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Effects of a Creative Expression Intervention on Emotions, Communication, and Quality of Life in Persons With Dementia

Phillips, Lorraine J.; Reid-Arndt, Stephanie A.; Pak, Youngju

doi: 10.1097/NNR.0b013e3181faff52

Background: Effective nonpharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia.

Objective: The purpose of this study was to test the effect of a storytelling program, TimeSlips, on communication, neuropsychiatric symptoms, and quality of life in long-term care residents with dementia.

Methods: A quasi-experimental, two-group, repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly, 6-week TimeSlips intervention group (n = 28) or usual care group (n = 28) at baseline and postintervention at Weeks 7 and 10. Outcome measures included the Cornell Scale for Depression in Dementia, the Neuropsychiatric Inventory-Nursing Home Version, the Functional Assessment of Communication Skills, the Quality of Life-Alzheimer's Disease, and the Observed Emotion Rating Scale (this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group).

Results: Compared with the control group, the treatment group exhibited significantly higher pleasure at Week 3 (p < .001), Week 6 (p < .001), and Week 7 (p < .05). Small to moderate treatment effects were found for Week 7 social communication (d = .49) and basic needs communication (d = .43). A larger effect was found for pleasure at Week 7 (d = .58).

Discussion: As expected, given the engaging nature of the TimeSlips creative storytelling intervention, analyses revealed increased positive affect during and at 1 week postintervention. In addition, perhaps associated with the intervention's reliance on positive social interactions and verbal communication, participants evidenced improved communication skills. However, more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes.

Lorraine J. Phillips, PhD, RN, is Assistant Professor, Sinclair School of Nursing; Stephanie A. Reid-Arndt, PhD, is Assistant Professor, Department of Health Psychology, School of Health Professions; Youngju Pak, PhD, is Assistant Professor, Department of Health Management and Informatics, School of Medicine, University of Missouri, Columbia, Missouri.

Accepted for publication August 31, 2010.

This research was supported by the John A. Hartford Foundation's Building Academic Geriatric Nursing Capacity Award Program, the University of Iowa Gerontological Nursing Intervention Research Center, and the University of Missouri Interdisciplinary Center on Aging. The authors thank Richard Madsen, PhD, for statistical consultation and Kathleen C. Buckwalter, PhD, RN, FAAN, for manuscript review.

Corresponding author: Lorraine J. Phillips, PhD, RN, S414 Sinclair School of Nursing, University of Missouri, Columbia, MO 65211 (e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.