Humour, irony and sarcasm in severe Alzheimer's dementia – a corrective to retrogenesis?

Observations on strategies used by people with dementia to manage being assessed using validated measures: A pilot qualitative video analysis

BACKGROUND

Analysis of video data was conducted of validated assessments with people with dementia as part of a feasibility control study comparing a lifelong learning service with other dementia services.

OBJECTIVE

The aim was to provide a new perspective on what occurs during the assessment process when using validated measures in research and explore which strategies people with dementia use to manage their participation.

DESIGN

Video recordings were made of pre- and postintervention assessments of people with dementia. An initial pilot analysis of 10 videos of the pre-assessments was conducted.

SETTING

Lifelong learning services and other dementia services situated in six municipalities in Northern Denmark took part in this study, with 55 people with dementia participating.

RESULTS

The themes identified were: 'State of mind' and 'Mental resources', showing how these aspects influenced the participants' reactions and the strategies they used.

DISCUSSION

The results are discussed in relation to how individual personality traits influence the assessment process and the way a person with dementia will manage the situation.

CONCLUSION

The assessment situation is complex and can be influenced by the strategies adopted by individuals with dementia as they try to manage the assessment process.

PATIENT OR PUBLIC CONTRIBUTION

People with dementia supported the decision-making for the choice of validated measure used within this study.

Dancing With Dementia: Exploring the Embodied Dimensions of Creativity and Social Engagement

Background and Objectives

Dance is increasingly being implemented in residential long-term care to improve health and function. However, little research has explored the potential of dance to enhance social inclusion by supporting embodied self-expression, creativity, and social engagement of persons living with dementia and their families.

Research Design and Methods

This was a qualitative sequential multiphase study of Sharing Dance Seniors, a dance program that includes a suite of remotely streamed dance sessions that are delivered weekly to participants in long-term care and community settings. Our analysis focused on the participation of 67 persons living with dementia and 15 family carers in residential long-term care homes in Manitoba, Canada. Data included participant observation, video recordings, focus groups, and interviews; all data were analyzed thematically.

Results

We identified 2 themes: playfulness and sociability. Playfulness refers to the ways that the participants let go of what is “real” and became immersed in the narrative of a particular dance, often adding their own style. Sociability captures the ways in which the narrative approach of the Sharing Dance Seniors program encourages connectivity/intersubjectivity between participants and their community; participants co-constructed and collaboratively animated the narrative of the dances.

Discussion and Implications

Our findings highlight the playful and imaginative nature of how persons living with dementia engage with dance and demonstrate how this has the potential to challenge the stigma associated with dementia and support social inclusion. This underscores the urgent need to make dance programs such as Sharing Dance Seniors more widely accessible to persons living with dementia everywhere.

A qualitative study of the shared experience of humour between people living with dementia and their partners

Humour is a complex social and emotional experience which could constitute a positive resource for people endeavouring to live well with dementia. However, little is currently known about the shared use and value of humour in dyads where one person has dementia. The purpose of this study was therefore to explore how people with dementia and their care-partners experience, use and draw meaning from humour in relation to their shared experiences of dementia and their ongoing relationships. Ten participant dyads (the person with dementia and their spousal partner) took part in joint semi-structured interviews. Interpretative Phenomenological Analysis revealed eight subthemes that were subsumed under three super-ordinate themes: ‘Humour Has Always Been There (and Always Will Be)’; ‘Withstanding Dementia’ and ‘Renewing the Value of Humour in Dementia’. Overall, the findings suggest that humour, in different forms, can represent a salient and enduring relationship strength that helps dyads maintain well-being and couplehood by providing a buffer against stressors associated with dementia. The findings highlight the potential value of integrating a dyadic perspective with strengths-based approaches in future research into how people live well with dementia.

Are Humor Styles of People With Dementia Linked to Greater Purpose in Life?

Objectives

Little is known about humor and purpose in life in people with dementia. Although having a sense of humor is typically associated with positive psychological outcomes, recent evidence suggests that outcomes may vary depending on whether the humor being used is adaptive versus maladaptive. The goal of this study was to determine whether humor styles are predictive of purpose in life in people with dementia.

Methods

Questionnaires were verbally administered to people with mild-to-moderate dementia to measure humor styles and purpose in life.

Results

Adaptive humor styles were associated with purpose in life whereas maladaptive humor styles were not.

Discussion

Having a sense of humor in dementia may be associated with a stronger sense of purpose in life, but it depends on the type of humor used. Results are discussed in the context of understanding the role of humor in the daily lives of people with dementia and implications for care.

Exploring the relationship between community-based physical activity and wellbeing in people with dementia: a qualitative study

This study sought to identify factors which influenced how a group of people with dementia living in their own homes participated in community-based physical activity and explored the effect that exercise groups, dance and walking had on their wellbeing. A broadly ethnographic approach was adopted in which participant observation and interviews were employed. Nineteen people with dementia and seven formal and informal carers were included in the participant observation phase. Eleven people with dementia were interviewed. The analysis and interpretation of data was informed by embodiment and social constructionist theoretical perspectives. Findings suggest that a complex interplay between attitudes and beliefs, retained embodied abilities, and aspects of the physical and social environment influenced how individuals engaged in physical activity and the degree to which they experienced wellbeing as a result. Findings suggest that when certain factors co-exist, physical activity can provide a context within which people with dementia are able to use embodied skills in order to support fragile identities, connect with others and express themselves.

Presence redefined: The reciprocal nature of engagement between elder-clowns and persons with dementia

Elder-clowns are a recent innovation in arts-based approaches to person-centred dementia care. They use improvisation, humour, and empathy, as well as song, dance, and music. We examined elder-clown practice and techniques through a 12-week programme with 23 long-term care residents with moderate to severe dementia in Ontario, Canada. Analysis was based on qualitative interviews and ethnographic observations of video-recorded clown-resident interactions and practice reflections. Findings highlight the reciprocal nature of clown-resident engagement and the capacity of residents to initiate as well as respond to verbal and embodied engagement. Termed relational presence, this was achieved and experienced through affective relationality, reciprocal playfulness, and coconstructed imagination. These results highlight the often overlooked capacity of individuals living with dementia to be deliberately funny, playful, and imaginative. Relational presence offers an important perspective with which to rethink care relationships between individuals living with dementia and long-term care staff.

The importance of being ironic: narrative openness and personal resilience in later life

This essay applies a narrative perspective to the topic of resilience. On various fronts (physical, social, biographical), aging itself, it argues, pushes us past a perception of aging as intrinsically tragic and toward a more ironic stance instead, one marked by increased acceptance of uncertainty and ambiguity. Moreover, intentional engagement in narrative reflection-by means of integrative reminiscence, life review, and the like-fosters such a stance directly by facilitating narrative openness and, with it, "a good strong story" for coping with the challenges of later life.