Presence redefined: The reciprocal nature of engagement between elder-clowns and persons with dementia

Abstract

Elder-clowns are a recent innovation in arts-based approaches to person-centred dementia care. They use improvisation, humour, and empathy, as well as song, dance, and music. We examined elder-clown practice and techniques through a 12-week programme with 23 long-term care residents with moderate to severe dementia in Ontario, Canada. Analysis was based on qualitative interviews and ethnographic observations of video-recorded clown-resident interactions and practice reflections. Findings highlight the reciprocal nature of clown-resident engagement and the capacity of residents to initiate as well as respond to verbal and embodied engagement. Termed relational presence, this was achieved and experienced through affective relationality, reciprocal playfulness, and coconstructed imagination. These results highlight the often overlooked capacity of individuals living with dementia to be deliberately funny, playful, and imaginative. Relational presence offers an important perspective with which to rethink care relationships between individuals living with dementia and long-term care staff.

Re-claiming citizenship through the arts

“…Dupuis & Gillies, 2014;Dupuis, McAiney, Fortune, Ploeg, & deWitt, 2014;Dupuis et al, 2012), and the nurturance of the creative and imaginative potential of people living with dementia (e.g. Beard, 2011; Dotsa Bitove Wellness Academy [http://www.dotsabitove.com/]; Genoe & Dupuis, 2013;Killick, 2008;Killick & Chapman, 2009;Kontos, 2014;Kontos & Martin, 2013;Kontos, Miller, Mitchell, & Stirling-Twist, 2015; Music for Life [http://wigmorehall.org.uk/learning/music-for-life]). These examples powerfully concretize the core principles of relational citizenship in practice (Miller & Kontos, 2016).…”

Elder‐Clowning in Long‐Term Dementia Care: Results of a Pilot Study

“…Four classes of drugs were considered for analysis of medication use: antipsychotics, benzodiazepines, antidepressants, and dementia symptom control medications (cholinesterase inhibitors and memantine). For antipsychotics, olanzapine equivalents were calculated based on within‐class dosing equivalencies for antipsychotic medication . Dosing equivalents were not calculated for the other drug classes because within‐class dosing equivalents were not found for antidepressants and dementia medications.…”

“…Secondary outcomes included effect on resident agitation levels, nursing‐perceived occupational disruptiveness, and resident psychotropic medication use. The evaluation included a qualitative component to explore the aesthetic and relational components of elder‐clowning …”

New Objects, Old Age. The Material Culture of Growing Old

“…Subjectivity and identity involve bodily dispositions and gestures, formed by social and cultural processes. (Kontos 2004;Kontos et al 2017. ) Consequently, as the ageing process is both social and biological, old age needs to be studied in conjunction with the ageing of bodies (Calasanti & King 2005).…”