Equally, some pictures can lead to disengagement and withdrawal and some to anxiety or distress. If we are to use pictures successfully with people in the later stages of dementia, we need to understand more.
These are commonly used when people develop dementia. Relatives and carers will often use them to help someone remember past events or people that were important to them. However, the problems of mid to later stages of dementia can create difficulties with the recognition and interpretation of many family photographs. Even a wedding photo can become just another irrelevant image for someone who doesn’t remember getting married.
Old street scenes or photographs of local landmarks are used by many care homes. This type of picture can be very effective in creating a talking point between those with earlier stage dementia, as long as memories remain intact and as long as someone can verbalise them.
However, this type of image will be less meaningful to those in the later stages of dementia, who may find the complexity of the images too challenging, or who can no longer remember or verbalise their stories. In the later stages, people need to have a much stronger and more personal emotional connection with an image.
If you spent your working life making cheese, or you had a special childhood picture book, a poster of your teenage heart-throb or a favourite music album cover, then it’s likely that these will always be images that have very special and very personal meaning. That meaning won’t be shared by the general population, but may be understood by family or friends. The difficulty lies in knowing what images might have meaning for someone and locating the right quality of image to use.
News photography has made events that we have never experienced very real to us and we have grown accustomed to seeing disasters in far distant places unfold before our eyes. War photography, the twin towers falling, a tsunami… a tiny percentage of us actually witnessed any of these terrible events, but through the visual imagery used, we all feel we have a personal connection to these events. Bad news events have become part of our life experience in a way that they never could without photography.
But when we have dementia, an inability to differentiate between a picture and reality and our inability to reappraise effectively our own anxiety and negative emotions about the image, can lead to some seemingly innocent pictures creating distress.
A painting of children paddling can create anxiety in someone with dementia if the water looks too threatening or deep and if there is no adult around to protect them from the possibility of drowning. The emotions that the picture creates can be those that would be felt if this was a real situation unfolding before them and the person with dementia may be unable to understand that it is ‘just a painting’.
Images can help us make our daily life easier. A map of the underground, a computer image of what our new kitchen will look like, road maps we use to get from A to B and diagrams which help us put together flat pack furniture. Informative images can have a deeper personal significance which may still have meaning when someone has severe dementia and we should not ignore this possibility for making connections with them.
A man who worked as a mechanic may enjoy a technical illustration of an engine, a keen hill walker may enjoy looking at ordnance survey maps and a keen amateur dressmaker may well still enjoy looking at sewing patterns.
In every culture, there are shared images which are recognised by most of the population, such as those of royalty, film stars or politicians, iconic advertising images, or famous packaging designs.
We may well recognise this type of image when we have dementia and they frequently crop up in reminiscence sessions. However, the relevance of these events and people is primarily cultural and not personal. It is not enough for a person with dementia to recognise an advert or packaging from the past; for it to have real meaning for them, it has to have a very particular relevance specific to the emotional memories of the individual; for example, a poster advertising a pop concert which the person actually attended as a star-struck teenager.