Art Interventions for Dementia Patients
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Art Intervention Processes for Dementia Patients
Art Interventions for Dementia Patients
There are few phrases that I dislike more than 'It is what it is'. I believe people that make use of this phrase are stating that whatever the concern, it is not worthy of thought; it is their under-mannered way of naturalizing the consequences of misguided choices. However, the fact that every choice, good or bad, has consequences is a truth that cannot be ignored. I know the frustration and anguish of rectifying the consequences of the horrific choices of others. I know because on October 24, 1998, I survived two violent crimes. In 2002, I was formally diagnosed with Post Traumatic Stress Disorder with Suicidal Ideation and placed on Social Security Disability Income. Nine months after my diagnosis, I again survived two violent crimes, and three additional traumatic life-experiences. Every memory that I had, good and bad, was muted into abstraction and my ability to trust anyone was shattered.
Indeed, I've lived in a fear-based reality that included hyper-vigilance, sleep deprivation, flashbacks, panic attacks, and nightmares. My ability to communicate with others was crushed, as was my confidence and self-esteem. I believed God was wishful thinking, suicide was my best option, and that I wanted to die. With more hard work than I sometimes care to remember, I recovered. But to do so, I was required to take responsibility for the actions of those that hurt me. I chose to forgo traditional therapy and instead opted for the holistic path offered through art interventions, mindfulness, and meditation.
As part of my recovery I created original artwork in every form of media that was available to me and I readjusted my fear-based reality by embracing my ability to make positive choices. However, the term 'choice' is a luxury that is absent in the daily lives of dementia patients. I know how strange and frightening their world has become, and I know the despair they feel but can't voice. I am forever grateful for the many people who chose to help me help myself and fortunately have the opportunity to offer the same for others. Without hesitation I have chosen to help dementia patients survive the symptoms of trauma by facilitating communication through the art therapy processes. I am confident that employing art interventions, as a vehicle for therapy and cognitive rehabilitation, holds positive limitless outcomes for dementia patients and their caregivers.
Topic and Purpose
Most types of dementia are neurodegenerative conditions for which there are no treatments capable of halting, let alone reversing, disease progression (Simpson, 2014; Chancellor, Duncan, & Chatterjee, 2014). According to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) the defining features of dementia are at least two distinct cognitive deficits affecting memory and at least one of the following impairments: (1) language (aphasia), (2) motor movement (apraxia), (3) object and facial recognition (agnosia), (4) and planning, organizing, prioritizing, and abstract reasoning (executive functions) (Christensen & White, 2006). The difference between mere forgetfulness and clinical dementia is that the latter will interfere with the individual's ability to live an independent life. DSM-V, the most recent version, divides dementia and other neurodegenerative disorders into two main classifications: mild and major neurocognitive disorders (NCDs) (Simpson, 2014). All types of dementia are included in the major NCD classification.
A definitive cause of dementia remains unknown, but defects in protein folding, which contribute to the formation of neurotoxic ?-amyloid plaques, has become one of the primary theories used to explain the loss of brain neurons (Riverol & Lopez, 2011). Other types of dementia include vascular, Lewy bodies, and frontotemporal dementias, in that order, from common to rare (Christensen & White, 2006).
In addition to the sometimes severe symptoms, the stigma associated with being diagnosed with dementia can have profound consequences (Milne, 2010). The patient not only has to cope with cognitive decline and memory loss, but also with being defined by the 'dementia' label. In addition to the lower quality of life (QOL), increased vulnerability, reduced independence, loss of social roles and identity, lower self-esteem, and lost social value, patients diagnosed with dementia tend to experience social exclusion and isolation, not only in the communities where they reside, but also within the healthcare system. Milne (2010) described the 'double-whammy' that most dementia patients' experience, which involves discrimination due to advanced age and a mental illness diagnosis. The 'dementia label has also been observed to result in what researcher call 'excess disability,' which implies that residual cognitive and psychological functional capacity are ignored and the activities available to dementia patients, whether at home or in a formal care setting, are too simplistic to be engaging (MacPherson, Bird, Anderson, Davis, & Blair, 2009). High quality dementia care should therefore strive to preserve cognitive abilities, lower the frequency and severity of adverse events, improve health, eliminate threats to safety, increase the health and well-being of the family caregiver, and improve the social environment inhabited by the patient (Odenheimer et al., 2013).
In the absence of effective medical interventions capable of slowing, halting, or improving the symptoms of dementia, there is a great need for non-medical interventions that can make a significant difference in the lives of patients and the people who care for them. One intervention gaining wide acceptance is patient engagement in creative activities, which has generated countless reports of positive outcomes for both patients and caregivers (Chancellor, Duncan, & Chatterjee, 2014; Kinney & Rentz, 2005; Rusted, Sheppard, & Waller, 2006; Stallings, 2010; Hattori, Hattori, Hokao, Mizushima, & Mase, 2011; Ferrero-Arias et al., 2011; Peisah, Lawrence, & Reutens, 2011; Mimica & Kalinkic, 2011). For example, Ruth is an art therapist who enjoys connecting with the intact parts of a patient's mind and watching them blossom (Alzheimer's Association, 2014a). When her own mother was diagnosed with Alzheimer's disease (AD) she was struck by how uninhibited and uncritical her mother had become towards her own drawings, a stark contrast to a pre-AD habit of unforgiving self-criticism. Observations like these are becoming more common and art activities are increasingly recognized as effective interventions for moderating the symptoms of dementia (Alzheimer's Association, n.d.). There have also been reports of accomplished artists producing remarkable works for years after receiving an AD diagnosis and using art to enhance remembrances of the past (Chancellor, Duncan, & Chatterjee, 2014).
The findings of a limited number of quantitative studies generally support the use of an art intervention for improving patient QOL, but little is known about the subjective experience of the patient, caregivers, and art therapists, which Ullman (2005) believed to be necessary for improving the provision of care. The purpose of this study is to provide insight into stakeholder experience during the provision of art therapy to patients suffering from mild to moderate dementia.
In 2013 an estimated 5.2 million Americans suffered from Alzheimer's disease (AD), which represented between 60 and 80% of all diagnosed cases of dementia (Alzheimer's Association, 2013). Close to 5 million were over the age of 65, a fact that highlights age as a major dementia risk factor. Accordingly, the prevalence of this disease increases to 44% for individuals' who surpass 75-years of age. Most of the care provided to dementia patients comes from informal caregivers, such as family members and friends, who in 2013 contributed nearly 17.7 billion hours of unpaid care with an estimated value of $220.2 billion dollars (Alzheimer's Association, 2014b). This amount is approximately equal to the total amount spent on direct medical care annually for dementia ($214 billion). Unfortunately, the stress associated with caring for loved ones with dementia can be substantial, resulting in an additional $9.3 billion in direct medical care expenses annually. In light of the lack of effective medical treatments or promising cures, and the growing burden of dementia care on society and families, any intervention that can improve patient QOL would represent an important contribution. Currently, art therapy represents one of the more promising interventions currently available (Chancellor, Duncan, & Chatterjee, 2014) and therefore deserves the attention of researchers.
In the State of Utah, an estimated 32,000 individuals suffered from AD in 2010 (Alzheimer's Association, 2013). This is a relatively small number compared the rest of the country, but current projections suggest that the number of Utah residents suffering from dementia will more than double by 2025 (127%). A quick word search for dementia on the Utah Museum of Fine Arts website retrieved no results. A similar search on Google created the impression that art and creative activities have not found their way into Utah dementia care, although the Utah chapter of the Alzheimer's Association is aware of the potential health benefits associated with art exposure (Jarvik, 2006). One sign that progress is being made however, comes from an initiative to implement the Music & Memory Initiative into Utah residential treatment facilities caring for dementia patients (Sneed, 2014), but much more needs to be done to optimize…