Creativity and dementia
Creativity is for everyone, and can give people living with dementia opportunities to get in touch with and express themselves. In this video, A/Prof Helen English and creative engagement specialists Maurie Voisey-Barlin and Margaret Rolla talk about how to use creativity as a tool to connect and engage.
Transcript
[Beginning of recorded material]
[Title card: Creativity and Dementia. Dementia Australia.]
Helen: Hello, everyone. My name's Helen English, and I've got the great pleasure today of talking about a topic dear to my heart, creativity and dementia. But first of all, I'd like to pay my respects and acknowledge the traditional owners of the land on which I'm lucky enough to live and work. That is the Awabakal people - I actually live near Lake Awaba which is a beautiful lake - and I'd also like to pay my respects to Elders past, present, and emerging, and also to any Elders past, present and emerging on lands where you live, or any Aboriginal people watching this webinar. I thought I'd start by giving an outline of my talk so you know what to expect.
First of all, I'll be talking about creativity. What is it? Almost impossible to answer, but good to think about. Secondly, I'll be talking about the benefits of creativity for older adults, generally. Thirdly, I'll talk specifically about benefits for people with a diagnosis of dementia. And then fourthly, I'll talk about some key aspects that help to bring wellbeing effects when you are engaged with creative activities. And then, during the talk, we're going to hear from two amazing people who work closely with people with a diagnosis of dementia in different creative forms. And finally, I'm going to point you towards some resources and programmes that you might like to look into.
First of all, what is creativity? I think we all agree that human beings are inherently creative, and creativity is not just the realm of the artist creator, a person who dedicates her or his life to producing works of art. No, creativity is also an everyday activity and ability. We use creative thinking to solve problems. Imagine different scenarios, make and change things, and so on. As Alfred Einstein famously said, imagination is more important than knowledge for knowledge is limited, while imagination embraces the whole world.
To help us understand different levels and uses of creativity. James Kaufman, an American psychologist who specialises in creativity, has come up with four types of creativity, which represent a progression and a development - from mini C to little C, to pro C and big C, where the C stands for creativity. And this ordering of creativity is useful to break down commonly held beliefs that only a small percentage of the population can be creative. For these four, mini C refers to everyday creativity. It might be a thought or an insight, not shared, but used to make sense of our worlds, to imagine possibilities and think around problems. Little C represents the step from an idea in our heads to an articulated concept that we might share with others. Pro C is a professional level of creativity, and big C covers a genius level.
So, what are the benefits of creativity for older adults? And this is something that I think about a lot, because I work with older adults and my topic is creative ageing, so I'm lucky to work in that area. The creativity is beneficial as we age, and in fact, we become more creative as we age. And this has been suggested for over 20 years, however, was established in research by Areeba Adnan and Roger Beaty in a study of older and younger adults, that the older group being around the age of 70, and the younger around the age of 20.
And using FMRI scanning, they observed that in divergent thinking tasks, which are used to measure creativity, the older adults showed in experiments that they call on imaginative thinking, in tandem with logical thinking to problem solve, and to perform a task. For example, listing all the possible uses for an object such as a brick. This is a standard divergent thinking test. So, from this, Adnan and Beaty demonstrated that in older adults, the imaginative network, which is also called the default network, is more strongly coupled with the executive or logical network during creative thinking than in young adults.
We can consider that this may be an adaptation to ageing, where we draw more readily on the amassed knowledge and experience of a lifetime. Therefore, we should explore and develop this later life strength, and take the courage to delve into both everyday creativity, and to explore our creative potential through engaging in creative activities. Further, there's a strong link between being creative and having an open mindset, and having an open mindset is a key aspect of ageing well, because it means we are more likely to seek solutions to the challenges of ageing. So what are the benefits of specifically engaging in creative activities, such as painting, joining a music group, or taking up a craft for older adults generally, and for people with a diagnosis of dementia specifically?
An important underpinning factor to mention first is that creative activities do not depend on memory, but have the power to evoke memories. Thus, people with a diagnosis of dementia and memory challenges can participate, and may benefit from a return of memories as a result. And this may, in turn, facilitate communication with loved ones, reinforce a sense of self, and support relationships with family and carers. Many of you may have seen the well-known documentary, Alive Inside, if you haven't, do look for it. In this video, someone who is usually very withdrawn and non-communicative hears music from their youth and becomes very excited, literally seeming to wake up, and begins to talk about the music that he is listening to. Moments like these stimulate compassion not only in the person's family, but also in professional carers, and therefore, have potential to improve not only the participant's quality of life, but also those around that individual.
What are the benefits of creative activities? Well, first of all, they are enjoyable. We experience positive emotions for engaging with the arts, whether painting, singing, dancing, or crafting. And positive emotions have been shown to affect cognition and wellbeing. Second, engaging with creative activities gives us a sense of control and purpose. Third, we have a sense of achievement through acquiring new skills and finishing a project. And fourth, we can share the final product. So for people who are gradually losing control in their lives due, perhaps, to diminishing physical health, cognitive issues, mobility challenges, creating something can bring back a sense of agency and control. When making art, they're given opportunities to make choices, where these are not so evident in everyday life.
I recently watched a video of an artist working with a person with dementia on one side, and their carer on the other. They were all working on the same project, yet, there are always choices, and the person with dementia chose to work with strong horizontal lines rather than free flow shapes. So, it doesn't matter what your choices are because everything is acceptable, there's no judgement in making art. Each follows their own aesthetic and each enjoys their different results. Being engaged in creative activities is a way to engage with emotions, whether experiencing them because of the creative process, or expressing emotions through the process. And it is good to note here that the process of making and creating is often more important than the outcome.
Feeling and expressing emotions gives us the opportunity to share and manage them. For people with dementia who may be challenged to complete an artwork, researchers argue they can still get benefits by expressing emotions and feelings through engagement in the activity. Further, research by Barbara Fredrickson shows that experiencing positive emotions broadens an individual's scope of attention and cognition. And her research highlights that creativity specifically increases with positive emotions. So, a lot of good things about positive emotions to note that. Importantly, arts and non-verbals will create a level playing field in terms of communication. People with dementia are often withdrawn, which may be linked to their perceived inability to communicate verbally. But when participants feel the space is safe, they have the opportunity to communicate through art making, and this may bring them out of themselves.
In a safe space, people can also be playful, living in the moment and responding to others or the art process. We'll hear more about this from Maurie Voisey-Barlin later. Arts provide a topic for conversation, a focus point with significant others, which is not related to the individual's dementia diagnosis. The creative activity and the products become the focus, rather than the dementia itself. Arts activities are stimulating, and participation is, therefore, fun and potentially relaxing for carers as well as the person with dementia. In addition, group art activities provide social context and mitigate against the isolation of dementia.
The person with dementia and loved ones can participate together in an activity that creates its own space, and is something of a refuge for its duration. Research shows that people with dementia may have benefits to behaviour and communication as a result of engaging with creative activities. For example, engaging with creativity may have a positive effect on mood and calm agitation. This is well documented with music. Although creative activities are non-verbal, they can also revive language, and there are many records of the return of language and communication continuing, even after the activity is over.
A second probable factor in stimulating communication is the access to memories that creative activities can evoke. So next, we're going to hear from Margaret Rolla. And Margaret is now based in South Murwillumbah, New South Wales. She's a creative ageing specialist and Director of ArtIntuit. Margaret now helps individuals and aged care providers who are looking for meaningful activities to engage and alleviate the boredom, loneliness, and symptoms associated with grief, loss, ageing, and dementia.
Margaret: Thank you, Helen, and a big hello to all our viewers. I'm really excited to share some of my work with you today as a creative engagement specialist. As we've already heard from Helen, creativity is so important for health and wellbeing of all people with all ages. My belief, though, is that being creative isn't a privilege, it's a basic human need. And having the opportunity to create is a human right. I support the emotional needs of older people, and those living with dementia through meaningful art making, using drawing as a tool of discovery. I'll be showing you, today, some simple practises that you might be inspired to tap into your own creativity, or within those you care for.
So why drawing? Well, drawing is primal. It's mankind's most basic form of communication. We drew before we could speak, but drawing also uses both sides of the brain, so it's cognitively stimulating. What I've found in my work though, is that it also assists with gross motor skills, and it strengthens hand to eye coordination. Drawing is natural, it's simple, and it's easy to instigate, and it can be done with any tool on any surface, within reason, of course. So, how do we tap into this creativity? My recommendation is to tap into their history first of all. Memories can inspire art making through the use of photos and printouts, but it can also generate the imagination too. Our memories can be true, or we can make new memories through our intuitive thought system. A person living with dementia does not lose their intuitive self and felt sense of experience.
Through my work in aged care, I've developed the four E's of engagement strategy, which may help kickstart the creative juices of those you care for. They're only suggestions based on my learnings. So the first E is the environment. Choose a quiet, non-intrusive, specific area to assist their memory. Let them mark their territory with their artworks. Treat the space seriously though, there's nothing worse than a focused resident being pulled away from creating, to be asked if their bowels have been opened that day.
The second E is exploration. Focus on the process rather than the outcome, because that's where the juicy bits lie. And try a variety of tools and media, and just simple mark making activities is enough. Offer suggestions and offer choices. I had a client who used their morning tea as inspiration, and strategically placed four pieces of her cake on each corner of her drawing. It was really beautiful. Just beware though, the paintbrush dipping into the coffee cup though.
The third E is expectations. People living with dementia need time to process their thoughts and digest instructions. Give them time, give them silence. There's no need to chatter during the art process. Expect the unexpected and embrace it. Expect resistance, so have a backup plan in place. The fourth E is excitement. Add music. I can't advocate this enough, but choose music that is relevant, meaningful, and appropriate to the person and their mood that they're in on that day. Let the music inspire art making. Draw the music, but join in and create together. Inject humour and laughter. Maybe do some movement, dance, make a mess, or simply just sit there with them quietly and enjoy watching what unfolds.
Remember that patience, persistence, and respect promotes dignity. So never take over their work to finish it. You can start off with a few lines and marks to help them, even guide their hand, but please don't finish it. Admire the outcome for what it is, an exploration of line, shape, and colour, and it's an intuitive felt sense of experience for them. And remind them too if they're being critical of their work, which they most often are. So what materials and media to use? I say mix it up. This allows freedom of choice and exploration of a variety of textures and colours, to sensory experience. What is accessible to one, though, may not be for another.
Why not try digital technology? Computer tablets have mixed reactions, but they do provide a solid surface and a defined boundary, and this is really good for sight impaired people especially. A client of mine, who was stroke impaired, found the tablet easy to manage with her non-dominant hand, where holding a pencil was very uncomfortable. It also encourages conversation and connection with families, particularly grandchildren. But no special tools are needed to create interesting marks and abstracts, look in the kitchen drawer, and in the backyard, you'll find something to draw with. If you purchase cheaper brands of materials though, I recommend removing the label, or covering up the word 'kids' from the label, this promotes dignity again. But overall, try something new. Think outside the paint box. This is just skimming the surface and I'm still learning from my artistic Elders. If you want to learn more, you can check out my website for more resources and amazing stories, but thank you for listening. Bye now.
Helen: So, my next point is what is important to consider when we try to make creative activities effective? So there are three things here, although the second two are very closely linked. So, there's engagement. The activity needs to be person centered and also co-created. But positive benefits in engagement is really the key element. The activity needs to be something participants enjoy and can relate to. Some researchers argue that the engagement with the activity is the most important aspect. It seems probable then that the intensity of engagement is what stimulates some return of communication and even speech.
So the second factor person-centered approach, this is very important, and we're going to hear more about it in a moment from Maurie, and it is linked to co-creativity, or co-creation. So, person-centered creativity works well even into advanced dementia. This approach uses improvisation to create a conversation through movement, gestures, touch, and sounds. This creative and improvised conversation is the essence of co creativity. The concept is to elicit responses using these means, and is often led by engagement therapists who use clowning. So we're now going to hear from Maurie Voisey-Barlin, who is a creative Elder engagement specialist. So now, it's my pleasure to introduce Maurie Voisey-Barlin, and Maurie is based in the Hunter region of New South Wales, and he's an engagement specialist who works with elders in residential aged care.
Maurie: Hello, my name is Maurie Voisey-Barlin, and I'm a creative therapeutic elder engagement specialist, which is a big mouthful, but it tries to encapture what I do. So, my role is to engage people who are living with dementia in residential aged care, with a focus on those that are living with grief or depression, or are choosing to self-isolate and socially withdrawing themselves from general activities and engagement. This could be related to their dementia; it could be related to their comfort or discomfort in residential aged care. This could also be fear around engaging with people. And when we are at our loneliest, we tend to push people away. So, my role is to get into the room, and engage them using history, personhood, individual interests, and to create curiosity so that I can draw them into relationship.
I would see around about 80 elders a week in one-on-one sessions. And these are the same 80 people that I build a relationship with, over seven sites throughout the Hunter Valley here in Newcastle. What I want to talk to a little bit today is to look at well, whilst I'm working in residential aged care, I think the application of what I'd like to talk about is the same for us who are care partners with people living with dementia in the community, at home, or in respite, or going into residential aged care. So what I want to talk about is looking at, rather than using the idea of conceptual engagement, I want to look at tangible.
To explain this, I've got a few photos I'd love to show you, and let's begin. Here, we have a good friend, Lee. Now, Lee lives in a dementia specific unit or memory support unit, whichever you would like to call it. And Lee is really engaged through music. Now, I use music quite a lot in my work, but I would say that it would be only 50% of my work. What I'm using is performative skills. So, I have a history as an actor, and I'm looking at improvisation, storytelling, yarns, banter, and of course, creating relationship, but music can play a large part in that with some people. I would not use any music, but with Lee, Lee has a great fondness for the song "Pearly Shells". And here I am, following Lee's lead. He sings the first line, and I repeat the line as I play it on the ukulele for him. So, this is a musical intervention, but of course, we go into relationship very quickly, and I've been engaging with Lee for probably around about four years now.
In terms of music, there is another musical intervention, which is probably would be seen as purely musical, but I'm actually working very deeply here with Laurel, my elder buddy Laurel here, who used to play the piano accordion. And there's some footage which I can share a link to, filmed by her son. So, Laurel loves old time music and it activates her. I use music to activate my elders. And in this sense, then I can start to engage Laurel using phrases, a cheeky banter, and interaction, and she'll pick up my social cues. Whereas prior to me seeing her each day, she would sit in her largely in her own thoughts and would not be able to construct words or sentences. Here, you see her wearing my hat, which she wanted to wear as part of the session.
When I say tangible, what I'm talking about is rather than talking to my friend Terry here about his beloved Penrith team, I'm actually taking photographs of the Panthers for him, but here, I was teasing him, trying to convince him to come back to Parramatta because I know, through my research, that he used to support Parramatta before Penrith, because Penrith came into the competition much later. And with that knowledge, and that looking back, I'm able to find out who his original team is. So here I am trying to show him a picture of Peter Sterling and convince him to come back to the fold.
So, the idea of using a tangible object, or a picture, or a painting, using photographs, it kind of does the work for you, and it's an invitation to engage. And it takes it away from the concept of talking about a photo of me as a baby, but rather presenting a photo of me as a baby. Here, I'm showing Loretta, or I had shown Loretta a photo of me as a baby, she didn't think it looked like me, so I flick over and I have one drawn on with a beard, although it does look like I drew it right there.
This is my mentee, Chloe. Chloe is a volunteer who comes with me every Tuesday, and has done for nearly two years. And here she is showing our friend Baz, who loves mischief, and the absurd, Chloe is using a picture of her dog on a skateboard. So, bringing in that photograph and showing him this picture, which he finds really amusing. Same here with my friend Norma. Norma used to say every day, "I'm sorry, Maurie, I'm in too much pain." And looking at the history, I noted that she loved textiles from foreign countries, as she called it. And so, I started to drape this Thai silk scarf, sorry, a Lao silk scarf around my neck, or a llama wool bag, and I would wear this in, and then I would validate her feelings, and accept that she wasn't able to see me, and then I'd go to leave when she looked at it. And sure enough, I'd say, "That's a shame, I would've loved to have asked you what this material was." And very soon, she would start to take note and feel the scarf, and before I knew it, we would be able to engage. So rather than talking about textiles, it's about placing them in someone's hand or in front of them so they can actually feel the material.
Finally, sometimes, some people like to ask me for a photo, and my mentee, Chloe, made this one up for me, so if they ask for a photo of me, I usually will give them this one just for a bit of fun. There is so much more to talk about, but obviously, there isn't the time. But I can supply some links to some of my work if you're interested in reading about some of the engagement strategies I've used, I really love to share what I do in the hope that others may take inspiration from it, or start discussion about how we might engage our elders living with dementia in our community and in residential aged care.
Helen: So, thanks Maurie, for your amazing contribution. I'm now going to talk about some resources and just draw your attention to some possible resources you might look like to look into, and I've got a list of those on a later slide, but I was just going to highlight a couple, so one of them is pressing nature into clay, which you can see at the top right of that image there. So, this is where working together, people can collect leaves and other plant material, and you press that into clay. But firstly, they need to roll out the white clay.
The activity can be extended, if it's a fine day and people can go out and collect leaves themselves, otherwise, you can bring them in. It is very simple, but very, very, looks really beautiful. So it gives a great result. So you press the leaves into the clay and then paint over them, and let it dry. And you can paint again later after you've removed the leaves if you want.
And that is in a resource, which I'll show in a minute, and also in the same resource is one called Concertina Houses, which is just a shadow representation of that in the bottom right of the screen. And that's where you may have done this when you were young, where you fold up a piece of paper and then you cut a shape. And that is echoed through the whole concertina effect. And in this one, you cut out a roof in a chimney and then you ask people to, or you do it with your partner, to put some images down that are important about one of the homes that they lived in that's got a strong memory. And they can also decorate the other houses in the Concertina shape with things, memories that come back. And then, the really lovely thing about this one is that you can then use that as a starting point to share memories in a group, and talk about why those memories, and what else comes up with that.
Just to finish up, for fun, I'd like to share this very short video, which comes from Crossroads Hospice and Palliative Care in the United States, and the reason I really like this is because there there's no text, there's no words. You just watch it, and you know what to do.
[Video Plays]
And so, here's a slide showing you some of the places that I found for you to look for more activities, and you'll see Postlethwaite, Liz, this is supported by the Baring Foundation in the UK, which is a fantastic charitable organisation. And that's the one where there are a lot of these ideas that I just shared. And the last page is references, and thank you everyone for watching, and thank you very much to Maurie and Margaret for contributing, and to Gina for helping make this webinar.
[Title card: No matter how you are impacted by dementia or who you are, we are here for you.]
[Title card: Dementia Australia. National Dementia Helpline 1800 100 500. Dementia.org.au]
[END of recorded material]
Further reading
For more on creativity and dementia, try:
The National Dementia Helpline
Free and confidential, the National Dementia Helpline, 1800 100 500, provides expert information, advice and support, 24 hours a day, seven days a week, 365 days a year. No issue too big, no question too small.