Implementing Creative Arts in a Memory Care Environment

“Art enables us to find ourselves and lose ourselves at the same time.”

Thomas Merton

Recent studies show that the cost of caring for Americans with Alzheimer’s disease and other dementias has surpassed the cost of treatment for cancer patients or victims of heart disease. These costs are virtually certain to go up as the baby boomers enter the age of highest risk. Last year costs associated with the treatment and care of Alzheimer’s were estimated to reach $226 billion. With Alzheimer’s disease hitting our pocketbooks hard, this new reality is resulting in increased research and the development of programs that seek to improve the lives of people living with Alzheimer’s and other dementias.

Much of the current research focuses on the value of music, art, dance, and social connections in the treatment of dementia. It is becoming increasingly evident that initiatives that help people with Alzheimer’s to get involved in art and other creative activity, obtain surprising results. Judy Holstein, Director, CJE Senior Life Day Service in Chicago sums it up. “Creative arts bypass the limitations and simply go to the strengths. People still have imaginations intact all the way to the very end of their progressive disease.” Through creative expression it is possible for those with dementia to reach beyond their disease and to connect with a past memory, sense of being, or a feeling in a way that many thought was impossible.

This ability to reconnect with a past memory is rooted in the physiology of the brain. Scientists have discovered that Alzheimer’s disease normally spares, to a very large extent, the parts of the brain related to emotions, creativity, and creative expression. Because of this, neurologists now recognize the benefits of non-pharmacological therapies such as art and music therapy. With scientific evidence backing the efficacy of these non-traditional, yet innovative advancements, the unfortunate reality is that only a very small percentage of nursing homes and care facilities are making use of these approaches. As a long term care community that embraces healing through music and art, Juniper Communities welcomes the opportunity to share with you what we’ve learned.

With no drugs currently available to effectively prevent or stop Alzheimer’s inexorable damage to the mind, what recourse is available to those suffering from this terrible, degenerative disease? A musical walk down memory lane, a creative arts project, or museum tour can do more than offer pleasant diversion, they can improve dementia symptoms as well. A study from New York University and the Museum of Modern Art (MoMA) evaluated a program called “Meet Me at MOMA” to assess how viewing and engaging with artwork effects people with early-stage dementia. The study design, which included a variety of measures to gather both qualitative and quantitative data through self-report and observation has yielded a comprehensive understanding of how and why the Meet Me at MoMA program impacts attendees and provides suggestions for modifications and future expansion. The results revealed program participants experienced fewer emotional problems during the week following a visit to the museum program, along with elevations in mood, an increase in social support, and elevated self-esteem.

In this paper we will shed light on two incredibly valuable creative initiatives: Memories in the Making, an art program developed by two artists working with the Alzheimer’s Association; and Music & Memory, a personalized music program developed by Dan Cohen.

Memories in the Making

One of the greatest tragedies associated with Alzheimer’s disease is the loss of the ability to communicate. At a time when people are most in need of support and assurance, the disease robs them of the ability to communicate their confusion and fears, as well as their hopes and wishes. “Memories in the Making” (MIM) is an innovative art program that enables persons with Alzheimer’s and related forms of dementia who are experiencing losses in their ability to verbally communicate their thoughts and feelings due to the disease process, to express themselves through art. Volunteer facilitators help people with dementia – many of whom have no art background, to create drawings and paintings. These sessions provide participants with social interaction and boost their self-esteem while opening the channels of communication with loved ones.

Memories in the Making began in 1988 as an annual art exhibit by Alzheimer’s artists sponsored by the Alzheimer’s Association of Orange County, California. The exhibit was designed originally as a general awareness program to educate the public about the impact and progression of Alzheimer’s disease and related disorders. It aimed to provide positive connecting links between family members and professional caregivers and to remind the research and medical communities, as well as the general public, that individuals with dementia do retain a great deal of the essence of their humanity and their being.

The Memories in the Making experience provides families an avenue to learn more about the person with Alzheimer’s. Through this program, the Alzheimer’s patient is able to reach a place outside of their dementia and extract some part of who they once were and, more importantly, who they still are. The artwork offers us a rare glimpse into their emotions and memories as they express a part of their spirit. The essence of who they are and what they care about shines through. “It often seems like all we have left are our memories of dad but what is happening at Juniper is causing us to enjoy Dad’s memories! He is thriving thru this experience and that is not a term often used!” Cynthia S, a Juniper Village at Louisville family member remarked.

Every year the Alzheimer’s Association honors participants and their families through a celebratory art exhibit and auction. Another Juniper Village at Louisville family member expressed “I am pleased with how mom likes to paint. I love how she is found and brought over to the painting area when Memories in the Making occurs. She had several Juniper Village at Aurora has been a part of the program for several years. Michelle Audet, Connections Director, describes the program like this, “What I’ve seen is residents painting who have never painted a day in their life. When I share their loved one’s artwork with their families they are absolutely amazed at their paintings and tear up when they realize this beautiful art came from their loved one. One of the daughters once told me, ‘my mother has never painted, you guys are amazing at what you can get her to do.’ I currently have five residents who have never painted before. A brother of one of our residents recently asked me if his brother gets agitated when he paints, I said ‘no, just the opposite. He is very calm and appears to enjoy putting paint to paper.’ “pieces of her work displayed and that made us proud.”

The Impact of Art on Those With Dementia

The Alzheimer’s Association realizes that “people with Alzheimer’s, a world grown confusing, overwhelming, and maybe even frightening has been comforted a little by a palette of watercolor paints and blank piece of paper. With the encouragement of a trained art facilitator, these artists glide their brushes on paper forming meaningful works of art. Participants in this program can feel a real sense of accomplishment and achievement while living with memory loss.” The Memories in the Making art program gives people with dementia the ability to paint their thoughts, emotions and memories. The art becomes their voice. Teresa, a Juniper Village at Aurora resident living with Alzheimer’s says, “I like to paint because it makes me feel closer to God”.

While participating in the program, people with Alzheimer’s are often able to reach outside of their dementia and paint a picture that reconnects them with a past memory. These documented memories become powerful tools that reassure family and caregivers that the essence of the individual is still there. For example, one artist painted a birdhouse sharing his lifelong love of building and hanging birdhouses in the yard. Another painted a fish remembering the hours spent nurturing his tanks of tropical fish. When the ability to communicate verbally is diminished, the art truly becomes their voice. It is a way to connect with others, to socialize and reduce isolation.

Kaitlin Hoover, Connections Director at Juniper Village Wellspring Memory Care at Brookline has seen this transformation first hand. “The power of artistic expression in the residents of Wellspring is nothing short of remarkable, especially to see in action. It seems to instill a sense of self-confidence, pride, and harmony in oneself by connecting the canvas (or whatever medium is being used) to that individual’s creative energy as a positive outlet of expression. Then to have an incredible, one-of-a-kind piece of artwork to share with friends, family, and visitors, keeps the joy alive well after the culmination of the creation process.”

Development of an Art Program

Several of our Juniper Communities are proud to offer the Alzheimer’s Association’s Memories in the Making program. At some of our locations there were no Memories in the Making programs in the vicinity. In order to make this programming possible in our communities, we had to get creative. We partnered with local universities and high school art departments to create an intergenerational program. We also approached church youth groups, and scout troops and asked them to partner with elders in the community. Creating this intergenerational artistic exploration will have far-reaching benefits for all parties. The opportunities are endless! You can learn more about the Memories in the Making program through your local chapter of the Alzheimer’s Association.

Music & Memory

Executive Director Dan Cohen founded Music & Memory with a simple idea: Someday, if he ended up in a nursing home, he wanted to be able to listen to his favorite ‘60s music. He’d heard a recent news report about how iPods had grown so popular. Why not bring used iPods as well as new ones into nursing homes to provide personalized music for residents?

At that time, in 2006, Dan discovered that none of the 16,000 long-term care facilities in the U.S. used iPods for their residents. Dan immediately jumped into action by volunteering his time at a local nursing home in Greater New York, creating personalized playlists for residents. The program was a hit with residents, staff and families, and became the prototype for a bigger effort. In 2008 Dan received funding from the Shelley & Donald Rubin Foundation. He brought 200 iPods to residents of four New York long-term care facilities and tested the program on a larger scale. Successful outcomes spurred the creation of Music & Memory as a 501(c)(3) non-profit in 2010. There are now hundreds of care facilities throughout the U.S. and Canada with iPod personalized music programs in place. You can read more about this program at www.musicandmemory.org.

The Power of Music

In his book, Musicophilia, Dr. Oliver Sacks, Professor of Neurology at New York University School of Medicine reminds us that “music can move us to the heights or depths of emotion. It can persuade us to buy something, or remind us of our first date. It can lift us out of depression when nothing else can. It can get us dancing to its beat. But the power of music goes much, much further. Indeed, music occupies more areas of our brain than language does–humans are a musical species.”

We have all listened to a song that instantly brings us back to our first love, our wedding, the funeral of a loved one; music is profoundly linked to personal memories and emotions. In fact, our brains are hard-wired to connect music with long-term memory. The connection can be so strong that hearing a tune long after the occurrence evokes a strong recollection of that event. Each individual’s prior experience with the musical piece is the greatest indicator of his or her likely response. A melody that is soothing for one person may remind another of the loss of a loved one and be tragically sad. Therefore, understanding the emotions associated with the music is imperative to the success of a a Music & Memory program. If the links with the music are unknown, it is difficult to predict an individual’s response.

A Juniper Village family member remarked, “If you have ever gotten a lift when you unexpectedly hear a favorite song, you can begin to imagine the pleasure it brings to the residents to have an iPod full of their favorites. The Music & Memory program has become part of the Wellspring routine, providing music to residents that soothes, calms and provides a great deal of comfort and mental stimulation. It is amazing to see it working!”

Outcomes of Music Therapy

Research shows that persons with dementia, Parkinson’s, and other diseases that damage brain chemistry, can reconnect to the world and gain improved quality of life from listening to personal music favorites. The power of music can spark compelling outcomes even in the very late stages of the disease. Research also concludes that music can shift mood, manage stress-induced agitation, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements. This is due to the fact that rhythmic and other well-rehearsed responses are influenced by the motor center of the brain and require little to no cognitive or mental processing.

A person’s ability to engage in music remains intact late into the disease. Candice, a resident of Juniper Village has Frontal Temporal Dementia which has impacted her speech. Her family observed that “with music playing Candice can sometimes mouth a word in the song. When the music is playing you can see Candice tapping her foot to the beat and joy in her face.” Another family, brought to tears by the success of the program added, “I didn’t know, I didn’t know. My dad had a serious illness and couldn’t communicate at all for three to five years. Years ago, someone played a piece of gospel music and he sang all of the words! I didn’t know what it was. Now I do.”

In selecting music for a Music & Memory program, music from the individual’s young adult years (18 to 25) typically have the strongest responses and the most potential for engagement. As individuals with dementia progress into the later stages of the disease, music from their childhood, such as folk songs and nursery rhymes, work well.

Music can also induce desired behaviors during caregiving. For instance, “stimulative music with percussive sounds and fairly quick tempos, tend to naturally promote movement, such as toe taps. This style of music can assist with activities of daily living: for example, at mealtime to rouse individuals who tend to fall asleep at the table or during bathing to facilitate movement from one room to another. On the other hand, the characteristics of sedative music like ballads and lullabies are the best choice when preparing for bed or any change in routine that might cause agitation.”

Individuals in late-stage dementia who are non-verbal often become agitated out of frustration and sensory overload due to the inability to process environmental stimuli. Engaging them in singing, rhythm playing, dancing, physical exercise, and other structured musical activities can diffuse this behavior and redirect their attention.

Music not only helps with caregiving, but provides an avenue for families to reconnect and express affection. As dementia progresses, individuals typically lose the ability to share thoughts and gestures of affection with their loved ones, but retain their ability to move with the beat. In some instances, couples who are able to ambulate, may dance which may evokes hugs, caresses or kisses. Those who are no longer ambulatory can follow rhythmic clues and swing their arms or gently rock or sway to the beat. This may lead to affectionate gestures as well.

The results of the Music & Memory program at Juniper Communities have been overwhelmingly positive. Another family member was so pleased at the peace of mind the program brought to her mother and the family. “The Music and Memory program at Wellspring is a fabulous addition to the program. Growing up, my Mom was not very big into music but she did love her Frank Sinatra, Big Bands and music associated with WW2 era. When generous donors gave Wellspring residents iPods and headphones, Kaitlin worked diligently with all of the residents to identify and record each of their very own playlists! That is quite a task. I heard that Mom was discovered singing to the music and smiling. I know she enjoyed music evoking happy memories of a time when she was young and in love with my Dad. At the end of her life she could not communicate due to a stroke, but I put the headphones on her pillow and cranked the speakers and saw her smile and nod. I know listening to her music helped bring her peace at the end.”