Professor Victoria Tischler

Background and Objectives

Among the various psychosocial interventions aiming at improving behavior, quality of life, and the well-being of people with dementia, one that has attracted recent attention has been object handling. This scoping review synthesizes available studies on object handling for people with dementia, their effects, and methodological characteristics and describes its components and likely domains.

Research Design and Methods

The search was conducted using CINAHL, PsycINFO, MEDLINE, PsycARTICLES, Academic Search Elite, and Art Full Text, plus review of reference lists and hand search. Data from the studies included were chattered and reported in narrative form.

Results

Eleven studies were included; of which, 9 described a group intervention and 10 investigated the distinctive value of heritage items. Studies used a mixed-methods or qualitative design and varied in their procedures, including number of sessions and length of intervention. Most studies reported positive effects on well-being, mood, and emotion in those with dementia. Qualitative investigations revealed that the co-construction of an object’s meaning facilitated new learning, social inclusion, and change in attitudes toward dementia. From the review and stakeholder consultations, a definition of object handling is proposed, which includes three components: presenting, receiving, and responding.

Discussion and Implications

The findings suggest that people with dementia may benefit from object handling interventions as a means of improving well-being, mood, and social inclusion. The review highlighted a variety of approaches used and a small number of studies were identified under the term of “object handling.” Further studies are needed to examine the complexity of object handling, its impact within dementia care settings, and that explicitly use the term “object handling.” Given the focus to date on heritage, archive, and museum objects, more studies involving the handling of everyday material objects are needed because these are by definition highly accessible.

This paper explores how everyday aesthetics shape and are shaped within dementia care settings. The authors draw upon research that explored the significance of clothing and textiles in care home settings, to identify the varied and complex aesthetic experiences of people with dementia. The study was carried out using a series of creative, sensory and embodied research methods working with people with dementia and care home staff. Findings demonstrate that aesthetics are important in care homes at a number of levels. People with dementia discussed personal aesthetic preferences and demonstrated such preferences through embodied practices. Attending to aesthetics facilitated moments of togetherness between people with dementia and care home staff, creating person-centred encounters outside task-orientated conversations. This paper supports the importance of everyday aesthetics within dementia care settings and demonstrates that greater attention should be paid to this, to reconsider and enhance not only the look and feel of care homes and everyday items, including clothing, but also dementia care practice more broadly.

Older women make a significant contribution to the European labour market yet still experience age and gender discrimination, lower wages and negative workplace impacts on health and wellbeing compared to their male counterparts. This review of the literature assesses the current situation for older female workers in Europe. The authors identify issues including work and domestic conflicts, menopause, stress and income disparities that impact negatively on older female workers. Research gaps are identified with an increase in qualitative and intersectional studies recommended to better understand the experiences of older women and the multiple, interacting factors that constrain their working lives. In addition, future studies should focus on novel interventions that promote effective digital working, intergenerational solidarity and effective menopause support.

There is a growing interest in using olfactory (smell) stimulation in dementia care. This study aims to extend current knowledge by synthesising the evidence on the efficacy of interventions using olfactory stimulation for people with dementia and to assess the effects of different types of odours and administration methods using a mixed methods approach. The rapid review was conducted based on searches in six electronic databases. A narrative approach was applied to assess 20 studies included in the review. Fourteen studies used a quasi-experimental design, five studies used an experimental design and one was a case study. High heterogeneity was found on odours and methods of application used, with the majority of studies administering lavender oil using a diffuser. Mixed results were reported on the benefits of olfactory stimulation on responsive behaviours and cognitive function. Although the evidence available is limited, encouraging results were found regarding olfactory stimulation and increased sleep duration, food intake and improved balance. It was not possible to draw any overall conclusion in relation to the effect of olfactory stimulation. However, this review shows promising results that support further investigation of olfactory stimulation as a nonpharmacological intervention for people with dementia. The review is limited due to the low to moderate quality of studies included. Furthermore, the broad range of approaches was employed, and comparison between the studies was difficult. Further high-quality mixed method studies using robust and detailed protocols are needed to clarify the effects of olfactory stimuli and any other factors that may influence the responses of people with dementia.

Background: People with dementia are often excluded from research due to ethical concerns and a reliance upon conventional research methods which focus on recall and verbal expression. Methods: Creative, sensory and embodied research methods typically involve techniques that conceptually bring individuals “into” the research, thus affording an expressive capacity that traditional methods do not. This paper details a “method story”, presenting three interlinked cycles of study used to explore the significance of clothing to people with dementia living in a care home. The studies drew upon arts-based and design led practices. This paper details the methods used and the opportunities that they presented when exploring the lived experience of dementia. Results & Conclusions: Creative, sensory and embodied approaches enabled people with dementia to engage with research, supporting imaginative, spontaneous and flexible participation. This supports the use of novel methods when undertaking research with people who have dementia.

Aims

Montessori-Based Programming (MBP) in dementia care refers to a growing body of research and practice that has developed Montessori methods to facilitate self-paced learning, independence and engagement for people living with dementia. A number of research gaps have been identified in the existing literature such as a lack of cross-cultural studies and well-powered, robustly designed outcome studies. The current study investigated the use of MBP with a focus on provision in the United Kingdom. It aimed to identify MBP implementation approaches, challenges and barriers, and research gaps.

Design and Methods

A qualitative design was implemented to analyse data from in-depth, semi-structured interviews with key stakeholders (N = 8) with experience of MBP in the UK. Participants included care home management and staff, MBP trainers and independent dementia experts with a background in Montessori methods. Thematic analysis identified 4 main themes and 12 sub-themes. The study took place between April 2019 and October 2019.

Findings

A framework describing knowledge and understanding of MBP in the UK, implementation considerations, challenges and barriers, evidence of outcomes and research gaps was developed to provide guidance for researchers and practitioners. Implementation considerations included using a whole-home approach and changing the culture of care through management support. Barriers to implementation included conservative attitudes to care, perceived lack of time and resources, health and safety issues, and issues of sustainability.

Conclusion

The benefits of MBP in dementia care are promising but require further empirical investigation. There is a need to design, execute and publish evidence to secure the support of key stakeholders in dementia care research, policy and commissioning in the UK.

Objective

Dementia, a global epidemic, currently affects 50 million individuals worldwide. There are currently limited effective treatments for moderate to severe dementia, and most treatments focus on reducing symptoms rather than improving positive factors. It is unclear if improvements are not possible due to disease severity. This review examines the efficacy of the current psychosocial interventions for people with moderate to severe dementia, focusing on improving cognition and quality of life (QoL) to evaluate what treatments are working and whether improvements are possible.

Methods

A systematic search was conducted using six key databases to identify psychosocial interventions for people with moderate to severe dementia, measuring cognition or QoL in randomized controlled trials (RCTs), published between 2000 and 2020.

Results

The search identified 4193 studies, and 74 articles were assessed for full-text review. Fourteen RCTs were included and appraised with the Physiotherapy Evidence Database Scale. The included RCTs were moderate in quality.

Conclusions

Aromatherapy and reminiscence therapy showed the strongest evidence in improving QoL. There was some evidence that aerobic exercise enhanced cognition, and a multicomponent study improved QoL. However, a quality assessment, using pre-specified criteria, indicated many methodological weaknesses. While we found improvements in cognition and QoL for moderate to severe dementia, results must be interpreted with caution. Future interventions with rigorous study designs are a pressing need and required before we can recommend specific interventions.

Aims: This study aimed to explore the experiences of a group of adults with a history of substance misuse taking part in a novel, multi-centre cultural intervention: Creative Conversations, including the impact of the project on participants' mental health.

Method: A qualitative approach was used including a Visual Matrix and observation in order to explore the experiences of 10 participants recruited from drug and alcohol services.

Results: The results indicated positive impacts on mental health including a growing sense of competence, engagement, social integration and a sense that the project provided therapeutic support that translated into integrating creative activities into their everyday habits.

Conclusions: Cultural interventions like Creative Conversations demonstrate positive impacts on mental health, engaging individuals who may find it difficult to access services such as those with substance misuse issues, and play an important role in sustaining and promoting mental wellbeing in the community. Despite positive findings, projects such as this require adequate staff training and sustained funding in order to provide wider benefits to those with mental health problems.

This paper aimed to review the potential for archival items to be used to support therapeutic interventions in dementia care, with a particular focus on olfactory stimuli. Archival research was used to identify objects and to re-create authentic historical product fragrances from Boots UK. Potentially therapeutic material and smells for people living with dementia were identified and olfactory profiles created. These were characterized by strong smells and items featuring well-known brands and distinctive packaging including carbolic soap and Old English Lavender talcum powder. A dataset of items has been created for use in future research studies.

Background

The COVID-19 pandemic has led to the suspension of community-based dementia services worldwide, where evidence-based interventions for dementia, like Cognitive Stimulation Therapy (CST), were delivered. Treatment access is paramount during the pandemic and beyond for people with dementia to maintain functioning and well-being. This study aimed to evaluate the feasibility and acceptability of a virtual, 14-session program of Individual Cognitive Stimulation Therapy (V-iCST) in the UK.

Method

A single-blind feasibility randomized controlled trial (RCT) was conducted in the UK. Thirty-four people with mild to moderate dementia were recruited from dementia organizations and networks. Seventeen were randomly assigned to receive V-iCST (14, 45-min sessions) and 17 to treatment as usual (TAU) over seven weeks. Feasibility and acceptability data, for example, recruitment, attrition, attendance, adverse effects, and fidelity, were collected. Outcome measures on cognitive function, quality of life (QoL), mood, and communication were collected pre and post-test. Analysis of covariance was used to compare changes in V-iCST and TAU.

Result

We have successfully completed recruitment. Results on feasibility, acceptability, and preliminary efficacy will be available at the conference.

Conclusion

We hypothesize that V-iCST is feasible and acceptable and will have positive effects on cognitive, QoL, mood, and communication. 

Older women make a significant contribution to the labour market yet still experience negative workplace impacts. We undertook a rapid review of literature to assess the current experiences of older female workers in the European labour market with the aim to inform policy innovation and service development that improves the working lives of older women in Europe.

Electronic databases including Business Source Complete, Social Policy and Practice and PubMED were searched. 4797 records were identified, of which 24 full-text reports were included.

Compared to men, older women were found to experience more adverse health impacts as a result of work-related stress. Older women bear a greater share of caring responsibilities which has a negative impact on their health. A lack of support for menopausal symptoms in the workplace often prompted early retirement for older female workers. Income and role disparities between men and women were identified, with women having relatively discontinuous employment histories and lower pension funds due to a higher burden of unpaid, domestic labour throughout their life course. This has a cumulative effect on their income, their role and position at work, and their ability to retire. Older women also reported experiencing workplace discrimination, and lack of autonomy and job control, and less training and developement opportunities. Flexible working was found to be contested terrain, with it being a means to support older women to maintain careers but also resulting in poorer career outcomes.

Culture Box was a creative project that responded to deprivation and distress experienced by those with dementia in care homes during the COVID-19 pandemic. Remote and digital creative activities were designed and delivered as ‘Culture Boxes’ to care homes, aiming to alleviate social isolation and loneliness for people with dementia. Eighty-eight people with dementia and 33 care staff from 33 care homes across England were recruited to the study, with 68 people with dementia and 28 staff completing the study 12 months later. Participatory Action Research combining mixed methods was used to evaluate the project. Baseline and follow-up surveys and dialogic interviews at 3 time points during the study collected quantitative and qualitative data and were analysed descriptively and via inductive thematic analysis respectively. Qualitative findings indicated that the project activities facilitated relational care through creative experiences characterised by sharing, building relationships, and developing a sense of community. Social health was promoted via participation in social activities and fostering independence. Future studies should further explore the utility of creative practices to develop relational care, to support care staff, and to maximise wellbeing benefits for those living with dementia.