Memory, aging & expressive arts: Fostering meaningful art experiences for persons with dementia

Received: May 04, 2017; Accepted: June 12, 2017; Published: June 15, 2017 Creative expression is part of who we are. The arts have and continue to enrich our lives by providing opportunities for discovery, expression, curiosity, joy, peace and wonder. From a societal view, the arts promote civic engagement, build community, and foster collective problem solving while also preserving cultural heritage and identity [1]. Visual art, music, writing and dance programs are a contributing part of patients’ health and wellness within healthcare. For people living with an illness, creative experiences can remind a person of their positive attributes and individuality while enhancing their well-being. Research has shown that creative activities release endorphins, which can improve patient’s attitude, emotions, and assist with pain management [2]. Likewise, Gene Cohen’s notable research on a community-arts program for older adults found that participants used less medication and had fewer doctor visits than a control group, showed improvements in mood and independent functioning, and scored better on depression, loneliness, and morale scales [3].

Creative expression is part of who we are. The arts have and continue to enrich our lives by providing opportunities for discovery, expression, curiosity, joy, peace and wonder. From a societal view, the arts promote civic engagement, build community, and foster collective problem solving while also preserving cultural heritage and identity [1]. Visual art, music, writing and dance programs are a contributing part of patients' health and wellness within healthcare. For people living with an illness, creative experiences can remind a person of their positive attributes and individuality while enhancing their well-being. Research has shown that creative activities release endorphins, which can improve patient's attitude, emotions, and assist with pain management [2]. Likewise, Gene Cohen's notable research on a community-arts program for older adults found that participants used less medication and had fewer doctor visits than a control group, showed improvements in mood and independent functioning, and scored better on depression, loneliness, and morale scales [3].
Government healthcare leaders are also acknowledging the positive impact of the arts. The United Kingdom's Report of the Review of Arts and Health Working Group emphasized the importance of the arts in reducing stress, improving working conditions, and building relationships between staff, patients and their families [4]. Australia's National Arts and Health Framework states "that arts and health activities have intrinsic, instrumental and institutional values and have a demonstrated range of social, artistic, environmental, cultural, economic and health benefits, including the potential to improve the quality of health care" [5].
For people living with memory loss, creativity has the potential to maintain and improve their quality of life by providing meaningful interactions and engagement through the use of imagination [3]. Although research in the field of arts and dementia is limited, dementia-specific arts programming has been shown to reduce depression and isolation while encouraging new ways to communicate [6]. The Alzheimer's Association of Greater Cincinnati's Memories in the Making© is an art program designed for persons with mild to moderate stages of dementia. Led by artists educated in dementia care, participants are guided through drawing and painting projects. Using an observational tool designed to test wellbeing, the researchers found that participants experienced higher levels of interest, pleasure, selfesteem, and sustained attention while participating in the program than they showed during other activities [7].
As an artist and Associate Professor at the University of Michigan (U-M) Penny W. Stamps School of Art and Design, I have been collaborating with the University of Michigan Geriatrics Programs and the Michigan Alzheimer's Disease Center on developing creative experiences for persons with memory loss. This has led to a decade long partnership with the U-M Geriatrics Silver Club Mild Memory Loss Programs (social programs for memory-impaired adults living in and around Ann Arbor, MI).
In 2013, working with a team of professors and staff, I piloted a new course, Memory, Aging, & Expressive Arts. The course originated from a series of meetings organized by the Michigan Alzheimer's Disease Center (MADC). They included art and health professionals from across campus that gathered to explore new initiatives in dementia and arts. In those meetings, we recognized the need for an interdisciplinary course to provide dementia and creative arts education, for the next generation of professionals and community leaders, to be developed. Memory, Aging & Expressive Arts fits within the Stamps School of Art & Design's community engagement mission of promoting positive social impact. It is designed to develop students' sensitivity and understanding towards people living with dementia through shared art making, and is open to undergraduate and graduate students primarily studying art and design, social work or public health. The students collaborate directly with U-M Silver Club Mild Memory Loss Program club members on art, music, dance, or writing projects that they design and create together once a week for 90-minutes throughout the course of a semester. Supporting our program goals, research has shown that medical students who participated in one 90-minute museum-based, art-centered program for persons with dementia and their family caregivers gained increased comfort and new insights into how arts programming can improve quality of relationships [9].
Within healthcare and wellness programs, expressive arts introduce a variety of experiences that use the creative process to positively impact a person's quality of life. Research has shown that combining a variety of activities can be beneficial. In a dementia research intervention that integrated cognitive stimulation with art, music and horticulture therapy, the participants experienced improved levels of cognitive functioning, enhanced mood, and decreased depression [10].
Individually paired, students and club members spend the first weeks of the semester participating in music, dance, art, and writing activities. These initial experiences provide opportunities for the pairs to learn about each other while encouraging the students to be in the moment. After these initial sessions, the pairs find a direction they would both like to start exploring for the remainder of the semester resulting in a variety of projects.
The Memory, Aging, and Expressive Arts team consists of myself as the lead professor, J Scott Roberts in Public Health, Beth Spencer in Social Work, Nancy Barbas in Neurology, Laura Rice-Oeschger at MADC, and Elaine Reed at U-M Silver Club. This team-teaching approach provides students with a holistic perspective of aging and memory loss, while multiple teaching methods encourage peer learning and critical reflection.
Local artists and musicians specializing in working with older adults assist in training the students how to apply their artistic skills to the collaborative projects. Exploring various creative activities enables the students to explore and deepen their understanding of creativity, as well as learn how to successfully interact with the community. For example, we worked with a local DJ to create custom playlists for the Silver club members, which students and members then integrated into visual art projects. Current programming and research in the field of arts and health are also discussed.
Class time is spent working with students to develop their "creative toolbox." As mentioned, this includes bringing in local artists and musicians, as well as researching art activities and practicing projects to inspire and guide the students. It is essential that the students learn to design age-appropriate and sophisticated projects for people with memory loss while learning how to properly respond to challenges they might encounter. This involves practicing communication and listening skills and discussing pre-determined attitudes and fears about people living with dementia.
In Memory, Aging & Expressive Arts, students and Silver Club members utilize their mutual creative experiences to learn together. Intergenerational learning offers "great promise for leveraging the strengths, skills, and experiences of older adults" [11]. Although the students are prepared to guide the art project, the art making sessions often lead to unexpected discoveries and discussions that promote a sense of reciprocity and empowerment. Many club members have remarked that they see these exchanges as an opportunity to share part of their lifetime of experience with young adults.
Over the course of their collaboration, the students and club members share ideas and stories that inspire their projects. A pair of examples illustrates this. A student and club member exchanged travel stories over several weeks. Together they found a common interest in their fond memories of walking through Florence, and decided to paint a street map of the Italian city. The student's interest in strong graphic elements and the club member's interest in abstract painting come together perfectly in this piece (Figure 1). Another pair focused on creating a book composed of the family stories the club member enjoyed telling. The student designed the book layout and together the pair worked on the design decisions including what stories to include and the image selection. The student remarked on how she gained a lasting friendship through this experience.
For other student and club member pairs, the collaborative experience relies less on verbal exchanges for project development and more on the process of experimenting with art materials, processes, and techniques to create together. In an example of this, a student and club member that both enjoyed painting became highly engaged in the making process. Each week they would build off of their previous explorations, creating more complex patterns and textures on paper. Then they cut up their explorations into various shapes to create collages with ( Figure 2). The club member explored non-verbal expression through paintings while being exposed to new sensory experiences, as discussed by Kinney & Rentz [12] and similar to the Memories in the Making© program.
The goal is that these experiences will enable young adults, our future leaders, to embrace creativity as a way to empower and connect to others, and to foster new programming and design innovations that