Article

Efficacy of Creative Arts Therapy in Treatment of Alzheimer’s Disease and Dementia: A Systematic Literature Review

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Abstract

This systematic literature review identifies existing evidence regarding the effectiveness of creative arts therapies among persons with memory loss and their care providers. A total of 112 articles were analyzed. Data from each article were extracted and synthesized to identify patterns in published results. Findings suggest that creative arts therapy is effective for treatment of behavioral and emotional challenges of the disease, but not for treatment of cognitive decline. However, small sample sizes, short (or nonexistent) follow-up, and the difficulty quantifying findings remain as challenges when interpreting the efficacy of creative arts therapy for persons with memory loss.

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... AT can be adapted to fit the needs of individuals in the earliest stages of SCD to the later stages of severe CIs [27]. Recently, a based on current evidence, no AT type was significantly more effective in dementia patients than the other types [28]. Additionally, the meta-analysis found that studies on a combination of visual art, music, and drama interventions found significant improvements in at least one outcome measure, such as mental stimulation, verbalization, personal control, positive emotional reactions, satisfaction, and self-esteem [28]. ...
... Recently, a based on current evidence, no AT type was significantly more effective in dementia patients than the other types [28]. Additionally, the meta-analysis found that studies on a combination of visual art, music, and drama interventions found significant improvements in at least one outcome measure, such as mental stimulation, verbalization, personal control, positive emotional reactions, satisfaction, and self-esteem [28]. This suggests that a combination of therapy types that engage participants in a variety of art activities may be effective for combating cognitive decline. ...
... AT, with appropriate modifications, has been shown to be suitable for individuals in the earliest stages of SCD to the later stages of severe CIs [27]. According to current evidence, no AT type is significantly more effective in individuals with dementia than the other types [28]. Additionally, the meta-analysis found that studies on a combination of visual art, music, and drama interventions found significant improvements in at least one outcome measure, such as mental stimulation, verbalization, personal control, positive emotional reactions, satisfaction, and self-esteem [28]. ...
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Background Given the aging population worldwide and the COVID-19 pandemic, which has been found to be associated with a deterioration in Alzheimer’s disease (AD) symptoms, investigating methods to prevent or delay cognitive decline in preclinical AD and AD itself is important. The trial described in this protocol aims to evaluate the effects of a staged integral art-based cognitive intervention (SIACI) in older adults with CIs (preclinical AD [SCD or MCI] and mild AD), in order to gather evidence on the effects of SIACI on cognition and psychological/psychosocial health gains and determine the mechanisms. Methods The planned study is a single-center, parallel-arm, randomized controlled trial with allocation concealment and outcome assessor blinding. A total of 88 participants will be randomized to two groups: (i) an intervention group that receives the 16-week, 24-session SIACI program and (ii) a waitlist control group (which will receive the SIACI program after completing the follow-up assessment). Global cognitive function, specific domains of cognition (memory, language, executive function, and visuospatial skills), and other health-related outcomes (quality of life, anxiety, depression, sleep quality, and physical activity level) will be measured at baseline, immediately after the intervention, and at the 6-month follow-up. Blood biomarkers, event-related potential (ERP)-P300, and magnetic resonance imaging (MRI) data will be collected at baseline and immediately after the intervention to explore the mechanisms of SIACI. Discussion The trial will elucidate the immediate and long-term effects of SIACI based on neuropsychological testing and blood biomarkers, and neuroscience involving ERP-P300 and MRI parameters will make it possible to explore the mechanisms of SIACI in older adults with CIs. The results will provide evidence on the effectiveness of an AT-based cognitive intervention, which may delay or even halt cognitive decline in preclinical AD and AD itself. Trial registration ChiCTR, ChiCTR2100044959. Registered 03 April 2021.
... It is challenging to define psychosocial interventions which operate by means of a recognised form or art. Cowl and Gaugler's far-reaching systematic review [8] included in their search "visual arts (painting, coloring, and sculpting, or viewing works of art created by others), music (listening to, singing, and playing music), drama/movement (acting, storytelling, dance, and expressive movement), songwriting, and poetry (writing and reading of poetry)." (p. ...
... (p. 284 [8]). Another way to categorise the arts is threefold, following Young et al. [9]: literary (e.g., reading aloud, poetry reciting, or creative writing); performing (e.g., music, dance, theatre) and visual (e.g., gallery visits, making art). ...
... Meta-reviews of psychosocial interventions are beginning to place arts interventions on a par with other non-pharmacological approaches to alleviate certain behavioural symptoms of dementia, such as agitation and apathy [55,56]. One of the broadest systematic reviews of the arts in dementia, cited earlier in this paper [8], summarises the characteristics of the included studies, and this gives an overview of the contemporary research field (Table 1). ...
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The growing prevalence of dementia, combined with an absence of effective pharmacological treatments, highlights the potential of psychosocial interventions to alleviate the effects of dementia and enhance quality of life. With reference to a manifesto from the researcher network Interdem, this paper shows how arts activities correspond to its definition of psycho-social care. It presents key dimensions that help to define different arts activities in this context, and illustrates the arts with reference to three major approaches that can be viewed online; visual art, music and dance. It goes on to discuss the features of each of these arts activities, and to present relevant evidence from systematic reviews on the arts in dementia in general. Developing the analysis into a template for differentiating arts interventions in dementia, the paper goes on to discuss implications for future research and for the uptake of the arts by people with dementia as a means to self-care.
... Art activities were found to include diverse activities within a single study. Although researchers used the word 'art' to refer to a single form of art, it was also used by researchers to describe different forms of arts such as Cowl & Gaugler (2014) who defined 'arts' to include multiple forms of arts such as music, dance movement, drama, visual arts, creative arts or the combination of different arts and culture activities. NICE mentioned arts separately with gardening and baking activities (Russell, 2019). ...
... Researchers mentioned arts-based activities for bringing sensory pleasures and useful for reducing loneliness, improving social bonding, lifting mood, confidence, friendship, emotional stimulation, intellectual fulfilment and decreasing difficulties with memory and depression (Cowl & Gaugler, 2014;Curtis, 2018;Harper & Hamblin, 2010). They also recommended using arts-based activities to keep people motivated and as independent as possible. ...
... Focusing on healthy ageing, arts-based creative and cultural interventions were considered as non-pharmacological approaches to improve health (Beard, 2012;Cowl & Gaugler, 2014). Wang & Li (2016) described art appreciation that involves cultures (such as museums and/or art galleries) as 'innovative'. ...
... The authors looked at how the creative arts influenced decreases or increases in the symptoms of dementia; in other words, symptomatic changes(Cowl and Gaugler, 2014;Aleixo et al., 2017;Karkou and Meekums, 2017; van der Steen et al., 2018; Brown Wilson et al., 2019; Clare and Camic, 2019; Dowson et al., 2019); • Most search strategies were isolated for randomized controlled trials (Blackburn and Bradshaw, 2014; Karkou and Meekums, 2017; Deshmukh et al., 2018; van der Steen et al., 2018; Brown Wilson et al., 2019); • The review articles focused on multiple settings (e.g., community and nursing homes) (Chatterton et al., 2010; Aleixo et al., 2017; Deshmukh et al., 2018; van der Steen et al., 2018; Clare and Camic, 2019); • Some articles did not clearly state the setting they wereinvestigating(Beard, 2011;Chancellor, et al., 2014;Cowl and Gaugler, 2014;Dowson et al., 2019;Jiménez et al., 2019;Klimova et al., 2017;Mabire et al., 2019;Ruiz-Muelle and López-Rodríguez, 2019;Salisbury et al., 2011;Zeilig et al., 2014); • Finally, two articles placed more emphasis toward the caregivers, staff, or therapists(Chatterton et al., 2010;Smith and D'Amico, 2020). ...
... The authors looked at how the creative arts influenced decreases or increases in the symptoms of dementia; in other words, symptomatic changes(Cowl and Gaugler, 2014;Aleixo et al., 2017;Karkou and Meekums, 2017; van der Steen et al., 2018; Brown Wilson et al., 2019; Clare and Camic, 2019; Dowson et al., 2019); • Most search strategies were isolated for randomized controlled trials (Blackburn and Bradshaw, 2014; Karkou and Meekums, 2017; Deshmukh et al., 2018; van der Steen et al., 2018; Brown Wilson et al., 2019); • The review articles focused on multiple settings (e.g., community and nursing homes) (Chatterton et al., 2010; Aleixo et al., 2017; Deshmukh et al., 2018; van der Steen et al., 2018; Clare and Camic, 2019); • Some articles did not clearly state the setting they wereinvestigating(Beard, 2011;Chancellor, et al., 2014;Cowl and Gaugler, 2014;Dowson et al., 2019;Jiménez et al., 2019;Klimova et al., 2017;Mabire et al., 2019;Ruiz-Muelle and López-Rodríguez, 2019;Salisbury et al., 2011;Zeilig et al., 2014); • Finally, two articles placed more emphasis toward the caregivers, staff, or therapists(Chatterton et al., 2010;Smith and D'Amico, 2020). ...
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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.
... 7 One problem in finding evidence regarding participatory visual arts interventions benefits in dementia is the lack of standardization of the interventions reported in the literature. Some reviews [8][9][10] include different types of use of art in individual studies, without differentiating the use of visual arts as an isolated intervention, making it difficult to draw conclusions. ...
... However, there are reasons to believe that participatory arts intervention may bring benefits to people with dementia. [8][9][10] The present review aims to weigh up the evidence for the effects of participatory visual arts on individuals with dementia, taking into consideration the quality of the research presented in the articles. This review adopts the narrative synthesis approach by Popay et al. 13 and builds on recent reviews by Deshmukh et al. 11 and Windle et al. 12 . ...
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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.
... Further, while not yet supported by quantitative data, it has been suggested that working memory is a particularly relevant component of visual art participation: researchers suggest that the mental maintenance and manipulation of visual imagery is of exceptional relevance to artistic ability and production (Baddeley and Logie, 1999;Pérez-Fabello and Campos, 2007;Takahashi and Hatakeyama, 2011;Young, 2014). However, when considering people with dementia, research on the subject of cognition and art is largely contradictory: a large body of qualitative research reports improved cognition and memory for those who participated in art making or viewing programs (Kahn-Denis, 1997;Rentz, 2002;Kinney and Rentz, 2005;Parsa et al., 2010;Peisah et al., 2011;Camic et al., 2014;Cowl and Gaugler, 2014;Young et al., 2015;Sauer et al., 2016;Windle et al., 2018a), while only two randomized controlled trials (RCTs) exist and both have shown no such cognitive improvements in people with dementia (Rusted et al., 2006;Hattori et al., 2011). ...
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Objectives The present study explores the effect of visual art training on people with dementia, utilizing a randomized control trial design, in order to investigate the effects of an 8-week visual art training program on cognition. In particular, the study examines overall cognition, delayed recall, and working memory, which show deficits in people with dementia. Method Fifty-three individuals with dementia were randomly assigned into either an art training ( n = 27) or usual-activity waitlist control group ( n = 26). Overall cognition and delayed recall were assessed with the Montreal Cognitive Assessment (MoCA), and working memory was assessed with the Backward Digit Span task. Results There were no group differences in overall cognition, or working memory, while a difference in delayed recall was undetermined, based on post-test—pre-test difference scores. Groups were comparable at baseline on all measures. Conclusion The measures of cognition, delayed recall, and working memory used in this study were not affected by an 8-week visual art training program. Clinical Trial Registration www.ClinicalTrials.gov , identifier NCT03175822.
... Keywords: art-making, positive mood, quiet ego contemplation, flow, growth orientation Engaging in art activities has a positive psychological impact on multiple aspects of well-being (All-Party Parliamentary Group on Arts, Health and Wellbeing, 2017;Potter, 2013) and is the basis of various forms of art therapy (Cowl & Gaugler, 2014;Hacking, Secker, Kent, Shenton, & Spandler, 2006;Leckey, 2011;Maujean, Pepping, & Kendall, 2014;Pearce, 2017;Pöllänen, 2015aPöllänen, , 2015bSchouten, de Niet, Knipscheer, Kleber, & Hutschemaekers, 2015;Slayton, D'Archer, & Kaplan, 2010;Stickley et al., 2017). Although research continues to build an evidence base suggesting that clinical and prescriptive art activities may be psychologically beneficial, few studies have examined the psychological mechanisms elucidating why art activities can be so helpful. ...
... Es konnten drei systematische Übersichtsarbeiten identifiziert werden, von denen sich zwei Arbeiten [25,26] 22] bezieht sich auf Menschen mit kognitiven Einschränkungen in einer geriatrisch-psychiatrischen Klinik, wobei hier der wesentliche Anteil der Teilnehmenden Menschen mit Demenz waren. ...
Article
Background: The German Prevention Act mandated long-term care insurance funds to support long-term care facilities in designing health-promoting structures. One area of action is the promotion of the cognitive resources of nursing home residents. The objective of this systematic review was to describe and analyze interventions and intervention components that improve cognitive resources of nursing home residents. Methods: First, we conducted a search for systematic reviews to identify relevant randomised controlled trials in Medline via PubMed, the Cochrane Library, CINAHL, Gerolit, Embase, Psyndex, and Livivo; additional sources were hand-searched. Second, references of all relevant randomized controlled trials (n=43) were extracted from the identified systematic reviews (n=26). The original articles of the primary studies included were then considered and data extracted using criteria for the evaluation of complex interventions. The quality of evidence was assessed using the GRADE approach. Results: Nine interventions to promote cognitive resources were identified: cognitive stimulation, cognitive training, physical training, art and music interventions, bright light, multicomponent stimulation, multisensory stimulation, care staff training and reminiscence. The quality of the underlying evidence in the inpatient long-term care setting was predominantly low, therefore, it was not always possible to draw clear conclusions regarding the efficacy of the interventions. The low quality of evidence was mainly due to the high heterogeneity as well as the low number and limited methodological quality of the primary studies. Conclusion: In general, a wide range of nonpharmacological interventions were reported. Due to the limited evidence, however, these may be regarded as ideas only or possible options for promoting the cognitive resources of nursing home residents.
... Arts-based therapies have been purported to ameliorate physical and/or psychological symptoms in patients with serious chronic illnesses (NIH 2014) and research on the potential for arts-based approaches to enhancing palliative care is increasing. Recent studies have examined the potential for art-based therapies such as movement or visual and written expression to promote well-being (Ehresman 2004;Byers 2011;Collier 2011;Cowl and Gaugler 2014). The project discussed in this article focused on creative expression via cloth (textile) and dress (fashion) as the primary integrative modality. ...
Article
Few forms of human behavior are more pervasive than the use of textiles. As shelter and clothing, textile products play a vital role in meeting basic human needs. Clothes are imbued with memories, intertwined with our histories and identities, interwoven into the “fabric of our lives.” In late-stage eldercare/assisted living scenarios, care priorities often shift from curative measures to palliative care for the relief of pain, symptoms and emotional stress. Palliative care is available at any stage of an illness. The purpose of this exploratory creative study is to better understand opportunities applying co-creative design approaches in late-stage eldercare through the development of wearable narratives. We develop a form of garment therapy, imprinted with a unique textile print that is visual, tactile and empowering to the user/creator. The design researchers adopted context mapping as a method to engage participants in creative, idea generating activities to help inform textile design processes. Context mapping empowers participants by allowing them to make collaged artefacts and then tell stories about what they have made. As designers, we seek to delineate textiles as a therapeutic modality in its own right, a form of expression that can be used as a therapeutic intervention to foster well-being. We view this creative design exploration as an entry point into broader interdisciplinary opportunities. In this way, the project aligns with emerging models that attempt to address important societal and cultural problems through practice, by design.
... Among the few available studies targeting the cognitive outcomes of art therapy on dementia, some point to enhancements of attention and memory [28,29]. Nevertheless, a recent systematic review concluded that art therapy may be useful for addressing the emotional issues of dementia, but not cognitive decline per se [30]. In an even more recent review [31], the cognitive outcomes of art therapy in people with dementia were classified as 'very low'. ...
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Art therapy has become known by its psychosocial and affective impact, but not so much by its effects on cognitive functioning. Based on a comparison between art therapy and music-making programs, we hypothesized that guided methods—dominant in music-making programs and characterized by an emphasis on execution (play the piece, produce the visual object) rather than ideation (conceive the visual object)—could boost the cognitive effects of art-making. We also hypothesized that removing ideation from the process with guided methods could decrease psychosocial/affective benefits. In order to test our hypotheses, we compared the effects of two art therapy methods on cognitive vs. psychosocial/affective domains. We implemented a short-term longitudinal study with patients with schizophrenia showing both psychosocial/affective and cognitive deficits. The sample was divided into two groups: unguided, instructed to ideate art pieces and execute them without external guidance, vs. guided, instructed to execute predefined art pieces following externally provided guidelines. There was no evidence that guided methods boost cognitive effects, since these were equivalent across groups. However, psychosocial/affective benefits were enhanced by unguided methods, suggesting that therapeutic methods can make a difference. Our study contributes to raising important new questions concerning the therapeutic mechanisms of art therapy.
... Art therapy Art therapy includes visual arts such as painting, colouring, sculpting or viewing art works. 40 The patient participated in painting, drawing, personalised artwork and handcrafts. ...
Article
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More than 90% of people with dementia experience neuropsychiatric symptoms which are often distressing and can result in early institutionalisation, diminished quality of life, increased frequency of emergency department visits along with stress and ill-health in caregivers. Non-pharmacological interventions are recommended as first-line treatment for neuropsychiatric symptoms, instead of medications such as atypical antipsychotics which have significant side effects. Most systematic reviews of non-pharmacological interventions for neuropsychiatric symptoms of dementia focus on patients in long-term care facilities and there are a limited number of research studies assessing the use of non-pharmacological interventions for patient’s living at home. In this case report, we discuss an elderly man with dementia whose cognitive symptoms were accompanied by significant neuropsychiatric symptoms of suspicion, delusions, agitation and aggression. We describe how a programme of individualised, non-pharmacological interventions was associated with an improvement in neuropsychiatric symptoms within 3 months.
... This research will focus on arts interventions and art therapies in the field of dementia studies (e.g. Aigen, 2008;Beard, 2011;Cowl and Gaugler, 2014;Daykin et al., 2008;Evans, 2002;Robinson et al., 2006;Young et al., 2016). In the absence of prospects in the near future for a cure for degenerative dementias or efficient pharmacologic treatment, arts interventions and art therapies have emerged that aim to improve the neuropsychiatric symptoms and the quality of life of people with dementia. ...
Article
This study applies video analysis to an investigation of interactions among people with dementia in a cultural context, specifically a visual art exhibition in a gallery. The study adopts a sociologically informed approach to explore the role of artworks and how these may be beneficial to dementia care, by focusing on meaning-making conversational practices among people living with dementia. The interactions of different individuals with various forms of dementia were recorded during three gallery visits, including their engagement with gallery attendants and artworks. The findings reveal the socially empowering impact of interactions related to artwork, with complex patterns in bodily behaviour and facial expressions meaning that orientation to dementia became negligible. The article makes a contribution to the growing field of sociology of ageing and well-being from an interaction analytic perspective, indicating that cultural values can play a greater role in the care of people living with dementia.
... The patient was reluctant to start the program but after 2 months of regular visits from the social care worker, the patient agreed to start home-based sessions. Interventions offered included validation therapy, [34] music therapy, [8,9,12] art therapy, [35] reminiscence therapy, [8] talking therapy, [36] reality orientation, [8,34] cognitive training, [8] smell therapy, [9] food therapy, [37] sensory stimulation, [9] garden therapy, [12] and physiotherapy. [9] From March 2018, selection of the personalized non-pharmacological interventions was supported by a structured cognitive intervention pathway developed with input from an academic partner and implemented by the care team as a decision-support tool within the community delivery model. ...
Article
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Introduction: In China, the over 60 population is estimated to grow from 12% in 2010 to 33% of the overall population by 2050. The escalation in the aging population is projected to result in an Alzheimer's disease prevalence of 27.7 million people in China by 2050 causing substantial health and economic burden. While there are some published studies on multicomponent, non-pharmacological interventions for people with dementia, we have found no published community-based approach to care that encompasses personalized selection of non-pharmacological interventions, active social participation, and dementia education. Patient concerns: An elderly female living at home alone in urban Beijing presented with significant short-term memory impairment, episodes of confusion, difficulty with language skills, and episodes of wandering. She had become reclusive and disengaged from her previous social networks, and no longer attended any community activities or events. The patient had no significant past medical or psychiatric history. Diagnosis: The patient was diagnosed with Alzheimer's disease by a local physician based on clinical features of impaired communication, disorientation, confusion, poor judgement, behavioral changes, and difficulty speaking. Depression was considered a differential diagnosis but is also both a risk factor and symptom of dementia. Interventions: A novel, community-based, multicomponent social care program for dementia was used to facilitate implementation of non-pharmacological interventions, gradual socialization and provide supportive carer and community education. Non-pharmacological interventions included a combination of validation therapy, music therapy, art therapy, reminiscence therapy, talking therapy, reality orientation, cognitive training, smell therapy, food therapy, sensory stimulation, garden therapy, and physiotherapy. Outcomes: Improvements in the patient's Geriatric Depression Scale and Mini Mental State Examination scores were noted in association with increased social participation in the community. Conclusion: The community-based, multicomponent dementia social care program described in this case report has enabled a socially isolated patient with Alzheimer's disease to reduce her social isolation with an associated improvement in her mood and prevention of cognitive decline. Educating the community was an essential part of re-integrating the patient into the social setting. Reducing social isolation and increasing community engagement were essential to maintaining the patient's independence in her own home.
... Despite new or growing interest in the use of art therapy as a nonpharmacological option for treating dementia, current research evidence limits the extent to which science can inform practice. Based on systematic reviews of the literature (Beard, 2012;Chancellor, Duncan, & Chatterjee, 2014;Cowl & Gaugler, 2014;Maujean, Pepping, & Kendall, 2014), only a few published case studies and small clinical trials have examined the effects of art therapy on the dementia population. For example, Mimica and Kalini c (2011) concluded that art therapy for a patient with moderate AD was beneficial for reducing stress-related behaviors. ...
Article
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Art therapy appears to be well positioned to assist people with dementia in improving their psychological well-being and quality of life because of its ability to address neuropsychiatric symptoms and to circumvent declining cognitive and verbal capacities. However, despite increased interest in nonpharmacological approaches to the care of people with Alzheimer’s disease and dementia, art therapy research in this area is still greatly needed. Neurologically informed art therapy offers the potential to overcome historical limitations in the direction of evidence-based practice.
... The benefits of art-based interventions extend to caregivers and family members of persons living with AD by reducing stress and reestablishing connections with their persons McFadden & Basting, 2010). Thus, art-based interventions not only entertain and educate but they may also provide clinical and reductions in depression and caregiver burden (Cowl & Gaugler, 2014;Young et al., 2016). ...
Article
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Purpose: Art interventions have demonstrated holistic benefits for persons living with dementia and their caregivers. In this article, we describe the results of a pilot photojournalism program for 10 unpaid caregivers of persons living with dementia, with respect to caregivers' experience in the program and their psychological well-being. Design: Caregivers participated in four sessions led by a professional photojournalist who taught principles of photography. Between the sessions, caregivers took photographs that represented what caregiving meant to them using digital cameras provided in the program. During the sessions, instruction was interspersed with discussion of caregivers' photographs. Method: Caregiver burden and depressive symptoms were measured pre- and postprogram. Qualitative exploration included sessions' observations, viewing caregivers' photographs, and recording caregivers' accompanying comments. Findings: For participants with pre- and postprogram data, caregiver burden decreased significantly ( p = .037). For caregivers with pre- and postprogram data, depressive symptoms decreased nonsignificantly ( p = .066). Clinically meaningful reductions in caregiver burden and depressive symptoms were attained. Qualitative findings highlighted caregivers' strong engagement with the project, the facilitator, and other participants, and reflection on multiple aspects of their experience. Conclusions: This intervention helped caregivers creatively communicate their experience and demonstrated efficacy in the improvement of caregivers' psychological well-being.
... Significant research attention has been addressed towards the arts therapies, whose structures and goals are comparatively well established Cowl and Gaugler, 2014), although they have proven similarly difficult to evidence convincingly Karkou and Meekums, 2017;van Der Steen et al., 2018). ...
Thesis
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There has to date been no extended study of the methodological challenges facing evaluators across the sector. This qualitative study aimed to identify and describe the challenges as they are reported within the literature, and to explore how they are experienced by evaluation stakeholders. It included a large and systematically-informed narrative synthesis of the literature using a hermeneutic framework. A collaborative project with an artist resulted in the creation of an illustrated graphic narrative used to communicate and disseminate findings. Commonly experienced methodological difficulties were identified through the literature review, along with a set of sensitising concepts: value, context, ethics, meaning, and use. The metaphor of ‘fabric’ is introduced to describe methodological challenge and the way in which these concepts may be woven through it. In interview, participants described anxieties and divisions experienced in evaluation when they had to make and act on decisions about what might be valuable or meaningful. They struggled to reconcile epistemic and non-epistemic values, particularly when trying to introduce standards of rigour to their practice. Interviewees’ responses are discussed in the light of key concepts for the field of arts and dementia, including cultural value, evidence-based medicine, ethics and rights, and quality. To help address the challenges identified for the sector as a whole, a novel values-informed approach to evaluation is proposed. This is based on the idea of arts and dementia activity as an ‘ethical practice’. Foundations for this approach are suggested, comprising attention to ideas of complexity, multidisciplinary and collaborative working, methods innovation, and an acknowledgement of the problems posed by lack of evaluation capacity and resource. Recommendations are made for practice and future research to support exploration and testing of these ideas.
... Results in the mind-body, relational and social domains of fertilityrelated quality of life are similar with those reported by other studies on participants with various medical conditions, such as asthma (Beebe, Gelfand, & Bender, 2010), cancer (Monti et al., 2006;Svensk et al., 2009), and dementia (Cowl & Gaugler, 2014). Effects on the Mind-Body Subscale of FertiQoL could be attributed to the mechanism of sustained relaxation that occurs during art-making, which also enables adaptive forms of cognitive processing (Czamanski-Cohen & Weihs, 2016). ...
Article
Female infertility is associated with a wide range of psychological consequences, including heightened depressive and anxiety symptoms, impaired quality of life, and self-esteem. Considering the paucity of data regarding psychological interventions tailored for female infertility, this case study is aimed at providing preliminary evidence related to the treatment protocol and outcomes of an experiential psychotherapy intervention that uses artistic activities tailored for female infertility. The Short Form Health Survey (SF-36), Fertility Quality of Life International (FertiQoL), Ways of Coping Questionnaire (WCQ), Dyadic Adjustment Scale (DAS), and California Psychological Inventory, Femininity Scale (Fe-CPI), were used pre- and post-treatment for assessing psychological correlates of infertility. The psychological treatment consisted of three psychological assessments and seven experiential psychotherapy group sessions. Experiential techniques, mindfulness techniques, and artistic activities were used during the group sessions, in order to modify psychological maladaptive mechanisms associated with female infertility. Self-report results showed that the experiential psychotherapy intervention enhanced the quality of life, coping strategies, and femininity personality trait. Throughout the experiential intervention, the participant redefined her perspective on infertility and motherhood. On the other hand, the participant reported lowered levels of dyadic adjustment at post-treatment. This case study illustrates the beneficial effects of using artistic activities in experiential psychotherapy for female infertility.
... Leisure activities can provide wide-ranging benefits for people living with dementia with research highlighting promising findings on quality of life, reduced agitation, social inclusion and improved cognition (Cowl & Gaugler, 2014;Legere, 2018). A key component in facilitating effective activities for individuals living with dementia is ensuring that the activities are meaningful and create a connection with the participants (Han et al., 2016). ...
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As individuals age, participation in previously accessible leisure activities can be compromised through diminished capabilities and negative societal expectations. This study investigates the unexplored accessibility of golf for older people with dementia using interviews and observations of Scottish participants in social enterprise–led golfing activities. The resulting thematic analysis concluded that golf is an accessible activity for people living with dementia, and continued participation generates social connectedness and enhances well-being. However, there remain social barriers to participation including societal stigma surrounding the perceived abilities of people living with dementia and the perception of golf as a middle-class and male-dominated sport.
... Creative expression in artistic activities such as painting or making music, for example, has been found to be an important way for people with a dementia to express and access emotions even when cognitive abilities are diminishing (McLean, 2011;Zeilig et al., 2014). Rather than as a form of treatment for cognitive decline, creative activities involving the arts are often used in the context of therapy as part of the treatment of behavioural and emotional problems in dementias (Cowl and Gaugler, 2014). Previous research argued that art therapy was a potentially beneficial non-pharmacological intervention for dementia to improve quality of life (Mimica and Kalini, 2011). ...
Article
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Creativity research has a substantial history in psychology and related disciplines; one component of this research tradition has specifically examined artistic creativity. Creativity theories have tended to concentrate, however, on creativity as an individual phenomenon that results in a novel production, and on cognitive aspects of creativity, often limiting its applicability to people with cognitive impairments, including those with a dementia. Despite growing indications that creativity is important for the wellbeing of people living with dementias, it is less well understood how creativity might be conceptualised, measured and recognised in this population, and how this understanding could influence research and practise. This paper begins by exploring prevailing concepts of creativity and assesses their relevance to dementia, followed by a critique of creativity and dementia research related to the arts. Perspectives from researchers, artists, formal and informal caregivers and those with a dementia are addressed. We then introduce several novel psychological and physiological approaches to better understand artistic-related creativity in this population and conclude with a conceptualisation of artistic creativity in the dementias to help guide future research and practise.
... It should be noted, however, that empirical studies utilizing creative approaches often have limitations in their study design (i.e. not having randomized control groups; small sample sizes; diverse approaches to art therapy, arts-based methods and arts activities; varied measurement scales; diverse competencies, experience and goals of the facilitators delivering these modalities; inconsistent outcome assessment; and the challenge of retaining participants; (Cowl & Gaugler, 2014;Huhtinen-Hildén, 2014;Schneider, 2018;Stuckey & Nobel, 2010;Wang & Li, 2016;Windle et al., 2016). ...
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Dementia syndromes can include language impairments (LIs) of severity extending from lexical access difficulties within anomic aphasia to non-fluent effortful speech and semantic aphasia, depending on the stage and etiology of the underlying disease. Relevant etiologies include neurodegenerative Alzheimer’s disease (AD) and non-AD dementias, such as frontotemporal lobar degeneration (FTD), Parkinson’s (PD) and Lewy body diseases, vascular and toxic alcohol-related dementia, depressive pseudodementia and mixed type dementia. Irrespective of the underlying disease, LIs interfere with social contacts and personal relationships, thus substantially reducing the quality of life and daily functioning of patients, while increasing their need for supervision and care. Socio-linguistic discourse describes such patients as experiencing “loss of self”, “no meaningful present”, “active presence of the past in the body itself”, and as the “long goodbye” (Snyder in Dementia: Mind, meaning and the person, Oxford University Press, p. 268, 2006), highlighting the stigmatization and low quality of life of dementia sufferers. In this chapter we summarize the similarities and differences in clinical and linguistic presentations of LIs in AD and the most commonly occurring types of non-AD dementias, emphasizing the decisive diagnostic and prognostic roles of LIs, as well as their implications for choice of treatment. We present an account of the neuropsychological and psycholinguistic approaches to assess LIs occurring in dementia through evaluation of language functions/domains, such as sound-based domain and lexis (naming, reading, writing), syntax (repeating, composing sentences), and semantics, pragmatics, and discourse (comprehension—auditory, semantic knowledge, understanding commands). We discuss research findings on the protective properties of cognitive reserve, second language acquisition (L2), and multilingualism, all of which can delay the onset of dementia symptoms. We make note of the available interventions in the management of LIs, which include pharmacotherapy (acetylcholinesterase inhibitors such as donezepil, galantamine, and rivastigmine), cognitive interventions (lexical-semantic therapy, action-language therapy, language socialization), and other options of person-centered care (e.g., narrative care). We also review the benefits of destigmatization activities that can be obtained through building a dementia-friendly community environment.
... Although more difficult to study due to the nature of neurodegenerative disease, at the Great Conversations, Dr. Chatterjee mentioned that Alzheimer's Disease (AD) is an area of inquiry in desperate need for scientific data to show efficacy of therapeutic intervention. Funding opportunities for AD should provide motivation for all therapeutic disciplines to generate sound hypotheses that test existing models of treatment and although there is solid research available, it is notoriously difficult to obtain quantifiable data in treatment of AD through the Creative Arts Therapies (Cowl and Gaugler, 2014). The CATs rely heavily on the engagement of imaginative systems in the production of symbolic expression, and the ability to bypass language and access less conscious material while attending to task is an important, if not crucial aspect of treatment that needs more attention. ...
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Transdisciplinary collaboration is the future of knowledge making in advanced post-industrial societies and there is a growing awareness that the most vexing problems we face cannot be solved by any single discipline. Best practices for complex and challenging physical and mental disorders require a multi-disciplinary approach, yet there is a void in bridging the gap between the most contemporary models. It is in this capacity that the Twenty-First Century Great Conversations in Art, Neuroscience, and Related Therapeutics serves as a missing link. It was with active minds and a collective spirit that artists, scientists, therapists, physicians, engineers, technology experts, healthcare practitioners, and researchers from across the globe transcended historical silos to explore the capacities for collaborative partnerships to influence the health of patients and the amelioration of disease. Hosted at Indiana University-Purdue University Indianapolis (IUPUI), presenters shared insights through didactic sessions and panel discussions aligned with three tracks led by prominent experts in their respective fields: (1) Neuroaesthetics, Anjan Chatterjee, MD; (2) Creativity and Consciousness, Arne Dietrich, PhD; and (3) Mobile Brain/Body Imaging (MoBI), Klaus Gramann, PhD. The goals for this symposium were developed from a vision which embraces cross-disciplinary intersectionality, a merging of viewpoints, and active dialogue surrounding the development of a common language with which to advance the Creative Arts Therapies and neurosciences. The goal was also to contribute to the development of a simplified roadmap to enhance and enrich the CATs with a greater understanding of neuroscience and the available technologies that can assist in research.
... A large focus of this literature is on how arts can benefit older adults living with dementia, though the evidence about efficacy is mixed. In one systematic review authors Cowl and Gaugler (2014) identified that creative arts therapies can contribute to health and well-being of adults with dementia by reducing emotional and behavioural manifestations of the disease and strengthening relationships with family members or caregivers that might be strained in light of the disease. In a similar review Chancellor et al. (2014) reported improvements in attention and benefits related to behaviour and quality of life, in addition to increased interest and self-esteem during art therapy sessions; however, it was not clear whether the benefits were sustained outside of the art therapy sessions. ...
Article
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Background: Outcomes of using art in therapy overlap with goals of occupational therapy with older adults in long-term care, which include improving and maintaining health and well-being through engagement in occupations. There is a lack of evidence about how art activities could complement or inform occupational therapy. Purpose: The purpose of this scoping review is to map existing literature about how art activities are used in long-term care. Methods: Six electronic databases were searched. Fourteen studies met inclusion criteria and were analyzed to identify patterns and discrepancies. Findings: The analysis suggests art activities can contribute to well-being by improving mood, promoting communication and reminiscence, and supporting the development and deepening of social relationships. Implications: Occupational therapists should consider incorporating art activities as these offer therapeutic benefits and can be adapted to individual strengths and preferred type and level of participation.
... There is increasing interest in the use of arts and creative activity to enhance dementia care (e.g. Beard, 2012;Cowl & Gaugler, 2014;Young, Camic, & Tischler, 2016), and to bring together and support professionals and those who use services, see Creative Practice as Mutual Recovery (2018). Over the past decade, a growing body of research has established this interdisciplinary field of study and there are strategic moves to embed the arts in healthcare more widely (All-Party Parliamentary Group for Arts, Health & Wellbeing, 2017). ...
Article
Background This paper reports on the learning from a 12-month interdisciplinary project (Dementia, Arts and Wellbeing Network– DA&WN) and its activities. These featured a series of four workshops on dance, visual art, theatre and music. The network was comprised of clinicians, academics, creative practitioners and people with lived experience of dementia and their carers. Methods The workshops were designed to draw out tacit knowledge about well-being in dementia through an action-based learning and research approach. This included, guided activities combined with reflective group discussions, visual documentation and baseline and follow-up questionnaires. Results Outcomes included new collaborations between group members, changes in creative practice for artists, and active and sustained involvement of people living with dementia and their carers in similar opportunities and participatory research. Conclusion This participatory and inclusive workshop model should be considered to develop and enhance interdisciplinary activities in dementia care.
... Thus, therapists (who may specialise in art, music, drama or visual art) tend to focus on the condition or on one particular symptom and how this can be "treated". For therapists, the arts are employed as tools to achieve measurable ends (Cowl and Gaugler, 2014). ...
Article
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Purpose The purpose of this paper is to explore the concept of co-creativity in relation to artistic practice with people with a dementia. The aim of the discussion is to outline how co-creativity offers fresh approaches for engaging artists and people with dementia, can contribute to less restrictive understandings of “creativity” and above all, expand the understanding of people with a dementia as creative, relational and agential. Design/methodology/approach In order to examine current conceptions of co-creativity and to inform the artistic practice, relevant literature was explored and eight expert interviews were conducted. The interviews were thematically analysed and are included here. Findings This paper consequently demonstrates that improvisation, structure, leadership and equality are central elements of co-creative processes and outlines how co-creativity can offer fresh insights into the way in which the arts can engage people with a dementia, the relationship between creativity and dementia and the transformative potential of the co-creative arts for those living with a dementia. Research limitations/implications The paper discusses some of the difficulties that are inherent a co-creative approach, including power relations and the limitations of inclusivity. Due to ethical restrictions, the paper is limited by not including the perspectives of people living with a dementia. Practical implications This paper paves the way for future research into co-creative processes in a variety of different contexts. Social implications A more nuanced understanding of co-creativity with people with dementia could challenge the dominant biomedical and social paradigms that associate “dementia” with irretrievable loss and decline by creating opportunities for creative agency. Originality/value This exploration of co-creativity with people with dementia is the first of its kind and contributes to the wider understanding of co-creativity and co-creative practice.
... It is also to prevent declines in health and to provide comfort at the end of life" [1]. The use of the arts and alternative therapies, including music, hand massage, therapeutic touch, tender touch, singing, and using or holding musical instruments may provide comfort [2][3][4][5][6]. ...
Article
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Objectives: The study objective was to promote hospitalized veterans’ comfort through an art intervention (AI). Kolcaba’s comfort theory guided the study. Sample and setting: Researchers recruited residents from a Community Living Center (CLC) at Miami Veterans Administration Healthcare System (MVAHS). Nurse researchers and recreational therapists collaborated to deliver the AI. Methods and variables: A quasi-experimental pre-post-test design tested the AI on veteran comfort, depression, and social connectedness. Results: Over six-months, staff identified 81 residents as appropriate to recruit for the study. Fifty-one males and 10 females (ages 26-95) agreed (75% response rate). Due to data collection challenges, residents’ cognition, time constraints, disabilities, and respondent burden, only 18 sets of usable pre-post data were available for analysis (ns results). Implications for nursing: The AI was “significant” to many other participants (n = 160) who were unable or unwilling to complete the research instruments. The most popular AI activity, the monoprint, has been “adopted” by recreational therapists and suggested to enhance communication with oncology patients. Kolcaba’s comfort theory will continue to be promoted during art activities on CLC I and II with extension of art activities to the bedside of CLC III Hospice residents. Keywords: Veterans, Art, Intervention, Comfort, Long Term Care
Article
Depression is a common comorbidity in dementia. Randomised controlled studies of antidepressants do not show a significant improvement in depressive symptoms in patients with comorbid dementia and are known to lead to an increase in side effects. However, there are relatively few studies of depression in dementia, and drawing firm conclusions about the use of antidepressants is limited by the amount of data available. Furthermore, it is unclear whether data can be extrapolated from similar populations (eg, those with late-life depression) to inform pharmacotherapy in this patient group. Given the lack of effectiveness and risk of side effects associated with pharmacological treatments, psychological interventions may offer important therapeutic benefits. There is evidence for the effectiveness of individual psychological therapy, and further research will establish which psychological approach is the most effective. Some studies have shown an improvement in depressive symptoms using structured sleep hygiene programmes, exercise, arts interventions and music therapy. These studies are hampered by small data sets, and the benefits to individuals may not be well captured by standard outcome measures. At present, the best evidence for arts-based approaches is in music therapy. Depression with comorbid dementia responds well to electroconvulsive therapy and this is a useful treatment modality for those with severe or life-threatening depressive symptoms. Alternative neurostimulation techniques such as transcranial magnetic stimulation are not widely used at present and further research is needed before they can be a more widely used treatment modality.
Article
Objective: Aged care services increasingly respond to the needs of people with dementia. Non-pharmacological approaches are preferable to reduce responsive behaviours, improve/maintain functional capacity and reduce emotional disorders. This rapid review of systematic reviews aimed to consolidate the evidence for non-pharmacological interventions and determine outcome effectiveness. Methods: Systematic review literature was comprehensively searched for non-pharmacological interventions for dementia in residential care. Quality ratings used adapted GRADE methodology, and ease of implementation assessed. Results: Of 629 abstracts screened, 81 full-text articles were retrieved, 38 articles included. The strongest evidence for reducing responsive behaviours was music, sensory stimulation, simulated presence and validation therapies. Exercise and light therapy improved/maintained activities of daily living, while cognitive stimulation and reminiscence improved cognition. Strongest evidence for reducing emotional disorders was music, psychological interventions and reminiscence. Conclusion: Much evidence of varying quality exists, with resource-constrained residential care providers now able to make evidence-based decisions about non-pharmacological interventions.
Article
Care home populations frequently feature older people who often experience poor physical health and cognitive difficulties, along with vulnerability to psychological and social stressors. To date there has been no systematic review which focuses on the impact of arts for health activities to the care home population. Evidence was sourced from several databases and 71 studies were deemed eligible for inclusion in this review. These studies underwent data extraction and quality appraisal and the findings associated with health, wellbeing and quality of life are presented within this paper.
Article
This comprehensive literature review analyzed relevant studies on the effects of exercise interventions for older adults with dementia. An extensive search of databases was conducted to identify relevant studies. Among the 64 reviewed studies, the highest number focused on Alzheimer’s disease, following by mixed dementia; none of the studies included older adults with Lewy body dementia or frontotemporal dementia. Methodological quality and risk of bias were evaluated based on Downs & Black’s Quality Index. A variety of exercise interventions have been shown to be beneficial for functional outcomes but there were mixed findings regarding the effects of exercise on cognitive function, behavioral and psychological symptoms, and overall quality of life. Not all high-frequency or longer-duration physical exercise interventions were associated with significant effects on cognitive function but positive outcomes of exercise intervention on cognitive ability were often accompanied by improvement in activities of daily living. More clinical trials are needed to determine how to motivate older adults with dementia to engage regularly in exercise and how group and individually tailored exercise programs may improve physical function and minimize behavioral and psychological symptoms associated with dementia.
Article
Introduction: Living with a person with dementia (PWD) causes physical and psychological problems in family caregivers (FCGs), as well as a reduction in their Quality of Life (QOL). The purpose of this study was to examine the possible effectiveness of the therapeutic songwriting method for improving the QOL and well-being of FCGs of PWD. Methods: The sample of caregivers (n = 21) was divided into three homogeneous groups that received 12 intervention sessions. A non-randomized, quasi-experimental design with repeated measures (pre-post intervention) was employed to determine a possible therapeutic effect. The State-Trait Anxiety Inventory (STAI), Short-Form Health Survey (SF-36v2), Beck Depression Inventory, and Rosenberg Self- Esteem Scale were administered before and after the intervention. Results: The results showed a decrease in anxiety and depression scores and an increase in scores of self-esteem after the intervention. Regarding QOL, post-intervention scores in the Mental Component Summary and Mental Health were significantly higher. In contrast, a small effect size was observed for difference between pre-test and post-test on the subscales of QOL: General Health, Social functioning, Role Emotional and Bodily Pain. Discussion: This exploratory study concludes that therapeutic songwriting can help to reduce caregivers’ symptoms of depression and anxiety and improve their perceived self-esteem and QOL. This work reinforces the progress made to date and provides new results that highlight the benefits of music therapy for FCGs of PWD.
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The aim of this bibliographic research is to study embodying techniques and the U.S. Department of Veterans’ Affairs (VA)-approved Cognitive Behavioral Therapies (CBTs)—Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT)—in relation to working with U.S. Veterans experiencing symptoms of combat-related Post-Traumatic Stress Disorder (PTSD). The review of embodiment and CBT can help open doors to exploring a therapeutic approach that connects the mind and body when working with PTSD symptoms. This study was inspired by the growing number U.S. Veterans struggling with combat-related PTSD and seeking help from the VA. Literature has shown that while PE and CPT are supported by the VA, they have low participation and/or high attrition rates. Current discussions in U.S. legislation have begun to explore the benefits of the Creative Arts Therapies (CATs) as Complementary and Alternative Medicines (CAMs) when working with U.S. Veterans (Americans for the Arts, AFTA, 2017). A thorough investigation of the literature found that embodiment: fosters reconnection with the body, improves life satisfaction and symptom reduction, and bypasses Alexithymia. More research is needed to determine the specific ways embodiment can be incorporated in PE and/or CPT practices to encourage post-traumatic growth for U.S. Veterans and Service Members.
Article
Background: There is currently no consensus regarding the definition and description of arts interventions for people with dementia. Developing a common language of classification will encourage reflection on artistic practice, support the evaluation and improvement of arts interventions, and enable their benefits to be communicated more effectively. Methods: Using a qualitative framework derived from taxonomy and realist methodology, a literature review was undertaken to identify what key principles underpin arts interventions. This analysis was complemented by focus groups and workshops incorporating the lived experience of carers, artists, practitioners and care staff. Results: Nine principles were identified as elements present in person-centred arts interventions for people with dementia: Animation, Transcendence, Selfhood, Humanity, Expression, Connection, Possibility, Involvement and Awareness. Conclusions: It is possible to identify the component parts of arts interventions for people with dementia. These principles form an empirical basis for understanding how arts interventions work, while still respecting their individual nature.
Article
Art therapy (AT) has been adopted in recent years as a possible non-pharmacological approach in older persons living with Alzheimer’s disease (AD) to improve both cognitive and behavioral and psychological symptoms that accompany the disease. Our main aim was to conduct a systematic review of the methodological and practical effectiveness of different approaches using AT in older people living with AD. The systematic analysis of the studies finally selected (n = 12) suggests that the measures applied to evaluate the effectiveness of AT may not always be the most appropriate to assess the impact of this approach in this type of population, in many cases not being sufficiently sensitive to adequately capture all the significant changes produced by the intervention. Neurologically informed AT, as well as the use of biomarkers, could better identify and capture intervention-induced changes, being a step toward evidence-based practice in the application of this type of approach.
Article
Dementia continues to be a global health issue with increasing numbers of people diagnosed each year. While ongoing research into pharmaceutical and medical treatments continues to yield hopeful results, complementary services and interventions seeking to improve the health and quality of life for those living with dementia are being investigated and implemented. This article presents a review of literature pertaining to the use of drama therapy with people living with Alzheimer’s disease and related dementias (ADRD). Seven themes emerged that offer insight into how drama and drama therapy may benefit people living with ADRD: quality of life; self-expression; psycho-education; communication in relationships; social engagement; sensory experiences; and physical exercise. A discussion of implications and recommendations for further research are included.
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The arts and dementia is a vibrant and multidisciplinary area of healthcare research, policy and practice. Uniquely situated at the intersection of various academic disciplines, paradigms and traditions, what tools and approaches are most effective for understanding this diverse and burgeoning field? This chapter explores how the arts and dementia evidence base has been strengthened by blending methodological approaches from the humanities and sciences to demonstrate how arts interventions can benefit people with dementia. In what ways can researchers identify, ‘measure’ and communicate the impact, effectiveness and outcomes of arts interventions for people with dementia? How can researchers reconcile scientific rigour with creative understandings and person-centred insights? By combining mutually enhancing methods, it is possible to generate multidisciplinary findings that are as robust as they are rich.
Article
Purpose The arts (e.g., music and painting) have received considerable theoretical and observational support as a cognitive stimulation technique for persons living with dementia (PLWD). However, particularly for visual arts, limited empirical support exists. Therefore, the purpose of this study was to pilot a free-form arts program for PLWD in the context of a cognitive stimulation paradigm and measure subsequent engagement, communication, cognitive–linguistic function, and quality of life. Method Three PLWD (one each in mild-to-moderate, moderate, and moderate-to-severe stages) were referred for study participation by a local long-term care facility. A single subject across subjects, ABA reversal design was used to assess intervention effects over a period of 8 weeks, in comparison to an active control condition (cooking activity). Cognitive–linguistic function and quality of life were assessed using standardized measures at baseline and follow-up. Engagement and communication were probed regularly across each study phase. Results Significant changes were seen in participants' engagement and communication during painting sessions compared to the control activity. A nonsignificant positive trend was noted for self-rated quality of life from baseline to follow-up. Pre–post testing revealed nominal change in cognitive–linguistic functions. Conclusions An arts program led to significant increases in constructive engagement and communication and a trend toward increased self-rated quality of life for the three PLWD. The fact that these changes were not sustained outside intervention sessions (i.e., pre–post testing) is consistent with the need for a larger paradigm shift in which rehabilitation specialists—including speech-language pathologists—better integrate creative, meaningful activities into the everyday lives of PLWD to maximize ongoing engagement, communication, and quality of life.
Article
Background: Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM-FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self-esteem, self-efficacy, self-expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design. Methods: The participants included 39 patients from a public dementia care centre in Seoul, Korea. The intervention group, which comprised 20 participants, received 12 MM-FAT sessions 3 times a week for 4 weeks, and the control group, which included 19 participants, received usual care. The MM-FAT program was evaluated based on its effectiveness on cognitive, daily living, emotional, and social functioning outcome measures at three time points using repeated measures analysis of variance. Semi-structured interviews (n = 9) were conducted to evaluate the overall experience of the MM-FAT program and its outcomes. Results: The findings reveal that MM-FAT has a positive effect on the cognitive, emotional, and social functioning of individuals with MCI and mild dementia. However, there were no enhancements in individuals' daily living functioning, and the lasting effects of the intervention could not be assessed. Cognition and depression increased significantly at the end of the MM-FAT program. Self-expression and self-efficacy were significantly higher in the MM-FAT group than in the control group. The semi-structured interviews revealed improvements in participants' behaviour, communication, and interaction. Conclusion: This mixed methods study focused on individuals with MCI or mild dementia contributes to an understanding of the effectiveness of a FAT program employing a multimodal approach. Despite the COVID-19 pandemic, the study was able to enrich the effects of MM-FAT on cognitive, emotional, and social functioning through qualitative findings.
Article
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Museums and cultural institutions are increasingly striving to respond to the interests and needs of the society that hosts them. This means, apart from other actions, that these institutions must be involved in the health and wellbeing of society, and the creation of cultural activities aimed at people with cognitive impairment, a group of individuals that is growing worldwide due to the aging of society and the increasing prevalence of dementia. The involved sectors are aware of the potential and benefits of activities for this population, even though there is much research to be conducted. To date, no systematic review has focused on the benefits of cultural activities for cognitively impaired people. This study aimed to explore the benefits of different modalities of cultural activities with evidence from 145 studies from various databases, which met the inclusion criteria. Significant improvements in general cognition, quality of life (QoL), emotional wellbeing, socialization, and communication were generally reported after interventions, with a reduction in depression symptoms. There was not enough evidence to prove memory, language, or daily functioning improvements attributable to cultural interventions. There were no significant reductions reported in apathy, sadness, agitation, or anxiety.
Article
Emerging adults face significant risk of experiencing mental health problems, especially since most lifetime mental problems have first onset by age 24. Despite the pervasiveness of these issues, emerging adults face barriers in receiving help including stigma surrounding help-seeking behavior and negative attitudes about perceived usefulness of therapy. Creative and expressive art therapies (CATs) can address these needs by providing potentially destigmatized, non-invasive approaches to mental health care. To examine how this population can benefit from CAT, we conducted a systematic review of the literature to understand the types of CAT interventions that have been empirically tested among emerging adults. From a total of 7,276 articles published between 1985 and 2020, we filtered down to 11 studies, both qualitative and quantitative, meeting our inclusion and exclusion criteria. Results showed art therapy and poetry therapy were the most frequently studied CATs for the emerging adult population; and art therapy studies comprised the largest proportion of studies reporting statistical significance on its efficacy among all CATs reviewed. We highlight the need for more studies using replicable, generalizable methods in evaluating CAT. We then discuss implications for counselors, practitioners, and clinician-researchers interested in using CAT to improve mental health care among emerging adults.
Chapter
By the year 2030, about 82 million people are projected to be living with dementia and that number is projected to reach 152 million in 2050 (World Health Organization. 2019. “Dementia: Key Facts.” https://www.who.int/news-room/fact-sheets/detail/dementia). These astounding figures demonstrate the obligation of healthcare systems and societies to address the issue of improving the lives of those living with forms of dementia and those who care for them. The language used in empirical literature to describe dementia very often focuses on suffering and behaviours and has been argued to do more harm than good because the terminology refers to people by their medicalized conditions. The need to look beyond the diagnosis and symptoms to see each person holistically and empathically is paramount. There has been considerable research on non-pharmacological approaches to dementia care. However, many of these commonly used and predetermined interventions such as the use of stuffed animals, laundry folding or doll therapy often have little or nothing to do with the individual and are not considered to be person-centred. Although these interventions may be beneficial for some people, they cannot be used as a one-size-fits-all approach in dementia care. Great strides have been made in long-term care practices, but they often remain medicalized and task-oriented. This chapter is an exploration of how the creative and expressive arts, nature and mindfulness practices related to people living with dementia have been researched. In addition, my experience using art, nature and mindfulness with clients living with dementia is explored as a meaningful and cohesive intervention. Case examples are presented from over two decades of my experience as a creative arts therapist who has worked with clients living with dementia to share opportunities for mindfulness; encourage exploration of natural materials; and focus on personhood, abilities, strengths, unique perspectives and gratitude.
Article
Art-based interventions have shown promise in improving quality of life and emotional wellbeing among older adults, but few have focused on improving cognition and reducing dementia risk. The current mixed methods pilot study investigated whether healthy older adults, who participated in a 12-week art-based cognitive health intervention, driven by a Conceptualist art approach, demonstrated improvements in their cognitive functioning and psychosocial wellbeing. Participants were cognitively normal, community-dwelling older adults who completed pre and post cognitive and psychosocial assessments, and qualitative interviews post-intervention. Results revealed statistically significant improvements in executive function, cognitive flexibility (set-switching), and life satisfaction. Qualitative exploration of older adults’ perceived outcomes from the intervention revealed that they experienced ‘Personal Growth and Learning’ from the skills and knowledge gained. Specifically, they reported becoming more open minded and critically engaged, being challenged in positive ways, and gaining a better understanding of cognitive health. Participants also reported that the course material was intellectually stimulating and personally relevant. Connections between quantitative and qualitative findings, and how they should guide future interventions, are discussed. This study supports the need to further explore conceptual art for its associations to dementia risk and wellbeing for older individuals.
Article
This descriptive study aimed to increase knowledge of the influence of trust that Alzheimer's patients place in the practitioner in art therapy through the care process. Persons diagnosed with Alzheimer's neurodegenerative diseases may use a non-pharmacological supportive activity in healthcare to increase self-esteem and decrease anxiety. French modern art therapy has been developed for this purpose as a sensory stimulation intervention giving an increase in feeling pleasurable sensations. This therapy requires from such patients a trust-based relationship with the therapist in order to better commit to the activity. This case study is an attempt to examine the importance of interpersonal trust built into the therapeutic relationship. Based on the person-centred approach developed by Carl Rogers, the aim of this paper is to explore how the empathic-based therapist's behaviour can help the patient to develop self-confidence from trust he placed in this therapist in order to better commit to the activity. An observational grid established from a model using love of self, self-confidence, assertiveness and trust. Field observations showed that trust represented about 40% of the variability in the self-esteem model. An empathic-based approach can considerably help the patient to develop trust. Thus, built trust between severe-stage Alzheimer's patients and the art therapist is regarded as essential in the context of this study. Trust reactivates self-confidence, which provokes a physical engagement in the art making, engagement regarded as key for art-therapeutic activity because the art making ultimately will lead to a decrease in anxiety. This is particularly noticeable at the beginning of the process at least during the first sessions (five in average in this study for elderly women diagnosed with Alzheimers) when the built interpersonal trust strengthens the therapeutic relationship. For the art therapists working with Alzheimer's disease people, this study recommends first increasing the empathic approach of practitioners to help the patient to develop trust. It also suggests better efficiency in the healthcare process when using a person-centred approach such as that established by Carl Rogers. The Rogers approach, as well as his dynamics of change theory, can apply to severe-stage neurodegenerative disease people and help the reactivation of patients’ self-confidence. Such an approach is recommended at the beginning of the care process, and then must be released when the patients express assertiveness. Empathy as well as absence of judgment facilitate aesthetic expression and creativity.
Article
Although there has been growing interest in visual art interventions for people with dementia, there is a restricted evidence base regarding their theoretical basis. To address this gap, this systematic literature review explored how and why visual art interventions work in dementia care. Common features of successful visual art interventions were identified, including: intervention ‘dose,’ session content, participant choice, artistic ability, the role of the facilitator/therapist, group work, and setting. Understanding the mechanisms and/or processes of visual art interventions is important for future development, evaluation, and implementation.
Article
Objectives As the global burden of dementia rises, the search for preventive measures such as interventions for mild cognitive impairment (MCI) remains a research priority. While arts-based interventions have demonstrated some success in improving cognitive functioning among older adults and those with dementia, its effectiveness for older persons with MCI remains unexplored. We conducted a systematic review to examine the effects of arts-based interventions on cognition in older persons with MCI. Method The following databases were searched in November 2019: PubMed, EMBASE, PsycINFO, and CINAHL Plus, supplemented by Google Scholar and ALOIS. Study inclusion criteria were older persons aged ≥ 60 with MCI; arts-based interventions such as dance, drama, music, or visual arts; and randomized controlled trial with cognitive outcome. Database search, study selection, and data extraction were conducted independently by 2 reviewers. Results Eleven randomized controlled trials examining 13 interventions (817 participants) were identified, of which 4 involved visual arts, 4 dance/movement, 3 music, and 2 storytelling. Significant improvement on at least one cognitive outcome was reported in 10 of the 13 interventions. These included improvements in global cognition (6/7 interventions), learning and memory (5/9), complex attention (4/10), executive functioning (2/6), language (2/3), and perceptual-motor function (1/4). Conclusion This review found that arts-based interventions can potentially improve various aspects of cognitive functioning in older persons with MCI, although our confidence was dampened by methodological limitations such as the moderate-to-high risk of bias present in studies and heterogeneity in the way MCI was defined. Recommendations for future research are discussed.
Article
Many care home residents lack opportunities for meaningful activity and social connection, resulting in poor physical and emotional wellbeing. Providing residents with varied activities and social opportunities can improve their quality of life. In this paper, we examine the potential for film to provide a meaningful, social activity. The limited existing research on film in care homes has predominantly examined the use of film clips and materials in stimulating reminiscence for people with dementia. In this paper, we adopt a broader, trans-disciplinary perspective of film, drawing on evidence from Film Studies that shared spectatorship has social and emotional benefits for the viewer. We offer the first qualitative study of care home residents’ social, emotional and embodied engagement with feature-length film and identify the key benefits of film in this setting. We ran social film screenings in two Scottish care homes over six weeks. Underpinned by psycho-cinematic theory, we collected and analysed observational data alongside interviews with care home staff and discussion groups with residents. Our findings identified three ways in which film screenings benefit residents and supports social connection: prompting reminiscence; enhancing residents’ experiences in the present; and creating a shared future and intergenerational connections. The paper offers useful insights into the rich potential for film to enhance the care home community, facilitate social connectivity and promote resident wellbeing.
Article
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In China, the ageing population and the prevalence of dementia are projected to escalate significantly by 2050 resulting in a substantial increase in health and economic burden on caregivers, healthcare facilities, healthcare providers and communities. There is no published national dementia policy or strategy in China. This case report describes significant barriers contributing to diagnostic problems and inadequate care of dementia through the case of an older female in rural China, whose condition deteriorated due to neuropsychiatric and functional symptoms of undiagnosed dementia. Intersectoral collaboration between care organisations facilitated delivery of a non-pharmacological intervention programme which was associated with improvements in the patient’s functional and neuropsychiatric symptoms. The case demonstrates that recruitment and training of a wider range of health and care professionals and caregivers in a systematic approach to non-pharmacological interventions could help overcome barriers to the specialised care needs of people with dementia where resources are lacking.
Article
Alzheimer’s disease (AD) is a threat to the individual and marital integrity of couples as the relationship is called upon to evolve into a caregiver-patient one. In Quebec (Canada), there are currently very few services offered in which these couples can participate together as a couple. In a qualitative multi-case study, five couples had the opportunity to participate in art therapy informed by integrative behavioral couple therapy over 10 meetings held in their homes. The results suggest that art therapy has many positive benefits on these couples, such as providing pleasure, expressing emotions, assessing relational dynamics, and fostering empathy. It was found that art therapy fulfilled five specific functions: play, appease, stimulate, express, and transform.
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An art therapy intervention using an eight-session pottery class based on the Eastern Method throwing technique was implemented with 20 elderly nursing home residents, with the aim of improving their psychological well-being. Quantitative evaluation was based on Hebl and Enright (1993) and employed a quasi-experimental design measuring the participants' self-esteem, depression, and anxiety compared with 20 nonparticipating elderly residents of the nursing home. Qualitative evaluation included client self-evaluations, case progress notes, journal notes, and photographs. Following the intervention, the participating group showed significantly improved measures of self-esteem, and reduced depression and anxiety at posttest relative to the comparison group. Implications for art therapy intervention with institutionalized elderly and further research are discussed.
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In this article the authors integrate perspectives from neurology and studio art therapy as they apply to the art production of an individual with dementia. The main areas of the brain involved in art production, and the art-related consequences of brain deterioration in different types of dementia, are discussed. The case of an artist with corticobasal degeneration is examined with respect to her neurological symptoms, changes in her art over time that occurred as a result of her dementia, studio adaptations and interventions, and therapeutic progress informed by neurological knowledge of her illness.
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Traditional therapy, with its emphasis on verbal communication between therapist and client, may not be appropriate for patients with dementia due to impaired cognitive and verbal abilities. This brief report presents a qualitative study on the use of collage in art therapy to aid in the process of reminiscence in individuals with dementia. Data were collected and analyzed using a modified Magazine Photo Collage assessment (Landgarten, 1993) with three participants. Findings support the hypothesis that collage allows older adults with dementia an opportunity to convey information that they might not be fully capable of verbalizing. Participants' interactions with collage as a therapeutic modality also were examined, as well as their interactions with the art therapist researcher.
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This paper explores findings from the fields of neuropsychology and art therapy as they relate to treating patients with dementia. It explains the biological, physical, and psychological manifestations of dementia, and current treatment modalities. Art therapy has been shown to be beneficial to patients with dementia. Unfortunately, it is the rare long-term care facility that offers such a program to its residents. The graphic indicators that manifest themselves in the art of patients with dementia are discussed along with four case examples that illustrate the benefits of art therapy programs for patients in varying stages of dementia. The implications of such treatments for society are explored, including the need for more studies integrating art therapy and neuroscience.
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This study examines the use of music as a strategy to decrease agitated behavior in cognitively impaired nursing home residents. Twenty agitated subjects, 68 to 84 years of age, were exposed to 15 minutes of calming music on two occasions. Agitated behavior scores were recorded before, during and after the musical intervention using the Agitated Behavior Scale. Results indicate that a statistically significant reduction in agitated behavior occurs both during (p. <0]) and after the musical intervention (p. <05). Calming music was shown to be an effective, nonpharmacologic strategy which nurses and other caregivers may use to reduce agitated behavior in the nursing home.
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Three male subjects with a primary diagnosis of Alzheimer's-type dementia participated in weekly, 30-minute music therapy sessions for 15 months. Subjects were selected randomly from among 29 residents of a nursing unit at Colmery-O'Neil Veterans Affairs Medical Center in Topeka, Kansas. All subjects were low functioning and required consistent supervision for behavioral management. Data were gathered in the last 11 weeks of the music therapy program for communicating, watching others, singing, interacting with an instrument, and sitting. Though the subjects deteriorated markedly in their cognitive, physical, and social capacities over the course of their disease in 15 months, data in the latter 11 weeks of the program indicated that they continued to participate in music activities in a structured group context. Data analyses showed that music participation was maintained over the course of the 11 weeks. Subjects consistently sat in chairs without physical restraints for the duration of each 30-minute session. Regardless of their deterioration, subjects were able to function with others in a group context. For most, this was the only time in their week when they could successfully interact with others in some acceptable form.
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With the advent of sensitive diagnostic procedures, Alzheimer's disease and other related dementias are being diagnosed in their earliest stages. Although early diagnosis provides opportunities for treatment, decision making, and planning, it also conveys some potentially negative consequences, including affective and interpersonal changes. Early-stage support groups for individuals with dementia and their caregivers have been developed to help individuals and their families cope with the psychological and social changes that the diagnosis brings. Although early studies provide anecdotal and qualitative support for the benefits of such groups, there have been few empirically based investigations of their efficacy. This article describes an ongoing randomized controlled clinical trial comparing early stage support groups with a wait-list control condition, and provides preliminary outcome data for participants and their family care partners. Results to date indicate improved quality of life and decreased family conflict following support group participation, indicating that this may indeed be a promising early-stage intervention.
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This case study examines a body of art work produced by Emma, a geriatric client admitted to a psychiatric ward for what appeared to be symptoms of Alzheimer's disease. On the ward, Emma attended art therapy groups, where she spontaneously created metaphors of loss. Her art work showed many similarities to art work produced by cancer patients. After a three-month stay on the psychiatric ward, Emma was diagnosed with cancer of the liver. She was transferred to a medical unit where she died three weeks later. Emma produced all her art work before she was diagnosed with cancer. This article presents evidence that Emma unconsciously knew she was dying, and independently worked on issues of her own death through her art work.
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Alteration in sleep function of the elderly is associated with the aging process. Subjective sleep surveys of the elderly commonly reveal a general dissatisfaction with the quantity and quality of sleep. The widespread utilization of sedative-hypnotic drugs in order to alleviate the sleeping complaints of the elderly probably rests on some untested assumptions made by physicians. Music has elicited some strong responses from subjects with Senile Dementia of the Alzheimer Type (SDAT), when other means of communication has failed. Music of a serene nature has been shown to lessen anxiety and allow individuals to relax. This study investigates music as an adjunct or alternative to sedative-hypnotic drugs in inducing sleep in “healthy” elderly subjects and patients with SDAT A behavioral assessment chart of sleeping behavior was designed and utilized by nurses on the midnight shift. Combined analysis of variance for the number of hours asleep for all four groups yielded a significant relationship between the numbers of hours asleep and music. A paired comparison between control and experimental SDAT disclosed a significant relationship between the use of music and the number of hours of productive sleep. A paired comparison of the number of hours asleep between control and experimental “healthy” elderly revealed no significant relationship.
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Adult developmental theories are explored regarding implications for art therapy with impaired elderly. The struggle inherent in the creative art process is examined as a means to facilitate developmental struggle, which culminates in mature expression of wisdom. This expression of wisdom becomes possible through the artistic process and through symbol formation. Artistic processes facilitate struggle, which can elicit conflict resolution and utilization of mature defenses with even severely impaired patients. Theoretical and practical strategies are explored in relation to psychosocial and art therapy theories and case material.
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A multisensory intervention combining the use of art, music, and movement was utilized within a long-term care setting for persons including those with Alzheimer's disease and related dementias. In spite of extreme cognitive losses, this experience enabled participants to utilize remaining strengths and call upon alternate pathways to realize their greatest potential and to experience their greatest degree of stimulation and pleasure. This paper details the benefits derived by some of the participants who attended the sessions regularly. Many were able to retrieve memories, enjoy socialization, and have the opportunity for affective expression, which they were no longer able to verbalize. These experiences served to increase a sense of self and to preserve the uniqueness of the individual.
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The purpose of this paper is to describe how art therapy can be used with an elderly population experiencing cognitive impairments that range from benign, “mild” confusion to a devastating, progressive dementia such as Alzheimer's disease. The evocative nature of art allows older adults with dementia to become expressive and bypass some of their cognitive deficits. The versatility of artmaking also assists elderly individuals in supporting the level of their cognitive status, and gives the art therapist a flexible method of releasing obscured thinking and feeling processes.
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The clinical course of a patient whose dementing illness defied DSM III (APA, 1980) diagnostic labeling is followed. Through the patient's art therapy work, the author attempts to corroborate the patient's behavior and performance with clinical and medical tests. This information is then related to present-day knowledge of brain dysfunction and impairment and to the autopsy findings. Art therapy served a special role for the patient, providing him with self-esteem, grounding, and boundaries, as well as with an emotional outlet and means of communicating the realities of his disease. While his well-drawn houses somewhat disguise his impairments, his drawings of people clearly illustrate aspects of the organic disease—regression, depression, and psychotic ideation.
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An individual with mild dementia of the Alzheimer's type (MMSE = 25) expressed an interest in restoring a family heirloom. She had a history of high levels of involvement in creative arts and crafts activities and was able to fully participate in this complicated arts project with assistance from the author. The primary cognitive disadvantage appeared to be associated with failures to carry out sub-goals as she painted the heirloom-which was presumably due to forgetting in short-term memory. Implications for individuals in the early stages of dementia are discussed.
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Non-artists with Alzheimer-type dementia created pictures as part of a biweekly (twice per week) activities program. The collages were made by residents at a long-term care facility in the Midwest and were analyzed for compositional complexity and asymmetry over the course of a three-year project. As indicated by a repeated-measures ANOVA, asymmetry did not change significantly with practice, but complexity did. Mean pictorial complexity was lower during later sessions than earlier ones. Mean asymmetry was not influenced by number of sessions (or time) in a generalizable fashion. Implications of the project for understanding the artwork of persons with dementia are discussed.
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This review is about the latest theories of the underlying mechanisms that explain why music and art promote health and have positive influences on the course of illness with ageing. It is also about the latest findings demonstrating the positive effects that music and the arts in general have on health with ageing; cost savings to society associated with these positive findings will also be discussed. Why would engaging in music and the arts in general have positive effects on health? In the modern world, without a clear understanding of the underlying factors to explain effects or outcomes, science and society become doubtful and dismissive of even positive reported findings. These issues will be reviewed with research examples illustrating how they can be effectively addressed and positively influence societal and scientific perceptions of the value of music, art, and creative engagement in promoting health with ageing.
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Music has been shown to be effective in a number of psychiatric conditions, including improving the quality of sleep. A pilot study was carried out to study the effect of Indian classical music on the quality of sleep in individuals with depression. Fifty individuals diagnosed with Major Depressive Disorder on DSM-IV were consecutively allocated into two groups. One group received music with selected raagas, while the other group was treated with hypnotic medications for a month. The changes in depressive symptoms and sleep quality were measured on MADRS and PSQI. Both PSQI and MADRS scores improved with music. Improvement in scores with music was comparable to hypnotic medications and persisted beyond the treatment period. We conclude that music is comparable to hypnotic medication in improving quality of sleep in depressed patients and can thus act as a useful adjunct in the management of depression.
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Aims: This study explores the impact of a poetry intervention at one care home and one day centre in England. It seeks to bolster the growing body of literature assessing the extent to which the arts and reminiscence can improve the quality of life and care for people with dementia (PWD). Method: Six care staff were interviewed about their experiences of the project. The data were analysed using interpretative phenomenological analysis. Findings: Six themes were elicited: exploring and preserving memories, communicating with service users, humanizing dementia sufferers, co-authorship of poems, continuity and the broader care context. These tell of an intervention which was valued by staff as having a positive impact on clients and their families. Conclusions: The research suggests that reminiscence-based poetry activities can improve the quality of life and care for PWD, helping to restore their “personhood” in the eyes of those who care for them.
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Argues that creative arts therapies are uniquely suited to the task of preserving and maximizing Alzheimer's disease (AD) patients' eroding sense of self. These are essentially nonverbal modalities that draw on the sensory, affective experiences of their participants and encourage reminiscence, self-expression, and socialization. Rhythmic structures in music groups, together with familiar lyrics from earlier life periods when self-concept was intact, help to organize the experience of affect and time, both potent reminders of selfhood. Movement therapy offers opportunities for depth and range of affective experience despite the patient's inability to communicate verbally those aspects of self. (PsycINFO Database Record (c) 2012 APA, all rights reserved)