"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

Dementia in the minds of characters and readers - A transdisciplinary study of fictional language

The concept of personhood in dementia has maintained its status as the definitive approach to dementia care. Personhood works at both practical and philosophical levels to maintain the humanity of people with dementia. The project described in this article used the concept of personhood to design community-engaged research which harnessed the power of literary language to access the internal life of a person with dementia. Here we outline the design and methods in detail, homing in on our main conclusion that literary language is a powerful tool in helping diverse stakeholder groups access the person in dementia. The research comprised three inter-linked strands. In Strand One we built a corpus of dementia fiction from which we identified twelve extracts from contemporary novels offering the internal perspective of a person with dementia. Strand Two involved six weekly meetings of separate reading groups with four distinct stakeholder groups - student social workers, members of the public, family carers, and people with dementia. The four groups engaged in separate, facilitated discussions of the extracts. This aspect of the project is unique as to the best of our knowledge no previous research has analysed readers' responses to extracts of fictional characters' narration of living with dementia. Strand Three was led by a well-known writer and comprised a series of public events and outputs which engaged readers and authors of dementia fiction with the genre. A dementia fiction festival and writer workshops resulted in publication of an anthology of short stories which included stories addressing a deficiency of racial and ethnically diverse characters noted in our corpus. The article concludes by discussing how working across disciplines and sectors to engage with dementia as a cultural as well as a clinical challenge has the potential to facilitate the understanding and emphasis of personhood in dementia studies.

Examining a Holistic Framework for Evaluating Clinical Outcomes in Parallel With Non-Clinical Outcomes

RATIONALE

While clinical research seeks to evaluate outcomes of various types, no framework has been identified that permits a sufficiently broad approach to evaluating clinical outcomes, in parallel with non-clinical outcomes.

AIMS AND OBJECTIVES

The objective of this paper is to examine a unifying framework for evaluating clinical outcomes in parallel with non-clinical outcomes by drawing on different understandings of the Common Good. The proposed framework must have broad application, accounting for the various types of outcomes that may emerge within different disciplinary approaches and identifying the benefits or harms that might be experienced by the clinical research participants.

METHOD

Six different definitions of the Common Good originally described by Boltanski and Thévenot are presented. The six conceptions of the Common Good identify organising principles by which an outcome is evaluated as beneficial or harmful. It also identifies the various ways that the researched persons, and the researchers, are subjectified. Academic literature that reported outcomes for persons living with dementia was purposively sampled to demonstrate the application of the six definitions of the Common Good.

RESULTS

A wide range of outcomes from clinical research may be evaluated in parallel, based upon the assumption that the Common Good may be expressed as a plurality of perceived goods extending beyond purely clinical, technically measured outcomes. Further, the subjects of interventions may be described in non-clinical language, thus respecting the many roles that may be important to them as human persons and agents.

CONCLUSION

Boltanski and Thévenot's Economies of Worth framework allows research outcomes to be evaluated consistently against the six definitions of the Common Good. The definitions of the Common Good inhere six different Worlds: Civic, Domestic, Industry, Inspiration, Market and Opinion (or Celebrity). Each World is structured around a Higher Common Principle by which the Common Good is defined within that specific world. The example of research amongst people living with dementia demonstrates the robustness of this framework by identifying a wide range of non-clinical outcomes. These extend the understanding of the practical ways in which participants, their families and associates, researchers, and also organisations, are variously presented as subjects according to the different definitions of the Common Good.

IMPLICATIONS

This theoretical approach has the potential to inform and support research in clinical settings and guide funding bodies in the evaluation of research projects that give rise to clinical and non-clinical outcomes. A matrix that applies the structure of the definitions of the Worlds could be developed to support the comparison of research outcomes arising from diverse objectives and methodologies.

An Art Exhibition on Creative Activities of Family Members of Persons with Dementia as an Effective Tool for Science Communication: A Qualitative Assessment Study

Dementia poses a huge challenge - not only to the persons living with the condition but also to their family and friends. Recent research has demonstrated that engaging in creative activities can serve as a coping mechanism to deal with the dementia of a loved one. An art exhibition was created to communicate this insight to a broader audience. As indicated by interviews with exhibitors and visitors as well as an analysis of notes that visitors left in the exhibition, the exhibition helped generating important knowledge regarding the usefulness of creative activities, opened new perspectives on dementia, and provided a platform for exchange and solidarity that inspired individuals to think and behave differently. In sum, this suggests that arts-based exhibitions can be a powerful tool for health communication and science communication and for broadening the societal discourse in the context of dementia.

Using Journey Mapping to support staff, family members and allies of people with dementia to think and act differently during a care transition: The benefits and limits of care imagination

Research methods are not just for data collection, but can also be engaged in to promote more immediate benefits for participants and to create social change. This paper reports on how journey mapping was used with staff and family members of people with dementia in a residential aged care facility in regional NSW, Australia. The study was conducted in the context of a care transition, where residents, including people with dementia moved from an existing site to another new facility. Care transitions are frequent yet difficult for people with dementia to negotiate, so it was important to predict their nature and understand what might make the move easier. We used an innovative visual method known as ‘journey mapping’ to engage 45 staff and 18 family members to inform supports for 30 people with dementia, who had been identified as needing additional support during the planned transition. The journey mapping process was useful for fostering the caring imagination and encouraging active and creative planning around change for the people with dementia. It also highlighted the entrenched inequalities in the aged care sector, where poorly paid staff wanted to enact broad ranging supports but felt unsupported to do so. In other words, to improving and re-imagining transitional care for people with dementia requires structural and systemic change rather than just localised re-imaginings. [245]