Nearly 16 million
Americans will be diagnosed with Alzheimer's disease or another type of
dementia by 2050, according to the Alzheimer's Association. Symptoms include
mood and behavior changes, disorientation, memory loss and difficulty walking
and speaking. The effects of anti-dementia drugs on patients' emotions and
behaviors are inconsistent. Now, University of Missouri researchers have found
that participation in TimeSlips, a drug-free, creative storytelling
intervention, improves communication skills and positive affect in persons with
dementia.
TimeSlips is
a nationally recognized storytelling program for people with dementia that
encourages participants to use their imaginations to create short stories as a
group.
It is an improvisational
storytelling method that replaces the pressure to remember with the freedom to
imagine. Rather
than relying on factual recall, participants respond verbally to humorous
images presented by facilitators who record the responses and read narratives
to further develop or end the stories.
The TimeSlips Project aims
to:
- Inspire people with dementia to hone and share the gifts of their imaginations.
- Inspire others to see beyond loss to recognize the strengths of people with dementia.
- Improve the quality of life of people with dementia and those who care for them.
TimeSlips works best with people in the mid
to late stages of memory loss. They are the most open to language
experimentation. People in early stages tend to be more eager to capture
factual memories.
"TimeSlips provides rich, engaging
opportunities for persons with dementia to interact with others while
exercising their individual strengths," said Lorraine Phillips, assistant
professor in the Sinclair School of Nursing. "It encourages participants
to be actively involved and to experience moments of recognition, creation and
celebration. Meaningful activities, such as TimeSlips, promote positive social
environments that are central to person-centered care." The storytelling
program is an easy and affordable activity for long-term care facilities to
implement and allows caregivers to interact with multiple residents at a time,
Phillips said.
"TimeSlips offers a stimulating alternative to
typical activities in long-term care facilities," Phillips said. "It
is an effective and simple option for care providers, especially those who lack
resources or skills required for art, music or other creative
interventions." In the study, Phillips and her colleagues delivered the
TimeSlips intervention in one-hour sessions, held twice weekly for six
consecutive weeks. The results included increased expressions of pleasure and
initiation of social communication. Improvements in participants' affect lasted
several weeks following the final session. The intervention is acceptable for
people with mild to moderate dementia, Phillips said.
Example
This
is a typical boy of another era. You can tell by his clothes. His name is
Tommy. Looks like he is eating something. He eats cookies from a nice
container. You can tell from his face that he thinks he is going to get caught
soon. He can already hear footsteps.
He
has already been caught by his faithful dog. The dog’s name is Rex. The dog is
sitting on a rug. Tommy got caught by the dog while eating cookies. Rex is
looking at Tommy and thinks: “Am I going to get some?” He wants something:
either cookies or to go outside.
Some
man or woman will find him soon and give him a good beating. You can’t do it
for a long time.
Tommy
is having fun. There is no one around. He knows he is doing something wrong and
that makes it many times better. He is licking his thumb.
When
he is older he falls in love with a girl who knows how to bake cookies. It may
be Regina! (the girl from our other story) They will get married. They’ll have
a little boy who likes to help himself from a cookie container. Like father
like son.
Key
program elements
A volunteer or staff member leads weekly group
sessions with 6 to 12 persons with Alzheimer's disease and related dementia.
The meeting follows a very structured format, because such individuals still
have their procedural memory intact. Participants, who are referred to as
"storytellers," sit in a circle. Each meeting progresses as follows:
- Introduction and setting the rules: At the beginning of each group session, one or more facilitators provides storytellers with name tags and sets the ground rules, explaining that the group is a safe place for storytellers to express themselves and that all responses will be woven into the story. Facilitators try to accommodate any specific needs of the participants. For example, if a storyteller is hard of hearing, the facilitator will move close to the person so that he or she can hear. Facilitators retell the story that was created the week before to reinforce the fact that participants still have the capacity to be creative and to combat those who say they do not. Retelling the story also reminds the storytellers of the structure of the group.
- Storytelling: The facilitators share a staged photograph or illustration and ask the storytellers questions about what is happening in the picture. Facilitators are purposeful in the way they encourage participants to become storytellers, building on participant responses and using specially designed types of questions to further stimulate imagination, such as:
- Open-ended: Facilitators strive to make all questions open-ended to encourage responses from the storytellers. They might use questions such as "what should we call the person in the picture?" or "why is that person doing that?"
- Sensory: Facilitators further encourage responses to the picture by asking storytellers about the sensory aspects of what is happening, such as "what sounds are in the picture?" or "how does the person in the picture feel?"
- Capturing the story: Facilitators record all storytellers’ answers (including seemingly nonsensical ones) on a large sheet of newsprint in an attempt to capture the emotion of what was said. If a storyteller contributes a response that does not seem to make sense, the facilitator repeats the response to the storyteller to make sure that they have captured it properly. Responses are recorded and crafted into a story in one of two ways—either chronologically or grouped by clusters (e.g., all responses about what sounds are in the picture are grouped together).
- Reengaging participants: Periodically, the facilitator rereads the story that the group has already created; the goal of this exercise is to keep participants engaged and to help them expand the story. When the group completes the story, the facilitator reads it back to them, using the same emotion and enthusiasm that the storytellers themselves used. Once the story is completed, facilitators and storytellers celebrate what they have created by clapping, and the facilitators thank the storytellers for participating.
- Sharing stories: After the group session ends, the facilitator types up the story and prints it on the back of a copy of the image. This paper is passed out to storytellers at the next session. Facilitators also strive to share stories more broadly with each storyteller’s community. For example, the facilitator might assemble a collection of stories into a book that can be shared with family and friends at a party, or might invite local artists (e.g., from the community or a nearby high school) to create an exhibit that illustrates a story.
Example
What
are they called? Penguins. There’s only two the same, don’t know what their
names are but they are doing alright holding hands. They are in Antarctica. The
one on the left’s name is Peter, 'Peter the penguin' and the one on the right
is Alice. They would swim to an iceberg and they would be feeling cold. Where
is it, down in Victoria? Ones thinner than the other one, that’s what I think
because probably one eats everything he sees. They look a little bit like
penguins, they may be related. Peter, that’s a good strong name. They would eat
whatever suits them. Fish, not these ones (points to the gold fish tank in the
corner).
One
is fatter than the other. After dinner they would go to bed or go swimming.
They look well anyway. Oh dear oh dear they would find an iceberg and settle
down. They are both enjoying whatever they are doing. Both good, nice and fine.
I’d invite them all together so they can meet one another, it might be the
seating accommodations they would have to think about, they’d have to have a
friend or they wouldn’t go. They would have problems with their wings if they
were invited all together in the lounge room, their wings would stick into each
other. I don’t think I would worry about having penguins at home. They look
like they are holding hands. One is fatter than the other. One wants to go one
way and the other wants to go the other way. What about transport? They’d go on
the ice. One is fatter than the other. There’s not much difference between
them. Be a bit awkward for the fellas to get in the lounge room, a bit awkward.
You couldn’t. If you had a pool you could let them swim there. It would be a
bit of a noise when they are talking, it might be a bit much for today. They
would find a nice iceberg and settle down.
Sources
and Additional Information:
