Dementia Gateway: Keeping active and occupied

Creative arts

Key messages

People with dementia often communicate in words that have a poetic quality, rich in feeling and meaning, if we really take the time to listen.
Singing is usually a very successful activity for people with dementia who may remember words of songs when other memories have been lost.
Music offers people a chance to express themselves in different ways, less reliant on words.
People who have dementia can enjoy activities involving drama, although we as staff may need to develop our confidence in giving this a go!
When bringing children together with people with dementia, it can help to include an arts related activity to provide a focus for being together which doesn't rely on words alone.

The frail old man in the corner becomes a King. Staff suddenly see the man in a different light!
Ladder to the Moon actor

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1. Introduction Open

Dementia can have a devastating effect on people's cognitive abilities. Interestingly, however, the creative, imaginative and emotional parts of a person often remain relatively strong.

People with dementia can also lose some inhibition and therefore might feel more free to express themselves creatively and spontaneously.

There have been some wonderful developments in creative work with people with dementia in the past decade – these have shown how important it is to celebrate a person's potential rather than always focus on problems and deficits.
2. People with dementia as poets Open

Have you ever spent time really listening to the words of people who have dementia?

The words may be very muddled and it might be easy to switch off listening. But, if you take time to listen, there are often very important messages to be heard through the muddled words which can often have a quite symbolic or poetic quality.

Quite often the person is trying to communicate something very important either about their past life or their present situation or perhaps about both.

The groundbreaking work of John Killick, who has spent many years listening to people with dementia and recording their words as poems, has helped open our eyes and ears to what people are trying to communicate (see www.johnkillick.co.uk).
3. Carry on singing! Open

A person with dementia often will remember the words of verses, songs and hymns when other parts of their memory are very damaged. Singing helps lift spirits, raise energy levels and feel connected with others! Many people with dementia do not always feel their voice is heard, so it provides an immediate sense of self-worth if they can sing and have others notice and respond.

When you are working with a person with dementia, it might help to suggest or start singing a song. You will be surprised how often a person with dementia will come to life and join in with great enjoyment.

One home care worker found that one of her clients with dementia hated having a wash, but when she incorporated singing a few favourite songs into the activity, her client was immediately more willing to go into the bathroom.

If you are not from the same cultural background of the person you are working with, you may need to find out about the types of music that they might respond to. You might even ask your manager to purchase some relevant song sheets so that you could help prompt a person by asking if they know a particular song.

The fact that you don't know the song doesn't have to be a problem as you are then asking the person to share something they know with you! (For more on this, see the 'Getting to know me: touchstones of my life' feature in the 'Getting to know the person with dementia' section.)

Most singing takes place informally throughout the day, but there are some groups who offer a more structured approach to singing in groups such as 'Singing for the Brain'™ (see www.alzheimers.org.uk/singingforthebrain).
4. Making the most of music Open

A very frail looking man with dementia suddenly took the drum and started to beat it with great energy and strength. Everyone else in the room turned around and looked at him. He had a huge smile on his face!
Music group leader

When verbal communication is challenging, holding and playing an instrument, even if only for a few minutes, offers a person a chance to be 'in control', express something about themselves and their mood. Many people with dementia find new ways to communicate through music perhaps with their eyes, their arms or their feet.

Some music collections in homes or day centres can be very limited. Older people do not just like music from the 1930s and 1940s! 'Rock and roll' collections from the 1960s or classical collections might be more popular.

Find out about the backgrounds and interests of the people you are working with (see the 'Getting to know me: Touchstones' feature in the 'Getting to know the person with dementia' section). If you are working with younger people with dementia, make sure that you have music that is appropriate to their age and interests.

One woman in our nursing home repeatedly called out 'Nurse, nurse' throughout the day from her bedroom. Her keyworker found out she loved Scottish country music and playing this for periods in the day helped lessen her loneliness and need to call out as often. She started to talk about her childhood in the Highlands of Scotland.
Care home manager

A number of organisations use professional musicians to work creatively with people who have dementia: Music for Life and Lost Chord are two examples.

Music for Life musicians use improvisation to draw out self-expression and communication, an approach that can be particularly helpful when working with people with advanced dementia (see www.wigmore-hall.org.uk/community-and-education/musicforlife).

Lost Chord run interactive musical sessions in Yorkshire and Nottinghamshire using dance, song and instruments (see www.lost-chord.org.uk).
5. Drama Open

We had a small group of people together miming what they did for a job. We had lots of laughter and some of the residents became extremely animated. One woman who used to be a nurse did a brilliant mime of taking the blood pressure of everyone in the group!
Care home manager

People with dementia will often enjoy being playful and spontaneous. Many people will have played charades when they were younger. However, sometimes care workers do not feel as confident. You might feel worried about looking silly. Using props or objects can help, for example bringing in different kinds of hats and seeing how people respond when they put a hat on.

For drama related activities it can help to choose a theme, for example 'weddings' or 'schooldays.' You might be surprised at who suddenly becomes the 'bride' or the 'strict school teacher'!

Interactive theatre in care homes Have you ever organised a visiting entertainer or theatre group to come to the care home and found that many of your residents have not really engaged at all with the experience?

Ladder to the Moon is a theatre company that involves people with dementia in taking on roles in their shows so that they are not just audience members. This can provide people with dementia the chance to be a 'star', sometimes only for a few seconds and sometimes for an entire performance (see www.laddertothemoon.co.uk).

The frail old man in the corner who rarely says a word becomes a King who gives commands to others. Staff members suddenly see the man in a different light!
Ladder to the Moon actor
6. Children and older people working together Open

Care homes and day centres sometimes report that it can be awkward for children visiting a lounge full of older people as the young people are not always confident about how to approach the older people.

By planning an art or drama activity, this can help prevent awkwardness and provide a focus for the two generations to be together.

The children prepared a simple drama sketch of the 'nit nurse' visiting the classroom, examining each child's head and then sending one poor child out of the classroom! The older adults immediately started talking about 'Nitty Nora' (the name given to the nit nurse) and one of the women got up and joined in the sketch.
Intergenerational project worker

If the activities (for example creating decorated name badges or making an autumn collage) are set up for groups working around tables, the children and adults can immediately have something to do together. If the children are more able to do some of the tasks than the adults, the older people will still feel involved with watching or picking up some of the art materials. Young and older people alike can enjoy singing songs such as 'Wind the bobbin' up' with associated actions. Magic Me, an organisation with extensive experience in intergenerational work, publishes helpful resources and guidance on this (see www.magicme.co.uk).

Over to you!

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