and meaningful part of the BATL program, and the intervention created a safe space with focused activity through engagement with art, and this facilitated PWD in self-expression, including humor, advice, and legacy.

How participatory arts can contribute to dutch older adults' wellbeing - revisiting a taxonomy of arts interventions for people with dementia

BACKGROUND

A growing body of evidence suggests the positive impact of arts on health and wellbeing. The mechanisms underlying the impact however, remain overlooked.

METHODS

38 Semi-structured interviews were held with 30 older adults and 10 artists, involved in five participatory art projects in the Netherlands. Case-based framework and cross-over analyses were done on the basis of Cousins et al.'s taxonomy.

RESULTS

Participatory art initiatives contributed to the wellbeing of older adults in a complex interplay with the artist, art form, group of participants, material aspects and continuity of activities. A welcoming environment appeared a consistent underlying mechanism for participants to grow on a personal and artistic level, connect with others and feel supported in their psychosocial wellbeing.

CONCLUSION

This article demonstrates the important social function participatory art can have for older adults, and argues for the importance of a thorough consideration of the context wherein underlying mechanisms and outcomes emerge.

Arts engagement facilitated by artists with individuals with life-limiting illness: A systematic integrative review of the literature

BACKGROUND

Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care.

AIM

To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice.

DESIGN

A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes.

DATA SOURCES

PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed.

RESULTS

Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice.

CONCLUSION

Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists' engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.

"It is the beautiful things that let us live": How engaging in creative activities outside of standardized interventions helps family members of persons with Dementia

Creative activities can have profound positive effects on family members of persons with dementia. Typically, these effects have been studied in the context of standardized arts-based interventions. However, family members of persons with dementia may also engage in creative activities outside of standardized interventions. As these kinds of creative activities have not been investigated so far, the present study tried to fill this gap based on seven semi-structured interviews. The interviews were analysed using qualitative content analysis. The participants reported a wide range of activities that included, but were not limited to, prototypical creative activities such as making music and writing. Crucially, the positive effects extended beyond the experience of engaging in the activities themselves and also included significant changes in cognitions, emotions and behaviour that helped the participants to make meaning of the challenges and difficulties that are associated with the dementia diagnosis of a loved one.

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.

What are the elements needed to create an effective visual art intervention for people with dementia? A qualitative exploration

BACKGROUND

This article aimed to advance the understanding of 'what works' in visual art interventions from the perspective of key stakeholders, including people with dementia, their family members and visual art professionals.

METHOD

Semi-structured interviews were conducted with 22 participants, exploring their perceptions on barriers, facilitators, perceived benefits, experiences of delivering/attending a visual art intervention and any recommendations for implementation.

RESULTS

Five factors were identified within the interviews that indicated important considerations for intervention structure and implementation, including benefits of group work, a skilled facilitator, participant choice, artistic ability and activity content. While art therapists expressed a clear protection of professional boundaries, the success of all of the visual art interventions was largely attributed to the supportive facilitator who possessed certain core values such as empathy and compassion and had knowledge in both artistic practice and the impact of living with dementia. It was clear the group dynamic was valued, and it was important to provide enjoyable, failure-free activity content with a strong focus on the creative process.

CONCLUSION

These findings offer a direction for evidence-based practice when implementing visual art interventions.

Evaluating quality of life and well-being at the intersection of dementia care and creative engagement

Increasingly, art and design projects are used in dementia care settings to support the well-being of people living with dementia. However, the way well-being is defined and evaluated varies significantly in reporting. This study briefly examines the development of the concept of well-being and how it is intertwined with concepts of health and quality of life. It presents a scoping review of studies that use art and design to support the well-being of people living with dementia. We examined the characteristics and methodologies of the studies, how well-being is understood and operationalized, and how the outcomes are reported. The aim of this study was to understand whether there is any consistency in how well-being and related terminology are understood, the methodologies used, how projects are evaluated, the assessment tools used, and in what outcomes and implications are discussed. Results showed well-being and related terminology are used to reference the social, physical, states of mind and feelings, and in opposition to identified deficits. There was no consistent approach to how arts engagement for well-being in the dementia care space is carried out and evaluated. However, this study suggests that this is not necessarily problematic across arts engagement activities for well-being, providing the use of terminology and approaches, and means of evaluation are consistent and retain integrity within the design of individual projects. It suggests that well-designed projects provide frameworks that are able to take into account the many variables in relation to art and creativity and dementia care, and can offer transferability.

Participatory community-based arts for older people living with dementia in the community: how are they evaluated? A scoping review

Although the interests in participative arts for people living with a dementia has increased over the last decade, what is yet to be reviewed is how participatory community- based arts activities for this group of people are evaluated. The overall aim of the following scoping review is to understand the scope of measurement/evaluation methods/approaches used in studies that recruited participants with dementia from the community (not from health/clinical or residential aged care settings or nursing homes) and delivered community-based participatory arts activities/programs (not art therapy programs) to them. The methodological framework by Arksey and O’Malley (2005) for undertaking a scoping review article was applied to this study. Collation, summarizing and reporting the results was carried out considering the research questions. 7 articles met inclusion/exclusion criteria published from 2013 to 2020. The type of arts activities included co-designs and co-creation of various types of arts (n=1), museum visiting and art-making activities (n=4), artistic education-based program (n=1), group singing (n=1). This scoping review shed light on the paucity of research in which older people living with dementia were recruited from the community (not healthcare/clinical settings) to participate in participatory community- based art activities. Also, the results revealed that evaluation of participatory community-based arts activities for older people living with dementia in the community should include methods/techniques to get a deeper insight into the participants’ values and perspectives and the social interaction benefits of such programs.

An integrative systematic review of creative arts interventions for older informal caregivers of people with neurological conditions

Objective

We aimed to assess and synthesise the current state of quantitative and qualitative research concerning creative arts interventions for older informal caregivers of people with neurological conditions.

Methods

A systematic search was employed to identify studies that examined creative arts interventions for older informal caregivers, which were synthesised in this integrative review. We searched the following databases: MEDLINE, PubMed, EBSCO, CINAHL, EMBASE, PsycINFO, Cochrane Library, Scopus, Web of Science, and Google Scholar. We also backwards searched references of all relevant studies and inspected trials registers.

Results

Of the 516 studies identified, 17 were included: one was quantitative, nine were qualitative and seven used mixed methods. All included quantitative studies were pilot or feasibility studies employing pre- and post-test design with small sample sizes. Studies varied in relation to the type of creative intervention and evaluation methods, which precluded meta-analysis. Large effect sizes were detected in wellbeing measures following singing and art interventions. The qualitative synthesis highlighted that interventions created space for caregivers to make sense of, accept and adapt to their identity as a caregiver. Personal developments, such as learning new skills, were viewed positively by caregivers as well as welcoming the opportunity to gain cognitive and behavioural skills, and having opportunities to unload emotions in a safe space were important to caregivers. Group creative interventions were particularly helpful in creating social connections with their care-recipients and other caregivers.

Conclusions

The current review revealed all creative interventions focused on caregivers of people living with dementia; subsequently, this identified gaps in the evidence of creative interventions for informal caregivers of other neurological conditions. There are encouraging preliminary data on music and art interventions, however, little data exists on other art forms, e.g., drama, dance. Creative interventions may appeal to many caregivers, offering a range of psycho-social benefits. The findings of the current review open the way for future research to develop appropriate and creative arts programmes and to test their efficacy with robust tools.

Changing perceptions towards dementia: How does involvement in the arts alongside persons with dementia promote positive attitudes?

The prevalence of dementia in Singapore is on the rise. Due to the negative perceptions associated with the condition, persons with dementia and their care partners face an increased risk of social isolation and loneliness. One objective of the Arts and Dementia programme offered by the Alzheimer’s Disease Association is to increase inclusivity of persons with dementia in the community. To investigate the impact of the programme on perceptions towards dementia, a mixed-method approach involving 75 artists and volunteers was conducted. Findings from the Approaches to Dementia Questionnaire revealed that participants involved in the programme had significantly more positive perceptions than new volunteers. A thematic analysis was conducted on the focus group discussions and four themes were identified: (1) meaningful and rewarding interactions, (2) focus on abilities, (3) learning process and (4) more can be done. These findings suggest that meaningful experiences during the programme may be a driving force behind positive perceptions towards dementia.

A Taxonomy of Arts Interventions for People With Dementia

BACKGROUND AND OBJECTIVES

The current evidence base for the arts and dementia has several limitations relating to the description, explanation, communication, and simplification of arts interventions. Research addressing these challenges must be multidisciplinary, taking account of humanities and science perspectives. Consequently, this research aimed to produce a taxonomy, or classification, of arts interventions for people with dementia as a contribution to this growing field.

RESEARCH DESIGN AND METHODS

This research was underpinned by taxonomy and realist methodology. Taxonomy, the science of classification, produces a common language to name, define, and describe the world around us. Realist theory explains how interventions "work" and produce their effects. The main findings in this paper were generated from a case study and a Delphi study.

RESULTS

An arts and dementia taxonomy of 12 dimensions was developed: Art Form, Artistic elements, Artistic focus, Artistic materials, Arts activity, Arts approaches, Arts facilitators, Arts location, Competencies, Complementary arts, Intervention context, Principles.

DISCUSSION AND IMPLICATIONS

Arts interventions can be classified according to their contexts, mechanisms, and outcomes. A range of stakeholders could benefit from the taxonomy, including people with dementia, artists, practitioners, carers, care staff, funders, commissioners, researchers, and academics. Language relating to the arts and dementia can be adapted depending on the audience. This is a foundational model requiring further development within the arts and dementia community.

Participatory visual arts activities for people with dementia: a review

AIMS

To report and summarise the effects of interventions using participatory visual arts activities in dementia research through a narrative synthesis systematic review.

METHODS

We searched four databases MEDLINE, EMBASE, PsycINFO and Applied Social Sciences Index & Abstracts (ASSIA). Of the 3263 records retrieved, 20 were included in this review. Quality was assessed with the Critical Appraisal Skills Programme (CASP) and the Downs and Black checklist.

RESULTS

The use of participatory visual arts has positive effects on cognition, social and psychological functioning of people with dementia, although the diversity of the studies provided inconsistent evidence of an overall positive effect. Participants evaluated the interventions as enjoyable and engaging.

CONCLUSIONS

This review adds to previous work done by Deshmukh et al. and Windle et al. with a focus on studies that had participatory visual art-making activities made by people with dementia. The use of participatory arts may bring benefits for people with dementia. The heterogeneity of the interventions prevented generalisation of the results. Criteria associated with positive outcomes of the intervention are reported to aid on the design of participatory visual arts interventions for people with dementia. Future research in participatory arts should have a more detailed description of the methods and art interventions.

How Is Quality of Life Assessed in People With Dementia? A Systematic Literature Review and a Primer for Speech-Language Pathologists

Purpose The purpose of this study was to determine how quality of life (QoL) is measured in people with dementia involved in interventions designed to improve well-being and to explore how those measures align with principles of person-centered care. Method A systematic literature review was conducted utilizing PsychInfo, CINAHL, and PubMed and combinations of the search terms: "dementia," "outcome measure," "creative engagement," "creative intervention," "TimeSlips," "art," "quality of life," and "well-being." The search was limited to studies published in peer-reviewed journals that reported outcomes for people with dementia in response to a creative intervention. Results Across the 24 reviewed studies, 30 different outcome measures were reported including eight self-reported, nine observational, and 13 proxy-reported measures. Self-report of QoL was elicited 16 times, observational measures were reported 17 times, and proxy-reported measures were used 28 times. All measures were used with participants across the dementia severity spectrum. Conclusion Current clinical practice of QoL evaluation does not align well with person-centered care principles of self-determination based on the low proportion of self-report. The previously reported limitations of proxy-report have been in part confirmed with this study. Implications of the findings for speech-language pathologists are discussed.

"Art, Colors, and Emotions" Treatment (ACE-t): A Pilot Study on the Efficacy of an Art-Based Intervention for People With Alzheimer's Disease

Increasing evidence suggests that non-pharmacological therapies impact on neuropsychiatric symptoms and quality of life in people with Alzheimer’s disease. Among these, art-based interventions seem particularly suitable for elders’ rehabilitation as they act both on cognitive functions and quality of life. However, their benefits are not yet appropriately explored. The main aim of this quasi-experimental study was to test the feasibility and the likely efficacy of a novel multi-dimensional visual art intervention for people with Alzheimer’s disease (PWAD), named Art, Colors, and Emotions treatment (ACE-t). A group of PWAD (N = 10) was recruited from the Memory Clinic of Don Gnocchi Foundation to take part in the ACE-t. A historical control group that followed a usual care program (N = 10) was used for comparison. We considered both feasibility output (adherence and acceptability) and efficacy outcome measures (neuropsychological and neurobehavioral scales). We observed a good adherence to and acceptability of the ACE-t. The following significant intervention-related changes were also observed in ACE-t with respect to usual care: improvement in general cognition, as assessed with the Alzheimer’s Disease Assessment Scale–Cognitive, amelioration in language, and in executive functions, and reduction in Neuropsychiatric Inventory Scale score. In conclusion, ACE-t could be considered as a suitable intervention for the rehabilitation of PWAD, with positive effects on the cognitive and the behavioral status. ACE is a promising new art-based intervention that merits further research, including confirmatory trials of our preliminary results.

The benefits of community-based participatory arts activities for people living with dementia: a thematic scoping review

BACKGROUND

The drive towards living well with dementia has resulted in a growing recognition of the value of community-based participatory arts activities. This review aimed to explore their overall impact and holistic benefits for people with early to moderate stages of dementia.

METHODS

Using a scoping review methodology and thematic analysis, this review explored relevant literature published between 2008 and 2019.

RESULTS

26 published papers were identified, comprising visual arts, literary arts, comedy, music and dance. The key themes included person-centred, in-the-moment approaches; participation and communication; attention and cognition; social cohesion and relationships; and the role of space, place and objects.

CONCLUSIONS

There is strong evidence in support of using participatory arts for dementia, regardless of art form. In-the-moment and person-centred approaches were deemed impactful. Further research is needed to explore the importance of setting, material culture and the methodological or theoretical perspectives in participatory arts and dementia research.

An intimate connection: Exploring the visual art experiences of persons with dementia

The purpose of this study is to describe and discuss the art experience of persons with dementia taking part in guided museum tours at a Norwegian art museum. The analysis is based on semi-structured open-ended interviews with participants and researcher field notes. The results demonstrate the capacity and willingness of persons with dementia to reach out and connect on a personal level with the artworks. We identified four experiential dimensions: (1) a new way of seeing, (2) being lifted out of everyday life, (3) activating emotional and bodily responses and (4) connecting art and life. Our findings draw attention to the existential dimensions of the art experience and show that dementia-friendly programmes can offer individuals with dementia a way to stay connected both to themselves and to the wider community through active participation in a cultural discourse. This is the first research study conducted in this emerging field in a Norwegian context.

Effects of Art and Reminiscence Therapy on Agitated Behaviors Among Older Adults With Dementia

BACKGROUND

Cognitive degeneration and agitated behavior symptoms of dementia in older adults are the main causes of disability and inability and increase the cost of medical care. Agitated behavior symptoms of dementia are the main causes of early institutionalization and make caregivers exhausted.

PURPOSE

The aim of this study was to examine the effects of art therapy and reminiscence therapy on the alleviation of agitated behaviors in older adults with dementia.

METHODS

An experimental research design with two experimental groups and one comparison group was conducted to examine the effects for each group on agitated behaviors. Participants were recruited from two dementia care centers in central and northern Taiwan. The study included 54 older individuals who met the sampling criteria and completed the data collection process. The participants were randomly allocated into the art therapy group (n = 24), the reminiscence therapy group (n = 22), and the comparison group (n = 8). The intervention consisted of 50-minute sessions conducted weekly for 12 weeks. Regular activities were continued in the comparison group. The structured questionnaires were completed, and observations of agitated behaviors were collected before the intervention and at 1 and 6 weeks after the intervention.

RESULTS

Significant differences were found in agitated behavior symptoms at the three time points in the art therapy group, whereas reminiscence therapy was found to have had a clear and immediate effect on decreasing agitated behavior. The generalized estimating equation exchange model test revealed a significant and sustained, postintervention effect of art therapy on agitated behavior. In contrast, no significant and sustained effect on agitated behavior was observed in the reminiscence therapy group.

CONCLUSIONS

The findings of this study support that art therapy may have a positive effect on dementia-associated agitated behaviors in institutionalized older adults. Reminiscence therapy activities conducted weekly for 50 minutes each session did not reach statistically significant implications. It is suggested that future studies consider conducting art and reminiscence therapies for a 16-week duration with two weekly sessions to evaluate the effectiveness of the therapy. The duration of follow-up should be extended as well in future studies.

The impact of including carers in museum programmes for people with dementia: a realist review

Background: "In the moment" museum programmes for people with dementia (PwD) are an increasingly popular way of supporting people to live well. Most programmes include carers, though it is not well understood what effects, if any, their inclusion has. This review aimed to understand how including carers in museum programmes impacts the PwD, the carer, and the relationship between them. Methods: A realist review of peer-reviewed and grey literature was conducted to develop theory in answer to the research questions. Results: Twenty-three documents were included and 15 theory statements were developed within four themes: seeing the PwD in a new way, shared respite, excess disability, and reduced social isolation. Conclusions: As both positive and negative impacts were found, it is important to consider that programmes may not be beneficial for all dyads. The review offers recommendations to support positive outcomes for dyads, highlights gaps in the literature, and suggestions for further research.

Evaluation of the ‘Unforgettable’ art programme by people with dementia and their care-givers

Art programmes have been shown to contribute to the quality of life of people with dementia. To understand how people with dementia benefit from art programmes it is important to evaluate them. ‘Unforgettable’ is an interactive museum programme for people with dementia and their care-givers in the Netherlands. This study examined how it is experienced and appreciated by its users. It also investigated whether the user experience and appreciation are linked to their specific background characteristics. In a single-group design, we used a ‘take-home’ survey to collect the participants’ background characteristics and their experience and appreciation of the programme. A before and after intervention measurement took place, using a smiley face scale, to measure the change in mood of participants. Participants evaluated the programme very positively. Social interaction proved a key factor in their appreciation. The mood of the persons with dementia (N = 95) and care-givers (N = 104) improved after participation in the ‘Unforgettable’ programme. The results of this evaluation may contribute to the quality of art programmes in museums.

Facilitating creativity in dementia care: the co-construction of arts-based engagement

This paper seeks to understand the engagement of people with dementia in creative and arts-based activities by applying a relational model of citizenship and incorporating concepts of contextual and embodied learning from adult learning theory. A theoretically driven secondary analysis of observational and interview data focuses on the engagement of staff, volunteers and people with dementia during an arts-based intervention in a day centre and care home. The processes through which learning is co-constructed between the person with dementia, staff/volunteer facilitators and peers in the group to co-produce a creative engaged experience involves: increasing confidence for learning, facilitating social and physical connections, and affirming creative self-expression. The role of facilitator is central to the process of creative engagement to reinforce a sense of agency amongst participants and recognise people's prior experiences of learning and engagement in creative activities. People with dementia continue to learn and grow through engagement in creative activities to produce positive outcomes for the individual participants and for the care staff who observe and participate in this creativity. Facilitating creativity requires attention to lifelong experiences of learning in addition to the immediate interactional context to integrate arts-based interventions in dementia care successfully.

Retaining identity: Creativity and caregiving

Arts programming for people living with dementia and their caregivers has gained popularity as a way to provide opportunities for social interaction, expression, and continual learning. The goal of the present study, referred to as Retaining Identity: Creativity & Caregiving is to: (1) describe the process of designing and implementing a structured art experience for people living with memory loss and their co-residing caregiver; and (2) to summarize feedback provided by caregivers at the conclusion of the program. Retaining Identity is an eight-week program offered by professional artists who instructed dementia caregivers in four visual art activities, which they then taught to their care recipient. The program was designed for individuals with no art experience and the art projects were carefully developed to be engaging for both people living with dementia and their caregivers. The evaluation process included a qualitative survey completed by the caregivers to measure the impact of the program on the caregiver/care recipient relationship. The main themes that emerged from the survey were: caregiver growth, caregiver awareness, and creative discovery. The participants' artwork supports that art making has the potential to encourage an equitable exchange and outcome for people with memory loss and their caregivers. Although the survey is limited in scope, the results support the use of the arts to positively impact caregivers and their relationship with their care recipient.

Involving People with Memory Loss in the Development of a Patient Handbook: A Strengths-Based Approach

A memory clinic used two key approaches in developing a patient and family handbook: partnership with people with memory loss and strengths-based social work practice. Social worker coeditors of the handbook intentionally sought guidance from people with mild to moderate memory loss regarding handbook content, design, and overall tone. A focus group, three sessions of a review group, e-mails, and personal interviews were used to solicit and review input from participants. The editors also incorporated content contributions in the form of essays, quotations, and an original poem from people with memory loss, alongside contributions from clinic staff, university faculty, and community service providers. People with memory loss provided input in five areas: response to a new diagnosis, coping with memory loss, messages to other newly diagnosed people and health care professionals, available community resources, and recommendations for handbook design. The development process reinforced a key message of the handbook: People with memory loss exhibit ongoing strengths, which help them participate in life. The process also ensured that the handbook content and design would be relevant and applicable to its users. The handbook is now regularly distributed as a primary patient education tool in the memory clinic and community programs.

Making a university community more dementia friendly through participation in an intergenerational choir

A dementia friendly community is one that is informed about dementia, respectful and inclusive of people with dementia and their families, provides support, promotes empowerment, and fosters quality of life. This study presents data from four cohorts of undergraduate college students and people with dementia and their family members, using an intergenerational choir as the process through which to begin to create a dementia friendly community. This was accomplished by breaking down the stereotypes and misunderstandings that young adults have about people with dementia, thus allowing their commonalities and the strengths of the people living with dementia to become more visible. Data were gathered for each cohort of students through semi-structured open-ended questions on attitudes about dementia and experiences in the choir, collected at three points over 10 weeks of rehearsals. Data about their experiences in the choir were collected from each cohort of people with dementia and their family members through a focus group. Results across all four cohorts showed in the students: changed attitudes, increased understanding about dementia and the lived experience, reduced dementia stigma, and the development of meaningful social connections. People with dementia and their family members expressed feelings of being part of a community.

Critical reflections on methodological challenge in arts and dementia evaluation and research

Methodological rigour, or its absence, is often a focus of concern for the emerging field of evaluation and research around arts and dementia. However, this paper suggests that critical attention should also be paid to the way in which individual perceptions, hidden assumptions and underlying social and political structures influence methodological work in the field. Such attention will be particularly important for addressing methodological challenges relating to contextual variability, ethics, value judgement and signification identified through a literature review on this topic. Understanding how, where and when evaluators and researchers experience such challenges may help to identify fruitful approaches for future evaluation.

Exploring the theoretical foundations of visual art programmes for people living with dementia

Despite the growing international innovations for visual arts interventions in dementia care, limited attention has been paid to their theoretical basis. In response, this paper explores how and why visual art interventions in dementia care influence changes in outcomes. The theory building process consists of a realist review of primary research on visual art programmes. This aims to uncover what works, for whom, how, why and in what circumstances. We undertook a qualitative exploration of stakeholder perspectives of art programmes, and then synthesised these two pieces of work alongside broader theory to produce a conceptual framework for intervention development, further research and practice. This suggests effective programmes are realised through essential attributes of two key conditions (provocative and stimulating aesthetic experience; dynamic and responsive artistic practice). These conditions are important for cognitive, social and individual responses, leading to benefits for people with early to more advanced dementia. This work represents a starting point at identifying theories of change for arts interventions, and for further research to critically examine, refine and strengthen the evidence base for the arts in dementia care. Understanding the theoretical basis of interventions is important for service development, evaluation and implementation.