1. Singing (and other arts/cultural activities) across the Dementias
Paul Camic
Professor of psychology & public health
Salomons Centre, Canterbury Christ Church University
Tunbridge Wells campus and
Co-director, Created Out of Mind,
Wellcome Collection, London

2. Why the arts and Health? Evolutionary importance Ethological evidence
Culturally relevant across all societies
Everyone can participate

3. My fantasied headline from the Daily Mail : The arts exposed as Key part of EU plot to take over dementia care for families

4. And from the BBC… Breaking News: Scientific discovery—the arts are a good thing for the dementias!

5. The arts across dementia care
Singing and music
Making and viewing visual art
Writing poetry
Handling museum and other material objects
Dancing

6. How might the arts impact the dementias? And why?
Emotionally connecting: Stimulating and relaxing activities
Allows learning to occur (even in later stage dementias)
Focuses attention on a sound, movement, texture, colour, word, action
Increases verbal and visual fluency ‘in the moment’ of the activity
Memory associations (but let’s not make reminiscence the focus)
Solo & Social: Individual, dyad and group possibilities

7. And why? more than a feel good experience…
Moderators
Mediators
For whom and in what circumstances are X arts effective?
Stage and type of dementia
Art form
Affects direction or strength between Independent & Dependent variables
Mechanisms of change: what occurs between input and output within the individual?
What causes/creates change?
What type of change are we looking for?

8. Singing and Music making
Later stages of dementias (residential)
Earlier-Middle stages of dementias (home & day care)
Community, charity and NHS venues
Age range: 40-90, 45/50% M/F
Groups (some with caregivers)
Mostly time limited (one offs-8 sessions)
A range of music styles from sea shanties to classical and everything in between
Mostly choruses, some with rounders, a few volunteer solos
Private, charity and authority based
Age range: 64-92; 60% F
Groups and one on one
Time limited (4-10 sessions)
More likely to involve musical instruments
Range of music styles, tends to be easy listening and classical
Some conducting/leading

9. An international forum
United Kingdom
Canada
Australia
Finland
Sweden
USA
France
Germany
Israel
Belgium
The Netherlands

10. Data collection (1 of 3) Psychological measures:
Quality of Life (e.g. QoL-AD, Dem-QoL-4, Dem-QoL-proxy, WHOQoL)
Wellbeing (e.g. Canterbury Wellbeing Scales, CWS)
Activities of daily living (e.g. Bristol ADLS)
Mood, including depression and anxiety (e.g. DASS)
Caregiver burden (e.g. Zarit Burden Interview, ZBI)
Remote episodic memory, short-term memory (e.g. usual neuropsych tests)

11. Data collection (2 of 3) Physiological measures
Stress hormones (e.g. cortisol, cortisone, testosterone, progesterone, DHEA) for pre-post measurement
using saliva assays
Variable heart rate (HRV), body temperature, physical movement, skin conductance) for process (ongoing measurement)
using Empatica-4 wrist monitors

12. Data collection (3 of 3) Qualitative approaches Thematic analysis
Grounded theory (including visual grounded theory)
Visual analysis (particularly useful with more impaired people)
Conversational and discourse analyses
Participatory action research (PAR)
Situational analysis (in progress)

13. Ingredients for success: What we know so far…
Community-based
Residential-based
Trained facilitator/conductor
Supportive, welcoming, kind
Volunteers to help out
Live music whenever possible
Ongoing is ideal (no one offs); if not possible, sessional groups (e.g sessions)
60-90 minutes; include refreshments and time to socialise
A range of music from easier to challenging over time
Consider public performances
Groups: trained facilitator/conductor
Supportive, welcoming, kind and understanding of more impaired singers
Live music if possible;
Involve care staff in the sessions (beneficial for them too)
6-8 weeks, minutes per week
Groups: musical instruments for all (percussion, simple stings)
Individuals: one-on-one live singing; iPods; roaming musicians

14. What might be achieved? Community-based Residential-based
Increases in subjective wellbeing for both PWD and caregivers
Increased QoL for caregivers
Feeling socially included
Having a ‘normalising’ experience
Experience of learning and being supportively challenged
Improved mood, short term memory
Reduced stigma
Music for Life (group approach)
Joint resident-staff participation in a non-caregiving activity
Engaging residents and staff in a co- creative experience (e.g. Music for Life approach)
Engagement of residents via attunement and direct interaction
One-on-one approach
Reduce challenging behaviours
Increase desirable behaviours
Provide different ways to interact for staff

15. Going forward…community-based
Consider the importance of ‘in the moment’ subjective wellbeing and subjective stress variables as session-to-session outcome measures
Easily measured with visual analogue scales (VAS)
Measure longer term outcome in public health rather than customary psychological variables (reducing stigma and social isolation, producing community resources, cross-generational activities)

16. Going forward…residential settings
A choir in every care home for those with and without a dementia
Involve but do not require staff, from the manager to the cleaners to be part of the singing group
Encourage and train staff who already like to sing to use singing as part of routine care
Partner with local colleges and universities for internships
Music, social work, nursing and psychology departments
Encourage families to participate from time to time in monthly community concerts, even for minutes per concert

17. Resources
Created Out of Mind, Wellcome Collection, London:
Free online 4 week course: Dementia and the Arts: Sharing Practice, Developing Understanding and Enhancing Lives:
Open access journal article: Conceptualising and Understanding Artistic Creativity in the Dementias: Interdisciplinary Approaches to Research and Practise: 42/full