Reminiscence therapy spreads to physical spaces for Alzheimer’s and dementia patients around the world
Originally published in the San Diego Jewish Journal, Dec. 2016 issue
By Natalie Jacobs
Susan Greer visits her husband at Seacrest Village six days a week.
“I come for an hour and a half,” she says. “I have friends that tell me I shouldn’t come that often, but I’m doing it not only for him but for me too.”
When we spoke, the couple, in their 70s, were sitting together under a sukkah in the courtyard of the Katzin memory care residence.
Irwin Greer was diagnosed with dementia in 2008 but Susan says he knew something was amiss “as far back as the early 2000s.” When he stopped driving in 2011, a handful of years before he moved into Seacrest, Susan began taking Irwin to the Glenner Center’s day program for adults with dementia and Alzheimer’s, in Encinitas. While Irwin attended the day program, Susan attended Glenner’s support groups.
According to Susan, Irwin’s “good disposition” hasn’t changed as his dementia has advanced. She worries that the pharmaceutical regimen he has been rotating through may have unknown long-term side effects, or at the very least she isn’t sure if the drugs are helping. She was encouraged by one of the Glenner support group speakers, a doctor who visits the group regularly and said that if her husband is still able to walk and manage the most delicate activities of daily living on his own, then “there has to be some good in there,” Susan reports.
Despite the uncertainties, Susan considers herself fortunate because, for the most part, Irwin still maintains his “wonderful, kind personality.”
As the disease progresses, many dementia patients become volatile, anxious or depressed because cognitive impairments overtake normal brain function and the “regular” world makes less and less sense. Although no new pharmaceuticals have been approved for Alzheimer’s or dementia by the FDA in the last 12 years, Dr. Howard Feldman, the newly appointed dean for Alzheimer’s and Related Neurodegenerative Research at UC San Diego’s School of Medicine, says that somewhere around 2,000 clinical trials have been underway over the last 20 years.
More recently, social science has entered into the clinical trial space and reminiscence therapy has emerged as a promising way to mitigate the emotional symptoms of dementia. The idea gained mainstream attention in the United States when CNN’s chief medical correspondent Dr. Sanjay Gupta hosted a 20-minute special from a “dementia village” in Amsterdam. It’s a residential facility where “everything is fake” a woman on the Glenner Center’s Board of Directors told me. The village is styled to look like the Amsterdam of the mid-20th century, the decades that its residents are most likely to remember, since dementia attacks new memories first. Caretakers are assigned to various jobs within the village, cleverly keeping an eye on residents who in turn are given a surprising amount of freedom within the facility. For example, if a resident goes to the grocery store and buys 10 cans of black beans, the checkout clerk simply smiles. Later, when the resident is asleep, a different caretaker will return the black beans to the store’s shelf.
“It is believed that reminiscence therapy can help elderly individuals by increasing self-acceptance, providing perspective, and enabling the resolution of past conflicts,” writes an Italian research team in a study protocol for a randomized, controlled trial of the therapy, published to the National Institutes of Health online database in October of 2014.
The Alzheimer’s Society says “reminiscence work involves talking about things from the past, using prompts such as photos, familiar objects or music.”
While San Diego’s Glenner Centers have employed this one-on-one tactic in their centers from Hillcrest to Bonita to Encinitas, their recently unveiled “Town Square” concept takes this therapy a step further than it has ever gone in the United States. The 20,000-square-foot facility will feature 23 storefronts built at a scale small enough to fit inside a warehouse but large enough to be functional. The town will be a replica of historic San Diego, from the years 1953-1961, because those are the years that Glenner Center participants remember most strongly right now. As the Town Square solidifies, the storefronts will change to represent later decades as new generations of people with dementia come through the doors.
Irvine-based architect Douglas Pancake, who specializes in senior living facilities, has been retained to design the buildings. The San Diego Opera’s Scenic Studios will build them.
It’s sounds like an unexpected collaboration, but the Opera’s General Director David Bennett says the Town Square concept is quite similar to building an opera set.
“We are in the business of taking drawings from a designer, which are, in effect, architectural renderings,” Bennett explains, “and building those out in a studio, making sure they work, and disassembling them, putting them on a truck and shipping them to another location to be set up.”
He says this is exactly the process they’ll be following for Glenner.
“They need to have someone who can design, construct, make look real, at a different scale, what they want to have elicit memory.”
Yes it’s a perfect fit he says, but it’s also not something Scenic Studios has ever done before, because these buildings are actually functional. An opera set is just a façade, but the Town Square buildings and everything inside of them are fully three-dimensional and in most cases, functional.
The team showed off their City Hall building at a launch event in the fall. It contained two offices, where Glenner Center employees will actually work, amidst wood-paneling, typewriters, Encyclopedia Britannica and black and white photos.
Glenner Center CEO Scott Tarde, who began discussions with the architect in December of 2014, envisions the finished Town Square to include a café, library, laundromat, pet store, diner, auto shop, beauty salon and old fashioned movie theater. Glenner’s Lisa Tyburski, director of business development, notes that the project is estimated to cost $3 million.
“My husband loves the opera,” Susan Greer says from the Seacrest sukkah. “I know that the San Diego Opera is helping with this new center,” she says.
I asked her if she thought her husband would benefit from the kind of reminiscence therapy they’ll be doing at the Town Square.
“Yes, absolutely,” she says.
Susan still drives, and she says once a week she takes her husband out and about. They usually go to Costco “to walk around, to see people and get a different view rather than being [at Seacrest] all the time.
“I don’t know if they would have admission to go [to the Town Square] but I would be happy to bring him on a Saturday.”
Glenner is currently in negotiations with a warehouse space in Chula Vista and is aiming to open Town Square in 2018.