‘Reminiscing villages’ are popping up around the world. These are mock villages built for residents who have dementia. The villages are designed to look as though they are from a bygone era.
Usually, they are decorated with antiques from 50 years ago, so that they look from a different, earlier period in time. Older patients with dementia feel comfortable in this environment because it reminds them of their youth.
The popularity of these villages is that they use a technique called Reminiscing Therapy to help patients with dementia. In 2005, Welsh scientist Bob Woods and his colleagues performed a review of four clinical trials – with a control group – and found that Reminiscing Therapy improved thinking (cognition), mood and general behaviour.
In addition, and as an added bonus, those caring for the patient also showed reduced level of stress and strain. Best of all, there were no harmful effects. Outcomes were again supported by more recent review in 2012 by Maria Cotelli and her colleagues.
The mounting evidence suggests that this therapy – to varying degrees – is effective in improving mood, thinking and well-being in patients with dementia.
Just under 40 years ago, a classic experiment became known as the counterclockwise study. Then Harvard University social psychologist Ellen Langer and her colleagues conducted a strange experiment with a group of men between the ages of 75 and 80. For five days, the men were randomly assigned to one of two groups. Both groups were asked to imagine themselves at 55 years of age.
One group was placed in an environment which mirrored the 1950s, with a Redifusion (hard-wired radio), black and white TV with 1950s old audio and TV programmes to match. Newspapers, magazine, decorations, furniture and food all matched the time period. While the second group was instructed to behave like they were 55 years old, but without the added environmental changes.
This therapy is effective in improving mood, thinking and well-being in patients with dementia
After only five days, the results were unexpected and dramatic. Men in both groups had improved hearing and memory, gained weight, increased muscle mass, improved hand strength and objectively looked younger by about three years. These surprisingly quick results were more distinct for the group that lived ‘in time of their 50s’ rather than the group that just reflected as their life was 20 years ago, although both groups improved.
Counterclockwise study catapulted the popularity of Reminiscing Therapy. RT involves many variations. Traditionally, by being the least expensive, RT involved the older adult discussing past activities, events and experiences. This was helped by the use of photographs, household and other familiar items from the past, music and video recordings from the past.
Over the last decade, RT has become one of the most popular psychosocial interventions in dementia care. A quick review comes up with more than 1,000 research papers published in 2016 on this topic. Marvin Formosa with the University of Malta has also applied it with older Maltese. So its popularity is spreading. How does it work?
Living with Alzheimer’s disease means to live in the moment, because the anchoring to the present and being able to see a future has been disrupted. But people with dementia relate to the past better, especially a time in the past when they were at their peak.
By thinking ourselves younger we allow our body and mind to behave as though we are younger and therefore we exercise these capacities more. Eventually, such exercise improves our overall capacity.
Becca Levy with Yale University and her colleagues had images of positive ageing shown in the background around the community. Even these suggestions lead to improved physical function that lasted for up to three weeks. The same is true when competitive sportspeople are told that they are testing a new drug, but which was placebo. Not only do they perform better but their body improves as well. This is not just an illusion, but an improvement.
It seems that we have some control or plasticity over our physical and mental functioning. And by pushing this plasticity, either up or down, we can improve or diminish our current capacity. This works just as well with healthy sportspeople as well as with people with dementia if they can relate to the past.
The surprising outcome therefore is that through Reminiscing Therapy older adults with dementia are given a way to aspire to a time when they were better and this pushes them to try harder and, as a result, to improve.
Such plasticity is a degree change in a trajectory, not a cure. Right now, there are some interesting developments in Reminiscing Therapy with dementia patients. Semi Ryu Ryu, a professor at Virginia Commonwealth University, has collaborated with Stefano Faralli of the University of Manheim in Germany to develop the interactive technology for her virtual puppetry.
Perhaps we can explore such a concept among the many nursing homes we have dotted around Malta. The surprising take-home lesson for us is that it might also work for people without dementia, to push that plasticity as far as it will go, to slow down the trajectory of ageing.
■ Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in California, US.
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