Developing relationships between care staff and people with dementia through Music Therapy and Dance Movement Therapy: A preliminary phenomenological study

Enabling people living with dementia to make choices during creative workshops: a conversation analysis study of co-creativity, choice-sequences, and the supportive actions of carers

PURPOSE

Creative workshops can promote various positive outcomes for people with dementia, such as reductions in undesirable symptoms and achieving levels of autonomy. Although these are undoubtedly positive outcomes, there is little understanding of the specific processes that can enable such outcomes. To address this issue, our study investigates the interactional processes of "choice-sequences," in which a PlwD makes a choice pertaining to materials (e.g. pens, coloured papers) for a creative activity.

METHODS

This Conversation Analysis study draws upon around 60 hours of video-recorded creative workshops involving artists, people with dementia, and carers. Drawing upon the notion of "co-creativity," we examine the collaborative work that goes into accomplishing choice- sequences.

RESULTS

While these sequences typically begin with an artist presenting a choice to a PlwD, carers routinely enter these interactions and provide various forms of support needed to accomplish each basic action of a choice-sequence.

CONCLUSIONS

This study shows carers working alongside the artist to pursue the PlwD's choice in a triadic participation framework, and carers supporting the PlwD in a dyadic participation framework with the artist having exited the interaction. In providing such support, carers can utilize their understandings of the communicative norms and requirements of the PlwD.

A quasi-experimental mixed-method pilot study to check the efficacy of the "SOUND" active and passive music-based intervention on mental wellbeing and residual cognition of older people with dementia and dementia professionals' burnout: a research protocol

Purpose

The SOUND method offers an innovative blended intervention based on music circle-activities and cognitive stimulation approaches which was co-designed by musicians, health professionals, older people with dementia, family caregivers and researchers, for its application in dementia settings. The purpose of the paper is to describe the detailed procedure of the quasi-experimental pilot study.

Method

The experimental phase of SOUND uses a mixed-method design encompassing qualitative and quantitative observations, cognitive testing, self-report and interviewer-assisted questionnaires to investigate the effectiveness of the intervention for 45 people with dementia and 45 professionals (15 in every study country: Italy, Portugal, Romania).

Results

The pilot study will be the first implementation of the SOUND intervention aiming to investigate the feasibility and preliminary effects of the method.

Conclusion

The novelty of SOUND is its multicomponent method, including the most evidenced features for improving the wellbeing of participants.

A conversational, small-story approach to narrative care for people with dementia living in care institutions: Strategies and challenges

The aim of the paper was to define what narrative care is and identify and discuss everyday conversational narrative care strategies regarding people living with dementia in long-term care institutional settings. To do so, we differentiate between two approaches to narrative care: a big-story approach (reflecting on life stories) and a small-story approach (enacting stories in everyday conservations). The paper is focused on the second approach, which appears to be particularly fit to be used with people living with dementia. We identify three main strategies to implement this approach in everyday care: (1) prompting and sustaining narratives; (2) valuing non-verbal and embodied cues; and (3) constructing narrative environments. Finally, we discuss some training, institutional and cultural barriers and challenges for providing conversational, small story-based narrative care for people living with dementia in long-term care institutions.

Experiences of implementing person-centered care for individuals living with dementia among nursing staff within collaborative practices: A meta-synthesis

BACKGROUND

Person-centered care is considered standard care in long-term care for individuals living with dementia. However, qualitative reviews that synthesize the staff experiences of the implementation of person-centered care are lacking.

OBJECTIVE

This review aims to synthesize the experiences of nursing staff members after the implementation of person-centered care for individuals living with dementia.

DESIGN

A meta-synthesis was conducted.

DATA SOURCES

Overall, five electronic databases (i.e., PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, and Cochrane Library) were searched for the following terms: "dementia," "person-centered care," and "qualitative." The search was limited to articles published in English from January 1998 to December 2021, considering the period when person-centered care was applied in dementia care.

REVIEW METHODS

Qualitative content analysis was conducted using a person-centered nursing framework. Meta-data analysis, meta-method, and meta-theory analysis were used to synthesize the results of the included studies. The methodological quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) tool.

RESULTS

Altogether, 19 studies were included in this review. Through meta-synthesis, 12 themes, including professionally competent, perspective shift, shared decision-making among staff, appropriate supportive system, understanding and respecting individuals living with dementia, interaction with persons living with dementia and their family members, collaboration among staff members, concern about the well-being of an individual living with dementia, meaningful relationship between staff members and individuals living with dementia, quality care, reflections for maintenance, and barriers to overcome, emerged.

CONCLUSIONS

A person-centered nursing framework could be implemented in person-centered care for individuals living with dementia. However, the framework should be modified based on the characteristics of individuals living with dementia. Additionally, reflection strategies for maintenance and barriers are added to facilitate successful person-centered care implementation.

REGISTRATION

The study was registered with PROSPERO (International prospective register of systematic reviews) in May 2022 (registration number: CRD42022316097).

Person-attuned musical interactions (PAMI) in dementia care. Complex intervention research for constructing a training manual

Introduction

Music is of vital importance for cognition, human care, and the formation of social communities throughout life. Dementia is a neurocognitive disorder that affects cognitive domains, and in late-stage dementia, care is needed in all aspects of daily living. Within residential care home contexts, carers play a significant role for the "caring culture" but often lack professional training in verbal and non-verbal communication skills. Thus, there is a need for training carers to respond to the multidimensional needs of persons with dementia. Music therapists use musical interactions but are not trained to train carers. Therefore, our aim was to explore person-attuned musical interactions (PAMI), and additionally, to develop and evaluate a training manual to be used by music therapists when supporting and training carers in non-verbal communication with persons with late-stage dementia in residential care home contexts.

Research process

With a realist perspective and systems thinking and within the framework for complex intervention research, the research group integrated several overlapping subprojects by applying a non-linear and iterative research process. Core elements related to person-centered dementia care as well as learning objectives were considered through the following four phases; Developing, Feasibility, Evaluation, and Implementation.

Results

The result was a training manual for qualified music therapists to use when teaching and collaborating with carers about how to implement PAMI in dementia care. The manual included comprehensive resources, a clear structure for training, defined learning objectives, and integration of theory.

Discussion

With increased knowledge about caring values and non-verbal communication, residential care home cultures may develop carer competencies and provide professional attuned care for persons with dementia. Further piloting and testing to examine the general effect on caring cultures is needed.

Moments of meeting: A case study of Shared Reading of poetry in a care home

There is a growing research interest in the value of participative arts-based strategies for enhancing wellbeing amongst adults living with dementia. One such intervention, centred around literature, is the group activity called Shared Reading. The purpose of this case study of weekly Shared Reading sessions of poetry in a care home in Merseyside is to investigate instances of how participants with mild to moderate dementia collaborate in processes of meaning-making that allow them shared experiences of being moved by poetry. An under-thematised aspect of psychological wellbeing is the capacity for being moved and for sharing such moments. This article addresses the following question: how can the specific multimodality of the text (participants have a copy of the text before them, the poem is read aloud and there may be use of non-verbal aids) in the Shared Reading model help to bring about such experiences? Using Stern’s concepts of Now Moments and Moments of Meeting, this case study discusses various instances of unpredictable, surprising and spontaneous intersubjective moments between participant and poem, participant and reader leader, participant and staff, participant and relative.

Everyday Experiences of People Living with Mild Cognitive Impairment or Dementia: A Scoping Review

Increasing attention has been paid to the 'voice' of people living with mild cognitive impairment (MCI) or dementia, but there is a lack of clarity about how everyday life is perceived from this insider's perspective. This study aimed to explore the everyday life experiences, challenges and facilitators of individuals with MCI and dementia living at home. A scoping review of qualitative studies, guided by the Joanna Briggs Institute Reviewers Manual, was conducted. Eight databases were searched, resulting in 6345 records, of which 58 papers published between 2011 and 2021 were included. Analysis was carried out by descriptive content analysis. Findings were categorized into seven spheres of everyday life: experiences related to the condition, self, relationships, activities, environment, health and social care and public opinions. The results show many disruptions and losses in everyday life and how people try to accommodate these changes. In all areas of everyday life, people show a deep desire to have reciprocal relationships, stay engaged through participation in activities and have a sense of belonging in the community. However, more research is needed on the factors that promote and impede the sense of reciprocity and belonging.

Free to be: Experiences of arts-based relational caring in a community living and thriving with dementia

AIM

To present findings about experiences of relational caring at an arts-based academy for persons living with dementia.

BACKGROUND

There is a compelling call and need for connection and relationships in communities living with dementia. This study shares what is possible when a creative arts-based academy for persons living with dementia grounded in relational inquiry and caring focuses on relationships through the medium of the arts.

DESIGN

A qualitative phenomenological methodology (informed by van Manen) was used to answer the research question, "What is it like to experience relational caring at an arts-based academy for persons living with dementia?" We address two research objectives: (1) to explore how relationships are experienced when a relational caring philosophy underpins practice, including arts-based engagements; and (2) to understand the meaning of relationships that bring quality to day-to-day living.

METHODS

Twenty-five participants were recruited from the Academy and interviewed in one-to-one in-depth interviews or small groups. Participants included five persons living with dementia, eight family members, four staff, five artists, one personal support worker, and two volunteers. Participants were asked to describe their experiences of relational caring or relationships in the Academy space.

FINDINGS

Three thematic patterns emerged, which address the research objectives.Relational caring is experienced when:freedom and fluid engagement inspire a connected spontaneous liveliness;embracing difference invites discovery and generous inclusivity; andmutual affection brings forth trust and genuine expression.

CONCLUSIONS

Findings contribute to the growing body of knowledge about both relational caring and arts-based practices that call forth a different ethic of care-one that is relational, inclusive, and intentional. Findings also shed light on what is possible when a relational caring philosophy underpins arts-based practices-everyone thrives.

Mouvement de passage: Creating connections through movement among persons with dementia

One of the challenging consequences of dementia is the change in relationships that can co-occur with the progression of this condition. Despite this well-documented change, few arts-based interventions target the relational dimension of dementia. This study aims to explore the effects of one arts-based relational intervention: a movement program designed to foster connections within a group of persons with dementia. We used ethnographic methods—including participant observations and informal interviews—to understand the relational effects of this program conducted by two dancers and a musician. The movement sessions were video recorded, and participant movement trajectories were analyzed for different ways in which they created connections. We identified two types of connections—nonreciprocal and reciprocal—and four subtypes of connections—connection to exercise/music, connection to participant, interpersonal connection, and group connection—that participants engaged in during the movement program. Despite most participants not remembering the previous movement sessions, they experienced increasing numbers of connections over the course of the program, particularly reciprocal interpersonal connections. Participants explored new forms of moving and creatively transformed the movement structures proposed by the dancers. The results demonstrate the effectiveness of this program in augmenting connections and fostering exploration and creativity in individuals with dementia, providing a template for further developments of interventions targeting the relational dimensions of dementia. This study also highlights the potential of combining ethnographic methods and video analysis to include the perspectives of persons with dementia in research.

Impacts of Music Intervention on Dementia: A Review Using Meta-Narrative Method and Agenda for Future Research

Background: Dementia, a significant cognitive impairment, is characterized by a decline in memory. It affects an individual’s mood and behavior, which can impair their quality of life and well-being. Studies show that the demand for applying music as a new therapy method for dementia has increased during the last decades. Objective: To review the studies conducted on the impacts of music on different symptoms of dementia and provide readers with a more detailed picture of the efficacy of music, and recognize gaps in the literature. Methods: Electronic searches were conducted in the Cochrane Library (1938), Embase (773), Medline and PubMed (700), PsycINFO (89), and Scopus (218) databases. The search was comprised of all the literature from 2010 to 2020. For the search, key terms including “Dementia” AND “music” OR “music intervention” OR “music therapy” and index terms “clinical trial” OR “randomized controlled trials” were used. Finally, after screening 891 citations, 30 studies were included. Results: In general, it was observed that in most cases, music could be used as one of the safe and cost-effective non-pharmacological approaches for dementia treatment. However, in some studies, no impact or short-term effect of music on some symptoms of dementia such as wandering, agitation, and cognition was detected. Conclusion: Observing no effect or even negative impact of music on people living with dementia could be due to a random selection of music, fewer individuals, and the lack of a standard protocol. High heterogeneity in outcomes did not allow for clear conclusions on the benefits of music in dementia. This demands a comprehensive non-pharmacological music treatment approach to be designed for each stage of dementia to be employed alongside pharmacological treatments. This study proposes 13 gaps in the research on the health impact of music on dementia that could be studied by future researchers.

Approach Matters: Linking Practitioner Approaches to Technology Design for People with Dementia

Technology design for dementia is an active and growing area. Though work to date has largely addressed functional needs, there is a growing recognition of the importance of supporting meaningful activities. However, technology for active, rather than passive, engagement is relatively novel beyond specific applications (e.g., music or reminiscence therapy). To better understand how to support active engagement of people with dementia in activities, we interviewed nineteen practitioners. Our findings reveal differing approaches to making sense of the actions of people with dementia, as well as to engaging them in activities. We discuss the importance of tracing epistemological understandings of dementia to different configurations of technology for people living with dementia and provide a practical guide to support designers to do so. Finally, we discuss considerations for the design of dementia technologies around facilitating self-actualization and managing emotional exposure for care-providers.

Therapeutic Dancing for Frail Older People in Residential Aged Care: A Thematic Analysis of Barriers and Facilitators to Implementation

Background

Adults who live in residential aged care can have reduced participation in physical activities and sit for prolonged periods. Therapeutic dancing aims to optimize movement, creative expression, well-being, and social interaction.

Objectives

To investigate the benefits, challenges, and facilitators to implementing therapeutic dancing in residential aged care.

Methods

Thematic analysis of semistructured interviews of residential aged care staff and therapists. Interviews were digitally audio-recorded and thematically analyzed. Findings: Four main themes were identified: (a) despite frailty, dancing classes afforded motor and nonmotor benefits, (b) music and dance genre selections were key to success, (c) the skills of the dance instructor were associated with successful outcomes, and (d) there were modifiable and nonmodifiable facilitators and barriers to implementation.

Conclusion

Enablers included support from management, resident supervision, age-appropriate music with a strong rhythmical beat, and a dance instructor skilled in comprehensive care. Barriers included multimorbidity, frailty, severe cognitive impairment, and funding.

Mindsong, music therapy and dementia care: collaborative working to support people with dementia and family carers at home

Mindsong brings music therapy to people with dementia across Gloucestershire. In 2016, it was part of an innovative co-production project funded by NHS Gloucestershire Clinical Commissioning Group that offered music therapy to people with advanced dementia and ‘challenging’ behaviour. Music therapy was used at times of crisis with couples in the domiciliary setting and the hardest to reach residents at a dementia specialist care home. Positive outcomes included improvements in well-being, mood, engagement and behaviours. Working with client and carer together resulted in increased carer resilience despite complex challenges. Collaborative working maximised results to the benefit of clients and those who care for them. This article focuses on work in the domiciliary setting.

Positive physical and mental outcomes for residents in nursing facilities using music: a systematic review

Objectives

The objective of this study was to investigate the applicability and effectiveness of the use of music in providing for positive physical and mental outcomes in nursing facilities.

Problem

Lack of quality of life (QOL) has been a significant issue within nursing facilities. With the rise in census due to Baby Boomers, it has become imperative to find ways to increase overall QOL.

Methods

The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate to collect data regarding the use of music to provide for positive physical and mental outcomes in nursing facilities.

Results

The most common facilitator mentioned was increased socialization or communication (18%), followed by reduced depression (12%), improved physical health (11%), and reduced agitation or behavior problems (9%). The most common barriers were as follows: cannot isolate effects of music (26%), cost prohibitive (11%), difficult to implement (11%), and no significant improvements in QOL or well-being (11%).

Conclusion

The use of music showed positive outcomes for residents in nursing facilities and should be considered for implementation as part of the normal culture within such facilities.

Nursing and music: Considerations of Nightingale's environmental philosophy and phenomenology

A philosophy of nursing is to express our considered opinion on what we believe to be true about the nature of the profession of nursing and provide a basis for nursing activities. It affirms the ethical values that we hold as fundamental to our practice. For many of us in nursing, our philosophy derives from Nightingale and phenomenology. We believe Nightingale and phenomenology are uniquely placed within nursing philosophies, to assist the nurse to understand the use of music within a holistic, caring-healing paradigm, as nursing continues to adapt and evolve in the 21st century. This article proposes that both Nightingale's environmental philosophy and phenomenology are excellent intellectual and practice frameworks for nurses to consider music-based interventions for older adults who experience dementia. The potential outcome is an enhanced understanding of the well-being of this vulnerable group of older persons.

Broadening the debate on creativity and dementia: A critical approach

In recent years there has been a growing interest in person-centred, ‘living well’ approaches to dementia, often taking the form of important efforts to engage people with dementia in a range of creative, arts-based interventions such as dance, drama, music, art and poetry. Such practices have been advanced as socially inclusive activities that help to affirm personhood and redress the biomedical focus on loss and deficit. However, in emphasizing more traditional forms of creativity associated with the arts, more mundane forms of creativity that emerge in everyday life have been overlooked, specifically with regard to how such creativity is used by people living with dementia and by their carers and family members as a way of negotiating changes in their everyday lives. In this paper, we propose a critical approach to understanding such forms of creativity in this context, comprised of six dimensions: everyday creativity; power relations; ways to operationalise creativity; sensory and affective experience; difference; and reciprocity. We point towards the potential of these dimensions to contribute to a reframing of debates around creativity and dementia.

International Ballroom Dancing Against Neurodegeneration: A Randomized Controlled Trial in Greek Community-Dwelling Elders With Mild Cognitive impairment

BACKGROUND

Many studies have highlighted the positive effects of dance in people with neurodegenerative diseases.

OBJECTIVES

To explore the effects of International Ballroom Dancing on cognitive function in elders with amnestic mild cognitive impairment (aMCI).

METHODS

One-hundred twenty-nine elderly patients with aMCI diagnosis (mean age 66.8 ± 10.1 years) were randomly assigned into 2 groups: intervention group (IG, n = 66) and control group (CG, n = 63). The IG exercised systematically for 10 months, and both groups were submitted to extensive neuropsychological assessment prior and after the 10-month period.

RESULTS

According to the independent sample t test at the follow-up, significant differences between groups were found in benefit of the IG while the CG showed worse performance in the majority of neuropsychological tests. According to the Student t test, better performance is detected in IG in contrast with CG, which had worse performance almost in all scales.

CONCLUSION

Dance may be an important nonpharmacological approach that can benefit cognitive functions.