Introduction

Almost every 3 seconds someone in the world will develop dementia, according to Alzheimer’s Disease International. They’ve predicted that the number of people living with dementia will double every 20 years, reaching 131.5 million people in 2050.

If the estimated growth of dementia becomes reality, then it is paramount that we encourage coping mechanisms for people living with dementia today, to help mitigate the healthcare effects of tomorrow.

You will find in this blog post, how memory studies are helpful as a coping mechanism for dementia through the use of reminiscence activities.

 

With special thanks

Editor’s note:

We have been fortunate enough to enlist the highly regarded advice and knowledge of retired teacher Gillian Ditch.

Gill has personal experience of seeing how dementia can affect family members; she became interested in the relevance of memory studies and a phase often referred to as the ‘reminiscence bump’, whilst undertaking reading for an MA in Cultural History, Identity and Memory.

We are thankful that Gill has dedicated her time and knowledge to help us write this post, even sharing her personal examples of how reminiscence activities have helped her with elderly relatives. Which, fortunately, we will share with you today.

Let’s get started…

 

What is the ‘reminiscence bump’?

As Rathbone (2016) notes,

“The reminiscence bump is a phase in life that refers to a period of life in young adulthood where many significant memories happen for the first time and it is these that re-emerge in later life.”

The reminiscence bump is a phase that can occur but is not always evident.

As many readers who know someone living with dementia, it is quite often we will experience the individual living in past times.

 

This has been summarised simply by Dr Pam Jarvis, in her insightful post, The Time Traveller’s Daughter. Dr Pam Jarvis’ mother lives with dementia, frequently forgetting her present life situation, with only her memories of her past existing in her mind. In these moments, Pam has to ‘time travel’ back to her mother’s childhood to exist in her new reality.

 

All the family history stories Pam has learnt have been crucial to providing the support and communication needed for someone living in the past.

The ‘reminiscence bump’ that many people living with dementia will experience will reflect the cultural history and context of the era the individual lived through.

We are beginning to see the use of reminiscence activities emerge and encouraged throughout caring for people living with dementia.

 

Reminiscence Activities

While out one evening, Gill received a call from the hospital caring for her elderly aunt living with dementia. The staff were frantic, needing Gill to assist in calming her distressed aunt. With the distance being too great to get there, Gill had to quickly think on her feet and suggested to the nurses they give her aunt a sugary tea and ask about the French onion men of Old Portsmouth, who used to reside at their boarding house. It did the trick! Her aunt immediately calmed.

Gill realised that having the family history knowledge was key to helping her aunt and the nurses in that situation.

 

The importance of memory

It is clear that when a person is living with dementia they can exist somewhere between their past to current life. This can make the ability to undertake simple tasks today extremely difficult with unfamiliar objects and devices. For Gill’s mother, she was unable to recall how to make a sandwich.  Gill had to get the ingredients out and then it became easier for her mum. Her mother’s dementia also caused her to forget how to use the telephone.

Day-to-day life for someone living with dementia can be full of frustrating and confusing moments. With the additional inability to recall names and events as the memories of their recent lives cannot so easily be retrieved.

Memories play an important role in the sharing of long-past events and people from the past. Knowledge of an individual’s life story can help to allay confusion as by having knowledge of important events or people, you are enabling easier communications to transpire.

Memory studies scholar Maurice Halbwachs suggests that memories are gathered in the form of frameworks.

For example, when a piece of music is heard other events from the past are evoked. He suggests each framework triggers memories to another frame through our collective memories on a personal and public sense set within the relevant time and context.

We also have Draaisma’s interpretation of how memory is triggered through autobiographical memory. He suggests that memory has a will of its own and will suddenly turn up uninvited from a trigger to the senses.

From either perspective on how memory arises, it is clear through Gill’s experience, knowing individual stories is key to support people living with dementia who are existing in a past time.

Now we know the importance that memories play in a supportive role, how does it link into reminiscence activities?

 

What are reminiscence activities?

Reminiscence activities are simply, memory reminiscing activities that can support families and carers with strategies to enable relatives living with dementia to communicate.

We go through in detail the benefits of using reminiscence activities for dementia in this blog post here: What is Reminiscence Therapy and how can it help?

Reminiscence activities to trigger memories

The act of reminiscing can come about in many forms. Today we are seeing ground-breaking technology and tools to take reminiscence activities to the next level.

“Before my Aunt (who never married and lived on her own) moved into care I used to go and visit her and occasionally she would bring out photos, most of which I had never seen before. It was at this point I began to appreciate that these could provide talking points as by this time she was beginning to struggle with her memory.” … “Once I started my Masters’ degree in Cultural History, Identity and Memory I began to discover a range of examples that can be used to support individuals living with dementia.” 

– Gillian Ditch.

It’s clear that by using prompts, we can encourage memories to surface.

Research by Green and Luscombe highlight that artefacts have an emotional significance that can be attached to inherited or personal objects.

These include:

1. Memory box artefacts

The use of artefacts can be a useful resource that can trigger memories, and be wonderful discussion points for carers or family members with the person living with dementia.

Having these discussions and reminiscence of memories around artefacts help to promote well-being and improve person-centred care.

 Clothes

Any item can be considered an artefact. As long as it has a special meaning to the intended and helps resurface a special memory. Artefacts could be anything from a shell on a beach (which could trigger happy holidays with a loved one) to a money box from their childhood.

Studies have found that clothing has a particular effect within reminiscence activities. Think of wedding outfits, uniforms, handbags or even shoes. These items have powerful connections with memories of a certain time and people connected to them.

Hallam & Hockey discovered that clothing and the memories resurfaced can help preserve a sense of self, and bring about a conversation on past stories in their lives.

An example of this is prevalent in my own personal experience. My grandfather has recently been diagnosed with dementia, and a new behaviour of his is to always be wearing his driving gloves no matter where he goes, plus he is obsessed with keys. After reading this section on artefacts, I now realise that his driving gloves and car keys are a reminder to him of his car. As a young man, he was very successful and drove a wonderful car. Plus, his father was the first in the village where they lived to even own a car!

Driving was a big part of his life, he taught all his children to drive and many of us grandchildren. After his diagnosis, he was told he couldn’t drive anymore. As a result, he carries keys and driving gloves with him at all times, even when sitting on the sofa at home.

I’m beginning to realise that these objects help him hold onto his identity.

 

2. Music

Music has wonderful healing benefits to the body. A case study featured at the 2017 European Reminiscence Network Conference demonstrates this.

A woman with advanced dementia who in her early career was a tailor began to smile and enact particular bodily actions when hearing the theme from Out of Africa. This musical piece triggered memories from that time and enabled her to become engaged while playing the music.

Artefacts with music:

Music Memory Box

The development into reminiscence artefacts for dementia has brought about incredible innovative ideas.

One wonderful example of this is the Musical Memory Box created by Chloe Meineck.

The Brighton University graduate was inspired to devise the Musical Memory Box to support her great-grandmother living with dementia. Her great-grandmother still had a wonderful connection to music, and thus found a way to recall memories.

The Music Memory box is simple to use, you fill the box with meaningful objects, music and photographs which are all fitted with stick-on-sensors that play music when lifted out of the box.

This way the artefact is always linked to familiar music making the reminiscence activity multisensory.

This device is being used personally and in care homes with those living with dementia. You can find out more about the Music Memory Box here. 

 

3. Art / imagery

Art and imagery have a powerful effect on memory too. Again from the European Network Conference 2017, A case study from Japan highlighted the way flags are used to celebrate cultural occasions. One elderly resident became agitated at the sight of the flags. The staff realised her agitation was caused by wanting to put on her special Kimono that she associated with the celebration.

This is where knowing the culture of a society is important. As, without the prior knowledge of her local background, the carers wouldn’t have been able to help her.

 

4. Film

Television and film from an earlier time can trigger discussion and memories. We’ve highlighted this in a previous post where a care home played Fawlty Towers. A resident who was usually reserved and had limited communication with advanced dementia suddenly became animated, excited and recalling and predicting the succeeding scenes accurately.

 

5. Religion

Certain hymns and rituals within a religion can be strong tools for reminiscence therapy. Singing songs together in a group has had wonderful effects on people living with advanced dementia, even enabling some people to communicate again when usually their communication ability is diminished.

 

6. Dance

A Jewish care home in Brighton (The Mazeltov Project) has focused on the cultural memories of how dance and the associated music is used in different rituals within the religion.

They saw results of residents reviving memories that contributed to a sense of self and wellbeing where residents are able to chat about times past.

Gill shared a personal experience that highlighted this. The care home looking after her parents dressed them up to go to a Naval Christmas Dance one year. Her dad was very poorly with a brain tumour, and her mum had vascular dementia, but despite their poor conditions, they both got up with help and remembered how to dance albeit it very.

 

7. Photos

Photos are a very commonly used way to trigger memories and discussion. A recent study by Le Blanc 2015, found that women who looked at young photographs of themselves from their 20s and 30s were more easily recognised than later life pictures. This prompted them to remember names prior to marriage.

Which is why some care homes have taken to using maiden names and younger photographs of residents on their bedroom doors so they are more easily recognised.

 

8. Themed rooms (cafes)

There are wonderful reminiscence activities which involve completely themed rooms from another era. This nostalgic space has everything that would have been used in that time, from decoration to music to food. This effect is particularly powerful to trigger memories and enable people living with dementia to feel comfortable and relaxed.

 

9. Food

Traditional, culturally based foods enjoyed in earlier years can be key for allowing people living with dementia to not only reminisce about their youth. They can also be a stimulant to boost appetite as was discovered by Hanssen & Kuven in 2016

 

10. Knowing their life story

My sister worked as an occupational therapist, and on one of her student placements in a care home in Essex, there was an elderly man living with dementia. Each morning he would knock on the doors of each resident bright and early at 4 am. It would wake each person and cause quite a stir!

Eventually, the carers found out after speaking to the family that he used to be a milkman.

The carers came up with a great idea to give him a stack of cardboard coasters to place at the doors each morning instead of knocking.

If you still have elderly family members who you are able to still communicate with and prompt memories with specific questions, then it’s not too late to try interviewing them about their life story. You’ll not only discover their personal stories, but it will give you points of communication with them in the future.

 

Resurfacing difficult memories

Memories can be both positive and negative, it is important that when we engage with reminiscence activities we are careful with what to do around painful memories.

Often long-forgotten memories, which were buried can resurface during the reminiscence bump. These ‘shadows of the past’ have raised ethical issues of using reminiscence activities due to the trauma the re-emergence can have on the individual.

Research by Summerfield highlights that difficult stories from the past may become adapted by the narrator to make them more comfortable to share in the present time. She used the term ‘composure ‘to describe this process and noted that in order to deal with these difficult memories that can resurface the narrator can overlay their memories with subsequent experiences, thereby the past is reinterpreted to suit the present audience and the present time. It is also relevant to note that different cultures/ genders may deal with memories in different ways.

This can be so also because of a difference in culture.

Cultural Influences on memories

Gill’s mother learned Welsh in school, which became more prevalent in memories when she developed vascular dementia in later life. Because of this difference in culture, Gill would often be in situations where she would be unfamiliar with phrases and words used by her mother which would cause confusion.

Cultural memory as researched by Erll is relevant when trying to understand the context of an individual’s life when younger, it also helps families and carers to travel back in time as we saw with Pam Jarvis’s experience.

Fivush et al researched the differences between Western and Eastern cultures and discovered differences in the way individuals might recall stories from earlier in life. The context in which the memory derived and the associated language used when telling the tale cannot be underestimated; attitudes change over the years so the tale you may hear may well have been mediated to suit attitudes from earlier in life.

When individuals enter care homes or residential care, it would valuable for staff to find out as much as they can about the individuals in the care. This where family knowledge can prove vital in terms of cultural history and identity. That frail relative, who cannot remember names may have had a fascinating life and career, they may have attended the first Isle of Wight pop festival, been on demonstrations, watched Moon landings, lived the early part of their life abroad speaking another language…who knows what tales they have to tell.

A wider knowledge of individuals may also help to negate any attitudes of ageism that can sometimes be encountered.

 

Effectiveness of Reminiscence activities

It’s hard to evaluate the benefits of reminiscence activities. In the moment of participating in reminiscence activities, many memories can be remembered, but even after a short time has passed, the memories can be forgotten again.

However, the effectiveness of reminiscence activities can best be measured through the benefits of the time spent communicating, being involved and feeling useful.

Each moment of a positive experience is felt by the person living with dementia, which seems enough to justify the amount of time spent in reminiscence activities. These moments can revive their sense of self.

The European Reminiscence Network completed a pilot project across 10 countries to widen understanding of the way reminiscence of people’s individual experiences can support activities.

They found positive trends in support for reminiscence activities, and as a great support for both people living with dementia and the carers.

However, a great deal of training is needed and knowledge on the individual for effective effects to take place. There needs to be more knowledge and skill gained on how to effectively approach and deal with sensitive memories.

Using reminiscence activities can be a wonderful way to boost communication between family members and carers. As the memory of the activity fades, the experience stays with the carer and family member. This can help support future communications as a better understanding of their individual story can help piece together snippets of information.

Gill’s mother would ask for certain items, and Gill couldn’t understand initially. But over time, Gill eventually understood and learned what her mum was referring to.

 

Gathering Life Stories

Interviewing a life story for someone living with dementia

While this activity may be too frustrating for someone with advanced dementia, you may get illuminating results for someone who you can still communicate fairly effectively with.

Chatting about the reminiscence bump era in their life can be a very therapeutic activity for the individual. The reminiscence bump can take them back to their 15 – 25-year-old life period (give or take a few years). During this time, it can be an incredibly special period in life as many first-time events take place. These can include, leaving school, first job, first car, first girlfriend/boyfriend, favourite social events, favourite foods, early marriage and even young babies.

Asking about this time period should enable you to learn a lot about them. But be mindful that some chats may reveal surprising stories and upsetting ones, so it is pertinent that you approach these topics sensitively as mentioned by Schweitzer and Bruce.

 

Tips for interviewing and recording history life stories with someone who is already living with dementia

When interviewing someone with dementia it’s important you lead with your questions but be ready to deflect any conversation if you can see it leads to a painful memory or if they can’t remember the answer.

For example, if you can see the individual becoming sad about a memory you can deflect with comments regarding the clothes individuals might be wearing.

You can use music, photographs, artefacts, basically any of the above reminiscence tools to evoke memories that will bring about a wonderful life story.

The most important part of interviewing is to make sure everyone is having fun, and it’s an enjoyable experience, celebrating their life story.

 

Benefits of interviewing

The best part about recording their life story either via video or audio is that you always have a reference point of discussion and memory triggers that you can refer to if their dementia makes their memories regress further.

Their life story can be treasured and passed on throughout the family as a cherished sentimental piece of family history. Grandchildren, great-grandchildren and great-great grandchildren can learn of what life of their ancestors was like in the 20th century.

 

What can you do today?

It is clear that reminiscence activities can provide a stimulus for reviving memories for people living with dementia. They provide an opportunity to extend communication, for both the individual and the carer /family member which in turn can support well-being.

However, as we touched upon in the introduction, there are activities you can be doing today to future proof your care for when you’re elderly.

Recording your own life story

You can start recording your own life story today for your family who may need these precious stories about you for reference.

Hausknecht believes there are social and emotional benefits to be gained from the process of storytelling. As well as the social benefits, storytelling provides a legacy for future generations. Enabling pride for their own memories and for future generations.    

For more information on interviewing and recording your life story, take a look at the Reliving app.

Reliving has been working closely with many partners who are passionate in the dementia space. These partners have helped develop the app to best suit people living with dementia, families and carers.

Here at Reliving we are promoting the concept of storytelling and recording these notes to come in useful at a later date.

We encourage the telling of life scripts before conditions like dementia occur so that our families and carers have valuable information on hand to help us.

Anyone with the experience of someone living with dementia can vouch for how valuable this information can and will be.

You can find out more information on the Reliving app here.

 

Conclusion

The responsibilities faced when dealing with family members living with dementia brings into focus the importance of memories in our lives.

Whether it’s conversations or a recorded life story, make sure you share your memories with your family. The significance of the role of your memories may serve a deeper purpose to the well-being of your future self.

Above all, we hope that you find the above reminiscence tools and examples helpful in your own personal situation.

If you enjoyed this post and found the content in this post helpful please share and take a moment to follow Gill on Twitter here: @gillditch55.