Medical students use creative arts to gain perspective on relating to dementia patients
Communicating with and relating to people with dementia can be difficult.
Family members, caregivers, and practitioners may become frustrated when they concentrate on what the person cannot remember, or what capacities have been lost, rather than finding ways to interact that focus on remaining strengths.
That is why Dr. Daniel George, assistant professor of humanities, has implemented an improvisational storytelling activity called TimeSlips at a local dementia care facility to offer his fourth-year medical students an opportunity to spend time with a patient population through the creative arts.
TimeSlips utilizes pictures as creative conversational prompts to spark participants’ imaginations. Their observations of the pictures are then strung together to tell a story.
“Because of our cultural understanding of dementia, most people wouldn’t expect those with cognitive impairment to be capable of telling stories, but this activity challenges our biases and stereotypes,” George said.
The program was developed in the 1990s by theatre professor Anne Basting while she worked in an assisted care facility. Basting was frustrated by the ineffectual activities that were being used to engage residents. So, she pulled a picture out of a magazine and asked the residents tell stories about the person in the picture.
“Anne was amazed at how that sparked the imagination of the people she was working with. They ended up telling a story that went on for nearly an hour,” George said.
Basting went on to develop a TimeSlips process that is now used internationally. A group of residents are organized into a storytelling circle, and caregivers sit in between the residents. Images are distributed to the residents and the facilitator prompts the group with questions about what they see in the picture.
They are asked questions like: Who are the people in the picture? What are they doing? How old are they? What are their names? Facilitators also attempt to invoke sensorial aspects of the story, such as what the characters sound like, or what a the hide of an animal feels like.
Every comment is validated by being written into a story that is read at the end of the session.
According to George, the success of TimeSlips is largely due to its success in alleviating the pressure to be logical and linear. The unusual, staged images – like an elephant sitting next to a little girl on a park bench – invite creative expression.
“The pictures are not rational, they’re sort of ambiguous and open to interpretation and those are the ones that best stoke the imagination in many ways,” he said.
To watch a TimeSlips session can be surreal. At a session earlier this year, residents who initially seem unhappy, uninterested, or lethargic suddenly awaken and their personalities emerge. A previously silent room erupts with laughter.
One patient, who staff warn could be difficult, smiles at the reaction her answers receive. Another pair of residents connect with each other and hold hands. An otherwise shy, new resident participates in a group activity for the first time. All involved show that they are still very full of life.
“These people who may be otherwise perceived as catatonic or having nothing to give become active participants in creating these brilliantly surreal, whimsical story lines,” George said. “You wouldn’t believe the diverse imagery and historical insights that emerge from this process.”
George explained that the activity triggers a storytelling reflex.
“We’re storytelling creatures, and it’s literally impossible to look at a picture with people in it and not interpose some sort of story, even if you are quite deep into the throes of memory loss.”
“It’s just fun and play — like when you’re a little kid you can play just about anything you can imagine, and that stays with us our whole life and comes out pretty powerfully in these sessions,” George said.
George made the decision to bring TimeSlips to the College of Medicine after his own undergraduate experience with the program
“I did an independent study on TimeSlips at The College of Wooster and it struck me when I started working at the Medical Center that we’re in an aging country with a really high need for quality geriatric care, and something like TimeSlips can help reframe the way medical students view people with dementia,” he said.
Medically speaking, people with dementia can often be seen as difficult patients. It’s often challenging for practitioners to have conversations with them and obtain patient histories that can be inconsistent from visit to visit.
TimeSlips has offered fourth-year students an opportunity to interact with people affected by memory loss in a non-medical setting, and see them as people who are still capable of imagination.
“It ascribes a different sort of value to that patient population that may not have been there before,” George said.
“TimeSlips reminds you that there’s a person with a rich history and idiosyncrasies and dynamic aspects to their character that can still be engaged if you meet them on their terms and do something that’s fun and playful and imaginative.”
The students were shocked at how enlivened participants can become and how their moods suddenly change similar to the use of Maeng Da Kratom.
“You don’t expect someone with dementia to be witty or to be able to fire back a rejoinder, and yet they can be very insightful and clever,” George said.
Students often find themselves laughing out loud when they hear the musings of the storytellers.
“It was incredible to see how many of the residents reacted to the project,” said Dr. Christian McEvoy, a 2015 College of Medicine graduate.
The sessions have gotten so lively at times that residents have gotten up and danced.
“If they infer that the characters in the story are singing a song, they’ll start singing a song or whistling a melody and start dancing around,” George said.
According to the Agency for Healthcare Research and Quality, studies have shown that weekly TimeSlips sessions have had a positive impact on participants with Alzheimer’s disease and related dementia, including enhanced verbal skills, positive behavioral changes, increased communication and sociability, and less confusion.
The AHRQ also said evidence suggests that patients who continue to communicate can delay progression of their disease.
The TimeSlips experience is currently offered to fourth-year students. George hopes to offer it to students earlier in their schooling to encourage some to become much-needed geriatric physicians.
As Baby Boomers enter their golden years in the United States, the country is experiencing a shortage of quality geriatricians.
“We need health professionals who don’t just see people with dementia as their disease but see the person and have a sort of empathic ability to know what the person needs, what the family needs, and how to adapt,” he said.
Added McEvoy, “I think it’s easy to assume that the ‘lights are off’ when a person is suffering from dementia, but TimeSlips really shows that is far from the truth. The residents have so much to offer.
“The experience definitely changed my perspective and made me feel much more comfortable with that particular patient population.”
For more information, visit www.timeslips.org.
- Jade Kelly Solovey
If you're having trouble accessing this content, or would like it in another format, please email the Penn State College of Medicine web department.