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Artistic Adaptations
By Barbara Worthington

Artistic activities offer a welcome connection to patients with Alzheimer’s disease (AD) who might otherwise be unable to express themselves and remain locked inside a seemingly impenetrable shell. A visionary program piloted by New York City’s Hearthstone Alzheimer’s Foundation has evolved into a successful program through which artists perform and collaboratively engage with these patients. Programs offer artists and cultural institutions opportunities to present experiences designed to educate and inspire patients with AD.

Launched in Boston, Artists for Alzheimer’s (ARTZ) recruits and trains volunteer artists to perform and work with these patients in a hands-on program that connects singers, painters, actors, and the like with small groups of elders with AD. Experts have found that observing art serves as an inspirational approach in promoting communication among sufferers of AD.

Volunteer artists and participants with dementia interact in small groups, usually limited to four or five participants, in art experiences ranging from poetry to sculpture to belly dancing. ARTZ volunteers receive training enabling them to engage in hands-on experiences in visual arts, dramatic arts, and poetry, among others, according to John Zeisel, PhD, president of ARTZ. With colleague Sean Caulfield, the artistic director, he bases the nonpharmacologic treatment for AD on the positive effects to be realized from art, music, and similar cultural activities.

Sharing more than their energy and artistic talents, volunteers create profound emotional connections with the patients. Their experiences provide opportunities to witness the awakening of participants’ personalities and creativity fostered by volunteers’ compassion and understanding.

Evolutionary Process
In 2003, ARTZ approached the education department at the Museum of Modern Art in New York, proposing the concept of creating an Alzheimer’s-specific access program within the museum’s Community and Access division. The program involved ARTZ conducting the research enabling the selection of artworks that would resonate with older adults with AD and develop focus groups and pilot tours to assist in shaping and defining the program.

ARTZ trained the education staff and all of the museum docents involved. In 2006, the program became available to the public. Now a permanent program offered on a monthly basis, it collaborates and develops partnerships with other museums the program contacts or that contact ARTZ to become involved in the innovative events.

Among those currently implementing the ARTZ programs for older adults with AD are Harvard University’s Museum of Natural History, the Louvre, the Rubin Museum, the Decordova Museum, the Peabody-Essex Museum, and the Museum of American Heritage, according to Zeisel. “Once we share with a museum that approximately one quarter of their membership is likely to have a relationship with someone who has Alzheimer’s, they begin to see an opportunity to reach out and make a difference,” he says. “The museums also realize that if part of their mission is to make the museum experience accessible to everyone, then this program can help them achieve their mission.”

ARTZ program volunteers, who usually learn of the program via the Web site or various media outlets, span a broad spectrum of ages. “We’ve had volunteers as young as 8 to the age of 102,” says Zeisel. “We get lots of teenagers, college students, and baby boomers who might have a parent with Alzheimer’s and would like to find a way to improve the quality of life for people living with Alzheimer’s.”

Making the Connection
It’s critical to engage individuals with AD in order to create the optimal experience. When artists receive ARTZ training, they learn to promote a hands-on art-making class through visual arts, dramatic arts, poetry making, and other artistic pursuits. They achieve the essential connection by “looking into the [individual’s] eyes, recognizing the dignity and humanity of [the individual], and creating an atmosphere where there is no right or wrong,” Zeisel explains. “Everything just is.”

For participants, a stunning transformation takes place. “They become themselves again,” Zeisel says. “The reason is that we don’t test areas of the brain that cause confusion or make them upset. There is no right or wrong reaction or answer when someone looks at Picasso’s Girl Before a Mirror.” Short-term memory becomes irrelevant, allowing patients with AD to relax and simply be themselves for an hour, frequently reducing some of the disease’s symptoms.

Zeisel says the art experiences diminish the stigma associated with AD. The artists become ambassadors when they speak of the wonderful, supportive experiences they enjoy as ARTZ volunteers. He says many people mistakenly believe that those with advanced AD experience mental deficiencies that keep them from participating in reality and find them almost removed from life settings. “When the public hears from these ambassadors or sees a group of elders in a museum, they realize that people living with Alzheimer’s are very much present and can interpret art, have opinions, engage in lively dialogue, and so forth.”

ARTZ achieves positive results because the program doesn’t test areas of the brain that have become damaged. “We know how to recognize that each person with Alzheimer’s might have a completely unique way of expressing themselves. Some people are quite expressive verbally. Another person might react to a painting by humming music in a soothing way. We acknowledge this and thus make the person feel that they are contributing and that their input is being respected,” says Zeisel.

Even in cases where individuals may have lost the ability to speak, Zeisel says they can use facial expressions and hand gestures to participate in the discussion. “We know that this is just as valid a form of contribution as any other,” he says. “We restore self-confidence through this acknowledgement.”

Participation occurs through individuals’ choices, whether on a weekly or monthly basis. There are no requirements per se. ARTZ provides a specially trained museum guide who is accompanied by a museum docent to effect true collaboration. Prior to each tour, ARTZ staff members and the museum docent review the tour offerings, discuss the artwork selected for that particular session, and ensure accessibility for participants. Following the session, the ARTZ staff and docents again meet to discuss the tour, offer critiques, and determine ways to improve the experience.

Accentuate the Positive
ARTZ programs accept individuals in varying stages of AD in their attempts to remain inclusive. “We do ask about participants’ level of function and ability to interact before each tour but not to screen them out, but rather so that we can be prepared for the tour,” says Zeisel. Participants aren’t screened out of the program because of physical limitations or cognitive levels. “We have participants that are from the early-stage support group at the Alzheimer’s Association all the way to people who are considered late stage in the Alzheimer’s sense and can no longer walk and hardly speak,” he says. “Everyone gets something out of an ARTZ museum tour.”

Keeping groups small promotes participation among individuals, along with the ability to see the art, be heard, and remain undistracted. During any particular tour, there may be several small groups to accommodate larger numbers of participants.

Zeisel says many of the artists have decided they want to become more actively involved, creating special projects such as painting classes. Such ventures formed the cornerstone of the program that has become known as ARTZ-in-Residence. Works of art created through this program by participants with AD have been showcased in public exhibitions in New York City, Paris, and Boston.

Although officials don’t actively calculate future growth and expansion, significant numbers of museums have approached the organization seeking to develop similar appropriate programs, Zeisel says. “It’s our goal that one day every cultural institution in the world will have an Alzheimer’s-specific cultural access program just as you see with the visually and hearing impaired,” he says.

— Barbara Worthington is editor of Aging Well.