CHICAGO – Whether the activity involves putting brush to paper or assembling images into a collage, expression through the visual arts can powerfully improve the quality of life for people with dementia and terminal illness.
Guided art activities can rekindle a sense of self in people with Alzheimer's disease and other dementias by facilitating a reconnection with long-term memories, said Cordula Dick-Muehlke, Ph.D., executive director of the Alzheimer's Family Services Center, Huntington Beach, Calif. For hospice patients, art therapy can afford the opportunity to find meaning and closure through the concrete expression of personal accomplishments, important relationships, and cherished experiences, Katy Barrington, Ph.D., professor of art therapy at the Adler School of Professional Psychology, Chicago, said in a separate presentation.
“The process of dying is a unique and vulnerable time for anybody,” Dr. Barrington said, and art therapy can provide an excellent catalyst for the expression of thoughts and feelings as hospice patients near the end of life.
She presented the results of a qualitative study of three elderly female hospice patients in rural Wisconsin. The study was based on existential philosophy, which emphasizes the importance of individual responsibility, choices, actions, and self-examination.
With guidance from Dr. Barrington and a hospice social worker over the course of four visits, patients completed a collage in collaboration with a selected loved one based on a story about their lives. She also asked each selected individual to tell a highlighted story that included the patient. The collages were framed and presented to patients and their loved one in the final session.
The process of creating a piece about one's life harmonizes with the goals and principles of hospice, which stress connectedness, dignity, respect for the patients' choices, and giving patients as much control over their lives as possible as they attend to psychological, physical, social, and spiritual concerns, Dr. Barrington said.
Art therapy helps patients cope with anxiety about death and encourages meaningful reminiscence. The latter is particularly valuable because it enables patients to take stock of their contributions and legacies at a time when they might wonder whether they have accomplished anything worthwhile in their lives, she said. Dr. Barrington analyzed the meaning in the finished art pieces using grounded theory, a qualitative research methodology in the social sciences in which data (in this study, patients' comments) are coded and grouped into similar concepts to generate a theory.
She said that she anticipated having to “pull” stories out of the three patients. Instead, “all of them unloaded on me … and I probably had 20 different stories. This tells me that confronting death is huge, and that there is a need to talk or bring it all together–to bring life together.”
Each of the three patients talked about mentors in their lives who had helped them deal with struggles and personal choices. Creativity (skill in embroidery, quilting, and sewing) had also played a prominent role in each woman's life, providing a means of navigating hardships, developing pride and dignity, saving money, and improving the quality of life for themselves and others. Their skills were parts of their legacies.
Through the creative process, patients “recognized that their experience was valuable, that it constituted knowledge, and that meaning came from that knowledge,” Dr. Barrington said. The project gave patients “choices and decisions to make, which made them whole and made them feel they were contributing to bettering their own lives, even as they confronted death.”
Creativity Despite Dementia
For people with dementia, activities have a different value. While providing an excellent vehicle for emotional release and social connection, art also can enhance cognitive functioning by helping individuals tap into brain functions that remain relatively intact, including long-term memory systems, Dr. Dick-Muehlke said.
“When we talk about art, we always talk about the creative process and the emotional process … but it's important for us to recognize that art allows people with Alzheimer's disease to use their preserved cognitive skills,” said Dr. Dick-Muehlke. She noted evidence that cognitive stimulation with medication might be more effective than medication alone (Dement. Geriatr. Cogn. Disord. 2006;22:339-45).
The neurodegenerative process of dementia impairs short-term memory, language, judgment, and visual spatial abilities. “We place a great deal of value on those [abilities] in our society. And we often forget about that other aspect of that person–the aspect of the person that is still so alive,” she said.
By tapping into what a person can still do and feel successful at, art helps individuals express essential features of themselves. Episodic autobiographical memories, such as “the day I got married” or “when I went to college,” as well as the long-term memories of skills and procedures called procedural memories often endure.