Engage: Is the telly good for older people with dementia?
“Is TV an escape from the world or a window into the world?”
Watching TV is often portrayed as a passive and unhealthy pastime. In relation to elder care, the use of TV in care homes is often associated with poor care. Most research in this area focuses on the negative impact of TV consumption on the lives of older people, especially in care home settings.
It is not uncommon to see statements like:
…residents stuck in dismal rows of armchairs, telly on, dreary atmosphere, terrible food, and often that tell-tale smell of wee…
“Telly on” is a phrase that because of its inclusion in such quotes gives the impression that TV is in itself a source of bad care.
We know that watching TV is bad for your health if used as an alternative to exercise or social interaction, but can the TV be a source for good in the care of the eldery?
A recent Dutch study looked at how viewing patterns changed in complex ways in response to personal experience For example during a period of loss we can find television plays an important part in helping us adapt to our new circumstances. This will also be true for carers facing the perceived loss of the person they are caring for as the effects of dementia progress. Tastes also changed with some types of programme becoming more important and older people themselves reflecting a wide range of views about the value of TV to them.
For most of us today, the TV is part of the furniture and a source of comfort and continuity when moving from one setting to another, we would expect to have access to a TV in most settings today. With the technological changes we see today, our use of the TV has changed too. Today we have an enormous choice when watching TV from traditional scheduled channels to subject specialist channels through to on-demand services.
In the review of the research in the area several practical evidence-based steps have been identified that every care home can take to make use of the benefits that digital technology can provide.
1 Understand and respect the difference between watching TV in public and private spaces.
Watching TV is sometimes private because the person may want to be alone, or to enjoy something different from others. But sometimes watching TV is a shared public experience, because the person may be taking part in a big event that is watched in a group, such as Wimbledon, or a football match.
There is no reason why the domestic pattern of individual choice of programme cannot be met in a care home setting. It simply needs careful thought and imaginative use of the opportunities now offered by multi-channel TV and other on-demand content.
The key thing is to maximise the value of residents having TV in their own rooms, so they can now watch what they want, when they want, if they have access to the right package that is selected for their particular needs or preferences.
2 Make sure that TV is user-friendly for everyone.
The consumer champion Which? has provided advice entitled “Which? Elderly Care” that includes a section on watching the television comfortably[1] . It talks about making the TV user friendly for older people. Remote controls with large numbers of small buttons are a problem, particularly as they are all different. Jumbo or giant remote controls are infinitely preferable. Advice is given about using hearing aid technology to avoid deafening the neighbours and causing disputes by having the television too loud. In care homes it is important to provide headphones particularly in communal areas to allow other people to do other activities while someone is watching loud TV. Advice on how to do this is provided, including contacts for the Action on Hearing Loss shop and information on how to get a free license for people over the age of 75.
3 Challenge assumptions about what TV means in a care setting.
Carers and care staff, who are younger, can help bridge the gap between how residents now consume the new active possibilities and the more traditional and passive viewing patterns of older people in their care.
This argues for what Ostlund describes as a deeper understanding of TV viewing[2] . Her work challenges the ambivalence amongst some staff about TV. They feel it breeds passivity which may make their working lives easier in some ways but it clearly reduces the lived experience of those they care for. “Instead, TV contributes to structuring daily life, to satisfying old peoples’ needs for reflection and contemplation and to remain socially integrated. As such, TV viewing makes a significant contribution to their capacity to cope with disengagement in old age and can be used as a way of promoting communication and well-being in geriatric care.”
4 Staff need to be present to help make TV as positive and active as possible for residents.
TV is an active occupation, not a passive one, so staff should be available to comment on what is on, discuss it, and even change the programme if people become uncomfortable.
This is about more than making use of content to support reminiscence or meaningful activities. TV includes key signals to the passage of time, weather, the time of year, time of the week (Songs of Praise or live streaming of religious services of other kinds) and offers a wider range of possibilities for residents than staff would understand without guidance.
The new media options also open up bespoke programming in individuals’ rooms as well in shared spaces. It requires creativity and imagination in care staff as a permanent part of their daily thinking to attend to this as much as the other technology which supports care for the resident. It needs to become a mainstream responsibility not something which can be handed off to an activities’ coordinator.
There is no evidence that particular types of programme are more stimulating or useful in managing conditions than others. Nor is there evidence that longer or shorter programmes are inherently preferable. These are local decisions best made by staff, residents and relatives together based on their own experience.
Problems really come when TV is used to “babysit”, as a substitute for active care and engagement by staff with people with dementia and their carers. There will inevitably be times when this might be necessary, but the impact of passive viewing on health suggests this should never be the norm.
Care homes could make creativity in using TV and on-line content part of the continuing skills development for all staff, as a core professional skill.
5 Do not make assumptions about choices of programmes.
A crucial element of reducing stress for people with dementia is providing what they prefer and removing irritants. It is crucial to get to know what the older person with dementia in a care home enjoys and to support them to have this, but not at the expense of others in terms of noise and monopolizing of public spaces.
Staff need to be vigilant in assessing the actual reaction to programmes rather than assuming it will be predictable and positive. There is no evidence for example that what might be considered bland or calming programmes, for example on nature or on animals, has that effect on people with dementia. Real nature and actual animals may do so, but images on a screen are different. It is far more important to get the overall design of the environment right.
It is revealing that innovative outreach schemes by museums and art galleries, such as “Meet me at MOMA”[3] , enable small numbers of people to engage with stimulating objects and art works in person. This brings all sorts of benefits from socialisation and stimulation. On demand TV offers real possibilities for similar benefits in care home settings, becoming available to many more people, for whom a journey out might be increasingly problematic. This is not an alternative to a stream of entertainment or sport, but it could form part of a commitment to creative and active use of TV with wider benefits.
6 Be creative and imaginative, so TV promotes healthy ageing.
New technologies allow complete control over timing and blend of programming. Care homes can in effect develop their own channels, mixing traditional live broadcast, when that is needed, with more chosen content, which perhaps provides the basis for group activities or validates the interest of residents. Staff do this for themselves at home, but from our work at DSDC over many years in care settings, it seems there are still barriers to bringing this personal creativity into their work for the benefit of residents.
There is real potential for carers also to help programme, to watch and to support the creative use of TV at home and in care homes. This needs active encouragement and support by care home owners. They can play an active role in helping decide content which maintains connections to entertainment and educational content which has been a part of the life of the person with dementia up to that point. This might include the obvious stimulus of dedicated history or sports nostalgia programming or, perhaps more importantly, current programmes which keep people connected to the here and now, rather than assuming dementia means automatically a focus on the past. Some writers suggest that active use of information and media in this way may go further and actually promote healthy ageing[4] .
7 Make the most of TV for staff as well residents.
New digital packages also offer possibilities for staff. The Social Care Institute for Excellence (SCIE) website on Social Care TV talks about what a good care setting looks and smells like[5] . That is an example of where content is really helpful for staff who work in those environments, and by extension their residents. All the information they need about caring for people and the right environment is available on televised resources like this, accessed on line when the time is convenient at work or at home.
TV and on-line content is still underused in this way by many employers. The creative use of available content can help promote a greater collective sense of learning at work and in itself stimulate a different way of looking at the care environment and the place of TV in it.
8 Consider the TV as part of the active design of the care environment.
Not everyone wants to watch TV all the time and the creation of a “viewing theatre” that is not the normal communal area can help make it possible for interest groups to watch what they want together. The design of the room may also help with viewing movies together in a congenial cinema like environment.
A regular audit of the role of the use of TV in the care home should be included in care planning and environmental audit programmes. Involving external expertise, including from broadcasters and content-providers, should be considered.
TV is increasingly included in the list of benefits in well-respected care homes, rather than being seen as a guilty secret. “TV On” can be a positive part of every care home and should be from now on.
For further information on this review see full report here
References
[2] Ostlund, B. (2010) Watching television in later life: a deeper understanding of TV viewing in the homes of old people and in geriatric care contexts. Scandinavian Journal of Caring Sciences 24, 233-243.
[3] https://www.moma.org/meetme/ (link is external)
[4] Niemela, R., Huotari, M. and Kortelainen, T. (2012) Enactment and use of information and the media among older adults. Library & Information Science Research 34, 212-219
[5] http://www.scie.org.uk/socialcaretv/video-player.asp?v=dementiaenvironmentinacarehome
