Clothing the Clown: Creative Dressing in a Day-center for People with Dementia in the Netherlands

Creatief met clowns is a creative and art-based workshop for people living with dementia that invites participants to join in a collaborative process of creating an outfit and clothing a clown. In this article, I look at what happened in workshop sessions and how this mattered to those involved, including what participants with dementia valued about the activity - by listening to what they had to say, but also by attending to their performative, creative and affective ways of engaging in Creatief met Clowns. To further articulate values that came up in practice, I analyzed my findings in terms of the quality of psychosocial relations, the role of embodiment, material aspects, and playfulness in person-centered care. By combining an ethnographic study of art-based care-practice with a value-sensitive theoretical reflection on empirical findings, my approach offers an alternative to problematic efforts to quantify the value of art in person-centered dementia care.

'I can see what's going on without being nosey…': What matters to people living with dementia about home as revealed through visual home tours

OBJECTIVES

This paper considers home from the perspective of people living with dementia supporting ongoing discourse around ageing in place and the significance of creating more inclusive communities.

METHODS

Forty-six home tour interviews led by people living with dementia were conducted in England and Scotland to better understand the connectivity between home and neighbourhood for people living with dementia. These interviews used a range of participatory and creative approaches including video, photographic images and in situ interviews. Data were analysed via reflexive thematic analysis.

RESULTS

Three themes were identified in data analysis. 1. Connected home and neighbourhood, where participants revealed the dynamic relationship between home and neighbourhood; 2. Practices of home, where participants discussed the everyday nature of their homes and routines; and 3. Displaying home and family, which reflected participant's biographical homes in the context of living with dementia.

DISCUSSION

The findings show that home holds multiple meanings for people living with dementia. For example, home is understood as a part of the neighbourhood and an extension of the home space into gardens and backyards, thus extending existing discourses that solely focus on the inside of people's homes. For people living with dementia, homes are also sites of negotiation and renegotiation where new meanings are created to reflect the changing nature and context of the home. There is not one fixed solution to these issues. Support and understanding for people living with dementia will need to evolve to adapt to the shifting dynamics and multiple meanings of home.

‘Ways of being’ in the domestic garden for people living with dementia: doing, sensing and playing

Domestic gardens represent a site for enacting embodied identity and social relationships in later life, and negotiating tensions between continuity and change. In the context of dementia, domestic gardens have significant implications for ‘living well’ at home, and for wider discussions around embodiment, relational selfhood and agency. Yet previous studies exploring dementia and gardens have predominantly focused on care home or community contexts. In light of this, the paper explores the role of domestic gardens in the everyday lives of people living with dementia and their households, using qualitative, creative methods. This includes filmed walking interviews and garden tours, diaries and sketch methods, involving repeat visits with six households in England. Findings are organised thematically in relation to different ‘ways of being’ in the garden: working in and doing the garden; being in and sensing; and playing, empowerment and agency. These different ‘ways of being’ are situated within relationships with household members, neighbours and non-human actors, including pets, wildlife and the materiality of the garden. Garden practices illustrate continuity, situated within embodied biographies and habitus. However, identities, practices and gardens are also subject to ongoing readjustment and reconstruction. The conclusion discusses implications for extending literature on gardens and later life, describing how social and material relationships in domestic gardens are renegotiated in the context of dementia, while highlighting opportunities for ‘play’, active sensing and agency. We also explore contributions to understandings of dementia, home and place, and implications for garden design and care practice.

The experience of lived body as expressed by people with dementia: A systematic meta-synthesis

INTRODUCTION

People with dementia undergo extensive bodily changes during the course of dementia. Even though this is largely unrecognised in the literature, these changes greatly impact on the persons' experiences of living with dementia. Consequently, health care professionals and family caregivers need to be aware of the implications this has for delivering care to people with dementia. Hence, a systematic review that synthesises the knowledge on this topic is called for.

METHOD

This article presents a qualitative systematic meta-synthesis of interview studies with people with dementia. The theoretical framework of lifeworlds by van Manen provided the context for the study. The Critical Appraisal Skills Program criteria for qualitative studies were used to appraise the studies. Thirty-nine qualitative research studies were included in the review. The analysis followed the principles of interpretive synthesis.

FINDINGS

When exploring people's experiences of their body when living with dementia, four categories emerge: (1) My body works; (2) My body betrays me; (3) Understanding and adapting to my body's changes; and (4) My body in relation to others.

DISCUSSION/CONCLUSION

Every individual has their own personal experience of living with dementia; however, if health professionals fail to regard the body as more than an object, this may lead to the person's alienation both from the relation and from the body. The lived body experience has relational aspects as people with dementia are aware that others observe them, and they also observe others. Others' behaviour may affect the person's experience of body; one can perceive oneself as approved or denounced. People with dementia describe that a body that is capable and strong gives access to the world and to participation.

Transing dementia: Rethinking compulsory biographical continuity through the theorization of cisism and cisnormativity

Using theoretical tools from trans studies and disability/crip studies, we reconceptualize the self in the context of dementia. We illustrate that most dementia discourse, scholarship and intervention emphasize a maintenance of the pre-dementia self. We argue that the compulsory biographical continuity needed to maintain the pre-dementia self is based on interlocking forms of ageism, ableism, and cogniticism, and interacts with what we call cisism (the oppressive system that discriminates against people on the basis of change) and its normative components, cisnormativity* and ciscognonormativity. After providing a critical genealogy of the term cisnormativity*, we resignify and redeploy this concept in the context of dementia, demonstrating how it is useful for critiquing compulsory biographical continuity. Following the verbs queering and cripping, we propose a transing of dementia that leads to a new conceptualization of the self that is fluid and changing, rather than one anchored in multiple oppressions.

Using the performance arts to address a "methods gap" in dementia research

Introduction: Traditional methods of research have frequently failed to accommodate the communication difficulties experienced by a significant proportion of residents living in long-term care. In dementia research, specifically, there is cause for more collaborative, creative ways of working.Methods: The Linking Lives Through Care study is a performance-based narrative inquiry that will take place in a long-term care setting and will bring together all three members of the care triad - residents who are living with dementia, family members and personal support workers - to explore relational care from multiple positions and perspectives.Discussion: In this article, we discuss the design choices and creative measures taken to ensure a more inclusive research environment, specifically for those participants who are cognitively frail and/or may find it difficult to express their views using just words.

The Seven Selves of Dementia

The self is a complex and multifaceted phenomenon, encompassing a variety of cognitive processes and psychosocial influences. Considering this, there is a multiplicity of "selves," the current review suggesting that seven fundamental self-processes can be identified that further our understanding of the experience of dementia. These include (1) an embodied self, manifest as corporeal awareness; (2) an agentic self, related to being an agent and influencing life circumstances; (3) an implicit self, linked to non-conscious self-processing; (4) a critical self, which defines the core of self-identity; (5) a surrogate self, based on third-person perspective information; (6) an extended self, including external objects or existences that are incorporated into the self; and, finally, (7) an emergent self, a property of the self-processes that give rise to the sense of a unified self. These are discussed in relation to self-awareness and their use in making sense of the experience of dementia.

Dementia-Friendly Neighbourhoods in Canada: A Carer Perspective

Based on findings from a study examining the lived experiences of dementia carers in their neighbourhoods, this article offers a vision of what dementia-friendly communities could look like from a carer perspective and in a Canadian context. Twelve carers in Ottawa and its surrounding regions were interviewed using a combination of social network maps, mobile interviews, and participant-driven photography. The findings, organized according to the categories "relationships", "places", and "everyday practices", reveal that many of the carers' choices regarding businesses, services, home location, outings, and everyday practices, are based on a desire to maintain social connections and social citizenship. The article concludes with recommendations for consideration in the planning of dementia-friendly neighbourhood initiatives.

‘So long as there's hair there still’: displaying lack of interest as a practice for negotiating social norms of appearance for older women

Although women's appearance is theorised as being central to their identity and social currency, much prior research has argued that as women age, other aspects of their lives assume a higher priority than their appearance. Nevertheless, they continue to invest time in appearance practices. In undertaking these various appearance practices, older women have to negotiate a range of conflicting social norms of age-appropriate appearance, such as managing the balancing act between ‘letting themselves go’, on the one hand, and looking like ‘mutton dressed as lamb’, on the other. This paper contributes to the growing literature on older women's attitudes to their appearance and related practices. Drawing on data from a two-year research project in a hair-salon catering primarily for older clients, I examine the question of the importance to women of their appearance through the lens of their hair-care practices. Focusing on a group of nine female clients aged 55–90 in a small hair-salon in southern England, I show how participants in their talk and embodied presentation display shifting orientations of investment/interest (or lack of interest) in their appearance. Comparing participants’ appearance practices, with their talk in two sequential environments in which a possible interest in appearance is made particularly salient, I argue that these shifting orientations reveal participants’ subtle negotiation of competing social norms of appearance for older women.

Sensor e-textiles: person centered co-design for people with late stage dementia

Purpose

– The purpose of this paper is to present design research investigating the development of sensory textiles with embedded electronics to support the wellbeing of people with late stage dementia in residential care.

Design/methodology/approach

– The research presented is qualitative and uses a mixed method approach informed by grounded practical theory and positive design methodologies. It uses an inclusive and participatory co-design process involving people with dementia and their families with an interdisciplinary team of experts.

Findings

– Both the co-design process and the artefacts developed have been beneficial in supporting wellbeing. The textile artefacts have been found to soothe, distract and comfort people with dementia. They have also been shown to facilitate in the moment conversational bridges between family members and carers with persons with dementia.

Research limitations/implications

– The findings are based on a small cohort of participants, observational reports and descriptive accounts from family members and carers.

Practical implications

– The paper proposes ways in which simple hand-crafted textiles can be used beneficially to support the wellbeing of people with late stage dementia. It provides examples of how technology can be used to personalise and extend the sensory properties of the artefacts created.

Social implications

– It promotes an inclusive co-design methodology involving care professionals, carers and people with dementia with designers and technologists.

Originality/value

– The paper describes new ways of extending sensory properties of textiles through the integration of technology.

‘Gonna make yer gorgeous’: Everyday transformation, resistance and belonging in the care-based hair salon

This paper makes a contribution to an emerging debate on dementia and citizenship through a focus on the everyday experiences of women living with dementia and in receipt of care. In particular, a link is drawn between hairdressing and citizenship in the context of dementia care. Informed by a wider debate over the importance of an emplaced, embodied and performative approach to citizenship, the authors highlight the way that intersecting forms of resistance unfold in the salon. The Hair and Care project, as the name implies, focused upon hair care and styling in the context of a wider consideration of appearance and how it is managed and what it means for people living with dementia. With a focus upon the routine, mundane and thereby often unproblematised aspects of everyday life in/with care, the discussion draws together two key ideas concerned with the interplay of power and resistance: Essed’s (1991) theory of ‘everyday discrimination’ and Scott’s (1985) notion of ‘everyday resistance’. The findings illuminate the creative and collective forms of agency exercised by older women living with dementia, in the context of their relationships with one another and with the hairdressers whose services and support inspire their loyalty and patronage. Findings from the study point to the link between (inter-)personal practices of appearance management and a wider set of social conditions that are manifest in the on-going struggle over time, space and bodies in dementia care.

Materialising memories: exploring the stories of people with dementia through dress

In this article, we use clothes as a tool for exploring the life stories and narratives of people with dementia, eliciting memories through the sensory and material dimensions of dress. The article draws on an Economic and Social Research Council-funded study, ‘Dementia and Dress’, which explored everyday experiences of clothing for carers, care workers and people with dementia, using qualitative and ethnographic methods including: ‘wardrobe interviews’, observations, and visual and sensory approaches. In our analysis, we use three dimensions of dress as a device for exploring the experiences of people with dementia:kept clothes, as a way of retaining connections to memories and identity;discarded clothes, and their implications for understanding change and loss in relation to the ‘dementia journey’; andabsent clothes, invoked through the sensory imagination, recalling images of former selves, and carrying identity forward into the context of care. The article contributes to understandings of narrative, identity and dementia, drawing attention to the potential of material objects for evoking narratives, and maintaining biographical continuity for both men and women. The paper has larger implications for understandings of ageing and care practice; as well as contributing to the wider Material Turn in gerontology, showing how cultural analyses can be applied even to frail older groups who are often excluded from such approaches.

'Once I had money in my pocket, I was every colour under the sun': using 'appearance biographies' to explore the meanings of appearance for people with dementia

Appearance and the work invested in it by and for people with dementia are a neglected issue within dementia studies. In policy and practice there exists an assumption that the role of supporting a person to manage their appearance is easily assumed by another within caring encounters, only to be subsumed within the daily task-oriented provision of care. This paper reports on interviews conducted as part of the Hair and Care project, which explored questions of appearance and the meanings it holds with people with dementia. The research used 'appearance biographies', a method which allows for a range of topics to be considered about appearance throughout the life course, acting as a conduit for reminiscence and life story work. The paper reports on the key themes and findings from these interviews, discussing them in the context of a wider debate on dementia, self-expression and agency. A key question posed by the authors is whether appearance and the work invested in it are legitimate considerations for dementia care policy and practice. And if so, how should we make sense of this work and what significance should we attach to it? In seeking to answer these questions the authors position the perspectives and experiences of people with dementia as central to their analysis. A narrative framework is suggested as a useful basis on which to understand the work of managing appearance over the life course. The implications for policy and practice are outlined.