Reminiscing with confidence

Sounds like crickets chirping and the taste of warm buckwheat pancakes can spark the senses of people with dementia — a fact faculty and students at West Virginia University used to develop a way for those people to experience parts of their cultural past and to relieve stress for their caregivers.

“Focusing on activities for people with cognitive impairment on something culturally based has the potential to be more effective than activities without a cultural connection,” said Professor of Social Work Kristina Hash, WVU’s 2021 Faculty Excellence in Community Engagement Award recipient. “If your present is a place you don’t recognize all the time and is confusing and upsetting, but your past is a pleasant place, we can bring the past into the present and make that a better, less agitating place for them.”  

Drawing upon psychology, social work and neuroscience research, the “Appalachian Activities for Dementia Manual” offers meaningful and enjoyable activities for individuals with dementia and other cognitive disorders — in particular those who grew up in the region. The manual draws on Appalachian cultural traditions, from recipes to games, and is designed for both one-on-one and group use.

“The goal is help people feel confident and competent. When you have mild to moderate cognitive impairment, you are losing pieces of information, and you have a hard time recalling information. It takes a hit on your self-esteem and self-concept. People become depressed and anxious, just like any of us would,” Hash said. “Especially with dementia, the first things in your brain are the last things out of your brain, and the last things in your brain are the first things out. But those early memories are in there, which are often tied to culture. Some of those pieces of culture are attached to memories that are really locked in and important and bring up positive memories.”  

Developed by Hash, Professor of Psychology Julie Hicks Patrick and psychology Ph.D. student Michaela Clark with assistance from psychology students Madeline Marello, Alexandria Ebert and Amber Rusch, the activities feature strategies for “reminiscing” or remembering past experiences centered around growing up in Appalachia.

The activities include crafts, games, folklore, music, recipes and other aspects of Appalachian culture that connect with individuals’ senses, such as hearing, smell and taste. Through sensory responses, the researchers hope the activities elicit meaningful experiences from a person’s past to encourage conversation.

“Neuroscience research shows how music is encoded in your brain and is often untouched by dementia,” Hash said. “Music and food especially are attached to past experiences. These activities inspire stories from the past, which then engages others in sharing their own related stories. It’s really magical.”  

With more than 85,000 family members caregiving for loved ones with cognitive impairments around the state, this project supports an ongoing need in West Virginia, where 10% of the population age 45 and older have some level of cognitive decline.

“Caregivers are always looking for something to fill the time and to keep their loved ones engaged and stimulated in a positive way. Hopefully our project will help decrease some of their stress in providing care,” Hash said. “It’s one of the toughest jobs in the world. Caregivers don’t know what they are going to be dealing with every day. This is a way to have some tools that they can implement to help their loved ones feel confident and less agitated. It helps with building relationships between staff and patients or caregivers and the individual with dementia. If you hear stories, you can connect with each other or those in a group setting.”

The manual is open access and available for free on the Department of Psychology’s website. It can be used for individuals and groups alike and can be facilitated by both family caregivers and paid caregivers.  

“My goal with this manual is that we can improve the lives of individuals in long-term care facilities and at home,” said Clark, a Mount Airy, Maryland, native who also teaches in the School of Social Work’s gerontology graduate certificate program. “We want the individuals to be engaged with the others around them, talk to them and share stories. I hope this project will improve the lives of the individuals going through these experiences and help support their caregivers.”

Clark is also expanding the manual through her dissertation research. She is comparing and contrasting the manual’s bingo activity with one from Montessori programming, which customizes activities to optimally fit an individual’s learning needs. While Montessori approaches are traditionally used with children, they can be used with adults, too, Clark explained.

“The basic idea behind Montessori is structuring activities from simplistic to more complex ideas to make sure they are successful in what they are doing,” Clark said. “We took those elements and applied them in developing our own activities in the manual, just with an Appalachian theme. My dissertation looks at the activities we’ve developed and compares them to more traditional Montessori activities used in nursing home facilities to consider how they engage the individuals with cognitive impairments.”

Hash and the research team look forward to seeing how the project grows under Clark’s leadership.

“Michaela did most of the development of the manual and made it much more evidence-based in terms of the various activities,” Hash said. “She has really taken it to a different level and continues to do so with her dissertation research. Who knows where she will take it after she graduates?”