Professional review of Using Art to Decrease Passivity in Older Adults with Dementia Savonna Nicole Esker, B.A.

, CTRS and Candace Ashton, Ph.D, LRT/CTRS University of North Carolina, Wilmington

Kacee P. Baucom University of Utah

Professional Article Review 2 Introduction This purpose of this paper is to review the article Using Art to Decrease Passivity in Older Adults with Dementia by Savonna Nicole Esker, B.A., CTRS and Candace Ashton, Ph.D., LRT/CTRS. This review will outline the research explained in the article and give an overview of the experimental study. Key findings, strengths, and limitations of the research will be discussed as well as implications for future use in the field of recreational therapy. The Research The article states that there are currently 18 million individuals suffering with Alzheimers disease throughout the world, and that number is expected to increase to 34 million by 2025. This particular study by Esker and Ashton (2013) focused on the behavioral changes and symptoms that are common side effects of Alzheimers disease and dementia. Among these behavioral symptoms, passive behaviors such as apathy, depression, and agitation are the most recurrent. Since people with apathetic behaviors do not often cause conflict or chaos, they are sometimes ignored. The article speculates that this loss of contact with other people is what greatly decreases their quality of life. This statement makes sense when reflecting on other theories explaining humans as social beings. It has been found that pharmacotherapy, or medicinal treatment with drugs and medication, is not the most effective action for reducing behavioral symptoms. Instead, the study Using Art to Decrease Passivity in Older Adults with Dementia (Esker & Ashton, 2013), took a nonpharmocological approach and focused on modifying the environment, activity level, and stimulation to fit the needs of the individual. The Study The study was designed in an ABAB format. A represented a steady baseline period where there was no intervention, and B represented an individual 30 minute art activity with

Professional Article Review 3 the participants. The art sessions were implemented five days a week, for two weeks, and then followed by the baseline period where treatment was withheld. There were three participants in this study ranging from ages 86 to 92. Each individual had a diagnosis of dementia or Alzheimers disease on their medical record and identified by the staff at the care facility as displaying passive behaviors. They were tested on the Mini-Mental State Exam and the Global Deterioration Scale before they qualified to participate in the study. These are exams that provide information about cognitive impairment and functioning. Since passive behaviors tend to increase as the day goes on, the art interventions were scheduled during late afternoon. The participant observable alertness was the dependent variable and was recorded during the intervention and baseline phases of the experiment. These observations were then compared and analyzed. The Results All three subjects seemed to return similar results when calculating their observable alertness. By displaying the results graphically for each individual, it was easy to visualize the changes in behavior during the art activities as compared to the baseline phases. An interesting finding that the article did not mention, as shown in the graphs, was that the second baseline phase averaged a lower response rating than the first baseline for each subject. However, the article did state that the individual art intervention phases were found to be effective in reducing passive behaviors for all three participants. Strengths and Limitations The interventions were very structured and steady which was found to be a strong point. The design of the study tested for external validity by allowing the researchers to observe behavior during the specific art activities and compare that with the behavior during the baseline.

Professional Article Review 4 This was important because it decreased the chance of other factors affecting the participants behavior. The art activities were also themed with seasons and/or holidays. This was to add more structure and a relatable element to help stimulate the participants. Particular attention to detail such as the addition of the state and global exams, and the time of day the interventions were implemented, were important elements of what gave this study its validity. Furthermore, the neat and simple nature of the watercolor paints made the activity less invasive and time consuming than other alternatives. Although these strengths were present, the experiment also had its limitations. The article points out many of these weak points such as the extremely small sample size. The use of only three participants doesnt allow room to generalize the findings across a large population. It is also limiting that all three participants were female. The article also admitted that physiological readings such as heart rate were taken during the activities, but the data was inconclusive. The last point that the article makes is that the study did not differentiate the one on one personal interaction with the subjects between the art activity. If the stimulated response during the interventions was due to the one on one personal interaction, the art activity itself, or a mixture of the two is unknown. Perhaps comparing the results of this study with another group-based intervention experiment could provide insight to this inquiry. Additionally, there were some limitations with the study that the article failed to point out. Since watercolor painting was the only option, it leaves wonder of what the results would be like if the activities were tailored to the individuals interests and preference. There are also challenges that come with an observational study because alertness or passive behavior could be defined differently based on the nature of the individual being observed. As with most studies, the researchers may have had

Professional Article Review 5 bias towards the results they wanted to achieve, which could alter the reality of their observations. Implications for Recreational Therapy This research and evidence provides a foundational platform for expansion and exploration on this topic. With the baby-boomer generation entering the prime years for Alzheimers and dementia, there will be increasing opportunities to expand research and knowledge on the effect of recreational therapy on these individuals. It would be interesting to compare the results of different recreational activities with the findings of this watercolor experiment. If recreational therapy gains validity over expensive psychotropic medication for individuals with dementia, it could be a revolutionizing movement for the treatment of these patients. Summary This particular study aimed at determining if visual art activities effectively reduce problem behaviors for individuals with dementia. The three participants in this study showed to reduce passive behaviors during the individualized art interventions. Although these findings cannot be generalized beyond the sample size, the article gives prolific insight about older adults with dementia both in the research explained prior to the study and the experiment itself. Like all experiments, this study has both strengths and weaknesses but overall, it presents valuable information that can be used and expanded upon in the field of recreational therapy.

Professional Article Review 6 Reference Esker, S. N., & Ashton, C. (2013). Using Art to Decrease Passivity in Older Adults with Dementia. Annual in Therapeutic Recreation, 21, 3-13.