2020 | Arts x Health || Dementia and the Arts: Reflecting on practice and mapping next steps for Singapore
This summer I completed the Dementia and the Arts online course on FutureLearn, created by University College London (UCL) with the Created Out of Mind team. The team consists of a variety of clinicians, researchers, and artists of various art forms. The Royal Society for Public Health accredited course begins with an introduction of dementias before examining the roles of arts-based practices in dementia care through case studies and research.
The scope of the work done in the United Kingdom is extensive and it has spurred me to question what stage Singapore is in our arts-based practice with people with dementia.
This reflection will thus be two-fold. First, I will contrast the theories and practices covered in the course with my own practice: in assisting with reminiscence drama programme, Facing the Sunrise, and being a docent for community art installations for Both Sides, Now. Then, I will map what I can from the UK context into Singapore’s scene in an attempt to sketch possibilities for practice and research.
Reflections on Practice
Facing the Sunrise was a series of reminiscence drama sessions carried out with seniors at St. Joseph’s Home in Singapore. The sessions were made up of four parts: a warm-up session; discussion with vintage objects and old photographs; an improvisational drama based on a pre-set theme; and a cool-down session.The programme is similar to Pam Schweitzer’s Remembering Yesterday, Caring Today programme where reminiscence of a familiar object is the key. The idea is that older objects that have been with persons with dementia from a younger age would stay with them and resonate with them. It is a particularly interesting mechanism of the human brain . It did occur once during a session when a senior with dementia got especially captivated with a photo that had a policeman from 1960s Singapore. He began to ask other seniors if that person was indeed him, sparking a level of engagement we had not witnessed before.
An alternative paradigm presented in the course is the idea of “in the moment” experiences especially with persons with more advanced dementia and/or dementias that impair semantic (language-based) or verbal abilities. It suggests that having activities that are reminiscence specific might place undue pressure and expectation on persons with dementia, making the experience more uncomfortable.
While this is something to be wary about, I wonder if the improvisational drama element of the session would provide other pathways for people with dementia to engage. After all, the improvisational element allows for any offers the participants provide to be woven into the story. There were moments where we invited responses through gestures. In a session about gangsters extorting hawkers, the seniors could decide whether or not they wanted to give/accept the bribe. A quiet man did dutifully reach out and pocketed the money and so, the story continued.
It has been a while since I was a docent for Both Sides, Now, a community engagement project that uses art to engage the public in end-of-life issues. One of the aspects of Both Sides, Now was an arts-installation in 2018 called, Closer. The arts installation which spanned a few residential blocks took on different mediums from photography, blankets, hand-made gifts and film.
It has been a while and I cannot recall the approach as a docent. I do remember vaguely about the need to be open to what the participants saw while also giving some information about the intentions behind some of the artwork. The Dementia and the Arts course introduced the Visual Thinking Strategies which are more exploratory ways of approaching works of art for members of all levels of arts exposure. This approach would be very helpful especially for Singaporeans who may not engage in the arts as much.
The Visual Thinking Strategies asked,
What’s going on in this [picture/sculpture/installation]?
What do you see that makes you say that?
What more can we find?
What’s going on in this [picture/sculpture/installation]?
What do you see that makes you say that?
What more can we find?
Interestingly, one of the questions I had from being a docent in Both Sides, Now got answered through some of the research featured in the course. I asked how it was possible to document transient art experiences with people with dementia?
In research done by the Salomons Centre for Applied Psychology at the Canterbury Christ Church University, visual analogue scales that had participants ranking how happy/sad; well/unwell; interested/bored; confident/not confident; optimistic/not optimistic on a 100-point scale was used (Tunbridge Wells Museum & Art Gallery, n.d., p.15). Thomas, Crutch and Camic (2018) also suggested the use of non-invasive physiological measures. However, for this research to be translated literally and practically would require continued support from local universities and institutions.
Mapping Possibilities to Singapore
In Singapore At This Moment
It is heartening to note that the niche intersection of the arts with dementia care has made headway in Singapore. Dr Michael Tan at Singapore’s Nanyang Technological University had designed a pilot programme in 2014, Let’s Have Tea at the Museum, for seniors at the Alzheimer’s Disease Association (2018). Funded by the National Arts Council, the 6-week long programme included a trip to the Peranakan Museum and other art-making activities related to the themes of the exhibit. The art making sessions provided the persons with mild to moderate Alzheimer’s with multi-sensorial engagement, encouraging play and boosting morale.The Alzheimer’s Disease Association seems to have built on this pilot programme with its dedicated Arts and Dementia programme. It has taken on a variety of arts activities such as: pottery, singing, movement and photography with partnerships with notable cultural institutions such as: The Peranakan Museum and the National Museum of Singapore (Arts & Dementia programme, n.d.). The partnerships will also oversee staff are equipped to carry out these programmes with persons with dementia. The association has also been actively documenting and highlighting the impacts of such “non-pharmacological arts-based” engagement in: improving the mood, social inclusion and wellbeing of persons with dementia; providing respite for caregivers; and fostering a more positive attitude among artists and volunteers (Alzheimer’s Disease Association, 2019a, 2019b).
The Association has also announced that they are preparing an Arts & Dementia toolkit for other centres to conduct their own arts and reminiscence programmes. This move can be seen to be in parallel with other online resources published by the National Arts Council of Singapore’s Arts for All initiative that includes arts and evaluation toolkits for engaging communities through the arts; as well as the Agency for Integrated Care (AIC)’s Wellness Programme online resources. AIC is the single agency coordinating aged care services with close partnerships with community care facility. Notably, AIC’s latest Arts, Ageing and Wellness Toolkit (Nanyang Technological University, 2020) is also led by Dr Michael Tan from Nanyang Technological University.
While these initiatives show that the conversation about the value of the arts in healthcare settings have been seeded, I worry that they become illusions that we have arrived. There are two nuances from the Dementia and the Arts course that I wish to draw upon.
Next Steps for Singapore
The first being a significant unit about the importance of the artist and that the work of the artist to support the contributions of persons with dementia is not something that can easily be augmented by volunteers or care staff. It would be essential that these toolkits do not add more burden onto care staff. The amount of attention required to build rapport, prepare the materials and do art in the moment should not be underestimated and there should be caution that these toolkits do not set such a precedent. That said, I acknowledge that I cannot speak on behalf of all stakeholders involved. It would be best to discuss these alongside grounded research on cultural and healthcare fronts.In the healthcare front, I believe that we need to understand the demographic of our healthcare staff and caregivers. What are their care responsibilities like? Are there enough resources and institutional support for such activities to take place? I imagine that if such art provisions are to be carried out by care staff who are already pushed to their limits, it would not be ideal for both staff and participants. On a more macro-level, conscious decisions also have to be made about the arts programmes offered. Do we include people with more advanced forms of dementia? In Singapore’s multi-racial and multi-religious social background, we should seek to provide diverse arts programmes too.
Spare Type’s The Garden aimed to be more inclusive to persons across the dementia spectrum and of different cultural backgrounds by adopting a sensorial, non-verbal approach to their performance. While this is one aspect, I wonder if in Singapore, we could instead find different ways to embrace traditional art forms or if it is possible to adapt traditional art forms to include entry points for interaction or participation.
In the cultural front, how ready are our artists to do such work? I note that most arts courses now include a module of sorts that includes community practice. However, are there opportunities for artists to acquire these skills and subsequently share insights and best practices with each other?
The Wigmore Hall’s Music for Life programme was one of the examples that really highlights the quality of the art activity when done alongside professional musicians. I imagine it would do Singaporean society a world of good when we realise the value of artists outside of their designated spaces in theatres, galleries and performance halls.
The Dementia and the Arts course has been valuable to my practice in helping me distinguish two modes of arts-practice: a reminiscence-based model and an “in-the-moment”, improvisational model. The case studies and research presented also provided insight into other ways of guiding people to engage with arts through the Visual Thinking Strategies and a wide spectrum of arts programmes that can be provided to people at different stages of dementia. It is a relief that Singapore has been making headway with the specific sector of arts-based programmes for persons with dementia. However, I highlight the room for better assimilation between the healthcare professionals and professional artists and the need to take into account the present workloads of our care staffs as well as the myraid of cultural backgrounds given Singapore's multiracial and multi-religious population. As such, I await with bated breath for further research such as Dr Michael Tan’s current research on the state of policies surrounding Singapore’s Art and Health sector.
References
Alzheimer’s Disease Association (2019a). Executive summary: Impact of the Arts & Dementia programme. Retrieved from https://alz.org.sg/wp-content/uploads/2019/12/EXECUTIVE-SUMMARY-IMPACT-OF-THE-ARTS-DEMENTIA-PROGRAMME-3Dec19.pdfAlzheimer’s Disease Association (2019b). Impact of the Arts & Dementia programme: A visual summary. Retrieved from https://alz.org.sg/wp-content/uploads/2019/12/Arts-Dementia-Research-Report-Infographics-031219.pdf
Nanyang Technological University (2020). Arts, ageing and wellbeing toolkit: A resource to kick-start creative art adventures for the community care sector. Retrieved from https://partners.aic.sg/sites/aicassets/AssetGallery/Community%20Care%20providers/AIC%20Wellness%20Programme/Art%20Ageing%20Wellbeing%20Toolkit.pdf
Tan, M.K.B. (2018) Connecting reminiscence, art making and cultural heritage: A pilot Art-for-Dementia care programme, Journal of Applied Arts & Health, 9(1), pp. 25-36. doi: 10.1386/jaah.9.1.25_1
Thomas, G. E. C., Crutch, S. J., & Camic, P. M. (2018). Measuring physiological responses to the arts in people with a dementia. International Journal of Psychophysiology, 123, pp. 64-73. doi: https://doi.org/10.1016/j.ijpsycho.2017.11.008
Tunbridge Wells Museum & Art Gallery (n.d.). Dementia toolkit. Retrieved from http://www.tunbridgewellsmuseum.org/__data/assets/pdf_file/0020/103385/Dementia-Toolkit-final.pdf