Exploring the theoretical foundations of visual art programmes for people living with dementia

Abstract

Despite the growing international innovations for visual arts interventions in dementia care, limited attention has been paid to their theoretical basis. In response, this paper explores how and why visual art interventions in dementia care influence changes in outcomes. The theory building process consists of a realist review of primary research on visual art programmes. This aims to uncover what works, for whom, how, why and in what circumstances. We undertook a qualitative exploration of stakeholder perspectives of art programmes, and then synthesised these two pieces of work alongside broader theory to produce a conceptual framework for intervention development, further research and practice. This suggests effective programmes are realised through essential attributes of two key conditions (provocative and stimulating aesthetic experience; dynamic and responsive artistic practice). These conditions are important for cognitive, social and individual responses, leading to benefits for people with early to more advanced dementia. This work represents a starting point at identifying theories of change for arts interventions, and for further research to critically examine, refine and strengthen the evidence base for the arts in dementia care. Understanding the theoretical basis of interventions is important for service development, evaluation and implementation.

A Taxonomy of Arts Interventions for People With Dementia

“…There is no consensus on what arts interventions should include, and little has been done to identify their component parts (Burnside et al, 2017). Moreover, arts and dementia research lacks appropriate theoretical frameworks (Young, Camic and Tischler, 2016), and few studies have attempted to explain how the arts 'work' for people with dementia (Windle et al, 2017). Furthermore, the field has no common language to name and communicate the mechanisms and outcomes of arts interventions between multi-disciplinary partnersfor example artists, care staff, researchers, funders and people living with dementia (Gray et al, 2017).…”

“…The case study and the Delphi study re-confirmed that the Principles dimension could be interpreted as outcomes or mechanisms of arts interventions. The fluidity of the principles as outcomes or mechanisms is due to the complexity of arts interventions, and how these components interact with each other (Windle et al, 2014;Windle et al, 2017). For example, combined, or working in sequence, these elements can cause different or certain effects (Rogers, 2008).…”

“…To help explain this theory more practically, Figure 2 shows an example of a music intervention in a care home, inspired by observations from the case study, articulated as a CMO configuration. The model demonstrates how the taxonomy dimensions and their contents can be used dynamically, as a theory of change, to suggest how arts interventions 'work' (Windle et al, 2017).…”

‘Unlocking the door to being there’: The contribution of creative facilitators in supporting people living with dementia to engage with heritage settings

“…For example, Billington, Carroll, Davis, Healey and Kinderman (2013) identified a number of features of effective facilitation, including addressing the participants by their names, maintaining good eye contact during engagement, speaking in a clear and loud but not commanding voice and creating a friendly atmosphere that allows people living with dementia to express themselves. A literature review by Windle, Gregory, Howson-Griffiths et al (2017) examined studies reporting visual arts programmes for people living with dementia, seeking "theoretical clues" (p.3) about the features that appear to contribute to the achievement of good outcomes and more positive and engaged experiences. They combined this with a qualitative exploration of stakeholder experiences of participation.…”

Conceptualising and Understanding Artistic Creativity in the Dementias: Interdisciplinary Approaches to Research and Practise

“…The role and value of the creative arts for people living with a dementia has been widely appreciated ( Young et al, 2016 ; Camic et al, 2017 ; Windle et al, 2017 ), yet it has not explicitly focused on the ability of people with a dementia to interact and engage as co-creators. This may also reflect different disciplinary aims and theoretical perspectives, and the location of the majority of theories of creativity within a cognitive framework ( Plucker and Beghetto, 2004 ) but may also be linked with dominant perceptions that people with a dementia are less capable of creative interactions ( Basting and Killick, 2003 ; Ullán et al, 2012 ).…”