Helping people to reconnect: positive projects for people with dementia

This Photo is licensed under CC BY Via Microsoft Word images

Every three minutes, someone in the UK develops dementia. Over 850,00 people in the UK are currently living with a form of the disease; 40,000 of these are people under the age of 65.  This week (20th– 26th May) is Dementia Action Week 2019. This year the focus is on encouraging people to talk about dementia, and to talk to people with dementia in order to help tackle loneliness and isolation among those who suffer from the condition, as well as to raise awareness and improve understanding around the condition and the impact it can have.

The power of music

You may have recently come across the BBC programme featuring Line of Duty’s Vicky McClure Our Dementia Choir (if you haven’t you should try and find a copy).  The documentary follows a group of people who suffer from varying degrees and types of dementia and highlights in sometimes painfully sad detail the changes and challenges that can occur when someone develops the disease. However, it also shows the great joy and relief that music brings to dementia sufferers and their families. We blogged a few years ago about the benefits of music therapy in dementia care – and since then the literature and research on its usage in different settings has only grown.

Research shows that music, in various forms can help encourage participation and trigger positive associations which can be really helpful for people suffering from dementia, particularly if they feel like a lot of other things may have changed. In our previous blog we highlighted a Care Inspectorate backed scheme called ‘playlist for life’ which encourages care homes to integrate music into their care for patients with dementia. Moving beyond just allocating a time to place headphones onto a patient and leaving them to listen alone (although at times this may be helpful too), the aim is for music to be a vehicle for connected care. It allows carers to use music as a tool to find out more about the person they are caring for and encourage them to engage through the music.

Tackling isolation with art, culture and the natural environment

Research has shown that it is not only music that can have a positive impact on quality of life for people with dementia. Painting and drawing, making use of the natural surroundings by encouraging gardening or light walking in safe spaces, and games like dominoes and draughts can all help in their own way to improve the quality of life for people living with dementia and provide an opportunity for loved ones to re-connect.

In a 2014 study researchers examined the experiences of people with dementia and their carers when they participated in an 8 week programme based in an art gallery designed specifically to tackle social isolation and improve quality of life for both the person suffering from dementia and their carer. The study found that while the impact in terms of qualitative measures was negligible, participants were unanimous in their enjoyment and satisfaction with the programme. They highlighted that the interventions at the galleries helped to foster social inclusion and social engagement, enhance the caring relationship between the carers and people with dementia, and stimulate cognitive processes of attention and concentration. In a similar study, looking at the impact of art and gallery settings and programmes delivered within these settings, similarly positive emotional effects on study participants were found.

In Liverpool, they are making the most of their city landscape and the fact that specific locations, building and objects around the city can act as positive triggers for people who suffer from dementia, stimulating memory and interest. Those individuals who are mobile enough can participate in “memory walks” (different from the Memory Walks convened by the Alzheimer’s Society, which are sponsored walks designed to help raise money and offer a public show of support for people with the illness). This not only helps to improve physical activity, it can also be an opportunity for people with dementia to connect with other people as the walks are usually carried out in small groups, they are also linked to befriending schemes across the city to help reduce social isolation among multiple groups.

Similarly, many care homes now also promote interaction with nature and outside spaces for residents with dementia, with many developing specifically landscaped “sensory” gardens for residents, while other innovative supported living accommodation projects have gone a step further and created entire villages on site, which allows residents to perform tasks such as shopping or visiting a hairdresser. (This project is based in the Netherlands, but there are suggestions that a similar scheme could also come to the UK in 2020.)

VR and creating virtual experiences for people

Using digital technologies has also become increasingly popular, particularly in care homes. Apps and VR headsets which allow people to be immersed in an experience they perhaps once enjoyed, such as flying (if for example they had previously been a pilot or air crew) or driving have been shown to have a significant positive impact on people’s wellbeing allowing them to reconnect with their past and memories and freeing them from the sense of being trapped and losing their independence which can sometimes come with moving away from home into supported accommodation.

Tablet computers and touchscreen technology can also sometimes be easier for people with dementia to use as they do not require the same level of dexterity as writing. Apps have been developed which can help with word association or use pictures which can be helpful in allowing people with dementia to communicate when their use of language becomes more of a challenge. While the technology its self is relatively new, research has shown definite scope and benefit of further development of this in the future, as well as relevant training for staff and carers on digital literacy to help support users.

A support to clinical interventions

Dementia is a cruel illness – 1 in 3 of us in the UK will develop a form of the condition at some point in our lives. As yet there is no cure and as the population ages, and life expectancy improves more generally, the number of cases is expected to rise dramatically in the coming years. However, where science is trying to cure, art and culture is trying to supplement and support the clinical interventions and, where possible, provide opportunities to improve the quality of life for people suffering with the condition and provide opportunities for people to re-connect with loved ones.

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Maggie’s Centres: wellness through building design and the environment

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

Interior of the Maggie’s Centre in Manchester, Foster and Partners

Award-winning architecture and design

In 2017 Maggie’s Manchester was shortlisted for the Architects’ Journal Building of the Year award. And many of the individual centres have won regional design awards for their innovative use of space and incorporation of the natural environment into their designs.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.


You can find out more about Maggie’s Centres though their website.

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Read more about innovative building design in our other blog articles.

Hidden in plain sight – the value of green spaces

jardin public

By Heather Cameron

They may be something most of us see every day but take for granted – the area of green space we pass on our way to work or frequent in our lunch break. And although we might make use of such spaces on a regular basis, is the true value of them really understood?

As highlighted by a recent report from the Land Trust, green spaces provide even more to society than we often think about.

Wider value

It has long been recognised that green spaces provide multiple benefits to communities and wider society, but there has been limited robust evidence on their wider economic value. The Land Trust report highlights that the services delivered by soil, grass, flowers, trees and water provide society and the economy with significant benefits.

It suggests that several important functions are provided by these green spaces, including:

  • Reducing and preventing flooding
  • Cleaning our water
  • Storing and removing carbon
  • Cleaning our air, reducing air pollution

Such functions help to alleviate costs to local and wider communities, such as to the health service, other public services and local businesses. Previous research has similarly alluded to such benefits.

Independent research by UK scientists in 2011 highlighted the true value of nature in relation to the economic, health and social benefits, estimating that it was worth billions of pounds to the UK economy.

Other research has also shown that green space has been linked to reduced levels of obesity in children and young people, and that access to open spaces is associated with higher levels of physical activity and reductions in a number of long-term conditions such as heart disease, cancer, and musculoskeletal conditions.

The proportion of green and open space is also linked to self-reported levels of health and mental health, through improved companionship, sense of identity and belonging and happiness. And living in areas with green spaces is associated with less income-related health inequality, thereby reducing the effect of deprivation on health.

What the Land Trust’s report does differently, is demonstrate these widely recognised benefits in physical and monetary terms to help create a greater understanding of the economic contribution of well-managed green spaces.

Natural capital accounting

A ‘natural capital accounting’ approach was taken to translate these benefits into financial terms, taking consideration of the physical land, its quality, how it is managed, used and the functions it performs.

Two different parks – Silverdale Country Park in the Midlands and Beam Parklands in London – were used in the study to demonstrate this value. Overall, Silverdale’s annual natural capital value was estimated to be £2.6 million, with a return on investment of £35 for every £1 invested, while Beam Parklands’ natural capital value, based on a 99 year period, has been valued at £42 million – an increase of £21 million since 2009.

Other benefits provided by Silverdale include:

  • Nearly £400,000 per year of flood risk reduction benefits
  • An annual value of £82,000 for the park and its maintenance to retain and purify water
  • A wider annual value of £840,000 of absorbed and stored carbon
  • A potential increase of 113% in local air pollution absorption since 2011

Other benefits provided by Beam Parklands (primarily a flood defence) include:

  • Nearly £600,000 per year of flood risk reduction benefits
  • Nearly £800,000 per year of educational and health benefits to the local community

As two well-maintained green spaces, they indicate the importance of long-term investment.

Final thoughts

Perhaps these financial values will help people to better comprehend the true value of our green spaces. As the report notes, it is important to remember that they are “not ‘one off’ monetary values or price tags” but rather an indication of what our green spaces are worth and their benefits to both society and the economy.

Put simply, as the Land Trust concludes, “green spaces… are valuable to society”.


If you enjoyed reading this, you may also like our previous articles on pocket parks and green spaces.

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Ecotherapy in practice: nature based mental health care

Ecotherapy, also known as nature-based or green care is an alternative therapy for people suffering from mental health issues. It can be delivered as an individual treatment or in combination with traditional medicinal and talking-based treatments. Charities and research has suggested that it can reduce depression, anger, anxiety and stress as well as improving self-esteem and increasing emotional resilience.

Spessartbach

The mental health charity MIND emphasises the positive health benefits, commenting that ecotherapy:

  • is accessible
  • can take place in both urban and rural settings in parks, gardens, farms and woodlands
  • works through people either working in nature or experiencing nature

It can be structured or more informal, with some areas providing therapist led classes while elements of ecotherapy, such as taking walks or gardening, can also be done without specialist supervision, on your own or with family members and friends.

AAT and AAI (Animal Assisted Interventions and Animal Assisted Therapy)

This form of therapy uses guided contact with animals such as horses or dogs. It is becoming increasingly popular in university settings, with dog cafes or dog rooms during student mental health weeks or during exam times to help alleviate student exam stress. Pet therapy has also been shown to be effective with children and young people who suffer from anxiety or who have experienced trauma, and for elderly people suffering from dementia.

Therapy could be one to one or in a group and could also be delivered to people who are in residential care setting. AAT can also be used to assist mobility and coordination or simply to spend relaxed time with animals where patients can feed or pet them. This interaction can promote bonding between the individual and animal which has been found to reduce stress and anxiety.

Nature Arts and Craft Therapy

Nature based art therapy takes inspiration from nature to create and provide materials to create art work. This type of therapy can also include social and therapeutic horticulture (STH). This can be a particularly effective form of nature based intervention as it can be adapted to suit a wide range of mobility and abilities and could potentially lead to work experience or the sale of goods created, which in itself can build self-confidence and transferable skills.

Adventure Therapy

This therapy focusses on using physical activities to encourage psychological support, It includes activities such as rafting, rock climbing and caving. Often done in a group, this type of therapy aims to build trust and raise confidence. While it can be strenuous, less able individuals can take part in green exercise therapy, which largely includes walks and rambling, or wilderness therapy (which includes physical group and team activities such as making shelters and hiking).

Effectiveness of ecotherapy

In February 2016, Natural England published A review of nature-based interventions for mental health care, which considered the benefits and outcomes of approaches to green care or ecotherapy for mental ill health.

One of the main challenges the report highlights is to increase the availability of green therapies in order to make the practice more normalised within treatment. The authors also speak about the importance of standardising the use of terms such as ‘ecotherapy’, ‘green care’ and ‘nurture based interventions’ to allow people to fully understand what different interventions entail. The report makes nine recommendations, including:

  • expanding the evidence base around green therapy
  • increasing the scale of commissioning of green care initiatives
  • increasing collaboration between the green care sector and health and social care practitioners

Ecotherapy is still not widely accepted as a mainstream approach to mental health treatment. However, it is increasingly being offered as a combination therapy alongside traditional drug-or talking-based interventions. Advocates of ecotherapy hope that this will lead to wider acceptance of the approach and the positive effect it can have on people who suffer from mental ill health.

Advocates emphasise the holistic and person-centred benefits of ecotherapy, which has been shown to improve physical health as well as mental wellbeing. As the video below demonstrates, it increases social skills and in many instances can help people build new or develop existing skills which can help them enter, or re-enter employment. Potentially this may also reduce the burden on care and community mental health services.


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