A new arts programme that uses birdsong and the smell of flowers is improving wellbeing for older people with dementia
Eyes downcast, head bowed, hands clasped and legs crossed; Eddie, an introverted wheelchair user, had been in a dementia care home for a decade when he began sessions with arts charity Age Exchange.
“He wasn’t talking, and more or less stayed in this bound posture,” recalls Jill, the artist who worked with the 63-year-old. “He was very shy in making eye contact ... His movements tended to be fast, eruptive and slightly aggressive and he found it very hard to engage in soft, slow movements.”
Over six weekly reminiscence arts sessions – work that explores memories using creative activity – Jill noticed how Eddie became “awake, sitting upright in his wheelchair, trying to talk, being better at regulating his mood and behaviour … He felt safe enough to allow himself to express some of these stored up energies and feelings through movement and making sounds which freed him and allowed him to start opening up and connecting with people.”
A simple gesture after the final session – previously unimaginable – reflected the transformation. Jill recalls: “I was very touched as we said goodbye; he extended his right hand towards me, I took it and we shook hands.”
London-based Age Exchange specialises in reminiscence arts and Eddie was among 200 older people involved in research into the method in Lambeth and Southwark, south London. The work is timely; by 2025 there will be one million people with dementia in the UK, according to the Alzheimer’s Society.
The research, funded by a £600,500 grant from Guy’s and St Thomas’ Charity, aims to create and measure best practice in creative care for dementia. Other partners in the three-year pilot, Reminiscence Arts and Dementia – Impact on Quality of Life, are Alzheimer’s Lambeth and Southwark, Guy’s and St Thomas’ NHS foundation trust and South London and Maudsley NHS trust.
Arts practitioners worked in groups or one to one in end-of-life care, care homes and the community. Results are due this autumn but early evidence from quantitative and qualitative research by arts and social science experts at Royal Holloway, University of London suggests quality-of-life improvements. Results show that wellbeing for participants – mood and level of engagement – increased by 42%.
The charity worked with 2,000 older people over three years, 200 of whom were involved in the evaluation. Age Exchange also trained 91 care staff in the practice and in person-centred approaches for dementia.
Age Exchange’s artistic director, David Savill, says of reminiscence arts: “It’s a means of opening up pathways of communications, using the past to inform the present … you’re validating someone’s identity and their life as being of value, and that has a massive effect.”
Although arts activities are common in dementia care, sessions are ad hoc, rely on traditional methods – group watercolouring sessions, for example – and are additional to clinical practice, not integral to daily life in care homes.
Age Exchange’s work usually involves hour-long, multi-sensory sessions for eight older people, facilitated by trained arts practitioners, supported by one or two care staff. The sessions include music, movement, craft, drama and dance with memories triggered by handling of objects – anything from typewriters to fabric – or using films or posters. A sensory world beyond the care setting can be evoked through recorded birdsong or the smell of flowers.
Savill says it is vital to identify memories and personal histories through people themselves or through carers and family – where someone lived or worked, for example, so arts-based activities “relate to their story”.
Helen Nicholson, professor of theatre and performance at Royal Holloway, evaluated the work. She explains: “Reminiscence arts need to be undertaken by highly skilled arts practitioners. It is not a model to be rolled out formulaically. It involves creativity, understanding of art form and the ability to improvise in the highly complex environment of a care setting.”
She warns: “To effect a cultural change in dementia care requires a change of thinking … this approach is complex and intricate, and can change cultural attitudes by regarding the arts as central to everyday life of the care home.”
Another participant, Mary*, a former teacher who had been bedridden for a year, read plays with the reminiscence arts practitioner. Mary enjoyed teaching the artist about the texts and, as the sessions progressed, the pair planned a theatre trip. Motivated by the trip, Mary got out of bed, prepared by sitting up in a wheelchair and enjoyed an unprecedented day out supported by staff, her daughter and the arts practitioner.
Age Exchange says it can encourage more stories like Mary’s if it establishes reminiscence arts as common practice in care; it is currently developing training for care staff.
The challenge, as Savill says, is tackling preconceptions about older people, and that care homes are “stuck on outside of communities”. He adds: “It’s partly about how we see vulnerable, older people and there’s got to be such a thing as healthy risk; we’ve got to enable people to be creative and active as long as they live.”
* Some names have been changed