• TACKLING DEMENTIA

By Michael Staton
Photography by Ashley Jones

Researchers use football memories to address debilitating effects of dementia.

One of Brookdale’s most active residents on her way to share memories of Clemson football.

The team huddles, gathering strength for the battle ahead. They face no ordinary opponent today, but then again, they are no ordinary players.

For most activities, the residents don’t arrive on time — if at all. But today they are early. One of the most active members makes it a point to leave extra early to get to the common area where the activity takes place. She makes good time with her walker, but she leaves no room for error.

“I’m the one who kicks things off, so I’ve got to beat everybody here,” she says.

This resident of Brookdale Senior Living Solutions and her harmonica are essential parts of this team. A Clemson student more than half a century her junior greets her and helps her into an orange T-shirt as the rest of her team rolls or walks into the common area to join her.

Like the team they came to discuss, they suit up, pulling on orange shirts and orange cloth helmets, grab their footballs and huddle up. They’ve gathered with Clemson faculty and students as well as their fellow Brookdale residents and family members who have come to share tales of gridiron glory, famous coaches and players, and established Clemson traditions. This is their final session, and it stands out because participants will end it by rubbing a replica of Howard’s Rock, a tradition known to every Clemson fan.

With harmonica in hand, the early bird leads the group through a rendition of “The Star-Spangled Banner.” This is followed by Clemson’s cadence count led by Brent Hawkins, assistant professor of recreational therapy. The residents of Brookdale in Central, South Carolina, quickly established these traditions with a sense of joy rarely seen in their other activities. Hawkins says these opening performances have only grown louder with each session.

35–40% of Brookdale’s residents have dementia or Alzheimer’s disease. It’s important for them to stay as active and engaged as possible.

“This small group makes a big noise,” Hawkins says. “We love it; it’s an encouraging sign because they’re facing something they have little hope of beating.”

The opponent faced by this senior living team is cruel, indiscriminate and unforgiving. The only victory comes in slowing it down, getting up every day and taking on the fight. Considering 35–40 percent of Brookdale’s residents have dementia or Alzheimer’s disease, it’s important for them to stay as active and engaged as possible.

Faculty and student researchers from Clemson University are using these innovative sessions to study the effectiveness of a reminiscence therapy program designed to address the debilitating effects of dementia. The program uses football history, game footage and memorabilia to provide a multisensory intervention for memory decline.

The response from residents, facility staff and family caregivers has been overwhelmingly positive. In addition, the research data showed that the positive effects didn’t end when the sessions were over. According to researchers, this novel approach to memory care, while thoroughly tested in Clemson’s backyard, shows that its impact doesn’t have to be limited to the small area around Memorial Stadium.

Participants suit up in orange T-shirts before starting.

AN UNLIKELY TEAM-UP

“Reminiscence therapy is one of the best ways to help people recall things; a smell from cooking or lyrics from a favorite song can bring back memories from decades ago,” Hawkins says. “This type of therapy is common in recreational therapy, but it’s rarely paired with sports.”

For the research team from Clemson’s Department of Parks, Recreation and Tourism Management, the program that ended with the activities at the Brookdale facility in November 2017 represented a rare opportunity to test the combination of reminiscence therapy with sports.

Hawkins credits Gregory Ramshaw, associate professor in parks, recreation and tourism management, with the original idea for the research project. Ramshaw’s research interests include sport-based heritage and tourism, and he had encountered similar therapy programs, including the Sporting Memories Network in the United Kingdom and a St. Louis Cardinals program that takes older adults for stadium tours.

These programs provided good leads for materials the researchers could use, but they lacked protocols to reliably and effectively deliver and assess this particular therapeutic approach. Hawkins and Ramshaw decided to apply for a grant through the Robert H. Brooks Sports Science Institute at Clemson that would allow them to explore the effectiveness of such a program and zero in on the best ways to deliver it.

“There’s an entire industry based around sports heritage and nostalgia,” Ramshaw says. “These memories are collective, especially in a community and college atmosphere like Clemson’s. It made sense that even if residents weren’t die-hard fans, the odds would be good that they would have a tangential relationship to those Saturdays every year.”

GAINING FANS

Taylor Yeomans, then resident program coordinator at Brookdale, says she was initially skeptical that the sports-centric intervention could be as effective as other activities programs at the facility.

But over the course of six sessions, Yeomans saw the effects of the program firsthand. She says one resident who had cognitive issues that made it difficult to speak and put thoughts together frequently told stories in the sessions that everyone could understand. Some residents even waved off physical therapists or delayed lunch so they could stay longer to play cornhole or discuss a session topic further.

“The second Taylor or Katie walked in the door the residents were chasing them down the hall,” Yeomans says, laughing. “[In the past] I often had to bring residents to programs, but now many were arriving 45 minutes early; residents and their family members were excited for it.”
June Harden is one such family member. At the time of the sessions, her mother had been a resident at Brookdale for close to two years and was experiencing the beginning stages of dementia. Harden says the effect of the program on her mother and the other residents was so apparent she decided to join in on the experience. She was impressed with how the researchers challenged the residents, but never to the point of frustration.

Harden says she felt her mother and the other residents responded to the program because it was mental exercise disguised as a fun program with varied activities. Harden ended up learning a great deal about Clemson history, and she said it set the stage for bonding activities with her mother in a way that normal visiting could not.

“My mother taught nursing students,” Harden says. “She was a genius, so it can be difficult to see her as she is now. But while the program was going on, I knew it was something we could do together that would be fun. It didn’t just push her to remember things, it pushed us to remember things we’ve shared together. I call her every night, and there wasn’t a single night that she didn’t talk about it.”

Memorabilia such as $2 bills stamped with Tiger Paws are used to spur memories.

BEYOND BROOKDALE, CLEMSON AND FOOTBALL

Ramshaw describes the atmosphere during the last session as bittersweet. One resident made a point to ask how he or the other residents could keep the program going. Others pointed out how much they would treasure the T-shirts and artifacts that the research team gave them.
After taking extensive notes and conducting pre- and post-program measurements and interviews, Hawkins and Ramshaw were able to break down the data gathered at the sessions to examine their effectiveness.

While they recorded little improvement in cognition — an unsurprising finding — Hawkins said the survey data revealed a statistically significant improvement in quality of life for participants. All involved reported seeing behavior that was counter to the isolation, agitation and aggression that can accompany dementia.

The interviews held after the program with residents, family members and Brookdale staff only backed up these findings.

“One of the facility’s administrators said the residents’ moods were ‘a thousand times better,’ and she made a point to tell us that wasn’t an exaggeration,” Ramshaw says. “Another great thing that we learned was that despite the apprehension they all reported having, [residents] overcame whatever barriers were in their way to participate in sessions.”

The feedback the researchers have received so far at recreational therapy and sports heritage conferences has been encouraging. Other non-academic groups conducting comparable programs have reached out to both Hawkins and Ramshaw to share similar anecdotal observations.

According to Ramshaw, the researchers hope to adjust the protocols to make a program like this possible for other teams and sports. They plan to conduct another study using different research methods with the aim to train recreational therapists or facilities in how to use the program.

They’ve also drafted a playbook for the program.

Ramshaw and Hawkins have found a unique entry point to the memories of people experiencing mental decline. Now, they’re in a position to better define how to improve quality of life and perhaps slow that decline by rediscovering good memories. For some, memories of Clemson and Clemson football are the best.

“The topics covered in reminiscence therapy allow you to meet people where they are,” Hawkins says. “In this case, holding a football or shaking a pompom are initiators of memories. So it’s great to see that we were able to help people find the memories as they went along.”

Partnership Provides Services for Seniors with Dementia

At the Golden Corner Respite Care program in Seneca, Clemson doctoral student Caitlin Torrence sat next to a woman with Alzheimer’s who rarely spoke. Torrence began humming Christmas music, and for the first time, she heard the woman’s voice as she sang the words to the song.

Michael Staton is communications and media manager for the College of Education and the College of Behavioral, Social and Health Sciences.