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«The Arts for Dementia in North America; Learning from Practice Amy Veale Churchill Fellow 2015 Photo of the ‘At this Age’ group run by Dr Dalia ...»

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During my time in Washington DC, I spent some time at IONA Senior Services, a non-profit organisation that provides a range of services to older people, many with dementia. It was here I learned about a program offered at the Philips Collection, a modern art museum that ] has partnered with IONA. The Phillips and Iona program encourages individuals with memory impairment to connect with each other through conversations in the Phillips galleries. Using the museum’s artwork as visual stimuli, individuals engage in dialogue with museum educators. The program continues back at Iona day center where individuals engage in art making that reflects the themes covered at the Phillips. Themes have covered risk-taking, music, journeys, and home, providing people with dementia an opportunity to express their emotions through the art. Artwork is displayed around IONA for family, staff and visitors to view.

In my conversations with museum educators and administrators I asked what factors needed to be considered in order to develop a successful museum based program for dementia. The responses were broadly similar and are outlined below; Tours should always be conducted when museums are closed to the public to ensure minimal distraction.

 Early afternoon sessions are preferable to morning sessions. Program educators stated that early afternoon sessions are better suited to the rhythms of the person with dementia ie less confusion and anxiety.

 Educators should always introduce themselves and wear a nametag. They should state clearly where they are and the purpose of the day.

 Educators should give all participants a name tag and spend time to introduce themselves personally.

 Museum educators must be trained in dementia in order to facilitate effectively.

 With bigger numbers, there should be more than one educator so that small groups can be run simultaneously. Groups should ideally be kept small (around 6 participants).

 Each session should focus on a theme and 4-6 pieces of artwork should be selected that reflect that theme.

 Discussions should typically focus around asking participants to communicate what they see in the painting, what they think is happening, identifying any emotion in the painting, and how the painting links to their own lives. The process should encourage participants to reflect on and express their thoughts. There is less of a focus on education, and testing questions such as ‘who painted this?’ should be avoided.

]  All participants should receive positive feedback for any contribution they make.

 Special training is required to ensure that paintings selected are appropriate for those living with dementia.

 Ideally, paintings and sculptures should be specially selected for tours by those actually living with dementia. As part of the planning process for a new program, Dr John Ziesel recommends presenting reproductions of paintings for people with dementia in order that they can select the artworks that will be included in the program. He found that educators are often unable to predict the paintings that will most appeal to those taking part in tours10. A recent study has shown that art appreciation is associated with the viewer’s visual working memory capacity11 As visual memory is known to be affected in dementia, seeing the artworks from the perspectives of those actually living with dementia is important.

 If art making is part of the process, have an end of program event with family and friends to celebrate the art work that has been created.

Evidence to demonstrate the effectiveness of museum based programs for dementia has been limited. One study sought to understand the experience of an eight-week art-gallerybased intervention offered at two different galleries for people with mild to moderate dementia and their carers. Interviews with 24 participants (12 with dementia) post intervention, found greater feelings of social inclusion, enhanced cognitive capacities and improved quality of life.12 A second Australian study found that for those with moderate to severe dementia, art-gallery programmes can also be worth-while, again citing the importance of social, cognitive and emotional benefits even if they occur ‘only in the moment’.13 I’m Still Here; a breakthrough approach to understanding someone living with Alzheimer’s. Dr John Ziesel.

Sherman, A., Grabowecky, M., & Suzuki, S. (2015). In the working memory of the beholder: Art appreciation is enhanced when visual complexity is compatible with working memory. Sherman, Aleksandra. Journal of Experimental Psychology: Human Perception and Performance, 41(4), 898-903 Camic, P. M., Tischler, V., & Pearman, C. H., (2014). Viewing and making art together: a multi-session artgallery-based intervention for people with dementia and their carers. Aging & Mental Health, 18, (2), 161–168 MacPherson, S., Bird, M., Anderson, K., Davis, Y., & Blair, A. (2009). An art gallery access programme for people with dementia: ‘You do it for the moment’. Ageing & Mental Health, 13 (5), 744–752.

] Verbal expression – storytelling and poetry The Alzheimer’s Poetry Project During my time in New York, I was fortunate to have spent time with the poet Gary Glazner and his Alzheimer’s Poetry Project. Gary founded the Alzheimer's Poetry Project (APP) in 2004 in Santa Fe, New Mexico. Since this time the APP has held sessions at over 100 facilities across America and Europe. The APP has given staff training for over 1,500 health care workers and family members in using poetry with dementia.





Before visiting the Alzheimer’s Poetry Project, I was unable to find any research literature that could explain the rationale behind using poetry to engage people living with dementia.

My observations of the program and my subsequent conversations with Gary however, revealed that poetry can in fact be a very effective way of engaging people with dementia.

The success of the Alzheimer’s Poetry Project is in no doubt due to the methods that Gary has developed. His skills as a poet coupled with a flair for dramatic expression means that Gary brings the poems to life in a highly expressive way. The ability to recognise emotions is usually spared in dementia so that, through dramatic expression, participants can connect with the poem and the poet, without necessarily following all of the language. Gary expressed that the rhythmic nature of poetry, much like music, does in fact make it easier to follow, and easier to repeat. I believe that this rhythmic quality, coupled with its dramatic delivery, overrides the communication barriers that are often experienced in dementia when trying to follow ‘normal’ language.

In terms of his methods, Gary starts by creating a poetry circle and walking around the circle to shake hands and become acquainted with each participant. A warm up exercise typically ensues. One such warm up was ‘pass the smile’, where each person seated in the circle smiles at their neighbour and they ‘pass’ the smile along. Gary then recites a poem to set the theme for the session. The theme at one of the sessions I attended was flying, so Gary chose to start by reciting Edgar Allan Poe’s ‘The Raven’. After reading the poem, it was recited again, except now participants repeated each line as it was read by Gary. Following this exercise, it was time for the group to create a poem together. As the theme was flying, Gary asked the simple question of where we would fly to if we were birds and why. Each person’s response was then skilfully pulled together by Gary to create a group poem which was read at the end of the session.

] The approach works so well for a number of reasons. Gary takes time to connect with each person at the beginning of the session and throughout the process. He creates a space where participants can freely express themselves, where their inputs are valued and were all individuals are praised for their contribution. He honours and acknowledges each participant in turn by reading back their segment of the group poem and everyone is impressed by what they have helped create. On reflection, poetry is much like the other arts in that it breaks down the barriers to communication that are typically experienced in dementia. The emotions expressed through the rhythm and the acting out of the poem, can be understood and felt in such a way that they create a connection between the poet and the participants, while the dramatic repetition of poems and the creation of the group poem serve to meet the human needs of social belonging, self expression and mastery.

Finally, there is a lot to be said about Gary’s talent as a poet. His ability to think on his feet in the creation of the group poem, while staying true to the voice of each participant, was an impressive skill, highlighting the importance of professional artists and skilled facilitation in this process.

TimeSlips

The concept of TimeSlips started in 1996. At the time Professor Anne Basting (University of Minnesota), who holds a PhD in Theatre Arts, was interested in seeing if improvisation techniques could be helpful for people with dementia. Anne recognised the powerful effects of creative drama for healthy older adults, and was curious to see if these benefits applied to people with dementia.

Anne’s initial focus on reminiscence based techniques was proving unsuccessful and she attributed this to issues of memory recall. As dementia progresses to the later stages, access to long term memory wanes and recall becomes problematic. Yet creativity remains.

Anne understood that she needed to replace the pressure to remember with the freedom to imagine, which is how the TimeSlips method developed.

TimeSlips is one of the many methods used by a New York based non-profit organisation, Elders Share the Arts (ESTA). I attended a dementia care facility with a TimeSlips certified trainer, Marcia Gilden, from ESTA to observe a session. The methods used in TimeSlips are fairly simple and involve presenting the group with a photo and then facilitating that group to work together in order to create a story based on the image in front of them. One persons input to the story will spark a thought in another, and in this way a story is created. It is, in ] essence, a method story telling through improvisation. Crucially, the picture is quirky or unusual in some respect, so that it encourages participants to imagine and be creative. An experienced facilitator is required to guide the session with open questions such as ‘what do we think is happening here?’, ‘what will we call them?’, ‘where will we say they are from?’ There are no right or wrong answers. Everyone’s input is valued and incorporated into the story. The story is read at a number of points throughout the hour long session in order to remind participants of the story so far, and to acknowledge the effort that has been made by the group.

You can listen to Anne discuss the history of TimeSlips in her TED Talk; ‘When Art is the only Medicine’ here: http://tedxtalks.ted.com/video/When-Art-is-the-Only-Medicine-| Case Study of the storytelling method Timeslips The dementia care facility I visited in the Bronx catered for people in the mid to late stages of dementia. About ten residents and two members of staff gathered round in a circle to create a story based on the Timeslips method. A black and white photo was produced by the facilitator. The photo was of an older gentleman, pouring a glass of champagne into one of two glasses held by an older lady. His arm was wrapped around her and they were smiling, wearing party hats and looking into each other’s eyes.

Looking around the group that were about to create the story, I was a little sceptical that the process would work for everyone present. While most participants seemed able to contribute, some of the group seemed distant and uninterested while two members of the group appeared to be in the later stages dementia.

When the facilitator asked what was happening in the photo, someone started the process by stating the couple were celebrating a wedding anniversary. This sparked another person’s imagination who thought that perhaps they had won the lottery. Someone else noted that they looked very old and thought they could be celebrating making it to 100 years old. And so an entire story developed about how and where the couple met (maybe in Ireland, or maybe at school where she fell over and he helped her to her feet), where they had their wedding (back in Ireland); and what they did with all their lottery winnings. All responses were included in the final story. With the freedom to imagine, to be creative and spontaneous, the story that developed was both original and entertaining. More importantly the group enjoyed the process, spirits were high and laughter filled the room. Members of the group that had been quieter to begin with joined in enthusiastically.

] What really struck me about the session was that the TimeSlips method seemed to foster a sense of community. Everyone got involved, including staff. The two members of the group who had more advanced symptoms were encouraged and supported by other members of the group. When one of these individuals became distressed, one member of the group noted this and suggested that we should sing for her.

A study published in the American Journal of Alzheimer’s Disease and Other Dementias, found that the TimeSlips method of improvisation and storytelling held a number of benefits for residents including increased creativity, improved quality of life and positively altered behaviour14. As was my experience, the same study also found that it creates a meaningful activity for staff and older participants to experience together, and can nurture relationships in the group. Anne Basting refers to ‘group solitary confinement’, where nursing home residents are in a room with their peers, yet do not interact with each other, and only interact with staff in regards to their care needs. By working towards a common goal, the TimeSlips method seeks to breakdown these barriers to communication.

The Society for the Arts in Dementia Care



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