The psychological and social impacts of museum-based programmes for people with a mild-to-moderate dementia: a systematic review

Abstract

The importance of museum-based interventions for people with demen­tia has been increasingly appreciated. Yet, there is relatively little known about the psychological and social impacts of these interventions. To address this, the authors undertook a systematic review to elucidate these aspects of museum-based programmes for people with mild-to-moder­ate dementia. Four electronic databases were searched systematically, and eleven studies were included. Key findings were synthesised thematically, and six themes were identified: mood and enjoyment, subjective wellbe­ing, personhood, cognition, engagement, and social outcomes. These pos­itive findings suggest that museum-based interventions for people with a mild-to-moderate dementia can offer a range of valuable benefits. This review also clarified that further mixed-methods studies and wait-list controlled studies, to clarify the factors that benefits may be attributed to, will contribute towards a more robust evidence base. In turn, this would positively impact funding and guide policy in this area.

Full text

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International Journal of Ageing and Later Life, Advance access, 2022 The Authors
doi: 10.3384/ijal.1652-8670.3532
The psychological and social impacts of
museum-based programmes for people with
a mild-to-moderate dementia: a systematic
review
By HannaH Zeilig1, laura Dickens2 & Paul M. caMic3
Abstract
The importance of museum-based interventions for people with demen-
tia has been increasingly appreciated. Yet, there is relatively little known
about the psychological and social impacts of these interventions. To
address this, the authors undertook a systematic review to elucidate these
aspects of museum-based programmes for people with mild-to-moder-
ate dementia. Four electronic databases were searched systematically, and
eleven studies were included. Key ndings were synthesised thematically,
and six themes were identied: mood and enjoyment, subjective wellbe-
ing, personhood, cognition, engagement, and social outcomes. These pos-
itive ndings suggest that museum-based interventions for people with
a mild-to-moderate dementia can offer a range of valuable benets. This
review also claried that further mixed-methods studies and wait-list
controlled studies, to clarify the factors that benets may be attributed to,
1Hanna Zeilig, London College of Fashion, University of the Arts, London, UK.
2Laura Dickens, Salomons Institute, Canterbury Christ Church University, Canterbury, UK.
3Paul M. Camic, UCL Institute of Neurology-Dementia Research Centre, University College
London, London, UK.

International Journal of Ageing and Later Life
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will contribute towards a more robust evidence base. In turn, this would
positively impact funding and guide policy in this area.
Keywords: dementia, museum based, psychological and social impacts,
systematic review, wellbeing.
Introduction
Dementia is a progressive condition marked by a deterioration in cogni-
tive functioning and domains such as social behaviours, emotion regu-
lation, and motivation, which affect a person’s ability to carry out daily
activities (World Health Organisation (WHO) 2019). There are many types
of dementia that differentially affect the brain’s chemistry and structure,
and Alzheimer’s disease is the most common form (Alzheimer’s Society
2017). The number of people worldwide living with a dementia is increas-
ing (from 47 million cases in 2015 to a predicted 75 million by 2030), sit-
uating dementia as a major cause of disability with high economic costs
(WHO 2017). Consequently, strategies and policies have been developed
to address this signicant public health issue. The Global Action Plan on
the Public Health Response to Dementia 2017–2025 (WHO 2017) outlines
areas for action for moving towards better physical, mental and social
wellbeing and reducing the impact of the disease on people with demen-
tia (PWD), their families, carers and communities. The WHO report also
notes the importance of developing person-centred and cost-effective
interventions (2017: 5). It is important to acknowledge that dementia man-
ifests differently in different people, and there are variations in cognitive,
emotional and physical symptoms. Symptoms tend to intensify as the dis-
ease progresses (Stephan & Brayne 2014).
The challenges of living with a dementia place PWD at a greater risk
of comorbid psychological difculties such as anxiety and depression
(National Collaborating Cent re for Mental Hea lth (NCCMH) 2018; National
Institute for Health and Care Excellence (NICE) 2018). NICE (2018) guid-
ance recommends a range of interventions that could support cognition,
independence and wellbeing (1.4). Importantly, the physical, psychological
and social impacts of dementia also affect families and carers (WHO 2019)
as a person with dementia’s roles, and relationships may alter (NCCMH
2018). The pioneering work of Kitwood (1997) is relevant here. Kitwood
dened the concept of “personhood” in dementia as: “a standing or status

Psychological & social impacts of museums
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that is bestowed upon one human being, by others, in the context of rela-
tionship and social being” (p. 8) and thus acknowledged the relational
impact of dementia. The concept of wellbeing is also a key focus in demen-
tia care (NICE 2018) although there are ongoing challenges regarding its
denition and measurement (Camic et al. 2019). Kitwood (1997) identied
ve key psychological and wellbeing needs of PWD: comfort, attachment,
inclusion, occupation and identity. Kaufmann and Engel (2014) extended
the Kitwood’s model, using empirical data to add “agency,” comprising
components of “self-determination,” “freedom of action” and “indepen-
dence,” which results in feelings of self-efcacy and self-worth. They also
noted PWD are important informants of their own wellbeing.
The World Alzheimer Report (Batsch & Mittelman 2012) highlights
stigma and social exclusion as signicant barriers for both PWD and
their carers, who describe feelings of being marginalised by society and
sometimes by family and friends. The 2019 report (Alzheimer’s Disease
International) also highlights experiences of unfair treatment, such as
others making jokes about dementia symptoms, and PWD being denied
choices or ignored. Moreover, understimulation, in combination with
diminished social contact, has been linked to loneliness and depression
in PWD, whilst social stimuli can increase positive affect (Cohen-Man-
seld et al. 2011). In addition, communication is an area of impairment
experienced by PWD, which can signicantly impact the quality of rela-
tionships with others and requires nding different ways to communi-
cate and understand each other (McCarthy 2011).
Social prescribing and arts interventions
The value of social prescribing for people with long-term conditions, as
well as for those who require support with their mental health, or are iso-
lated, has been increasingly evidenced (Chatterjee et al. 2018; NHS England
2019; Veall et al. 2017). With particular reference to PWD, in the United
Kingdom, the All-Party Parliamentary Group on Arts, Health and Wellbe-
ing (2017) championed the wider role of the arts in improving the quality
of life in PWD and their carers, including visual art programmes such as
those in museums and galleries. In line with this approach, museum-based
interventions have proved an important way to promote the engagement
and wellbeing of PWD (Camic & Chatterjee 2013; Smiraglia 2016).

International Journal of Ageing and Later Life
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The present review
A number of previous reviews have drawn together existing research,
including grey literature on longstanding museum and art programmes,
such as the Museum of Modern Art’s Alzheimer’s project “Meet me at
MoMA” (Mittelman & Epstein 2009) and have examined their role for
people living with dementia. The extant reviews have outlined the value
and potential benets of museum-based interventions for this popula-
tion (Cousins et al. 2019; Kinsey et al. 2021; Sharma & Lee 2020; Windle
et al. 2018). The current review differs from previous reviews in its aim
to explore and identify the psychological and social impacts specic to
museum-based programmes for people with mild-to-moderate demen-
tia. In psychological literature and studies, subjective wellbeing is a key
concept in relation to dementia. Moreover, wellbeing for people living
with dementia is increasingly a concern in social policy; therefore, this
was selected as a search term for this review. This provides an in-depth
understanding specic to this population and setting and can inform
future research and practice to contribute to a growing evidence base for
museum interventions for PWD.
Methodology
A systematic review of the literature was undertaken, as described by
Grant and Booth (2009). A search was conducted using the electronic data-
bases: PsychINFO, Medline, Web of Science and Applied Social Sciences
Index and Abstracts. The following search terms were used to identify
relevant literature: Dement* OR Alzheimer* AND art* OR object* OR par-
ticipatory OR creative* OR wellbeing OR well-being OR well being AND
heritage* OR galler* OR museum* (Appendix 2). Other combinations of
search terms were tried, including outcomes or combining the interven-
tion type and location; however, these yielded tens of thousands of results,
and it was decided outcomes would be implicit in the museum-based
studies identied. Search terms were guided by the review topic, and key
terms used in relevant literature and other literature reviews in the area.
Dementia or Alzheimer’s terms were thought sufcient to capture all sub-
types of dementia. Terms used in the literature to describe relevant inter-
ventions were utilised with appropriate truncations to capture variations

Psychological & social impacts of museums
5
in wording or grammar and those relevant to the setting posed by the
research question. No limits were applied to the year of the study; how-
ever, the search stop time was January 2020.
Figure 1 displays the process of identifying the papers reviewed here.
Inclusion and exclusion criteria, as shown in Table 1, were developed to
allow studies’ eligibility for the review to be systematically determined.
Records identified through
database searching
(n = 162)
Additional records identified through other
sources (Google Scholar using same search
terms, and other literature reviews in the area)
(n = 9)
Records after duplicates
removed
(n = 124)
Records screened by title
(n = 124)
Records excluded by title
(n = 56)
Full-text records assessed for
eligibility
(n = 40)
Records excluded after reading full-texts
(n = 29)
Studies included
(n =13)
Records screened by abstract
(n = 68)
Records excluded by abstract
(n = 28)
Studies included from the
additional searches (as above) and
reference lists of included papers
(n = 2)
Figure 1. Flowchart of the process of identifying included studies

International Journal of Ageing and Later Life
6
Studies that met these criteria were selected for inclusion. Those on the
border of the criteria were discussed amongst two of the authors and an
independent researcher to ensure these were applied as systematically as
possible. For example, some studies were conducted in part in a heritage
setting and in part in an outreach setting, such as a day centre. Studies
were excluded if they did not take place exclusively in heritage settings, or
used PowerPoint presentations as opposed to viewing authentic art. This
enabled the studies to be as homogenous as possible in order to meaning-
fully synthesise their ndings in relation to the research question. Find-
ings from studies including samples with a range of dementia severity
(mild to severe) were included provided the intervention, and its ndings
were separately and clearly reported for people with a mild-to-moderate
Table 1. Inclusion and exclusion criteria
Inclusion criteria Exclusion criteria
English language
Empirical studies published in peer-
reviewed academic journal articles
Grey literature or reports
Dementia sample (or clearly specied as
in the large majority)
Non-dementia sample, e.g. other
cognitive impairment, older people
without a dementia or where this is not
specied
Mild-to-moderate dementia Where the stage of dementia is not
clearly indicated or specied
Museum-based interventions Other interventions, e.g. reminiscence
and art therapy
The intervention takes place exclusively
in a heritage setting, e.g. a museum or
gallery
Part of the intervention takes place in
a museum and part in a non-heritage
setting
The study includes a focus on outcomes
relating to the psychological and/
or social impacts including wellbe-
ing impacts on PWD following an art
intervention
Focus is on physiological, clinical and
environmental outcomes on PWD fol-
lowing an art intervention
Note. PWD: people with dementia.

Psychological & social impacts of museums
7
dementia. In addition, studies in which samples consisted of PWD and
other cognitive disorders were included in cases where these character-
istics were clearly specied, and the large majority of the samples were
PWD. Table 2 presents a sum mary of the 11 studies included in this review.
Quality assessment
The QualSyst (Kmet et al. 2004) was used to systematically assess the qual-
ity of the included studies (Appendix 1). This set of criteria was chosen
for its ability to simultaneously appraise both quantitative and qualitative
studies. Mixed-method studies were scored using the tool for both for their
quantitative and qualitative aspects. The tool was developed drawing on
existing appraisal tools, has good inter-rater reliability and is particularly
appropriate when synthesising different study designs. A specialist librar-
ian was consulted and advised the authors on the search strategy and use
of search terms. All authors agreed on the terms and search criteria and
ensured that the subsequent data extraction was robust and accurate.
Ethical considerations
Ethical approval was not needed for this review because only data from
previously published studies in which informed consent was obtained by
the primary investigators were retrieved and analysed. Nonetheless, the
authors were cognisant of search, availability and language bias and were
careful to include a wide range of databases and not to simply include
those studies that were most easily accessible.
Results
Overview of included studies
Of the 11 studies reviewed, three employed quantitative methods, two
were qualitative and six utilised a mixed-methods approach. Two studies
undertook different analyses on the same intervention. Given the infancy
of research in this area, the majority of studies were exploratory, feasi-
bility or pilot studies either investigating existing programmes or con-
ducting sessions for the purpose of the research. They utilised a range

International Journal of Ageing and Later Life
8
Table 2. Summary of studies included in the review
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Burnside et al.
(2017)
USA
Quality
rating score:
qualitative
80%
PWD (n = 21)
Early or mild stages
of dementia on
average. Clinical
Dementia Rating
scale (CDR) 4 = 0.5,
14 = 1, 1 = 2
Age (60–84, M = 76)
76% university
degree. Prior arts
experience: none
19%, moderate
24%, extensive 57%
Carers (n = 21)
Spouses (52%),
daughters, paid
carers and other
family members
1 African American
dyad, 1 Asian dyad,
19 white dyads
To explore
the impact of
“Here: now,”
a museum-
based expe-
riential arts
programme
for PWD
and their
carers and
to develop
a concep-
tual model
regarding
important
compo-
nents, pro-
cesses and
outcomes
Two (on-going)
programmes:
1. Monthly one-time
discussion-based
gallery tours (90 min-
utes, 5–6 dyads, 3 art-
works) include group
and dyad discussion
2. Six-week pro-
gramme including a
gallery tour and studio
art-making classes
(120 minutes, art work
discussion and mate-
rials around themes of
the art shown)
Total of 7 gallery tours
and 3×6 art-making
classes. Dyads partic-
ipated in 1 or more of
these
Guided by a museum
educator trained in
working with PWD
and visual thinking
strategies
Frye Art Museum
Semi-
structured
telephone
interviews
with PWD
(n = 13) and
their carers
(n = 21).
These took
place 2 weeks
post-partici-
pation
Interviewer
was indepen-
dent to the
programme
Qualitative
Grounded
theory
Major themes: facilitation,
engagement, mindfulness,
enjoyment, socialisation, joint
respite, personhood, relation-
ship normalising, relationship
afrming, relationship growth
and personal growth
These were divided into
relationship effects and
personal effects
Important factors to the
programme: museum space,
facilitation process and
socialisation with others
Conceptual model comprised:
antecedents, structural
factors, process (mindfulness
incorporating the themes
of enjoyment, socialisation,
joint respite and personhood),
outcomes
(Continued)

Psychological & social impacts of museums
9
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Camic et al.
(2014)
UK
Quality
rating score:
Qualitative
90%
Quantitative
77%
PWD (n = 12)
Mild-to-moderate
dementia. Mini-
Mental Status Exam
(MMSE) scores
ranged from 10 to
24 (M = 20.1)
Addenbrooke’s
Cognitive
Examination-
Revised (ACE-R)
scores ranged from
18 to 73 (M = 52.8,
SD = 18.4)
Age (58–94,
M = 78.3,
SD = 8.8)
17 White British,
4 White European,
2 British Asian,
1 Black British
Carers (n = 12)
Neuropsychiatric
inventory (NPI)
completed by carers
To explore
the feasi-
bility and
impact on
social inclu-
sion, carer
burden,
quality of
life and daily
living activi-
ties of a gal-
lery-based
intervention
for PWD and
their carers
8-Week group
art-viewing (60 min-
utes) and art-making
(60 minutes) sessions
across two different
art galleries for PWD
and their carers
Dulwich
picture Gallery
and Nottingham
Contemporary
Standardised
measures:
PWD:
Dementia
Quality of Life
Questionnaire
(DEMQOL-4)
Carers: Zarit
Burden
Interview (ZBI)
and the Bristol
Activities of
Daily Living
scale (BADLS)
Semi-
structured
interviews with
participating
dyads 2–3
weeks post
participation
(50–90 minutes)
Field notes
taken by
researchers
who attended
all sessions
Mixed-
methods,
pre-post
design
Thematic
analysis on
interviews
and eld notes
No signicant pre-post
differences between galleries
No signicant pre-post
differences in quality of life
(which remained stable),
activities of daily living
or carer burden (although
there was a slight trend in
reduction)
Key qualitative themes:
social impact, cognitive
capacities and art gallery
setting
(Continued)

International Journal of Ageing and Later Life
10
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Camic et al.
(2016)
UK
Quality rating
score:
Qualitative
85%
(This is the
same interven-
tion and data
as in Camic
et al. 2014)
PWD (n = 12)
Mild-to-moderate
dementia
Carers (n = 12)
To develop
a theoretical
under-
standing of
the impact
of art gal-
lery-based
programmes
for PWD and
their carers
8-Week group
art-viewing (60 min-
utes) and art-making
(60 minutes) sessions
across two different
art galleries for PWD
and their carers
Gallery facilitators
(n = 4) led guided
discussions on 2–3
artworks and in 3
sessions dyads also
discussed an artwork
or object of interest
Art-making in studio
with professional artist
with experience work-
ing with older people.
Theme inuenced by
paintings discussed.
Different materials
provided each week
Semi-
structured
interviews
with partici-
pating dyads
2–3 weeks
post-par-
ticipation
(50–90 minutes)
Field notes
written by the
researchers
Written com-
munication
between the
facilitators and
research team
Semi-
structured
interviews
with program
facilitators
(30–60 minutes)
Qualitative
Grounded
theory
Triangulation
of data
sources
Emerging theory with four
primary components: valued
place, intellectual stimulation,
social interaction and changed
perceptions
Impact on individual (posi-
tive affect), relational (social
interaction) and community
(changed perceptions) levels
(Continued)

Psychological & social impacts of museums
11
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
D’Cunha et al.
(2019)
Australia
Quality rating
score:
Quantitative
86%
(The physio-
logical data in
this study were
not included in
the review)
PWD (n = 25)
Moderate dementia
as indicated by
scores on the Mini-
Addenbrooke’s
Cognitive
Examination
(M-ACE)
17 female
Age (M = 84.7)
Majority living in
residential care and
one living in the
community
Moderate level of
independence as
scored on BADL
17 Alzheimer’s
disease, 3 vascu-
lar dementia, 2
Parkinson’s, 3 mixed
60% Australian
Median of 10 years
of education
Family members/
friends/care staff
were asked to act as
a study partner
An explor-
atory study
to inves-
tigate the
impact of
an arts pro-
gramme on
physiologi-
cal and psy-
chological
measures
6-Week discus-
sion-based art-viewing
sessions (90 minutes,
3–4 works of art).
Form of art differed
each week. 5 groups.
Led by 2 art edu-
cators trained in
working with PWD
and attended by 1–2
researchers
Care staff and
researchers were
asked to limit their
input and sat behind
the group
National Gallery of
Australia
PWD: Geriatric
Depression
Scale (GDS),
Health-Related
Quality of Life
Questionnaire
for PWD
(DEMQOL),
M-ACE
General
Wellbeing
Questionnaire
(GWQ) ses-
sions 1, 3 and 6
Carers:
DEMQOL-carer
Behavioural
observation
using a stan-
dardised
template
Exit question-
naire for those
who recalled
the sessions
6 weeks later
Quasi-
experimental
One week
pre-1 day post
the 6-week
intervention
with 6 week
follow-up
Statistical tests
Improvements in pre-post
self-reported QoL for PWD
but no differences were found
in QoL as rated by carers
Improvements in pre-post
symptoms of depression and
M-ACE scores (immediate
recall and verbal uency only)
GWQ scores improved from
sessions 1 to 3 and were main-
tained at session 6
Behavioural observations:
increase in laughter and
happiness between sessions
1 and 2 and then decreased.
No other changes
48% completed exit question-
naire. Overall rated experi-
ence as memorable, looked
forward to it, and carers felt
it was benecial for PWD.
Participants rated average
experience as 8.12 out of 10
(Continued)

International Journal of Ageing and Later Life
12
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Eekelaar et al.
(2012)
UK
Quality rating
score:
Qualitative
80%
Quantitative
82%
PWD (n = 6)
Early-to-mid stages
of dementia. MMSE
(18–24, M = 21.67)
Age (68–91,
M = 78.67)
Carers (n = 6)
Five spouse, one
son
Both groups three
male
Exploratory
study inves-
tigating the
impact of
a gallery
intervention
on cognition
in PWD,
namely,
episodic
memory
and verbal
uency
3-Week gallery ses-
sions: discussion-based
art-viewing (30 min-
utes, 2–3 artworks)
and art-making
(60 minutes) in a
studio
Led by an art educator
and an art therapist
Dulwich Picture
Gallery
Semi-
structured
interviews
with PWD
and carers pre-
and 4 weeks
post-partici-
pation
Audio
recordings of
art-making
sessions
Mixed-
methods
Pre-post
design
Content anal-
ysis for out-
comes relating
to cognition
from inter-
views and
art-making
sessions (not
art viewing)
Thematic
analysis on
carer post-in-
terviews
Patterns of increased episodic
memory from pre-interviews
across the sessions and main-
tained at follow-up. A more
ambiguous increase in verbal
uency (a slight decrease in
disuencies) from pre-inter-
view across the sessions and
not maintained at follow-up.
Both consisted of much uc-
tuation across sessions
Carer reports corroborated
these improvements
Themes: social activity, PWD
becoming their old selves,
shared experience
(Continued)

Psychological & social impacts of museums
13
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Flatt et al.
(2015)
USA
Quality rating
score:
Qualitative
85%
Quantitative
82%
PWD (n = 8)
Early-stage
dementia (n = 6)
(Alzheimer’s) and
related cognitive
disorders (n = 2).
Referred to as
ADRD
Age (60+)
Five female
Eight Caucasian,
two African
American
Carers (n = 10)
Family
To explore
the subjec-
tive expe-
riences of
people with
ADRD and
their carers
of a museum
activity
A one-time art
museum activity:
a discussion-based
guided tour (60 min-
utes, 4 artworks) and
an art-making studio
activity (120 minutes).
Four one-off sessions
were held
Led by a museum
educator
The Andy Warhol
Museum
Unvalidated
brief satisfac-
tion survey
Focus groups
using a script
to guide the
interview
(n = 4; 4–7
participants,
30 minutes)
Both took
place immedi-
ately after the
intervention
Field notes
Cross-
sectional,
qualitative
Thematic
analysis
Descriptive
and statistical
analysis for
the satisfac-
tion survey
Key themes: cognitive stimu-
lation, social connections and
self-esteem
In addition, themes of pro-
grammatic issues such as
activity-specic concerns and
program logistics were iden-
tied that could help improve
future art programmes
Participants enjoyed the
art-making most followed by
the group interactions (rated
higher by people with ADRD
than carers) and the guided
art discussion
Overall satisfaction related to
having previous art/museum
experience and to perceived
social cohesion, including a
sense of and positive feelings
of morale
(Continued)

International Journal of Ageing and Later Life
14
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Johnson et al.
(2017)
UK
Quality rating
score:
Quantitative
82%
PWD (n = 36)
Early-to-mid stages
of dementia
2 early onset
Alzheimer’s,
17 Alzheimer’s,
5 FTD, 4 Vascular,
8 mixed
25 male
Age (58–85, M = 74)
Living at home
Carers (n = 30)
Could attend with
or without carer
To compare
the impact of
two museum
activities
and a social
refreshment
break on the
subjective
wellbeing
of PWD and
their carers
Group object han-
dling (45 minutes)
and art-viewing (45
minutes) with a social
refreshment break in
the middle (shorter in
duration). 11 sessions
in total. 4–8 people in
a group.
Included facilitator
and volunteers. Same
facilitator for all
sessions.
Museum in South East
England
Subjective
wellbeing pre-
and post- activ-
ities (4 time
points): Visual
Analog Scales
(VAS) happy/
sad, well/
unwell, inter-
ested/bored,
condent/
not condent,
optimistic/not
optimistic
Feedback
questionnaire
Quasi-
experimental
Mixed 2×4
repeated-
measures
crossover
design with
two groups:
PWD and
carers
Signicant improvements in
wellbeing during both activi-
ties (irrespective of order) but
not in the refreshment break
for both PWD and carers
This increase was not
signicantly greater after
object handling than
art-viewing
Positive feedback on partic-
ipant experiences: 91% used
positive adjectives and 6%
neutral. 55% said preferred
object handling, 36% art-view-
ing, 9% both equally
(Continued)

Psychological & social impacts of museums
15
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
MacPherson
et al. (2009)
Australia
Quality rating
score:
Qualitative
70%
Quantitative
82%
Only partic-
ipants with
mild-to-mod-
erate dementia
(community
group) are
included as
group inter-
ventions, and
ndings were
conducted and
reported sepa-
rately for those
with moder-
ate-to-severe
dementia
(residential
group)
PWD (n = 7)
Mild-to-moderate
dementia. CDR = 4
mild, 3 moderate
Living at home
Age (56–80,
M = 70.8)
Accompanied by
an Alzheimer’s
Australia volunteer
Presence and role
of carers is unclear
Measure of
behaviours
associated with
dementia that
cause carer stress
completed (only
pre-intervention)
A pilot study
to assess
whether
PWD could
engage with
an art-view-
ing activity
in a gallery
and explore
the impact
of this for
participants
Ongoing programme
6-Week art-viewing
group sessions (45–60
minutes, 4 artworks).
1 all male and 1 all
female group
Groups facilitated by
the same 2 gallery
educators
National Gallery of
Australia (NGA)
Video-recorded
sessions for
behavioural
analysis
Focus groups
6 weeks
post-interven-
tion with PWD,
carers and
educators
Mixed-
methods
Mixed-subject
design. Time
sampling
methods
to analyse
engagement.
(Weeks 1 and
5 coded to see
change over
time)
Grounded
theory to
analyse
focus group
transcripts
No signicant differences in
engagement between sessions
1 and 5 suggesting partici-
pants started off and remained
engaged throughout
No signicant main effects for
type of participant (commu-
nity vs residential) or session
(1 or 5)
Focus groups:
PWD: enjoyment of the pro-
gramme, engagement and
intrinsic benets independent
of having dementia, normali-
sation and discovery of resid-
ual abilities, social aspects,
future of the programme
Carers: recall, enjoyment,
social aspects and (no) last-
ing change. Logistical issues
and improvements to the
programme
Educators reports likely
across both groups (commu-
nity and residential): initial
expectations and subsequent
experience, gaining skills.
Enjoyment/condence and
memory stimulation in PWD
(Continued)

International Journal of Ageing and Later Life
16
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
McGuigan
et al. (2015)
New Zealand
Quality rating
score:
Qualitative
80%
Quantitative
68%
PWD (n = 8)
Severity of demen-
tia not specied
but noted all par-
ticipants could
provide their own
written consent
Age (73–90)
Three men
Six Alzheimer’s,
one mixed, one
vascular
Carers (n = 8)
Five spouses, three
children
A prac-
tice-based
pilot study.
To explore
the expe-
riences of
a muse-
um-based
programme
for PWD and
their carers
An addi-
tional aim of
the museum
was to
consider
the devel-
opment and
delivery to
develop the
programme
for future
use, the
programmes
development
and imple-
mentation
6-Week museum
programme (120
minutes: 20–30
minutes settling in,
35–40 minutes activity,
refreshments provided
after). Sessions took
place in the members’
lounge or gallery
and included the use
of objects or images
alone, a combination
of both, and three
different gallery tours
Led by museum vol-
unteer guides with
training to increase
their understanding of
dementia. A special-
ised tour style with
“occasional opportuni-
ties for participants to
speak”
Focus was on an inter-
vention PWD and cares
could do together –
equal focus
Auckland Museum
Participant
observation by
independent
researcher
Focus groups
at completion
(n = 2, 2 with
carers, 1 with
volunteers,
60–90 minutes).
Did not include
PWD
Individual
interviews with
Alzheimer’s
Auckland and
museum staff
Feedback
sessions with
volunteers and
museum staff
Mixed-
methods
Time-
sampling to
evaluate atten-
tiveness using
unvalidated
scale and
continuous
observation in
rest of sessions
Thematic anal-
ysis for focus
groups and
interviews
Average attentiveness
remained high on average
across the sessions. PWD
were found to be most
attentive in the session who
used both objects and images
and overall in sessions in
the lounge compared with
the gallery
No statistical analysis
Key themes: socialisation,
programme delivery,
shared experiences and
practical issues
Noted using objects in
isolation was difcult for
PWD without contextualising
images and due to facilitators
moving to the next topic
whilst the previous object was
being passed on, putting extra
demands on attention to split
this between the object and
facilitator
(Continued)

Psychological & social impacts of museums
17
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Schall et al.
(2018)
Germany
Quality rating
score:
Qualitative
70%
Quantitative
79%
PWD (n = 44)
Mild-to-moderate
dementia
Living at home
23 female
32 Alzheimer’s dis-
ease, 7 vascular, 2
Parkinson’s disease
dementia, 3 unclear.
Age (51–93, M =
75.1, SD = 7.70 in
the intervention
group and 76.4
years, SD = 8.68 in
the wait-list control
group)
54.5% had a uni-
versity or similar
higher education
degree. 4.5% had
no vocational
qualications
Carers (n = 44)
Spouses (56.8%)
or adult children
(31.8%)
To explore
the impact
of the ART
Encounters:
Museum
Intervention
Study
(ARTEMIS)
on PWD and
their carers
A subsample
of a related
study
Intervention group
(25 dyads): 6-week
group guided art tour
(60 minutes, different
themes, 4–8 people)
and an art-making
activity in studio
(60 minutes, where
carried out tasks
in pairs). Total of
13 groups
Staff had dementia
training based on the
TANDEM training
model
Frankfurt Stadel
Museum
Control group
(19 dyads): indepen-
dent museum visits
4 months prior to the
intervention
Standardised
measures
PWD: cognitive
status (MMSE
and ADAS-
Cog), Geriatric
Depression
Scale (GDS),
Quality of Life
in Alzheimer’s
Disease
(QoL-AD), NPI
PWD and
carers well-
being: self-
rating Smiley
Scale pre-post
each session/
museum visit
Carers subjec-
tive evaluations
of PWD after
each session
Randomised
wait-list con-
trolled study
Mixed-
methods
Pre-post mea-
sures a few
days before/
after the
intervention
Follow-up
assessments
with carers
3 months
later
Signicant pre-post improve-
ments for self-reported QoL
for PWD in the intervention
group when compared with
the control group, who had a
positive non-signicant trend
Signicantly improved total
NPI scores and the subscales
affective (depression and
anxiety) and apathy post-
intervention and signicant
improvement in apathy in the
control group
Signicant positive increase
in emotional wellbeing pre-
post each intervention session
for PWD with medium effect
sizes
Subjective evaluations by
carers “largely conrm the
positive impact on emotional
state and wellbeing”
(Continued)

International Journal of Ageing and Later Life
18
Table 2. (Continued)
Study/quality
rating Sample Aims Intervention Measures/
evaluation
Design/
methodology Key ndings
Young et al.
(2015)
UK
Quality rating
score:
Quantitative
82%
PWD (n = 13)
Early-to-mid stage
dementia. Inclusion
criteria: MMSE
score between 10
and 24
11 female
All White British
Age (group 1:
60–94, M = 78.8,
group 2: 73–91,
M = 81.6)
Carers (n = 13)
To inves-
tigate the
impact of
art-mak-
ing and
art-viewing
on verbal
uency and
memory
Built on
Eekelaar
et al. (2012)
to increase
sessions and
explore both
art activities
8-Week discus-
sion-based art-viewing
(60 minutes, 1 art-
work) and art-making
in studio (60 minutes).
In weeks 2 and 8 asked
to bring in “interesting
objects” to also pass
around and discuss.
Total of two groups
Led by an artist educa-
tor who had dementia
awareness training
Contemporary art
gallery
Audio
recordings of
art-viewing
and art-making
sessions
(6.25% data
missing due
to failed audio
recordings)
Quantitative
content
analysis on
group data
Data
presented
graphically
as statistical
analysis was
not possible
Verbal uency: disuencies
decreased and semantic clus-
tering increased in both art
activities from the rst to nal
sessions. Disuencies were
more improved in art-making
sessions and semantic cluster-
ing in art-viewing
Reports of lifetime memories:
overall increase from rst to
last sessions in both sessions,
and more so in art-viewing
However, these ndings were
not linear and considerable
uctuation occurred between
sessions
Exit interviews: carers
reected positive impact of
the groups (not mentioned
before the discussion)

Psychological & social impacts of museums
19
of pre-post and cross-sectional designs and quasi-experimental designs,
including one waitlist randomised controlled trial. Studies broadly aimed
to investigate the experiences or impacts of museum-based interventions
on PWD (and, to a lesser extent, their carers) in a range of domains such
as subjective wellbeing, cognitive functioning, engagement, quality of life
and mood. In addition, one study compared two museum-based interven-
tions, and two studies also sought to develop a conceptual understanding.
All interventions took place in public art galleries or museums, in either
or both the main galleries and private rooms. The length of interventions
varied from one-off sessions to 8-week programmes, and sessions ranged
from 45 minutes to 3 hours. Of the interventions used, seven included
both art-viewing and art-making components (one of which also asked
part ic ipants to bring in objec ts to share in two of eight session s), two st ud-
ies consisted of art-viewing only, one compared art-viewing and object
handling, and one used only images, only object handling, a combina-
tion of both and gallery tours. The majority of interventions included a
discussion-based exploration of art and involved facilitators with some
training in dementia awareness or working with PWD. In addition, all
interventions included carers. Some interventions were designed equally
for carers and PWD, others noted carers were invited as support for PWD,
and one study stated carers were optional, but most attended with a carer.
The role of carers in one study was not specied. The majority of car-
ers not only were family members but also included close friends, paid
carers and staff. Data collection varied from in-the-moment measures to
those several weeks post-intervention. Some measures relied more on the
self-reports of PWD and others on the observations of researchers or car-
ers. The studies took place in Australia, Germany, the UK and the USA.
Quality check and critique of studies
The overall scores of studies ranged from 68% to 91%. Overall, studies
stated their aims clearly and used appropriate designs to address these.
Most included small sample sizes (range = 6–44). This was deemed appro-
priate for one quantitative study. However, for many studies, this was
rated as only partially appropriate, particularly given the use of statistical
tests and general lack of power calculations, or the inability to conduct sta-
tistical tests and instead rely on drawing interpretations from descriptive

International Journal of Ageing and Later Life
20
data. One study did include power calculations, but their sample size was
smaller than that specied for some calculations.
In relation to the recruitment of participants, studies were typically
lacking in replicable detail around recruitment methods and procedures.
All studies were rated as partially meeting the quality criteria in this
domain, given the opportunity samples used. Authors demonstrated
some awareness of this limitation in which samples may be biased to
include people who have an interest in the arts.
The range of participant characteristics reported varied across the
studies, although all but one study was rated as giving sufcient infor-
mation. This study provided fewer characteristics and did not specify
the sex of participants or where they were residing. One study did not
specify the level of dementia severity but did note participants could
consent for themselves. Several did not report the subtypes of demen-
tia of people within the sample. These characteristics were not central
to the research questions but can make it difcult to compare samples
across studies.
Overall, studies did not control well for confounds. Few studies used a
control group, and only one was able to randomly allocate to groups and
used an appropriate method for this. However, comparability of baseline
characteristics was conducted for a few studies.
Measures for outcomes were generally well reported and explained,
including non-standardised measures. These were appropriate, again
given the studies’ exploratory nature. For example, two studies used
quantitative content analysis as a novel way to explore data in a natu-
ralistic setting, which, whilst not as robust as validated measures, was
appropriate to the aims of the study to use non-obtrusive methods to cap-
ture in-the-moment change. A range of measures were used to explore
diverse outcomes (including psychological, social, cognitive and, whilst
not a focus of this study, physiological) sometimes using different tools
across studies for the same domain. This can make it more difcult to
compare studies and also reects the widely reported difculty of den-
ing concepts such as “wellbeing” (Dodge et al. 2012). It should be noted
that “wellbeing” is an outcome in the studies included here, rather than
an intervention.

Psychological & social impacts of museums
21
Quantitative analytical methods were often well described and appro-
priate. However, there were instances in which statistical tests were not
conducted, without a clear rationale for their omission. In other cases,
statistical tests were run for some parts of the data and not others, again
without a clear rationale. It is possible this was due to small sample sizes
but could also be due to only reporting tests that were run and yielded
signicant results, thus giving an incomplete picture of the analysis.
Variance was often not adequately reported, only providing standard
deviations.
Qualitative data collection methods were generally described well and
were transparent and could, therefore, be replicated (Aguinis & Solarino
2019), with the exception of two studies, which did not give sufcient
detail about the focus of interviews or focus groups. Qualitative method-
ologies varied from descriptive to thematic analysis and grounded the-
ory. These were typically well explained with supporting quotes, and all
but one study reported some method to increase credibility, including
the triangulation of data, peer reviews and inter-rater reliability. How-
ever, only two studies reported using reexivity, and none specically
described how their own characteristics may have inuenced the data.
Qualitative analyses were only partially explained in some instances.
These included having few supporting quotes to allow a judgement to be
made on the appropriateness of the interpretation in one study, and not
clearly describing the analytical procedure, so that it could be sufciently
understood.
Results were reported in sufcient detail and had logical conclu-
sions. Where descriptive results were interpreted as support for positive
changes in a domain, conclusions presented this evidence more tenta-
tively, acknowledging the limitations within the methodology. This was
appropriate and prevented ndings from being overstated.
Themes
Given the overlap in the outcomes and themes of the studies’ ndings,
these were synthesised thematically through a reexive process of re-read-
ing studies to identify and rene themes.

International Journal of Ageing and Later Life
22
Psychological outcomes: mood and enjoyment
Overall, improved mood and enjoyment were important aspects of the
interventions.
Although quantitative results connected with mood and enjoyment
were mixed, they suggested that positive outcomes were not maintained
over time (D’Cunha et al. 2019; Schall et al. 2018).
In qualitative studies, improved mood and enjoyment featured consis-
tently as benets of the interventions identied by PWD (Flatt et al. 2015;
Johnson et al. 2017; MacPherson et al. 2009). Burnside et al. (2017) high-
lighted “enjoyment,” and Eekelaar et al. (2012) identied the theme PWD
“becoming old selves,” which included the subtheme “improvement in
mood.” Enjoyment was reported both during and after the interventions
by D’Cunha et al. (2019).
Two studies investigated the specic components of the interven-
tion that might have contributed to enjoyment, in more depth. In John-
son et al. (2017), preferences of the experienced art activities were rated
equally (object handling and art-viewing). Flatt et al. (2015) found partic-
ipants enjoyed the components of the intervention in the following order
from the most enjoyable: art-making (rated signicantly higher than the
following two components), group interaction, and guided art discussion.
Finally, two studies (MacPherson et al. 2009; Schall et al. 2018) draw-
ing on carers’ and/or facilitators’ perspectives regarding the impact of
interventions on PWD also reported benets to mood and enjoyment
levels. MacPherson et al.’s (2009) analysis of carers’ reports in relation to
PWD resulted in the theme “enjoyment,” with one carer noting, “you do
it for the moment” (p. 748). Schall et al. (2018) descriptively reported car-
ers’ subjective evaluations of PWD during sessions. These reected fre-
quent expressions of positive emotion by PWD during creative activities
such as those based on biographical themes and when drawing to music.
The authors noted the reports “largely conrm the positive impact on
the emotional state and well-being” (p. 738) reected in their quantitative
ndings. Quotes from open-ended questions also referred to PWD expe-
riencing enjoyment.
Clearly, notwithstanding the mixed results from quantitative mea-
sures, the reviewed papers suggest enjoyment and improved mood for
PWD are two important potential benets of the interventions.

Psychological & social impacts of museums
23
Subjective wellbeing
The ndings from the studies reviewed provide support for museum-
based programmes having a positive impact on subjective wellbeing.
Employing a measure of general wellbeing questionnaire (GWQ),
D’Cunha et al. (2019) found an increase between weeks 1 and 3, which was
maintained at week 6. Johnson et al. (2017) found subjective wellbeing to
signicantly increase pre-post both art-viewing and object handling ses-
sions but not for a refreshment break for both PWD and carers, suggesting
wellbeing was impacted by the art activities over and above socialisa-
tion and refreshments. There was not a statistically signicant difference
between art viewing and object handling. Schall et al. (2018) also used a
visual subjective wellbeing measure (Smiley Scale) pre- and post-interven-
tion and control group sessions, nding signicant improvements follow-
ing the intervention and a non-signicant but slightly positive trend in
the control group. Comparisons between each of the intervention sessions
with the control group showed an overall majority of medium effect sizes.
Personhood
Findings highlight the potential for museum-interventions to support the
personhood of PWD.
Several qualitative studies identied concepts relating to personhood
as themes in their analysis. Burnside et al. (2017) developed a concep-
tual model comprising themes of “personal growth” and “preservation
of personhood.” They also highlighted “personhood” as one of several
incorporated themes that made up “mindfulness,” which was reported
to contribute to the process and essence of the intervention. Camic et al.
(2016) also noted that both others and the gallery setting contributed to
“a sense of normalcy, equality and personhood.” MacPherson et al. (2009)
identied themes of “normalisation and discovery of residual abilities”
relating to being treated by others as normal and having the ability to
do things despite dementia. Flatt et al. (2015) identied the theme “self-
esteem” referring to the positive feelings expressed when discussing the
intervention. This theme comprised the subthemes “feeling accepted or
a sense of normalcy,” “a sense of autonomy or control or mastery” and
“feeling special or important.”

International Journal of Ageing and Later Life
24
Cognition
Memory and verbal uency were two specic cognitive domains that
featured in the reviewed literature. Overall, the ndings suggest art gal-
lery and museum interventions were cognitively stimulating and may
improve aspects of memory and verbal uency in PWD; however, these
positive effects may not be maintained over time.
In qualitative analyses (Camic et al. 2014, 2016; Eekelaar et al. 2012;
MacPherson et al. 2009; McGuigan et al. 2015), memory emerged as a
commonly reported theme. Memory is a broad concept, and the studies
referred to a range of processes, including “memory stimulation,” “recall”
(MacPherson et al. 2009), “engagement and new learning” (Camic et al.
2014) and “cognitive stimulation” (Flatt et al. 2015). McGuigan et al. (2015)
referred to subthemes “nostalgia,” “memories inspired by the sessions”
and “other memories.” Eekelaar et al. (2012) identied the subthemes
“recalling memories” and “increased verbalizations.” They found an
overall increase in episodic memory frequencies from pre-interviews
across sessions which were maintained at follow-up (including some
variability). The authors noted these ndings were corroborated by qual-
itative ndings.
Camic et al. (2016) reported a superordinate category of “intellec-
tual stimulation” referring to a learning experience rather than merely
reminiscence.
Eekelaar et al. (2012) found overall improvements in verbal uency (as
explored through disuent speech and semantic clustering) from pre-in-
terviews to art-making sessions, but these were not maintained at fol-
low-up. Disuencies in speech only decreased slightly during art-making
(and include some anomalies), which the authors acknowledge as a more
ambiguous nding. Building on Eekelaar et al. (2012), Young et al. (2015)
reported that both disuencies and sematic clustering improved in both
art-viewing and art-making activities from the rst (or second session
where there was missing data) to the nal session. Lifetime memory
reporting was also found to increase from the rst to nal sessions in
both art activities, with a bigger impact during art-viewing than art-mak-
ing (increase of 7.18% and 4.08%, respectively). However, changes in ver-
bal uency and memory were not linear and uctuated considerably
from session to session, which the authors note presents challenges when

Psychological & social impacts of museums
25
trying to draw denitive conclusions without looking in more depth at
the content of session discussions.
Other ndings also related to whether positive cognitive effects were
maintained after the intervention. D’Cunha et al. (2019) reported a pre-
post intervention increase in cognitive function (using the Mini-Ad-
denbrooke’s Cognitive Examination) in both the overall score and the
subdomains of “immediate recall” and “verbal uency,” but this was not
maintained 6 weeks later. Improvements in verbal uency from pre-inter-
views to art-making sessions in Eekelaar et al. (2012) were similarly not
maintained at follow-up.
Engagement
Overall, ndings indicate that the art programmes engaged PWD in a vari-
ety of ways (including with the artwork and others present). Qualitative
and quantitative results alike indicated that engagement was an import-
ant feature of the interventions. In the context of the studies reviewed,
“engagement” referred to being involved in the art activity, being atten-
tive and communicative, as well as participants feeling connected with
others.
Thus, for Burnside et al. (2017), “engagement” encompassed partici-
pant responses including communication with the facilitator, the pro-
cess of the art activity and the feeling of connected with others, whilst
in Camic et al. (2016), the subthemes “engagement” included different
perspectives on engaging with art from positive to feeling overwhelmed
or discomfort.
Quantitative methods enabled some researchers to capture high levels
of engagement experienced by PWD. MacPherson et al. (2009) explored
changes in engagement. No signicant differences were found between
sessions 1 and 5, which the authors note suggests participants began and
remained engaged throughout. Only a small proportion of negative or
neutral observations was made (less than 10% across groups). McGuigan
et al. (2015) found that the average attentiveness of PWD remained high
across sessions. This study found higher mean scores in sessions held in
a members’ lounge (however several members were also observed to fall
asleep) compared with the sessions involving gallery tours. However,

International Journal of Ageing and Later Life
26
the authors considered the potential impact of the increased difculty in
observing participants in the gallery in relation to this nding. PWD were
found to be most attentive in a session that used both objects and images.
The authors recommend this combination for maximising engagement
opportunities.
Other studies reported more mixed results. D’Cunha et al. (2019)
found that behavioural observations showed no changes in prompted or
unprompted discussion, sleeping or negative emotions. However, they
did nd an increase in happiness and laughter between sessions 1 and
2. Eekelaar et al. (2012) found factual observations and opinions made by
PWD in response to art works decreased during art-making sessions and
rose again at follow-up, with some individual variability at follow-up in
factual observations. The frequencies of emotional reactions to paintings
occurred at a similar rate both pre- and during sessions and decreased
in post-interviews; however, individual data show variability. Solicit-
ing information (seeking knowledge and requesting guidance) was also
observed. Seeking knowledge showed similar levels at pre- and during
sessions, which dropped at post-interview, but with inconsistent individ-
ual patterns. One PWD displayed direct requests of guidance to facilita-
tors (about what to do or say) and more so in sessions than in pre–post
interviews.
Social outcomes
Overall, the studies highlighted a broad range of social benets of the
interventions.
McGuigan et al. (2015) identied themes of “socialisation,” includ-
ing subthemes of “connecting with others,” “novelty,” “re-engagement
with the museum,” “opening up another venue to visit” and the theme
“shared experiences.” Eekelaar et al. (2012) identied themes of “social
activity” and subthemes of (reduced) “isolation” and “structure,” and the
theme “shared experience,” with subthemes of “learning together” and
“making art together.” Camic et al. (2014) identied the theme “social
impact” and subcategories of “social aspect of the group” and “caring
relationship.” Camic et al. (2016) also reported a superordinate category
of “social interaction” with associated subcategories of “carer respite
and support” and “interaction.” Flatt et al. (2015) identied “social

Psychological & social impacts of museums
27
connections” as a theme with the subthemes “connecting with others”
and “how others shaped the experience.” In addition, they found peo-
ple with early-stage Alzheimer’s disease or related cognitive disorders
to rate the group interactions signicantly higher regarding enjoyment
than their carers.
MacPherson et al.’s (2009) theme “social aspects” not only included
positive elements of social contact but also expressed concerns such as
“making an idiot of self.” In addition, an identied theme from carers
reports was “social aspects and [no] lasting change,” whilst a theme from
the comments of session facilitators was “excess disability,” where PWD
displayed less condence when their carers’ were present. Burnside et al.
(2017) developed a conceptual model that identied the process and
essence of the intervention as the theme “mindfulness,” incorporating
themes including “socialisation” and “joint respite.” Their model high-
lighted an outcome of relationship effects comprising themes of “rela-
tionship normalising,” collaborating and removing the stigma associated
with dementia, “relationship afrming” in relation to the current bonds
and “relationship growth” together in a meaningful experience.
Discussion
This review has investigated the psychological and social impacts of
museum-based programmes for people living with a mild-to-moderate
dementia. A synthesis of the ndings of the 11 reviewed studies has high-
lighted key themes across the literature in relation to these impacts.
The papers reviewed here were largely exploratory in nature. Due in
part to the practical restraints imposed by conducting research in nat-
uralistic settings, sample sizes were small. As a result, any conclusions
must be drawn tentatively, something the studies tended to acknowledge
appropriately. With this caveat in mind, this review offers observations
regarding key themes, acknowledging the evidence reviewed and its
limitations.
Clear themes emerging across both qualitative and quantitative stud-
ies included social benets, improvements in mood (although quantita-
tive ndings were mixed) and enjoyment. These reect the ndings of a
previous review of museum programmes in a more general older adult
population (Smiraglia 2016).

International Journal of Ageing and Later Life
28
The theme of cognition was also evident and is more broadly explored
in a review by Young et al. (2016). Papers utilising quantitative methods
were again limited in the conclusions they could draw in relation to these
ndings. Sample sizes meant statistical analyses were unable to be run,
instead descriptive frequencies and improvements were reported where
small increases in measures were observed. At times, these observations
appeared to obscure the substantial uctuation in scores that occurred
between sessions. However, as exploratory studies employing novel
methods that seek to capture changes during sessions, rather than simply
pre- and post, these emerging ndings are promising.
Themes of subjective wellbeing, of which PWD are important infor-
mants (Kaufmann & Engel 2014), and personhood, relating to the concept
dened by Kitwood (1997), were also reported in a number of reviewed
studies and highlight the interventions as valuing PWD in a society
where much stigma still exists (Batsch & Mittelman 2012). These stud-
ies demonstrate that whilst stigma continues to negatively affect the self-
worth of people who live with dementia, art gallery and museum-based
interventions can help ameliorate this.
Across the themes identied by this review, ndings from quantita-
tive measures were often mixed, which may reect methodological lim-
itations discussed, such as small sample sizes and a lack of power or,
indeed, reect a differential impact of different interventions. However,
much overlap was found in the qualitative themes across the studies, sug-
gesting a range of benets for PWD. This nding supports Camic et al.’s
(2014) assertion of the value of using mixed-method designs in the face of
small sample sizes, as qualitative information can be useful in exploring
the impact of interventions in the face of these issues.
Overall, the studies reviewed offered evidence that art gallery and
museum-based interventions can be engaging and have a range of ben-
ets pertaining to the psychological and social wellbeing of PWD. The
ndings also reect wider literature promoting the positive benets of
museum settings and interventions for PWD (Camic & Chatterjee 2013).
Therefore, it is recommended that health and social care professionals
partner with local public health departments, museums and art galler-
ies, to consider making these interventions more widely available and
explore ways to increase access. This is in line with recommendations for

Psychological & social impacts of museums
29
improving dementia care, such as those outlined in the Prime Minister’s
Challenge on Dementia (DOH, updated from 2012 in 2020), social pre-
scribing (NHS England 2019) and public health interventions (Camic &
Chatterjee 2013).
Research considerations
Art galleries and museums in many countries now offer programmes and
activities for PWD and their carers. What their future roles will be for
dementia care within a public health framework – and how that will be
funded – remains an area of discussion. The role of social prescribing may
have an important impact here. Knowing what the most relevant out-
comes are to assess also needs careful consideration. Wellbeing and qual-
ity of life are aligned with the concept of personhood (Kitwood 1997) and
a more holistic and positive psychological approach to care (Stoner et al.
2019). This cuts across all types of dementia and levels of impairment and
provides additional outcomes to consider other than outcomes limited
to a cognitive domain (e.g. memory, thinking, language and judgement).
Pursuing mixed-methods studies (Camic et al. 2014) and including
more wait-list controlled studies, as conducted by Schall et al. (2018),
to clarify the factors that benets may be attributed to will contribute
towards a more robust evidence base, sensitive to the realistic issues faced
in these settings. In turn, this could positively impact funding and guide
policy in this area.
Limitations of this review
The Qualsyst tool (Kmet et al. 2004) used to assess the quality of the stud-
ies was appropriate, given its ability to guide critique on both quantitative
and qualitative studies. However, despite clear questions and an adequate
guide, there is still room for subjective interpretation.
This review sought to control for some confounds of the stage of
dementia and setting by limiting its inclusion criteria to those living
with a mild-to-moderate dementia and interventions based exclusively in
heritage settings. Therefore, the ndings may only be applicable to these
specied settings and population. Future reviews could seek to compare

International Journal of Ageing and Later Life
30
outcomes for those with a mild-to-moderate and moderate-to-severe
dementia, or in authentic heritage settings versus outreach interventions,
to understand what impact these factors may have.
Given the focus of the research question, there was scope to consider
other themes neither in the studies’ ndings, such as the museum setting,
facilitation and logistics, nor in the ndings relating to carers, facilita-
tors or functional and physiological ndings (of which there were fewer
reported ndings). These may lend themselves more to the processes and
practical features in improving future interventions, which were not the
focus of this review.
Conclusion
Art gallery and museum-based programmes are increasingly recognised
as having the potential to engage PWD in the community and to positively
impact wellbeing. However, there is a recognised lack of methodological
rigour and research funding, which consequently limits the quality of the
evidence-base. This systematic review has extended understanding of the
psychological and social impacts of these interventions for people living
with a mild-to-moderate dementia. Themes relating to psychological out-
comes comprised mood and enjoyment, subjective wellbeing, and person-
hood; other key themes were cognition, engagement and social outcomes.
These positive ndings suggest that museum-based interventions for peo-
ple with a mild-to-moderate dementia can offer a range of valuable bene-
ts to this population in these domains.
Corresponding Author
Hanna Zeilig, London College of Fashion, University of the Arts, London.
20 John Prince’s St, London W1G 0BJ, United Kingdom. Email: h.zeilig@
fashion.arts.ac.uk.
References
Aguinis, H. & Solarino, A. M. (2019). Transparency and replicability in
qualitative research: The case of interviews with elite informants.
Strategic Management Journal 40: 1291–1315. doi: 10.1002/smj.3015

Psychological & social impacts of museums
31
All-Party Parliamentary Group on Arts, Health and Wellbeing. (2017).
Inquiry Report. Creative Health: The Arts for Health and ellbeing. UK:
All-Party Parliamentary Group on Arts, Health and Wellbeing. Avail-
able on http://www.artshealthandwellbeing.org.uk/appg-inquiry/
Publications/Creative_Health_Inquiry_Report_2017.pdf (Accessed:
January 10, 2021).
Alzheimer’s Disease International. (2019). World Alzheimer Report 2019: Atti-
tudes to Dementia. London: Alzheimer’s Disease International. Avail-
able on https://www.alzint.org/u/WorldAlzheimerReport2019.pdf
(Accessed: January 10, 2021).
Alzheimer’s Society. (2017). The Dementia Guide: Living Well after Diag-
nosis. Available on https://www.alzheimers.org.uk/sites/default/
les/2020-03/the_dementia_guide_872.pdf (Accessed: January 2, 2021).
Batsch, N. L. & Mittelman, M. S. (2012). World Alzheimer Report 2012: Over-
coming the Stigma of Dementia. UK: Alzheimer’s Disease International.
Available on https://www.alz.co.uk/research/world-report-2012
Burnside, L. D., Knecht, M. J., Hopley, E. K. & Logsdon, R. G. (2017).
Here:now – Conceptual model of the impact of an experiential arts
program on persons with dementia and their care partners. Dementia
16: 29–45. doi: 10.1177/1471301215577220
Camic, P. M., Baker, E. L. & Tischler, V. (2016). Theorizing how art gallery
interventions impact people with dementia and their caregivers. The
Gerontologist 56: 1033–1041. doi: 10.1093/geront/gnv063
Camic, P. M. & Chatterjee, H. J. (2013). Museums and art galleries as part-
ners for public health interventions. Perspectives in Public Health 133:
66–71. doi: 10.1177/1757913912468523
Camic, P. M., Hulbert, S. & Kimmel, J. (2019). Museum object handling: A
health-promoting community-based activity for dementia care. Journal
of Health Psychology 24: 787–798. doi: 10.1177/1359105316685899
Camic, P. M., Tischler, V. & Pearman, C. H. (2014). Viewing and making
art together: A multi-session art-gallery-based intervention for people
with dementia and their carers. Aging & Mental Health 18: 161–168. doi:
10.1080/13607863.2013.818101
Chatterjee, H. J., Camic, P. M., Lockyer, B. & Thomson, L. J. (2018). Non-clini-
cal community interventions: A systematised review of social prescribing
schemes. Arts & Health 10: 97–123. doi: 10.1080/17533015.2017.1334002

International Journal of Ageing and Later Life
32
Cohen-Manseld, J., Marx, M. S., Thein, K. & Dakheel-Ali, M. (2011). The
impact of stimuli on affect in persons with dementia. The Journal of
Clinical Psychiatry 72: 480–486. doi: 10.4088/JCP.09m05694oli
Cousins, E., Tischler, V., Garabedian, C. & Dening, T. (2019). Principles
and features to dene and describe arts interventions for people
with dementia: A qualitative realist study. Arts & Health 11: 202–218.
doi: 10.1080/17533015.2018.1490787
D’Cunha, N. M., McKune, A. J., Isbel, S., Kellett, J., Georgousopoulou, E.
N. & Naumovski, N. (2019). Psychophysiological responses in peo-
ple living with dementia after an art gallery intervention: An explor-
atory study. Journal of Alzheimer’s Disease 72: 549–562. doi: 10.3233/
JAD-190784
Department of Health. (2012). Prime Minister’s Challenge on Dementia:
Delivering Major Improvements in Dementia Care and Research by 2015.
London: Older People and Dementia Team. Available on https://
www.gov.uk/government/publications/prime-ministers-chal-
lenge-on-dementia (Accessed: December 15, 2020).
Department of Health. (2020). Prime Minister’s Challenge on Dementia 2020.
Available on https://assets.publishing.service.gov.uk/government/
uploads/system/uploads/attachment_data/le/414344/pm-demen-
tia2020.pdf (Accessed: December 15, 2020).
Dodge, R., Daly, A. P., Huyton, J. & Sanders, L. D. (2012). The challenge
of dening wellbeing. International Journal of Wellbeing 2: 222–235.
doi: 10.5502/ijw.v2i3.4
Eekelaar, C., Camic, P. M. & Springham, N. (2012). Art galleries, epi-
sodic memory and verbal uency in dementia: An exploratory study.
Psychology of Aesthetics, Creativity, and the Arts 6: 262–272. doi: 10.1037/
a0027499
Flatt, J. D., Liptak, A., Oakley, M. A., Gogan, J., Varner, T. & Lingler,
J. H. (2015). Subjective experiences of an art museum engagement activ-
ity for persons with early-stage Alzheimer’s disease and their family
caregivers. American Journal of Alzheimer’s Disease & Other Dementias
30: 380–389. doi: 10.1177/1533317514549953
Grant, M. J. & Booth, A. (2009). A typology of reviews: An analysis of 14
review types and associated methodologies. Health Information and
Libraries Journal 26: 91–108. doi: 10.1111/j.1471-1842.2009.00848.x

Psychological & social impacts of museums
33
Johnson, J., Culverwell, A., Hulbert, S., Robertson, M. & Camic, P.M.
(2017). Museum activities in dementia care: Using visual analogue
scales to measure subjective wellbeing. Dementia 16: 591–610. doi:
10.1177/1471301215611763
Kaufmann, E. G. & Engel, S. A. (2014). Dementia and well-being: A con-
ceptual framework based on Tom Kitwood’s model of needs. Dementia
15: 774–788. doi: 10.1177/1471301214539690
Kinsey, D., Lang, I., Orr, N., Anderson, R. & Parker, D. (2021). The impact
of including carers in museum programmes for people with dementia:
A realist review. Arts & Health 13(1): 1–19. doi:10.1080/17533015.2019.
1700536
Kitwood, T. M. (1997). Dementia Reconsidered: The Person Comes First. Buck-
ingham: Open University Press.
Kmet, L. M., Lee, R. C. & Cook, L. S. (2004). Standard Quality Assess-
ment Criteria for Evaluating Primary Research Papers from a Variety
of Fields. Alberta, Canada: Alberta Heritage Foundation for Medi-
cal Research. Available on https://www.ihe.ca/advanced-search/
standard-quality-assessment-criteria-for-evaluating-primary-re-
search-papers-from-a-variety-of-elds (Accessed: Octember 20,
2020).
MacPherson, S., Bird, M., Anderson, K., Davis, T. & Blair, A. (2009).
An art gallery access programme for people with dementia: “You
do it for the moment.” Aging & Mental Health 13: 744–752. doi:
10.1080/13607860902918207
McCarthy, B. (2011). Hearing the Person with Dementia: Person-Centred
Approaches to Communication for Families and Caregivers. London: Jessica
Kingsley Publishers.
McGuigan, K. A., Legget, J. A. & Horsburgh, M. (2015). Visiting the
museum together: Evaluating a programme at Auckland museum for
people living with dementia and their carers. Arts & Health 7: 261–270.
doi: 10.1080/17533015.2015.1045531
Mittelman, M. & Epstein, C. (2009). NYU Aging and Dementia Research
Center Evaluation of Meet Me at MoMA. Available on https://assets.
moma.org/momaorg/shared/pdfs/docs/meetme/Resources_NYU_
Evaluation.pdf (Accessed: January 2, 2021).
National Collaborating Centre for Mental Health. (2018). The Demen-
tia Care Pathway: Full Implementation Guidance. London: All-Party

International Journal of Ageing and Later Life
34
Parliamentary Group on Arts, Health and Wellbeing. Available on
https://www.rcpsych.ac.uk/docs/default-source/improving-care/
nccmh/dementia/nccmh-dementia-care-pathway-full-implementa-
tion-guidance.pdf?sfvrsn=cdef189d_6 (Accessed: January 12, 2020).
National Institute for Health and Care Excellence. (2018). Dementia:
Assessment, Management and Support for People Living with Dementia
and Their Carers. NG97. UK: National Institute for Health and Care
Excellence. Available on https://www.nice.org.uk/guidance/ng97/
chapter/Recommendations#interventions-to-promote-cognition-in-
dependence-and-wellbeing (Accessed: Octember 15, 2020).
NHS England. (2019). Social Prescribing and Community-Based Support:
Summary Guide. England: NHS England. Available on https://www.
england.nhs.uk/publication/social-prescribing-and-community-
based-support-summary-guide/ (Accessed: Octember 15, 2020).
Schall, A., Tesky, V. A., Adams, A. K. & Pantel, J. (2018). Art museum-based
intervention to promote emotional well-being and improve quality
of life in people with dementia: The ARTEMIS project. Dementia 17:
728–743. doi: 10.1177/1471301217730451
Sharma, M. & Lee, A. (2020). Dementia-friendly heritage settings: A
research review. International Journal of Building Pathology and Adapta-
tion 38(2): 279–310. doi: 10.1108/IJBPA-01-2019-0005
Stephan, B. & Brayne, C. (2014). Prevalence and projections of dementia.
In M. Downs & B. Bowers (eds.), Excellence in Dementia Care, Research
into Practice (pp. 2–19). Berkshire, UK: McGraw Hill Publishing.
Smiraglia, C. (2016). Targeted museum programs for older adults: A
research and program review. Curator: The Museum Journal 59: 39–54.
doi: 10.1111/cura.12144
Stoner, C. R., Stansfeld, J., Orrell, M. & Spector, A. (2019). The develop-
ment of positive psychology outcome measures and their uses in
dementia research: A systematic review. Dementia 18(6): 2085–2106.
doi: 10.1177/1471301217740288
Veall, D. et al. (2017). Museums on Prescription: A Guide to Working with Older
People. UK: Arts and Humanities Research Council. Available on
http://www.artshealthresources.org.uk/wp-content/uploads/
2018/09/2017-Museums-on-Prescription-Guide.pdf (Accessed: Octember
15, 2020).

Psychological & social impacts of museums
35
Windle, G., Gregory, S., Howson-Grifths, T., Newman, A., O’Brien, D. &
Goulding, A. (2018). Exploring the theoretical foundations of visual art
programmes for people living with dementia. Dementia 17: 702–727.
doi: 10.1177/1471301217726613
World Health Organisation. (2017). Global Action Plan on the Public Health
Response to Dementia 2017–2025. Geneva: World Health Organisation.
Available on https://apps.who.int/iris/bitstream/handle/10665/
259615/9789241513487-eng.pdf;jsessionid=F538D3E4745EC-
960C597967AC302929B?sequence=1 (Accessed: October 15, 2020).
World Health Organisation. (2019). Dementia. Available on https://www.
who.int/news-room/fact-sheets/detail/dementia (Accessed: Decem-
ber 10, 2020).
Young, R., Camic, P. M. & Tischler, V. (2016). The impact of communi-
ty-based arts and health interventions on cognition in people with
dementia: A systematic literature review. Aging & Mental Health 20:
337–351. doi: 10.1080/13607863.2015.1
Young, R., Tischler, V., Hulbert, S. & Camic, P. M. (2015). The impact of
viewing and making art on verbal uency and memory in people with
dementia in an art gallery setting. Psychology of Aesthetics, Creativity,
and the Arts 9: 368–375. doi: 10.1037/aca0000030

International Journal of Ageing and Later Life
36
Appendix 1. QualSyst quality checklist and scores for quantitative and qualitative studies
QualSyst quality checklist and scores for quantitative studies
Camic
et al.
(2014)
D’Cunha
et al.
(2019)
Eekelaar
et al.
(2012)
Flatt et al.
(2015)
Johnson
et al.
(2017)
MacPherson
et al. (2009)
McGuigan
et al. (2015)
Schall
et al.
(2018)
Young
et al.
(2015)
1. Question/objective sufciently
described?
Yes Yes Yes Yes Yes Yes Yes Yes Yes
2. Study design evident and
appropriate?
Yes Yes Yes Yes Yes Yes Yes Yes Yes
3. Method of subject/comparison
group selection or source of
information/input variables
described and appropriate?
Partial Partial Partial Partial Partial Partial Partial Partial Partial
4. Subject (and comparison group,
if applicable) characteristics
sufciently described?
Partial Yes Yes Yes Yes Yes Yes Yes Yes
5. If interventional and random
allocation was possible, was it
described?
N/A N/A N/A N/A N/A N/A N/A Yes N/A
6. If interventional and blinding of
investigators was possible, was
it reported?
N/A N/A N/A N/A N/A N/A N/A N/A N/A
7. If interventional and blinding
of subjects was possible, was it
reported?
N/A N/A N/A N/A N/A N/A N/A N/A N/A
(Continued)

Psychological & social impacts of museums
37
Appendix 1. (Continued)
QualSyst quality checklist and scores for quantitative studies
Camic
et al.
(2014)
D’Cunha
et al.
(2019)
Eekelaar
et al.
(2012)
Flatt et al.
(2015)
Johnson
et al.
(2017)
MacPherson
et al. (2009)
McGuigan
et al. (2015)
Schall
et al.
(2018)
Young
et al.
(2015)
8. Outcome and (if applicable)
exposure measure(s) well
dened and robust to measure-
ment/misclassication bias?
Means of assessment reported?
Yes Yes Yes Yes Yes Yes Yes Yes Yes
9. Sample size appropriate? Partial Partial Yes Partial Partial Partial Partial Partial Partial
10. Analytic methods described/
justied and appropriate?
Yes Yes Yes Yes Yes Yes Partial Partial Yes
11. Some estimate of variance is
reported for the main results/
outcomes
Partial Yes N/A Partial Partial Partial N/A Partial Partial
12. Controlled for confounding? Partial Partial Partial Partial Partial Partial Partial Partial Partial
13. Results reported in sufcient
detail?
Yes Yes Yes Yes Yes Yes Yes Yes Yes
14. Conclusions supported by the
results?
Yes Yes Yes Yes Yes Yes Partial Yes Yes
Total score (%) 17/22
(77)
19/22
(86)
18/22
(82)
18/22
(82)
18/22
(82)
18/22
(82)
15/22
(68)
19/24
(79)
18/22
(82)
Key: Yes (2); Partial (1); No (0).

International Journal of Ageing and Later Life
38
Appendix 1. (Continued)
QualSyst quality checklist and scores for qualitative studies
Burnside
et al.
(2017)
Camic
et al.
(2014)
Camic
et al.
(2016)
Eekelaar
et al.
(2012)
Flatt
et al.
(2015)
MacPherson
et al. (2009)
McGuigan
et al. (2015)
Schall
et al.
(2018)
1. Question/objective sufciently
described?
Yes Yes Yes Yes Yes Yes Yes Yes
2. Study design evident and
appropriate?
Yes Yes Yes Yes Yes Yes Yes Yes
3. Context for the study clear? Yes Yes Yes Yes Yes Partial Yes Yes
4. Connection to a theoretical
framework/wider body of
knowledge?
Partial Yes Yes Yes Yes Yes Yes Yes
5. Sampling strategy described,
relevant and justied?
Partial Partial Partial Partial Partial Partial Partial Partial
6. Data collection methods clearly
described and systematic?
Yes Yes Partial Yes Yes Partial Yes Yes
7. Data analysis clearly described
and systematic?
Yes Yes Yes Partial Yes Partial Partial Partial
8. Use of verication procedure(s)
to establish credibility?
Yes Yes Yes Yes Yes Yes Yes No
9. Conclusions supported by the
results?
Yes Yes Yes Yes Yes Yes Yes Yes
10. Reexivity of the account? No Partial Partial No No No No No
Total score (%) 16/20
(80)
18/20
(90)
17/20
(85)
16/20
(80)
17/20
(85)
14/20
(70)
16/20
(80)
14/20
(70)
Key: Yes (2); Partial (1); No (0).

Psychological & social impacts of museums
39
Appendix 2
Search terms
Dementia AND Intervention AND Setting
Dement* OR
Alzheimer*
art*
object*
participatory
creative* OR
wellbeing
well-being
well being
heritage
galler* OR
museum*