My cousin and I were signing my aunt out of the memory care facility to go into town for breakfast. When the aide at the front reception recognized me as an unfamiliar face, she asked my aunt, “Who’s come to visit you today?”
My aunt smiled. “That’s my grandson.”
I clarified, “I’m actually her nephew.”
My aunt stopped smiling. She seemed taken aback by my tone and confused by my answer. By choosing to correct her, I had missed an opportunity.
I am a geriatric physician and co-lead the federally funded Emory University Geriatric Workforce Enhancement Program, called Georgia Gear. We work to improve the care and quality of life for all older adults, particularly focusing on the unique needs of those living with Alzheimer’s disease and related dementias, as well as their families and caretakers. We ally with talented and like-minded partners to amplify their work and collectively come up with eye-opening solutions to difficult problems. And one of my favorite solutions is improv.
Improvisers talk about the concept of “yes, and…”, a core tenet of improv, which means accepting what has been offered and building on it. The tenets of improvisation and successful practices for meaningful engagement with people with dementia complement each other quite well.
Coming back to my interaction with my aunt at the front desk, I did nothing wrong, but I could have done better. I opted to correct and call out the precise relationship — that I’m my aunt’s nephew and not her grandson. I had choices: I could correct, or I could redirect and join (more about that in George State University professor of gerontology Candace Kemp’s research). I reflected on who needed to hear the facts about how my aunt and I were family. My cousin already knew. The aide at the facility did not mistake me as young enough to need a fake ID for drinking, nor did she believe that memory care residents offer factually correct answers — she was simply trying to engage with my aunt.
I needed to use strategies from the Improving Care Through Improv training. Kemp and Amanda Lee Williams, an Atlanta-based improvisor, co-lead the training. They developed educational materials and have trained over 1,500 people. Of those, 1,000 have watched a one-hour presentation, 560 have watched the presentation followed by a one-hour participatory workshop, and 40 have had eight hours of hands-on training.
Here are some better “yes, and” answers that I took away from the training. So many possible choices follow “that’s my grandson.” Each of the below endorses the kernel of what she said, builds on it, and helps my aunt look good, all the while furthering the conversation. Here are a few ways I could have answered my aunt as we left for breakfast that day:
- Yes, and it is a great day for family time!
- Yes, and we are headed out for great conversation and a delicious and filling breakfast!
- Yes, and because it is so cold outside, we’re taking these warm hearts out to enjoy a cup of hot coffee!
Our group is not the first to use improv training for dementia professionals — or family or friend-care partners. Nor are we the first to publish on this type of work. Two prior programs have published on improv for care, with 15 people, and “improv to improve” with five people completing training. In their work, they found that care partners had decreased depression and a decreased feeling of burden. We have submitted a manuscript describing the more detailed outcomes for the 40 care partners who completed the eight-hour training, looking specifically at care-giving burden and quality of life.
Our program is unique because we partner closely with gerontologist researchers and improv educators. Our gerontologists provide the technical details and framework of the “improvisation mindset.” Our improvisers — many of whom have family members with dementia — teach care partners to apply these techniques and find these work. My colleagues and I are testing the innovation for proof of effectiveness and establishing a sustainability plan.
Here’s the basic overview of educational intervention evaluation seen in our research. We know from care partner participants that they both enjoy the training and recommend the training to others as a valuable activity. We have a high endorsement of the next higher level as well: participants will use the skills learned in their lives and work and give specific examples as to exactly how. We can safely call this an evidence-informed practice. We hope to make this an evidence-based practice, period.
We also want to make this training widely available for all. Dad’s Garage, a nonprofit theatre company in Atlanta, and Georgia Memory Net, a state program supporting those with living with dementia, have developed an online library of free video training that will be soon available. The short video clips walk people how to use improv tools and techniques to change common, challenging scenarios into opportunities for connection.
Here is how the rest of the breakfast outing went. After correcting my aunt, I move on. She’s forgotten the whole episode. Pick yourself up, dust off, and get back on the horse, as my uncle would say. With an improvisation mindset, there is always a next chance (especially, let’s be frank, when you’re working with dementia patients!). The rest of the breakfast trip went great.
My cousin is a rock-star family care partner, always helping the conversation move forward. My aunt frequently brought the conversation back to “Dad.” Most of the time, she was talking about our grandfather (her dad). But sometimes it seemed like she was talking about my dad (her brother). She would talk about the 1990s, then the 1950s, then 2010. We’d be hearing stories about Oregon, or maybe Montana, that would blend into a story clearly about Washington state. Sometimes she’s a mom with a large family. In others, she’s a teenager answering her parents’ house phone and getting into a spat about proper telephone etiquette with the lady who was married to the town’s banker — and why that was a big deal.
The breakfast outing was a success. I’m not sure that my aunt recognized me, but I recognized her. My aunt and I have always lived thousands of miles apart, but today during this visit, I saw the aunt that I remembered: engaged; animated; funny, even a little spicy; and opinionated. She orders coffee but doesn’t drink it. She eats two pancakes, a three-egg omelet, and a pile of potatoes, which is a lot for someone who is 4’10”.
Ted Johnson, chair of Emory University Family and Preventive Medicine, is the program co-director of the Emory University Geriatrics Workforce Enhancement Program funded by the Health Resources and Services Administration. He is a geriatric physician who works in the Integrated Memory Care primary care program supporting people living with dementia and their families.