Creating moments and memories for people with dementia

Faith Wray is a master’s student at the Royal College of Art and co-founder of Paper Birch, an organisation which develops creative workshops to engage and stimulate people with dementia. Faith and her co-founder Laura Venables both witnessed the effects of ageing, dementia and cognitive impairment in their families and recognised the potential for structured, stimulating creative workshops to help patients feel more at ease and access old memories. Paper Birch workshops are currently offered on the acute Witherow and Lewis Lloyd wards at St Mary’s Hospital thanks to a grant from Imperial College Healthcare Charity. Here, Faith explains how the workshops help improve patient experience and help patients and staff engage more effectively with one another.

I founded Paper Birch workshops with Laura Venables in 2015. We design workshops around a number of subjects, including fine art, sculpture, reading and writing and print making. We realised that sensory experiences and creative activities could benefit patients during their time on acute and rehabilitation units in hospital.

The workshops are designed to be less about outcome and more about the present moment of engagement, so we ensure that they are tailored delicately to each participant’s needs and personal preferences. Workshops may start with a chance to handle tactile materials, smell a variety of scents and discuss previous life experiences or personal worries. We are always careful to ensure the creative experience is suitably facilitated to each individual, and ensure the experience is patient-led.

I work across two acute wards at St Mary’s Hospital, the Witherow and the Lewis Lloyd wards, delivering one-to-one and group workshops. When a ward is under a lot of pressure, workshops can have a positive impact in reducing the workload of staff, and allowing those who need additional companionship and reassurance to be stimulated for the session. In addition, the workshops can be a positive distraction for someone who may be agitated or experiencing ‘wandering’.

On one occasion, I arrived on the ward and noticed a man who appeared to be rather distressed and was wandering up and down the ward. I asked whether he would like to join our workshop. He refused, however I encouraged him to come and sit down for a rest. The nurse who was supporting him was unsure whether it would be a successful encounter, as he had wanted to walk constantly.

I decided to try a different approach. I looked at him, smiled and said: ‘Please can you sit down, now I have a job for you.’ He replied ‘I think I should! You sound very authoritative, now what’s my job?’ I gave him some textured papers to look through and asked him to find me his favourite one.

He disclosed to me how he felt his mind was preoccupied with worry. He was frustrated as to why this was, as he couldn’t work it out. He said he felt he had wasted time in life. With his consent, I decided to write down what he was saying. He came to the conclusion that he was in fact frustrated, as he never married the women he loved.

We spoke in depth about philosophies around the subject of love, and smelt scents that could represent love. I held a paper soaked in rose under his nose and he smelt it intensely. He began to talk about love and colour. As we selected materials in shades of reds and pinks, he spoke to me about a particular colour that someone had once defined to him as the colour of love.

‘Shocking pink!’ he shouted! I selected it from the pastels and coloured in some paper with it.

I asked him if he felt more peaceful than he did when he originally sat down. ‘Much more peaceful, yes,’ he replied. ‘I feel I always have so much to do, so many places to be, and so many things I need to find out in my head. Sometimes I forget that I just need to sit and enjoy myself.’

I encourage staff to be aware and involved with the workshops, and use their expertise to advise who may benefit from additional stimulation and support. After each workshop, I complete an evaluation report, discussing points such as particular moments and positive impacts to the ward on that day. I send these evaluations to several members of staff to ensure that everyone on the ward is aware of any particular issues or ideas which have been brought to light through the workshops.

I had another wonderful experience with a man who was insistent that he wanted to glue an entire page, including every last inch, before sticking strips of paper to it. When his wife came to visit and saw his actions, she smiled and explained that he used to be a ‘real handy man’ at home and ‘was always wallpapering the walls.’ It seemed to his wife and me that this task may have facilitated the chance to re-visit life skills.

On a number of occasions, I’ve worked with frightened and confused patients, particularly those who do not have English as their first language. When speech is limited this type of creative, sensory engagement can have the potential to unlock a participant’s needs. For example a particular scent may draw light upon their favourite fruit to eat, or a particular comforting aroma they are drawn to.

The Alzheimer’s Society states: ‘In the later stages of dementia, relying only on verbal communication can lead to difficulties understanding what the person is trying to communicate, possibly missing basic needs such as pain, hunger and thirst’.

This is why it is so vital to explore other methods of engaging with people with dementia. This type of creative stimulation can be easily transferred when participants are discharged from hospital. Often, when family members have joined in with a workshop, they have been able to take away ideas to use in their loved one’s permanent home. These ideas may be in the form of a creative activity, or simply a conversation topic that may provoke positive memories.

I strongly believe that this type of carefully curated patient engagement is a great addition to a person-centred care approach in healthcare environments. Patients become people again, and we can really begin to understand patient behaviour when we start to take note of their personality and their life outside of hospital. Understanding colour, smell preferences and material choices can create an abstract understanding that enables facilitators and staff to see participants in a new and creative light.

Learn more about Paper Birch workshops