Capturing a Moment: Does creative writing have a place in dementia care?

Image generated by OpenAI’s DALL·E, created with assistance from ChatGPT.

Creative writing has, throughout history, been used as a means to capture time and real human experiences by providing a window into the unheard voices of lives beyond our own. It serves as a powerful tool that helps to encourage memory recall–providing the opportunity to utilise our imagination to share thoughts and feelings which may be otherwise difficult to express verbally–in a manner that relieves stress and boosts mental health and well-being.

But does creative writing have a place in dementia care?

There is a woman in this house, I don’t recognise her face

There is a woman in this house, she’s intruding in my space

My palms begin to sweat, and my heart is racing fast

I am looking for my exits, how long will this capture last

As time goes on, I’m anxious, my mum will expect me home

This woman is making me stay, won’t even let me use her phone

The things she says are madness, she thinks she is my wife

But I am just a young lad, lived with my mother my whole life

I can’t recall how I got here, that part is most confusing

When I say I need to go home, that woman, she is refusing

When I get my chance, I’ll make a run towards the door

I’m scared now, just want my mum, don’t want to be here anymore

She’s locked it, I can’t get out, this is my worst fear

I’m trapped and shouting loudly, in the hope someone will hear

That woman looks upset now, tears rolling down her cheek

She reaches out to touch my hand, she’s too upset to speak

We’re both distressed but catch up glimpse, there’s something in her eyes

It’s familiar, it’s warm, I know her; she’s let down her disguise.

There is a Woman in this House in The Stories We Tell with Alzheimer Scotland. This is a poem on the confusion and anxiety that can be associated with living with dementia.

Research continues to prove that creative writing is a therapeutic channel for writers and readers alike which can be beneficial for people living with dementia, helping to promote better health and well-being across all dementia care, alleviating symptoms of depression and anxiety through enabling creativity. Poetry, in particular, has been found to provide a freedom of expression that helps people with dementia to access certain images or memories from their lives and build these fragments together.

Here are some known benefits of creative writing:

• Boosting Physical Strength – Creative writing requires small amounts of physical movement and strength which uses both the fine and gross motor skills, and so engaging in these creative activities which use the hands can help prevent these skills from deteriorating and avoid health problems that can occur from this lack of use. This includes increasing muscle tone and reducing poor cognitive function, poor coordination (such as hand-eye coordination), and poor balance.
• Cognitive Function Stimulation – Research has shown that cognitive development improves through creative writing techniques. It increases brain stimulation by providing a creative way that stimulates the mind and helps them to engage in simple activities more easily. This can result in a better capability to process information quickly and sharper alertness.
• Creative Expression – Creative writing is a powerful self-expression tool. It helps caregivers and family to gain an understanding as to how the person with dementia is feeling as it provides an outlet that they might not otherwise have if there are, for example, speech or language problems which makes it difficult for them to express themselves verbally. You can ask yourself, Is there a theme to what they are writing or certain colours they gravitate more towards? • Memory Improvement – Research has shown that having a person with dementia engage in creative writing may encourage memory recall. If they write about themselves, it helps to reminisce about the past and retrieve core memories. Even though creative writing will not likely bring back the whole memory, it may bring back a sense of happiness which can help them to reminisce.

• Mental Health and Well-being Improvement – Research has shown that writing, creative and not, helps to calm the mind and alleviate negative thoughts and emotions. This is because writing promotes the production of endorphins which is a chemical that makes us feel happy and relaxed. It also helps to combat intrusive thoughts which allows us to overcome these instead of neglecting them and allowing them to escalate.
• Sense of Achievement – There is also no better feeling than the pride at creating something beautiful and unique. Research has shown that this sense of achievement helps to boost confidence and improve mental health and well- being.
• Social Interaction Opportunity – Unfortunately, there is a correlation between dementia and social isolation and loneliness. This can bring about many negative effects on physical and mental health. However, creative writing does not have to be a solitary endeavour. A group activity–such as writing poetry together–promotes communication and social benefits purely through the social interaction of art stimulation. This can help to support relationships between the person with dementia, their carer, and their family by fostering a better sense of community.

Picture Prompt Creative Writing Exercise:

Take a picture from a newspaper or magazine and use this as your reference point to set the scene for the story you are about to tell. By using this visual prompt as a focal point, you are encouraging the person with dementia to seize the opportunity to create a story all of their own which may even have some reflection on the memories that still live inside their heart.

First, review the picture that you have chosen. Then, as you both make your examinations of it, take the time to think about relatable questions–what is taking place, where it is taking place, and who you imagine these characters to be.

You can ask questions such as:

• Who is this person?
• What is this person doing?
• How do you think this person is thinking?
• What is this place?
• What does this place make you feel?

The questions you ask will, of course, vary depending on the picture you have chosen and the person’s stage of dementia. If it is a picture of two people at a market, you could ask, “What is their relationship?” and “What would you buy at this market?” Or if it is a picture of a mountain range, you could ask, “Have you ever climbed a mountain?” and “Is there a mountain you would want to travel to?” However, it is recommended to keep all questions simple and open-ended (questions which go beyond “yes” or “no” answers) to help guide them as they build their narrative.

Then, while they provide their examinations from the picture, you can write these answers down to create a storyline. You can take a moment, after every few questions, to pause and read aloud what has been written so far. This may even inspire conversations which might turn into new stories that stray from the original one you are writing together.

Even if the picture, questions, and discussions do not seem to bring about memory recall, this activity still offers an opportunity to engage in an opportune moment that elicits positive feelings and sparks new memories for the both of you to share.

Creative writing also has a place amongst health professionals. Research has shown that the creative arts can be used to help health professionals connect with those with dementia to help them reflect on their own understanding of patients’ experience of dementia and support good mental health and well-being. It helps health professionals to develop the qualities to deliver sensitive and compassionate dementia care through understanding the experience of the disease from the perspective of patients and their relatives.

A 2015 article in the International Journal of Older People Nursing on investigating the value of creative writing in dementia care as part of dementia-related reflective practice also suggested that creative writing techniques can support insightful and reflective dementia focused practice. In this, creative writing workshops were undertaken by nine preregistration nursing students (general and mental health), one family carer, and five care professionals working with people with dementia. From this, the nursing students reported that the creative writing exercises felt more “real” than the reflective practice models that was used in their academic and practical studies. It was also reported that they had learnt some creative writing techniques which they found helpful to reducing work-related stress and anxiety. This demonstrates that creative writing, as a tool in reflective practice, has implications for practice in enabling health professionals to become confident and creative partners in dementia care.

My husband lives in a care home, my husband cannot speak,

Sometimes he utters a ‘yes’ or ‘no’, but his eyes are sad and he’s growing weak.

At first, I could still care for him, and still feel like his wife,

But since this lockdown started, he has been vacant from my life.

I ‘visit’ every day to see him through a windowpane,

He waits for me and grabs his coat, in the hope he’ll get home again.

Everyone is hurried and silence is all I fear,

I have no-one else to turn to, yet to rules I must adhere.

When will I see my love again, it’s always been the two of us,

I want to scream and shout sometimes, but don’t like to make a fuss.

Should I bring him home again, I ask myself each day,

We cannot go on living like this, I need to find a way.

When Will I See My Love Again in The Stories We Tell with Alzheimer Scotland. This is a poem about a wife caring for her husband who is living with dementia.

The Stories We Tell is a collection of short stories and poems penned by Locality Leader Gillian Councill intended to convey some of the challenges and moral dilemmas people with dementia face. All the stories and poems are all based on real experiences but have been anonymised for confidentiality reasons.