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Improving quality of life for people with dementia through reminiscence arts practice

1. Summary of the impact

Research undertaken by Frank Keating demonstrated the positive effects of arts practice on improving the lives of people with dementia in care homes. He developed a methodology that established the effectiveness of reminiscence arts, an innovative form of creative practice designed for people with advanced dementia that blends storytelling and art-making. His research showed positive increases in mood and behaviours of people with dementia. This evidence-based research enabled Age Exchange, a charity in South London, to i) trademark reminiscence arts practice, ii) secure funding to extend the practice, iii) expand Age Exchange to a national charity via a new partnership with Community Integrated Care, and iv) increase and inform Age Exchange’s the provision of training programmes for artists, health professionals and carers nationally and internationally.

2. Underpinning research

Maintaining and supporting quality of life for people living with dementia has been identified as a significant challenge by the Government and leading Charities on Ageing, compounded by a rapid rise in the number of people affected by dementia. Age Exchange has a longstanding history of providing support for people affected by dementia through reminiscence and creative practices. Reminiscence arts uses a variety of creative art forms to access memory and connect people to their present. Examples include music, drama and dance, handling objects, smell and touch. In 2013, Age Exchange approached Professor Frank Keating (Social Work and Social Policy) and Professor Helen Nicholson (Drama) respectively to evaluate the Reminiscence Arts Dementia Improving Quality of Life programme ( R2). The RHUL research team included two research assistants at Royal Holloway (Laura Cole, a Psychologist and Jayne Lloyd, a PhD student) and a health statistician (Robert Grant, St Georges University). The research was funded by Guys and Thomas’s Charitable Foundation (GBP83,000).

Keating and Nicholson’s interdisciplinary evaluation ( R1) comprised two elements: a) a qualitative part (led by Helen Nicholson, R1) that focused on the embodied experience of participants in the reminiscence arts one-to-one and group sessions and b) a quantitative part (led by Frank Keating, R2 & R3) to provide statistical evidence on the effectiveness of reminiscence arts for people with dementia. The qualitative component provided the context for the quantitative study by defining the principles of Reminiscence Arts. Keating’s quantitative research consisted of direct observations of Reminiscence Arts group sessions recording behaviours and mood of participants to achieve a measure of quality of life. The sessions were facilitated by Age Exchange’s Reminiscence Arts Practitioners. Six care homes were assigned to the intervention group and 6 to the control group The quantitative findings were published in Dementia (a highly regarded, international peer reviewed journal that acts as a major forum for social research of direct relevance to improving the quality of life and quality of care for people with dementia and their families) ( R2).

Overall, the study found that Reminiscence Arts had a strong positive effect on the quality of life of participants, with the difference between the intervention homes and the control homes being statistically significant ( R2). More precisely, the study found that attending a Group Reminiscence Arts session steadily and significantly improved the quality of life of people with dementia week-on-week over a 24 week period (October 2013 to May 2014). Positive behaviour increased by 25% and this was sustained after the sessions. Mood and well-being of the participants improved by 42% during the group sessions. People with advanced dementia, many of whom are post-verbal, were shown to be able to learn new creative skills when artists and carers are attuned to their cultural heritages, tastes, physicality, sensory memories and their everyday lives ( R1). The research demonstrated that reminiscence arts practice improved the quality of life for people with dementia and provided new and independent/peer-reviewed evidence to a provider of care to people with dementia.

3. References to the research

Royal Holloway staff are highlighted in bold.

R1) Nicholson, H., Keating, F., Lloyd, J. & Cole, L. (2015). Reminiscence, Arts and Dementia Care: Impact on Quality of Life 2012 -2015, A Final Report of the Evaluation, December 2015. Egham: Royal Holloway University of London. Available from HEI on Request.

R2) Keating, F., Cole, L. and Grant, R. (2018). ‘An evaluation of group reminiscence and arts sessions for people with dementia living in care homes.’ Dementia, pp1 -17. QI: Peer reviewed, international journal. DOI: 10.1177/1471301218787655.

R3) Cole, L., Keating, F. & Grant, R. (2015). Reminiscence, Arts and Dementia Care: Impact on Quality of Life 2012 -2015, Quantitative Evaluation Final Report, November 2015. Egham: Royal Holloway University of London. Available from HEI on Request.

Grant: Guys and Thomas’s Charitable Foundation (GBP83,000)

4. Details of the impact

Context

There are currently around 850,000 people living with dementia in the UK and indications are that this figure will rise incrementally. Dementia is strongly associated with reduced quality of life; national reports establish that those living in care homes have lesser quality of life. The primary beneficiaries of this research are people with dementia and their carers; voluntary sector agencies; NHS trusts; practitioners and policy makers. Research presented in section 3 above, had the following effects. First, the research confirmed their internal assessment of benefits of reminiscence arts practice for people with dementia (E1). Second, Age Exchange used Royal Holloway’s research to change how they operated as a charity. Using this evidence-base, the charity was able to attract additional funding and expand the reach of their reminiscence arts provision. Third, the research enabled Age Exchange to influence policy on the arts and well-being.

Enhancing health and well-being of people with dementia

Prior to Keating’s research, Age Exchange only had anecdotal evidence that arts and reminisce practice is beneficial for people with dementia. Keating’s research provided strong evidence that the quality of life of participants improved significantly during the intervention. Based on this overwhelming finding, the reminiscence arts intervention was rolled out to 6 care homes in South London. Age Exchange’s 2019 impact report stated: “Age Exchange’s evidence based model of Reminiscence Arts (RADIQL), first tested and evaluated in residential care in Southwark and Lambeth between 2012 and 2015, had a measurable impact on the wellbeing and behaviour of residents with a diagnosis of dementia who participated in the programme. Independent evaluation of the RADIQL programme found that the well-being of residents with dementia who participated, increased by 42%, and positive behaviour by 25% during the course of the programme.” (E3; E8). This service model is now advertised on the Age Exchange website as “the RADIQL evaluated model” (E2)

On the basis of Keating’s research Age Exchange found their approach compelling. Therefore, the charity was invited to extend their provision to other care homes in London, directly reaching approximately 500 people living with dementia per annum (E4). Age Exchange now provides weekly group and one-to-one sessions to other organisations based on the RADIQL model.

RADIQL enabled Age Exchange to take this proven model and extend it for the first time into day and community care, where they currently run 9 programmes annually supporting 9000 plus people with dementia and their carers (E1). During the current Pandemic when delivering reminiscence arts activities in person was no longer possible, Age Exchange developed reminiscence arts activity boxes to improve the mental health, mood and engagement of someone with dementia. These boxes have been distributed to 150 people with dementia and their carers on a weekly basis totalling 600 boxes per month.

Improving a public service agency

On the basis of Keating’s research, Age Exchange was transformed as a charity. The research resulted in a new sense of identity and purpose and an evidence-base for presentation of their work.

The Artistic Director said: Royal Holloway’s research has revitalised our charity. It helped us learn a language we didn't know, and it helped us practise in a different way. We can now articulate a vision of dementia care, we can now say confidently what Reminiscence Arts is about and that it has measurable benefits’ (E1). In 2016 Age Exchange trademarked their reminiscence arts model ‘ RADIQL™’ (E8), which added significant value to their work. Keating’s research is cited in Age Exchange’s 2019 Impact Report (E8).

Age Exchange was nominated for prestigious awards in recognition of their reminiscence and arts practice, e.g., Charity Times Change Project Award, 2019 and The National Dementia Care Award, 2020 (E8). With Keating’s research providing clear evidence of how their interventions raised the quality of life in care homes, Age Exchange presented their work confidently to potential users and commissioners: ‘We know that without our [i.e. RHUL’s] evaluation we wouldn't even get through the security gate with most commissioners. We're really excited to be able to talk to commissioners on the same terms as traditional providers, backing up with hard evidence what we've instinctively known, that arts-based interventions can offer a more effective alternative to mainstream activities that are designed to improve wellbeing for older people, and one which is cost effective.’ (E3; E4) With a higher profile Age Exchange broadened its reach nationally and internationally. Over the last 3 years, Age Exchange has transformed from an organisation operating as a local charity in South London to a national actor with international reach. The Artistic Director of Age Exchange (E1) directly credits RHUL’s research for enabling their new national partnership with Community Integrated Care (CIC), one of the UK’s largest providers of health and social care, established in 2018. CIC provides services to over 3,000 people with dementia and their carers. The Chief Executive Officer of CIC stated that the quality of Age Exchange’s interventions was critical to the partnership: “Age Exchange is a beacon of best practice in reminiscence arts and dementia intervention. We have been inspired by the impact that their life-enhancing work has had on the people in its care and in the wider local community. The new partnership was launched at the House of Lords in 2019” (E8).

Age Exchange used the evidence from Keating’s research to create a more stable financial base by securing over GBP1,000,000 to expand their services, a 22% increase in funding (E1; E8).

Age Exchange has extended their RADIQL™ training and support programme for reminiscence arts practitioners and community workers, informed by, and benefitting from Keating’s research. The training programme is delivered locally, nationally and internationally, for example, in Canada, Hungary and Poland (E1). Age Exchange offers a day’s training on the RADIQL model aimed at staff, caregivers, activity coordinators and service providers. This training has been provided to staff at Kings College Hospital, Guys & St Thomas Trust, L & Q Housing and the Peabody Trust (E1). On the back of this training, at Guys & St Thomas’, Age Exchange co-produced and delivered a reminiscence arts intervention, the first of its kind in the country over a 10 month period. This benefitted 6 hospital wards for older people (E8).

Informing UK Government Policy in Arts in Dementia Care

Age Exchange has directly drawn on Keating’s research to seek to influence parliamentary policy debates on the role of the creative arts in promoting well-being. The findings were presented at an All Party Parliamentary Group (APPG) Roundtable on Arts and Dementia (22 participants that included senor parliamentarians, policy makers, practitioners and academics) in 2017(E5); were included as a case study in the Inquiry report of the All Party Parliamentary Group on Arts, Health and Well-being (APPG, 2017: 132; E5); and cited as an example and evidence of the beneficial impact of the arts on dementia. The Director of Arts and Health Southwest (participant in the APPG, E6) stated this: “The report, the case studies and impressive research behind them have been critical to the APPG’s advocacy work and building a robust case and support for the establishment of the National Centre for Creative Health, through which we will amplify and support work that transforms people's lives and communities through culture and creativity”. The findings from the APPG report (E5) was used by the APPG and a consortium of public agencies to develop five policy briefings on culture, health and well-being, which the APPG included in their submission to the Culture White Paper Consultation by the Department for Culture, Media and Arts in 2017 (E7). A final outcome of this consultation was the establishment of The National Centre for Creative Health that was launched in 2020.

In conclusion the objective evidence provided by Keating’s research confirms that people with dementia are positively affected by Age Exchange’s work; their quality of life has not only improved it has been shown to have improved. Age Exchange continues to build its work and profile based on the overwhelming evidence provided by Keating’s research.

5. Sources to corroborate the impact

E1) Testimonial letter from David Savill, Artistic Director of Age Exchange: ‘Letter of Support for Professor Frank Keating, Royal Holloway University of London, in improving quality of life for people with dementia through reminiscence arts practice’, 2020.

E2) Age Exchange Website: ‘RADIQL™ (our dementia research)’. Available from https://www.age-exchange.org.uk/what-we-do/caringtogether/radiql/ [accessed 8 June 2020].

E3) Fujiwara, D. and Lawton, R. (2015 ). Evaluation of the Reminiscence Arts and Dementia: Impact on Quality of Life (RADIQOL Programme) in six care homes. London: Simetrica.

E4) Testimonial from [text removed for publication], part of the Cultural Commissioning Programme’s case study, ‘Rolling out an evidence-based model of arts-based work for dementia care’ included as part of the NVCO’s work on Commissioners and Influencers.

E5) All-Party Parliamentary Group on Arts, Health and Wellbeing (2017). ‘Reminiscence Arts and Dementia: Impact on Quality of Life (RADIQL)’, in Creative Health: The Arts for Health and Wellbeing (2nd edition). All-Party Parliamentary Group on Arts, Health and Wellbeing: London. Available from https://www.artshealthandwellbeing.org.uk/ [accessed 8 June 2020].

E6) Testimonial from Alex Coulter, Director of Arts and Health South West.

E7) Coulter, A and Gordon-Nessbit, R (2017) All Party Parliamentary Group on Arts, Health and Wellbeing Submission to the DCMS white paper consultation. London: APPG.

E8) Age Exchange (2020) Impact Report 2019. London: Age Exchange

Additional contextual information

Grant funding

Grant number Value of grant
1616 £83,000