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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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I was very fortunate to sit in on a storytelling session with the ‘At this Age’ group, run by Dr Dalia Gottlieb- Tanaka from the Society of the Arts in Dementia Care. The group meets regularly to engage in various projects related to the arts. In the session I attended, group members were working on their current project, ‘My Mother’s Story’. Members had been asked to tell the life story of their mother, from their mother’s perspective. I was privileged to hear each participant read aloud the (often emotional) stories they had written over the course of the previous weeks. It is important to note that no one in the group had dementia, yet evidence has suggested that engaging in these types of activities can delay the onset of memory problems. As a group, we also created collages from magazine cuttings about our mothers. The session was fun, and it was clear to see that members of this group have a strong social bond, attending various social activities together outside of the group.

Continued social engagement is also known to be an important factor in the prevention of dementia, and this is something Dr Gottlieb- Tanaka is keen to promote, through the arts.

George, D., R, & Houser, W., S., (2014) I’m a Storyteller! Exploring the Benefits of Timeslips Creative Expression Program at a Nursing Home. The American Journal of Alzheimer’s Disease and other Dementias.

] Music and movement Of all the arts, music has the largest evidence base to demonstrate its efficacy for dementia, with studies generally reporting significant reductions in the Behavioural and Psychological symptoms of dementia that include reductions in agitation, apathy, and wandering behaviours, and increases in attention span15. More than this however, music appears to tap into the emotions and feelings of the individual, and to restore humanity. In his book, Musicophilia, the late Oliver Sacks, a highly regarded professor of neurology and psychiatry, shares his account of the power of music;

‘I have seen deeply demented patients weep or shiver as they listen to music they have never heard before, and I think that they can experience the entire range of feelings the rest of us can, and that dementia is no bar to emotional depth. Music is part of being human. Its’ very ubiquity may cause it to be trivialised in daily life. But to those with dementia, the situation is different. Music is no luxury to them, but a necessity, and can have a power beyond anything else to restore them to themselves’16.

Oliver Sacks provides numerous case studies showing how music can transcend the cognitive challenges posed by dementia. The effects of music that he witnessed were often longer term and resulted in ‘improvements of mood, behaviour, and even cognitive functionwhich can persist for hours or days.’ The following case study is taken from Musicophilia;

Case study taken from the book Musicophilia The simple intervention (was made) of turning on the classical music channel in front of the couch where her mother-in-law had mostly sat watching TV show for the preceding three years. The mother-in-law, diagnosed with dementia, had kept the house awake at night when the caregivers turned off the TV. Daytimes, she would not get off the couch except for toileting or family meals.

Beard, R., L., (2012) Art therapies and dementia care: A systematic review. The International Journal of Social Research and Practice, 11(5), 633-656.

Sacks, Oliver. 2007. Musicophilia: tales of music and the brain.

] After the channel change she had a profound behavioural change: she had asked to come to breakfast the following morning; and did not want to watch her usual TV fare the next day, and asked for her long neglected embroidery the next afternoon. Over the next six weeks, in addition to communicating with her family and taking more interest in her surroundings, she mostly listened to music. After six weeks, she died peacefully.

People with dementia can greatly benefit from having music integrated into their daily lives.

As Oliver Sacks regards music as a necessity for people with dementia, Dan Cohen, founder of Memory and Music, has witnessed the powerful effects of implementing iPod personalised music programs in hundreds of care facilities throughout the U.S and Canada. Something as simple as an iPod appears to dramatically improve quality of life. A clip from the film Alive Inside provides a moving example of music’s ability to restore personhood and can be seen here;- https://www.youtube.com/watch?v=5FWn4JB2YLU I was able to witness the power of music first hand during my Fellowship. Firstly in Washington DC, when I attended a nursing home with violinist Anthony Hyatt, from Arts for the Aging (a non profit organisation that offers a range of arts programs for older people across the Washington DC area). Anthony preformed a range of well known songs for residents, most of whom appeared to be in the later stages of dementia. Many were slumped over in wheelchairs, and seemed disengaged with their surroundings. Yet, when Anthony played, the body language of many of the residents changed. They appeared more alert and engaged. The effects were even more pronounced in certain individuals when Anthony played a particular genre. For one lady sitting next to me, this was Scottish Highland music. I had tried, unsuccessfully, to engage this lady before the session started. Yet, when her music played, it seemed to spark something in her. She called for my attention from her wheelchair, grabbed my hand, and led me in time to the music.

Anthony also introduced simple dance sequences for a number of the songs. The movements, along with the music, added to the sense of a shared experience. Again, my hand was grabbed and moved in a sort of dance. Anthony explained that touch is a human need, but that people with dementia are often touched out of requirement, not out the desire for human connection. Anthony believes that the music he plays creates the conditions for that connection to take place. It taps into deeper emotions, joy and memories that are experienced universally, allowing for an experience that transcends the dementia. Anthony frequently combines dance with music for this reason, creating opportunities for touch through dance in his classes.

] The second time I witnessed the potential of music was not at a music program, but at a TimeSlips storytelling session. One member of the group, in the later stages of dementia, was visibly distressed. Yet her intense anxiety disappeared immediately with a verse of ‘You are my Sunshine’. She became alert, engaged and calm.

I also visited with Concerts in Motion, a New York based non-profit organisation that brings music to the housebound and performs concerts in hospitals, nursing homes and senior centers. Concerts in Motion prides itself on the quality of musical performances that they offer, using professional musicians who play on Broadway or in the orchestras of the Lincoln Center. I visited an intergenerational program where a number of Concerts in Motion’s youth performers took to the stage. Though the audience for this program were considered to be ‘healthy elders’ (the concert took place in a community center), there is some evidence to suggest that intergenerational programs can have a positive impact on people with dementia17,18 though this is an area which needs further research.

Music creates a connection. ‘We bond when we sing together; but bonding is deeper, more primal, if we dance together’19. In Washington DC, I attended a Dance for PD (Parkinson’s Disease), session at IONA Senior Services. The Dance for PD program is built on one fundamental premise: professionally-trained dancers are movement experts whose knowledge is useful to persons with Parkinson’s. While the Dance for PD program is specifically focused on dance techniques that address concerns related to Parkinson’s (such as balance, flexibility and coordination), research has shown that 24-31% of those with Parkinson’s disease also have dementia20. The session that I attended was led by three dance professionals who integrated movements from ballet, tai chi, folk dance and modern dance, all to live music. All abilities were catered for and variations on each move were provided for those who were chair bound. What struck me most about this program was the huge level of professionalism that I witnessed. Each individual was supported and encouraged to perform to their highest ability. The dance was the focus, not the Parkinson’s.

Jarrott, S., E., & Bruno. K., (2003). Intergenerational activities involving persons with dementia: An observational assessment. American Journal of Alzheimer’s Disease and Other Dementias, 18(1) Lee., M, (2007). Effects of intergenerational Montessori-based activities programming on engagement of nursing home residents with dementia. Clinical Interventions in Aging, 2(3): 477–483.

Sacks, Oliver. 2007. Musicophilia: tales of music and the brain.

Aarsland, D., Zaccai, J,, & Brayne, C. (2005) A systematic review of prevalence studies of dementia in Parkinson's disease. PubMed, 20(10):1255-63.

] Everyone showed great enthusiasm in mastering the dance move they had been given.

Much of the dancing also required that participants danced with a partner. The fun of dance, the physical benefits of exercise, the mastery of a dance move, and the feelings of connectedness through touch and eye contact with a partner, would certainly be beneficial for those with dementia.

In New York I visited the innovative New York Memory Center, which provides a vast range of programs for those with memory loss including; cognitive training; yoga; meditation;

exercise; therapeutic recreation classes; trips to concerts and sporting events. Many of the activities in the New York Memory Center focus on the arts where professional artists run a range of programs. A twice weekly program run at the center has a dance and music focus and is run by Rhythm Break Cares. Music, movement and touch are the founding principles behind Rhythm Break Cares’ (RBC) Dance for Dementia programs which focus on improving the quality of life for early and middle stage Alzheimer’s communities and those affected by dementia. In addition to being professionally trained dancers, all staff are trained to interact with those living with dementia and Alzheimer’s. The session that I attended at the New York Memory Center encouraged participants to dance in whatever way they felt moved to do so by the music. A range of classics were played and the atmosphere was party like. In this particular session, there was much less focus on the ‘art’ of dance and technique, rather the aim of the session was to create a fun and energised environment – and it seemed to work.

The hour flew past, with most people on their feet dancing, or tapping their feet to the music.

While this session didn’t focus on teaching dance, the program coordinator and professionally trained volunteer did demonstrate some salsa and jazz moves for participants to observe or follow if they wished.

With more of a focus on movement, Tai chi, a form of martial art, is also being used as a movement based relaxation technique for people with dementia. Chinese martial arts combine simple physical movements and meditation, with the aim of improving balance and health by concentrating on a series of integrated exercises. I took part in a Tai Chi session at the Veterans Association in Washington DC. All participants were wheelchair bound, so the session focused on the upper body. The program facilitator took us all through a series of slow and controlled movements, which were quite challenging. Participants were encouraged to take breaks when needed. While the dance moves of Rhythm Break Cares were fun and energising, the tai chi session created a peaceful and relaxing environmentevident when a number of participants ‘nodded off’ at different points. At the end of the session, all participants were vocal in terms of how much they enjoyed the experience.

] In a review of the academic research, Renee Beard (2011) found that Dance Movement Therapy studies do report small reductions in the Behavioural and Psychological symptoms of dementia, such as decreased agitation, increased self-care practices, and improved cognitive performance or procedural learning21. Beard found that the primary benefits however related to an increase in communication and a focus on empowering people with dementia. Non-verbal communication means that any ‘lost skills of ordinary conversation’ can be rediscovered. Dance emphasizes quality of life, encouraging a sense of community, and the ability of people with dementia to meaningfully interact.

Art making One of the highlights of my trip was a trip to a residential care facility in Canada with Jeanne Sommerfield, Secretary for the Society for the Arts in Dementia Care, where we visited a program run by a trained art therapist.

What struck me about this particular program was the level of professionalism and attention to detail. The day-long, twice weekly arts session is open to all residents and they can come and go as they please throughout the day. The room had been specially designed for the purpose of making art and was cut off from other distractions in the facility. Quality arts materials were provided (aprons, easels, brushes, paint palettes etc). Each participant had their own station, materials and plenty of space). Classical music was playing in the background. When I arrived, participants were all painting with an intense focus, thoroughly engaged in the process of making art. The art seemed to have an almost hypnotic effect.

There were none of the typical signs one would expect with dementia. Everyone was calm and engrossed in their work, and the atmosphere was incredibly relaxing.

I spoke with the art therapist during a break. She was pleased I had witnessed the effects of the program, and the potential of the art making process to provide relaxation, focus and purpose. Many of the participants who took part in the program were new to art making, having had no previous experience before entering the home. Yet, they enjoyed attending the art class every week. The art therapist believed that the setting was just as important as the art itself. She believed that by running the program in a professional way, with quality materials, in an appropriate setting, meant that participants knew they were respected and Beard, R., L., (2012) Art therapies and dementia care: A systematic review. The International Journal of Social Research and Practice, 11(5), 633-656.

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