he 2008 report ‘On Our Own Terms' by Help the Aged looked at the challenge of providing and measuring dignity in care. One of the criteria for measuring whether dignity of care is provided is whether the cultural, recreational and social needs of those in care are being satisfied and whether there are choices in the activities available.
For the majority of people with dementia and the associated problems of isolation and depression, the provision of suitable resources and activities is crucial to their mental and emotional well-being. Of particular importance in the case of those with dementia, is that these activities must be meaningful and relevant to the personality and the life experience of the person involved.
One activity that has been shown to be valuable for many people with dementia, is the appreciation of the visual arts. Like the vast majority of the population, people with dementia ‘know what they like'. A recent study (Halpern,A et al. Brain & Cognition) looked at the art preferences of people with and without dementia, and found that those with dementia were as able as those without, to express a preference for particular pictures, and that these preferences remained consistent over time.
The Museum of Modern Art in New York provides interactive tours of its collection of modern art for people in the early and middle stages of dementia, along with their family members and carers. Specially trained Museum staff engage participants in lively dialogue by looking at iconic art from the collection, including works by artists such as Henri Matisse, Pablo Picasso, Jackson Pollock, and Andy Warhol. This ongoing and successful project illustrates how the act of looking at art together can be a rich and satisfying experience for people with dementia and their carers.
Over the past two years, a small UK social enterprise ‘Innovations in Dementia' has carried out research amongst people with middle to later stage dementia, investigating their responses to a wide range of art images including painting and photography, colour and black and white images, the representational and the abstract.
They have discovered that whilst the age or style of an image does not preclude those with dementia from enjoying it, the complexity or the content of the image might well create confusion or distress in the viewer. Whilst a bold, semi-abstract painting of a landscape may tap into the emotions of one individual, that same person may be caused distress by their inability to interpret correctly a photograph showing a group of children waiting at an ice cream van.
The work carried out by the Museum of Modern Art in New York, the Halpern study and the research by ‘Innovations in Dementia' have all shown that there is not a simple formula for what people with dementia like to look at in terms of art and pictures. This will depend very much on their own aesthetic preferences as well as the cognitive limitations imposed by their condition.
Old photographs used by so many in reminiscence work, can be helpful in prompting memory. Photographs cut from magazines can provide a tool to prompt discussion about a particular topic. However, people with dementia are able to appreciate so much more in the way of art and visual imagery. To deny them that possibility is surely to deny them the dignity of choice, and also to deny them the potential enjoyment and benefits that can be gained.
The walls of care homes are often decorated with a selection of old black and white photographs of film stars or old local scenes, framed pages from old newspapers and ‘corporate' style decorative prints more suited to a hotel or office. However, carefully selected reproductions of old or modern art can offer so much more in terms of enjoyment and communication, particularly when chosen to take into account the aesthetic preferences of the residents concerned.
Books of old photographs of the Royal family, the War or daily life have a place in reminiscence work, but what people with dementia also deserve is the freedom to look at a wide selection of high quality art and photographic images in a format that is easy to use. Books specifically designed to be accessible to people with dementia have shown that when combined with suitable texts, a wide range of art can be used to foster sharing and discussion. Well-designed books can make art accessible for those with dementia who do not have the opportunity to visit galleries. They can provide a quiet and reflective half hour shared with a loved one or a carer. Alternatively they can be used to raise the spirits with novelty, humour and colour.
Purpose designed art and photography books can enable relatives and carers to engage in a meaningful way with those with dementia. They may also just as importantly, help people with dementia to keep in touch with an aesthetic, emotional and spiritual part of their life; an important part that can often be ignored or neglected by those responsible for their day to day care.
Pictures to Share is a social enterprise established to provide appropriate media for people with dementia. There are currently seven illustrated books in Pictures to Share's range. These have been compiled after extensive research investigating the responses of those with dementia to a wide range of images. The research was undertaken with people in care homes and day centres and has allowed Pictures to Share to build up significant expertise in understanding what type of images positively engage those with dementia.
The books can now be found in venues across the UK and abroad, including care homes, day care centres, hospitals, public libraries and private homes. Last year many thousands of people benefited from the improved communication the books encourage. For further information or to order books, visit www.picturestoshare.co.uk or telephone 01829 770024
The Museum of Modern Art in New York is currently finalizing the content for a printed publication to be released in the spring 2009, that will not only contain a guide for museums but also guides for care facilities and family caregivers, all of which will also be available on their website www.moma.org/alzheimersproject
Measuring Dignity in Care for Older People by the Picker Institute Europe 2008.
The full report plus appendices is available via the Help the Aged
‘‘I Know What I Like'': Stability of aesthetic preference in Alzheimer's patients . Halpern et al. Brain and Cognition 66 (2008) 65-72