{"id":2216,"date":"2020-02-18T10:00:56","date_gmt":"2020-02-18T09:00:56","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=2216"},"modified":"2020-08-07T10:03:35","modified_gmt":"2020-08-07T09:03:35","slug":"talking-past-dementia-timeslips-and-the-creative-aging-revolution","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2020\/02\/18\/talking-past-dementia-timeslips-and-the-creative-aging-revolution\/","title":{"rendered":"Talking Past Dementia: TimeSlips and the Creative Aging Revolution"},"content":{"rendered":"

Video and Blog by David Ney<\/strong><\/p>\n

When I was ten years old, my mom and I went to see the doctor because my grandfather was sick. He had been there for me when I was sick as a kid, and I wanted to be there for him now. Pop sat on the exam table crinkling the thin white paper beneath him while my mom and I sat in chairs and looked at framed diagrams of organs on the walls. When the doctor came in, we all stood. He started with a battery of questions I could barely follow. Then he asked my grandfather, whom I called Pop, about me. \u201cWho came in with you today?\u201d<\/p>\n

\u201cI don\u2019t know,\u201d Pop said with a tilt of his head that made us all smile.<\/p>\n

\u201cWho\u2019s this?\u201d he nodded towards my mom.<\/p>\n

\u201cKaren,\u201d he said with a wry grin. \u201cOf course I know who my own daughter is.\u201d<\/p>\n

\u201cAnd who\u2019s this handsome fellow?\u201d All the eyes in the room turned on me.<\/p>\n

\u201cNever seen him before in my life.\u201d All four of us laughed for a moment. Then the doctor pressed.<\/p>\n

\u201cJoe, is this your son?\u201d My mom rested a hand on the back of my neck. She must have begun to feel nervous.<\/p>\n

\u201cNo, that\u2019s not my son.\u201d Good, we all nodded. But then he continued. \u201cHe\u2019s a stranger.\u201d<\/p>\n

My mother choked out a laugh, but this time she was the only one. \u201cCome on, Pop,\u201d she strained to smile, \u201cI know you know who this is.\u201d But he did not.<\/p>\n

\u201cHe\u2019s a stranger and I haven\u2019t seen him before.\u201d No one was laughing or smiling. My throat burned with shame.<\/p>\n

\u201cPop, it\u2019s me.\u201d<\/p>\n

\u201cDave,\u201d my mother interrupted, \u201cIt\u2019s okay he\u2019s just joking.\u201d<\/p>\n

\u201cIt\u2019s me.\u201d But Pop folded his arms and turned his attention back to the doctor for more questions. Though he was unbothered, I saw fear in my mother\u2019s eyes. My legs hung from the hard armchair and as soon as I started to cry, my mom scooped me out of the room. Before the door closed behind me, I heard my grandfather say once more: \u201cNever seen him before. Total stranger.\u201d<\/p>\n

*<\/p>\n

In 1995, Anne Basting founded TimeSlips<\/a> as a way to connect to older adults with dementia. She scrapped the concept having patients remember their past. Instead, she focused on creating spaces and tools for people with dementia to create new ideas. Using historical or silly photos and objects, Basting asked open-ended questions to the participants. The result: people with dementia generated stories that sounded like personalized Mad Libs comics. Her experiment was a success. Today, TimeSlips operates in 20 countries and all 50 U.S. states. Anyone can become a facilitator by completing an online course. Any room with enough seats can be transformed into a session.\u00a0 The method has been praised for its positive impact on facilitators and participants.<\/p>\n

I learned about the organization in my first year of medical school and now I am leading TimeSlips sessions with my classmates at a nearby Assisted-Living facility. Researchers have found that participating in or leading these sessions improves medical students\u2019 attitudes towards people with dementia.[1]<\/a><\/sup> For the participants with cognitive impairment or dementia, it has been shown to boost joy and increase quality of life.[2]<\/a>,[3]<\/a><\/sup><\/p>\n

When someone starts to lose their memory, there is usually a rush to recover the past. When this fails, as it always does when a person develops dementia, the gap created by a lack of memory can be filled with a lot of things\u2014in my family it was filled with silence. For some families, this silence is not benign. In the silence, the person with dementia can feel a crushing pressure to remember. It can lead to shame and embarrassment. People in these situations can be marginalized by isolation, stigma, and in more severe cases, by chemical restraints via anti-psychotics. The end of the story so often has patients getting siloed into nursing homes with staff who are too busy, leading to downward spirals of isolation, dehumanization, and residents clinging to wisps of autonomy.[4]<\/a><\/sup> Older adults who perceive aging in this context can have negative thoughts about growing older and this has dire consequences on long-term health. In a study designed to target how older adults understand aging and associated stereotypes, researchers showed that negative self-images about aging among the elderly were associated with an average loss of 7.5 years from life expectancy.[5]<\/a><\/sup><\/p>\n

At ten years old, I just wanted my grandfather to stay the way that he was.\u00a0Following the appointment where he failed to recognize me, I was determined to help him get better, which meant finding ways to get his memory back. I thought I could reverse his memory loss by flooding him with more memories. After school, I would go to my grandparents\u2019 Manhattan apartment to comb through photo albums. For years, he would sit at the head of his dining room table with me flipping pages by his side. When memories burst forth, they felt like breakthroughs. Over time, I came to recognize these moments as mere blips. I became a stranger in his house. Sometimes he would yell at me to leave and my grandmother would have to calm us both down. He lived like this for ten excruciating years until he died surrounded by family.<\/p>\n

*<\/p>\n

The first time I witnessed a TimeSlips session, I thought I had witnessed a miracle. I could not believe that the people around me had dementia. I wanted to try to capture the energy I had seen and share it with my friends, my classmates, and my family. I wanted them to know that good people were taking creative approaches to dementia care that might make living with this disease just a little bit more bearable.<\/p>\n

While no two TimeSlips sessions are ever the same, the session that I filmed stands out. Most of the participants in this activity do not have dementia. They come from a variety of backgrounds of people who are cognitively normal, have Mild Cognitive Impairment (MCI), or slightly more advanced stages of dementia. Anyone in this film who has cognitive impairment is accompanied in this video by a caregiver\u2014either on camera or in the room just outside the circle. They all agreed to appear in the film and documented their consent in writing. Those with cognitive impairment signed additional waivers and had their caregivers sign additional waivers too, explaining that they understood they were appearing on camera and that this film would be used for educational and advocacy purposes. However, I will not tell you who has dementia or how many people have a diagnosis. I suspect that you will not be able to determine who is cognitively normal and who is not. In this small circle of reminiscence and storytelling, I think you will know who is mischievous, who is nostalgic, and who is watchful\u2014but that just illustrates the TimeSlips perspective that allows us to peer into the minds of the participants and helps us form connections.<\/p>\n

The sessions that I\u2019ve led at Jefferson begin with the refrain: \u201cThere are no right or wrong ideas, only your ideas<\/em>.\u201d TimeSlips has redefined what dementia means to me and it has changed how I support people with this disease. Now, when patients do not remember my name or cannot follow along in a conversation, we forge forward and forget about the pressures of who remembers what. We laugh and make up stories and find new ways to connect.<\/p>\n

The world as it is in 2019 does not offer cures for dementia, but TimeSlips offers something else. It brings meaning to those who give and receive care. It offers playfulness to brighten a disease that is so often cloaked in fear. If I were sitting on Pop\u2019s couch today, I would put away the old photo albums and pull out zany pictures or objects. If I could re-do how we spent our time, I would not force old memories out of him, but work to create new ones together. As someone who cares for others with dementia, it forces me to consider: if this were me, what would I want? <\/em>If dementia comes for me, I know that I will still want to find meaning in my life. I would want to have fun, be able to laugh, and find companionship, however fleeting those feelings will be. I would want to be known as more than a disease. I would want to know that there are people doing everything they can to help me enjoy life.<\/p>\n