Effects of a Creative Expression Intervention on Emotions, Communication, and Quality of Life in Persons With Dementia

Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA.
Nursing research (Impact Factor: 1.36). 11/2010; 59(6):417-25. DOI: 10.1097/NNR.0b013e3181faff52
Source: PubMed


Effective nonpharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia.
The purpose of this study was to test the effect of a storytelling program, TimeSlips, on communication, neuropsychiatric symptoms, and quality of life in long-term care residents with dementia.
A quasi-experimental, two-group, repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly, 6-week TimeSlips intervention group (n = 28) or usual care group (n = 28) at baseline and postintervention at Weeks 7 and 10. Outcome measures included the Cornell Scale for Depression in Dementia, the Neuropsychiatric Inventory-Nursing Home Version, the Functional Assessment of Communication Skills, the Quality of Life-Alzheimer's Disease, and the Observed Emotion Rating Scale (this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group).
Compared with the control group, the treatment group exhibited significantly higher pleasure at Week 3 (p < .001), Week 6 (p < .001), and Week 7 (p < .05). Small to moderate treatment effects were found for Week 7 social communication (d = .49) and basic needs communication (d = .43). A larger effect was found for pleasure at Week 7 (d = .58).
As expected, given the engaging nature of the TimeSlips creative storytelling intervention, analyses revealed increased positive affect during and at 1 week postintervention. In addition, perhaps associated with the intervention's reliance on positive social interactions and verbal communication, participants evidenced improved communication skills. However, more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes.

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Available from: Youngju Pak, Aug 04, 2015
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    • "Consequently, a growing evidence base is establishing that participation in TimeSlips benefits persons with dementia and their professional carers. Individuals with dementia who engaged in a six-week session of TimeSlips were found to experience greater positive affect than those receiving a control intervention (Phillips et al. 2010). Facilities that have integrated TimeSlips into their care services over a ten-week period were found to have more frequent staff-resident interactions and social engagement, while also nurturing more positive staff views of residents than in control facilities (Fritsch et al., 2009). "
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    ABSTRACT: In The Birth of Tragedy, Friedrich Nietzsche celebrated the dueling forces of reason and emotion as personified by the ancient Greek gods Apollo and Dionysus. A subtle Apollonian-Dionysian balance can be observed in TimeSlips, a group-based creative storytelling activity developed in the 1990s and increasingly used in dementia care settings worldwide. This article explains how the Apollonion-Dionysian aspects of TimeSlips are beneficial not only for persons with dementia, but also for their carers. Narrative data from medical students at Penn State College of Medicine who participated in TimeSlips at a local retirement community are shared.
    Full-text · Article · Jun 2013 · Bioethics Quarterly
    • "The issue of how to improve QoL in institutional care by means of interventions is gaining increasing attention, confirmed by the number of research studies that have focused on investigating QoL of institutionalized people with dementia as the main outcome parameter (O'Shea et al., 2011; Phillips et al., 2010; Verbeek et al., 2010). However, information about the factors influencing QoL and changes in QoL in people with dementia living in longterm care settings is currently lacking. "
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    ABSTRACT: BACKGROUND: Quality of life has become an important outcome measure in dementia research. Currently there is no convincing evidence about which factors are associated with quality of life of people with dementia living in long-term care facilities. OBJECTIVE: This study aims to investigate which factors are associated with quality of life, including factors associated with change over time, of people with dementia living in long-term care facilities. DESIGN: A systematic literature review was performed. DATA SOURCES: Cochrane, Pubmed, CINAHL, Web of Science, and PsycINFO were searched. REVIEW METHODS: Three researchers independently assessed studies for eligibility. The inclusion criteria were: (1) the primary focus was on factors related to quality of life; (2) the study was performed in long-term care facilities; (3) the study regarded quality of life as multidimensional construct. Methodological quality of studies included in the review was assessed with a quality criteria checklist. RESULTS: Ten cross-sectional and three longitudinal articles were included in the review. In cross-sectional studies, depressive symptoms were negatively related to self-rated quality of life of people with dementia. The association between depressive symptoms and proxy-rated quality of life was less clear. Behavioural disturbances, especially agitation, appeared to be negatively related to proxy-rated quality of life. There appeared to be a negative relation between quality of life, activities of daily living and cognition, although this could not be confirmed in all studies. In longitudinal studies, depressive symptoms were negatively related and cognition was positively related to self-rated quality of life, whereas dependency and depressive symptoms were negatively related to proxy-rated quality of life. CONCLUSIONS: There are only few high quality studies that investigate associations of (change in) quality of life of people with dementia living in long-term care facilities. Our results suggest that depressive symptoms and agitation are related to lower quality of life. Perspective of quality of life measurement, i.e. self- or proxy rating, may influence its associations. Longitudinal studies are needed to determine which factors are related to change in quality of life over time. This information is essential for the development of interventions that aim to improve quality of life.
    No preview · Article · Mar 2013 · International journal of nursing studies
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    • "The sample for the current study consisted of LTC residents with dementia who were enrolled in an intervention study that tested the effects of a storytelling intervention on communication, behavioral and psychological symptoms, and quality of life. The design, implementation, and analysis of the original intervention study are described in detail elsewhere (Phillips et al., 2010). The sample used in the current study consisted of both treatment and control participants, with CSDD and PHQ-9-OV assessments collected 1 week post intervention. "
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    ABSTRACT: The purpose of this study was to extend available psychometric data on the Patient Health Questionnaire-9-Observation Version (PHQ-9-OV) by comparing it with the Cornell Scale for Depression in Dementia (CSDD) in a new sample of long-term care residents. Data were collected post intervention in a quasi-experimental storytelling study across six communities. The sample (N = 54) was 87% women with mean age of 84.5, mean CSDD score of 3.96, and mean PHQ-9-OV score of 4.22. Prevalence of depressive symptoms by CSDD criteria was 20.4% and by PHQ-9-OV criteria was 40.7%. The CSDD and PHQ-9-OV were well correlated (r(s) = 0.78, p < 0.0001). Neither scale was significantly correlated with depression diagnosis nor antidepressant agent use. Both measures demonstrated adequate reliability. The PHQ-9-OV item scoring and established cut-off points designate a lower threshold than the CSDD to detect clinically significant depressive symptoms. Further study is needed to determine the sensitivity of the PHQ-9-OV in identifying treatment effects.
    Preview · Article · Dec 2011 · Research in Gerontological Nursing
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