Participatory arts involve persons living with dementia and caregivers in their development, creation, and evaluation processes.
Persons living with dementia gradually experience a decline in mental processes, including memory, orientation to space and time, and abstract thinking. The decline in cognitive skills may lead to social withdrawal and difficulties in communication.
To reduce this decline in cognitive and social skills, dementia specialists have expanded from the roots of biomedical treatment to explore other innovative interventions. They adopt the philosophy of ‘Re-mentia’, which refers to gradually improving the functioning of persons living with dementia by fostering a secure environment that sustains their well-being and remaining competencies. A specific non-pharmacological intervention that supports the notion of ‘Re-mentia’ is gaining increasing attention – participatory arts.
Participatory arts, also called community-based arts, constitute a range of activities that directly involve the participants in the development, creation, and evaluation processes. Activities involved may include conceptualizing ideas, experimenting with different mediums in the creative process, and exhibiting the final product to an audience.
Participatory art programs are often delivered over several weeks under the supervision of allied health professionals or art practitioners to small groups of participants and provide a failure-free space for creative expression, self-discovery, and social engagement. Some examples of these art forms include:
• Clay work, Pottery
• Craft work, Collage, Origami
• Expressive Writing, Poetry
• Music, Singing and Movement
• Performing Arts (Dance, Drama, Opera)
• Storytelling, Sharing life stories
• Visual Arts (Museums, Art Galleries)
Despite the variety of participatory arts available, they all share a common value base – person-centered care (PCC). The PCC approach comprises four components emphasized by program facilitators that promote individual dignity:
1. Valuing persons living with dementia and their caretakers
2. Understanding and tailoring to individualistic values, choices, and preferences
3. Looking from the perspective of the individual
4. Reinforcing a positive social environment
Participatory arts are art-related activities that involve persons living with dementia in the development, creation, and evaluation processes.
By creating and building a space where persons living with dementia can feel safe and thrive, research suggests that engagement in these creative activities can enrich the lives of persons living with dementia. Synthesizing the findings across multiple research studies, the benefits can be summarized into these five fundamental aspects:
Nurturing a Purpose in Life
Participatory art programs provide various opportunities for persons living with dementia to explore new interests or strengthen existing ones. Often, persons living with dementia may lose their sense of direction in life. Exploring a diverse range of creative activities can broaden their range of activity-related skills. Through the application of these acquired skills, they may develop a strengthened sense of purpose to lead a meaningful life.
Participatory art programs purposefully include all participants as co-creators in the artistic process. Whether the program pertains to learning a new instrument, writing expressive autobiographies, or constructing figures using clay, everyone has the autonomy to map their art journeys based on their values, choices, and preferences. When their efforts are recognized and validated, persons living with dementia feel a sense of achievement and become more empowered to lead independent lives.
With guidance from experienced art facilitators, persons living with dementia can be supported to take on obstacles they originally lacked confidence in. A sense of assurance and inspiration are key ingredients to gradually enhancing self-esteem. This enhanced self-esteem can serve as a stepping-stone for persons living with dementia to seek and approach challenges that they may face in their daily lives with a resilient perspective.
Building Positive Relationships
The core of all participatory art programs is the mission to bring people together. Due to difficulties associated with cognitive decline, persons living with dementia may face social exclusion and withdrawal. This is further compounded by difficulties in the caregiving process, where communication difficulties can become a barrier between persons living with dementia and their care partners. Participatory arts programs use arts as a creative medium to bridge the lives of persons living with dementia, their care partners, and members of their community, enabling meaningful social relationships to be forged.
Improving Cognitive Skills
Engagement in the arts has some positive effects on the mental processes which are declining in persons living with dementia. Research suggests that many forms of art, such as singing and listening to music, can activate brain regions associated with attention and memory. There is emerging evidence that it may be possible to minimize the progressive cognitive decline that characterizes the biological processes of dementia through active engagement in the art creation journey, which may involve attentional and memory resources.
Systematic research studies have highlighted the importance of several key aspects in the delivery of participatory arts programs that can maximize the likelihood of positive outcomes. These key aspects should ideally be integrated to construct a meaningful social and physical environment that promotes the well-being and remaining abilities of persons living with dementia.
Interacting Social Contexts
Organizing frequent and regular programs allows the strengthening of bonds among all participants involved in the program, including care partners and volunteers. Through the strengthening of bonds, facilitators build rapport and establish trust with persons living with dementia. This enables persons living with dementia to become accustomed to the program. Fostering a secure environment that allows everyone to interact with one another is foundational for instilling a sense of social inclusion and engagement.
Incorporation of Reminiscence
Exposure to the arts, especially those with significant cultural or historical value, can bring about unique topics of conversation among persons living with dementia. Through self-expression, persons with dementia can, in part, “re-live” their past in the stories they share through meaningful and structured discussions. The promotion of sharing experiences through self-expression and social engagement can serve as a catalyst for building a supportive and caring environment.
Incorporating Creativity and Imagination
The unique topics of conversation amongst persons living with dementia, facilitated by exposure to the arts, can encourage their creativity and imagination. It is pivotal to incorporate activities that tap on imagination and self-expression. These activities may include discussions about the cultural elements of viewing museum artifacts, or the practices of free association and story-sharing through reminiscing with music or images.
Role of the Facilitator
The facilitator’s role includes encouraging interactions among participants, imparting knowledge, and serving as a role model of confidence and love for learning. Through framing challenges for participants to tackle, promoting self-exploration and discovery, and validating participants’ artwork, facilitators can build an intellectually and socially stimulating environment for everyone to challenge their own abilities and learn from each another.
A pressing concern in society today is the social stigma towards persons living with age-related conditions, including dementia. As a result of the stigma, these individuals may experience negative emotions, self-discrimination, and poor self-efficacy.
In recognition of the importance of reducing discrimination and stigma towards persons living with dementia, contemporary societal movements have been initiated and have witnessed benefits.
Dementia-Friendly Communities (DFC) adopt the PCC approach and employ participatory art activities to connect persons living with dementia with members of the public. Social prescribing interventions, such as the “Arts on Prescription” model, reflect the validation and importance of a holistic approach to well-being.
Frequent interactions between members of the public and persons living with dementia can promote greater understanding of dementia and a more positive attitude towards this condition.
With the knowledge that stigma is often propagated by misconceptions, lack of knowledge, and the absence of one-on-one interaction with stigmatized populations, these movements aim to provide opportunities for members of the public to personally interact with community members who are experiencing dementia. Frequent interactions between members of the public and persons living with dementia can promote greater understanding of dementia and a more positive attitude towards this condition. Fostering care and acceptance in the community towards persons living with dementia can encourage these persons to learn to strive, and maintain meaningful, independent lives.
Here are two participatory arts programs for persons living with dementia:
Sing Out Loud!
Sing Out Loud! was developed by Esplanade – Theatres on the Bay in partnership with Dementia Singapore in 2016. This programme is built on the belief that the arts is transformative and can be used to promote positive ageing, boost mental wellness, and enhance overall well-being in persons living with dementia, and their caregivers.
It offers a nurturing platform for participants to learn new vocal techniques and helps stimulate emotional and memory recall through the reminiscence of songs, culminating in a graduation showcase at the end of the eight-week programme. Each session is low in intensity, making it especially suitable for persons with dementia. It consists of eight vocal sessions stretched over two to four months, and may also include learning simple choreography.
The programme is tailored to suit different levels of physical mobility and participants’ needs, and is facilitated by artists, with inputs from therapists and social service professionals. Participants learn voice projection, breathing techniques, use of the diaphragm as well as facial muscles to control tone and pitch.
Arts & Dementia
Arts & Dementia is a programme initiated by Dementia Singapore for clients from its New Horizon Centres (dementia daycare centres) with the objective of raising the quality of engagement using the person-centred approach to dementia care (PCC).
As participatory arts are progressively implemented in dementia care settings, there may be a lack of facilitators available to guide small-group programs. With the advancement of technology, virtual reality (VR) technology may provide a cost-effective, accessible, and flexible method to address these human resource concerns by providing an alternative interactive platform for persons living with dementia to engage in the arts.
VR refers to a computer-generated artificial environment, which individuals can freely interact with using body tracking devices and visual displays. Recently, research exploring customized VR designs for persons living with dementia suggests that VR can provide a secure, pleasant, and evocative environment for individuals to interact with. Some VR-facilitated activities include visiting virtual locations (e.g. a countryside, beach, or forest) of one’s choosing, multi-sensory relaxation exercises, and virtual museums or art gallery tours. These VR capabilities facilitate a larger goal of VR technology implementation, which is to provide persons living with dementia an opportunity to engage in life that otherwise might not be possible due to their health or mobility limitations.
The emerging research on the implementation of VR technology in dementia care is promising. More insights, particularly in design factors for optimal user experience and the personalization of VR technology to improving cognitive skills is an ongoing area of active experimentation and implementation.
As their memory and communication skills decline, the opportunities for persons living with dementia to have meaningful interactions with their loved ones can become increasingly scarce. ‘Re-menting’ interventions, such as bringing art-based programs to persons living with dementia, offer soulful and refreshing experiences and bring about opportunities for persons living with dementia to forge closer relationships with their care partners and interact with the society.
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