Developing films for people with mid to late stage dementia
Helen Bate B.A.Dip.Arch.B.A.(Hons) M.A.
Television has often played a very important part in people’s lives and it’s one of the most physically accessible activities for many people with dementia. Yet only a small amount of research has been carried out over the past few years that relates to dementia and film or television viewing.
With the problems care homes face in providing meaningful activity for people with dementia, it’s important that we try to maintain the possibility of people enjoying and benefitting from the use of television. However with no TV designed specifically for those with dementia at the moment, television watching can often result in boredom, disengagement and agitation in people with dementia who find it confusing and irrelevant.
The Alzheimer’s Society cites research relating to visuoperceptual difficulties that people with dementia face including an impaired ability to understand and interpret complex or rapidly moving images such as those presented in a typical television programme.
Research carried out in 2009 in the USA relates specifically to the televison watching behaviour of people with mid to later stage dementia living in care homes. (de Medeiros, Beall, Vozzella and Brandt. 2009)
This research showed that “dozing” was the most common activity during programme viewing – even when those programmes were ones selected as being most suitable by relatives and carers. The exception to this was a programme about Venice that had no plot to follow and used still images that changed every 15 to 20 seconds. The study highlighted the need for more research in this area.
In the UK we at ‘Pictures to Share’ are currently one of two organizations working on the research and development of films specifically for people with dementia and this research has resulted in two different and innovative types of film that meet different needs.
The Yorkshire Film Archivehas been working in collaboration with a range of healthcare and dementia specialists to research and develop a set of DVDs using specially selected and short archive film clips. With topics such as Holidays, Schooldays and Sporting Fun, the final films are intended to be used with people with dementia for a range of reminiscence activities and each film comes with an information and ideas pack to support carers.
Pictures to Share C.I.C. is a social enterprise. We use our expertise in the use of powerful visual imagery with people with dementia, to research and develop films to engage and entertain people with mid to later stage dementia. Our format follows in principle the findings of the American study in using still images. We have however taken this research further as recommended by the original American researchers. Using the type of images that we know from our past research, works best with people with dementia, we put together a prototype film of 30 minutes duration using still images. This was developed to investigate the practicalities of using still images in a film and to provide a vehicle for trials. We looked at:
• Type of image (complexity, quality, colour etc)
• Length each image appeared on screen
• Zooming in and out of the image
• Image sequence and transition
• The use of music, sound effects and poetry
In 2010 the prototype film was trialled by staff in 4 care homes both in groups and with individuals, some of whom have dementia and some who don’t.
The results of the prototype trials are summarised below:
90% of viewers remained interested throughout the film. With those with more advanced dementia, it was sometimes necessary for staff to watch the film with an individual to ensure interest was maintained. This was achieved by drawing attention to, and talking about the images on the screen.
The film prompted the following feedback comments - “lots of discussion”, “cheered up” residents, “brought out ‘the spark’ one lady has been missing of late”, “lots of laughter and reminiscence”, “a therapeutic sharing time” “thought the whole film was ‘wonderful’ “a very enjoyable intervention”
The time that the images were on screen (10 – 12 seconds) was long enough to allow people to understand what they were seeing and to respond to it. (Pausing the film if an image is creating discussion allows viewers to look in greater detail at the image and to spend longer in discussion).
15 minutes was felt to be a good length for the film by users.
The success of the poetry read out with the text appearing on screen was moremixed. Those with more advanced dementia appeared to lose their concentration and for this reason it was decided to leave poetry out of the final versions.
The subtle ‘zooming’ in and out of the images was not commented on and therefore it was assumed that this was a successful way of helping to hold attention and draw attention to key elements within the images.
The type of music was commented on by some viewers and staff. The song ‘Frere Jaques’ (shown alongside an image of children singing), was a popular element as it was recognized by most, but the unknown music also elicited a positive response. One lady who usually becomes emotional and tearful when listening to music was OK when she watched the film as she was also focussing on the images.
Using the results of these trials, the two final Pictures to Share films ‘Childhood’ and ‘Work & Leisure’ were developed and are now available as DVDs of approximately 25 – 30 minutes in length (divided into two sections) with a musical and sound effect backing track. As with the Pictures to Share books, the images used in the DVD are chosen for their ability to overcome the visuoperceptual and cognitive difficulties of people with dementia. They also engage the viewer in an entertaining way, providing potential for meaningful discussion with relatives and carers.
Carers have reported that people with dementia watching the Pictures to Share films have benefitted widely from watching a film that they enjoy leading to improvements in mood and reduced agitation. With support, even those with more advanced dementia remain engaged in the film, avoiding the problems of disengagement or ‘dozing’ so common with traditional television viewing. As with the Pictures to Share books, to get the most benefit from the films, they are best used with a relative or carer sitting alongside and prompting discussion.
When we are looking to improve standards in dementia care, television should be seen as a valuable and accessible resource whether in care homes, at home or in hospital. However, what we show on the TV demands serious thought and imagination on the part of the carer if it is not to be an ineffective and even a detrimental intervention. With work now being done to provide easily available and effective film resources, the TV entertainment needs of those with dementia and their carers are eventually starting to be met.
Visuoperceptual difficulties in dementia. Alzheimer’s Society Factsheet
Television Viewing and People With Dementia Living in Long-TermCare : A Pilot Study Kate de Medeiros, Erica Beall, Stephen Vozzella and Jason BrandtJournal of Applied Gerontology 2009 28: 638 originally published online 5 March2009 DOI: 10.1177/0733464808330964
Yorkshire Film Archive www.memory-bank.org