Scottish Football Museum Reminiscence Pilot Project for People with Dementia: A Realistic Evaluation
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Scottish
Football
Museum
Reminiscence
Pilot
Project
for
People
with
Dementia:
A
Realistic
Evaluation
Report
for
the
Scottish
Football
Museum,
Hampden
Park,
Glasgow
February
2010
Dr.
Irene
Schofield
Professor
Debbie
Tolson
School
of
Health
Glasgow
Caledonian
University
Glasgow
2010
Published
by:
School
of
Health
Glasgow
Caledonian
University
Cowcaddens
Road
Glasgow
G40BA.
0141
331
8492
Tel:
ISBN
9781905866441
©
Glasgow
Caledonian
University
For
further
information
contact:
The
Scottish
Football
Museum
Hampden
Park
Glasgow
G42
9BA.
Tel:
0141
616
6100
The
views
expressed
in
this
report
are
those
of
the
research
team
and
do
not
necessarily
reflect
the
views
of
the
funding
body.
You
are
welcome
to
quote
from
the
report
but
please
acknowledge
the
source
as:
Schofield,
I.
and
Tolson,
D.
(2010)
Scottish
Football
Museum
Reminiscence
Pilot
Project
for
People
with
Dementia:
A
Realistic
Evaluation.
Glasgow
Caledonian
University,
Glasgow.
2
Acknowledgements
We
would
like
to
thank
the
people
with
dementia
and
their
family
carers,
members
of
the
Scottish
Football
Heritage
Network,
care
home
staff,
and
staff
from
Alzheimer
Scotland
who
contributed
to
the
evaluation
of
this
pilot
project.
Thanks
also
go
to
Culture
and
Sport
Glasgow
and
the
Scottish
Library
and
Information
Council,
who
produced
the
digitalised
photographs
and
managed
the
project
website.
3
Table
of
Contents
Executive
summary........................................................................................................................................................ 6
Section
1............................................................................................................................................................................. 8
Background
to
study...................................................................................................................................................... 8
Section
2...........................................................................................................................................................................11
Aim
of
the
evaluation ..................................................................................................................................................11
Objectives..................................................................................................................................................................................................11
Section
3...........................................................................................................................................................................12
Project
procedures.......................................................................................................................................................12
Evaluation
Methods .............................................................................................................................................................................12
Observation .............................................................................................................................................................................................13
Interviews.................................................................................................................................................................................................13
Data
analysis ..........................................................................................................................................................................................14
Ethical
considerations
and
practicalities
in
gaining
the
views
of
people
with
dementia.....................................14
Section
4...........................................................................................................................................................................16
Case
study
findings.......................................................................................................................................................16
Case
study
1 .............................................................................................................................................................................................16
Alzheimer
Scotland
South
Ayrshire
Service
group.................................................................................................... 16
Case
study
2 .............................................................................................................................................................................................24
Central
Scotland ........................................................................................................................................................................ 24
Case
study
3 .............................................................................................................................................................................................29
Care
home
reminiscence
sessions..................................................................................................................................... 29
Case
study
4 .............................................................................................................................................................................................33
Football
club
historians ......................................................................................................................................................... 33
Section
5...........................................................................................................................................................................38
Overall
findings
and
discussion...............................................................................................................................38
Table
1
Established
community-based
group
sessions ........................................................................................................42
Table
2
Care
home
and
one-to-one
sessions .............................................................................................................................44
Section
6...........................................................................................................................................................................45
Recommendations........................................................................................................................................................45
Section
7...........................................................................................................................................................................46
Conclusions.....................................................................................................................................................................46
References.......................................................................................................................................................................47
Appendices......................................................................................................................................................................49
Appendix
1-
Example
interview
schedule...................................................................................................................................50
Appendix
2
–
Example
information
sheet ..................................................................................................................................52
Appendix
3
-‐
Example
cover
letter...................................................................................................................................................57
Appendix
4
-‐
Example
consent
form ...............................................................................................................................................58
4
5
Executive
summary
Background
Recalling
the
past
through
what
is
known
as
reminiscence
work
is
widely
acknowledged
to
be
a
positive
activity
for
most
people.
This
novel
pilot
project
offers
digitalised
images
from
the
Scottish
Football
Museum
archive
on
a
password
protected
website
for
the
purpose
of
stimulating
reminiscence
for
people
with
dementia.
This
outreach
project
was
funded
by
Museums
Galleries
Scotland
and
involved
collaborative
working
with
Alzheimer
Scotland,
Culture
and
Sport
Glasgow,
the
Scottish
Library
and
Information
Council
and
a
number
of
football
clubs
from
around
Scotland.
The
role
of
Glasgow
Caledonian
was
to
evaluate
the
benefits
of
the
specific
football
material
to
people
with
dementia
and
their
carers.
Study
Methods
The
approach
to
evaluation
took
the
form
of
a
realistic
evaluation
in
order
to
take
account
of
the
different
contexts
and
methods
of
carrying
out
reminiscence
work.
Patterns
of
relationships
between
context,
mechanism
and
outcomes
were
sought
through
examination
of
a
number
of
cases
studies,
which
included
established
reminiscence
groups,
relatively
new
groups
and
one-‐to-‐one
sessions.
The
descriptive
case
studies
were
analysed
in
terms
of
their
context
and
mechanisms
and
the
outcomes
that
were
achieved.
Data
was
collected
through
systematic
observation
of
reminiscence
sessions
and
through
interviews
with
people
with
dementia,
their
family
carers
and
reminiscence
facilitators.
Findings
and
Conclusion
It
was
concluded
that
football
reminiscence
has
the
potential
to
contribute
to
the
wellbeing
of
men
with
dementia
in
terms
of
enhancing
their
self-‐
confidence,
self-‐expression,
sociability
and
sense
of
enjoyment.
The
context
and
mechanisms
provided
by
established
and
supported
groups
with
skilled
reminiscence
facilitators
were
seen
to
produce
the
best
outcomes
in
terms
of
sustainability
of
the
group,
engagement,
anticipation
and
increased
confidence
of
the
group
members.
In
addition,
strengthening
mechanisms
through
6
training,
provision
of
images
specific
to
the
lives
of
people
with
dementia
and
increased
organisational
support
for
reminiscence
facilitators
is
likely
to
result
in
a
corresponding
improvement
in
outcomes.
There
is
scope
for
more
extensive
use
of
football
reminiscence
for
men
with
dementia,
especially
those
for
whom
generic
reminiscence
activity
holds
little
appeal.
Next
Steps
The
study
has
identified
the
principles
upon
which
to
build
and
further
expand
football
reminiscence
for
men
with
dementia.
The
challenge
ahead
is
to
maximise
the
range
of
benefits
that
such
an
intervention
can
bring
to
individuals
and
family
carers
and
to
capitalise
on
this
opportunity
in
a
way
that
continues
to
build
the
evidence
base.
7
Section
1
Background
to
study
Reminiscence
is
about
recalling
past
memories
and
‘bringing
memories
to
life’
(Age
Exchange,
2008).
It
is
well
known
that
structured
reminiscence
around
a
person’s
life
experiences
can
be
beneficial
in
terms
of
stimulating
their
interest
and
enjoyment
and
maintaining
their
identity
and
self-‐esteem
(Age
Exchange,
2008;
Schweitzer,
2007;
Wang,
2007).
It
has
been
suggested
that
reminiscence
is
highly
appropriate
and
makes
intuitive
sense
for
use
with
people
who
have
mild
to
moderate
dementia,
as
they
will
be
able
to
draw
on
past
memories
during
these
stages
of
the
condition
(Woods
&
McKiernan,
1995);
(Gibson,
2004).
Furthermore,
there
is
some
evidence
to
suggest
that
improvements
in
quality
of
life,
behaviour
and
communication
can
be
gained
through
reminiscence
for
people
with
mild
to
moderate
dementia
(Brooker
&
Duce,
2000;
Haight
et
al.,
2006;
Thorgrimsen
et
al.,
2002b;
Wang,
2007).
Gibson
(1994)
describes
this
as
‘the
search
for
islands
of
lucidity’
p.
60
using
reminiscence
to
locate
intact
parts
of
a
person’s
memory.
Gibson
(ibid)
cautions
the
use
of
reminiscence
solely
as
a
good
old
days
nostalgic
activity,
as
to
do
so
seriously
undervalues
the
potential
of
reminiscence
to
enrich
people’s
lives.
Although
reminiscence
has
been
described
as
a
universal
activity,
there
is
evidence
to
suggest
that
not
everyone
wishes
to
engage
in
recalling
the
past
(Coleman,
1986).
Gibson,
(1994)
suggests
that
there
is
no
single
approach
to
reminiscence
and
describes
it
as
‘a
loose
collection
of
disparate
ideas,
resulting
in
varied
activities
undertaken
with
very
different
people
in
diverse
circumstances’
p.48.
The
practice
of
reminiscence,
which
is
led
by
a
facilitator
is
often
referred
to
as
‘therapy’.
Gibson,
(ibid)
and
Bender,
(1994)
argue
however,
that
this
is
suggestive
of
a
medical
approach
whereby
there
is
a
person
seeking
a
solution
to
a
problem
that
will
be
cured
or
resolved
by
undergoing
therapy;
there
is
also
an
implication
that
the
therapist
has
professional
expertise.
Gibson,
(1994)
prefers
the
term
‘reminiscence
work’
as
it
emphasises
normality
and
widens
the
scope
for
people
other
than
health
and
social
care
professionals
to
become
involved
in
reminiscence.
There
are
approximately
58,000
to
65,000
people
with
dementia
in
Scotland.
It
is
estimated
that
the
prevalence
of
dementia
doubles
every
five
years
and
by
2031
there
will
be
102,000
to
114,000
people
with
dementia.
Sixty
per
cent
of
people
live
in
their
own
homes
and
40%
live
in
care
homes
or
hospitals
8
(Alzheimer
Scotland,
2008).
Reports
on
institutional
care
for
people
with
dementia
suggest
that
often
there
are
few
opportunities
for
stimulating
and
appropriate
activity
(Care
Commission
and
Mental
Welfare
Commission
for
Scotland,
2009;
Mental
Welfare
Commission
for
Scotland,
2007).
According
to
the
seminal
work
of
Kitwood,
(1990)
lack
of
stimulation
is
likely
to
have
a
disabling
effect
on
the
person
with
dementia,
by
reducing
their
cognitive
ability
to
a
lower
level
than
that
produced
by
the
disease
alone.
A
stimulating
environment
is
increasingly
recognised
to
be
an
integral
aspect
of
quality
dementia
care
(Scottish
Intercollegiate
Guidelines
Network,
2006);
(National
Institute
for
Health
and
Clinical
Excellence,
2006).
Furthermore
the
experience
of
dementia
is
potentially
disempowering,
as
people
with
dementia
can
be
treated
purely
as
recipients
of
services,
rather
than
dignified
individuals
with
their
sense
of
self-‐worth
intact
(Goldsmith,
1996).
The
Scottish
Football
Museum
based
at
Hampden
Park,
Glasgow
houses
a
substantial
collection
of
football
memorabilia,
much
of
this
in
the
form
of
documents
and
images
of
social
and
historical
importance.
The
museum
wished
to
increase
its
community
participation
and
outreach
work
and
recognised
the
potential
to
use
this
extensive
archive
to
provide
a
service
to
the
increasing
numbers
of
older
people
who
have
been
and
remain
enthusiastic
and
loyal
supporters
of
football.
The
museum
has
been
successful
in
winning
a
small
grant
from
Museums
Galleries
Scotland
for
outreach
work.
The
grant
was
used
to
fund
a
novel
pilot
project,
whereby
digitalised
images
on
a
wide
variety
of
aspects
relating
to
football
were
made
available
to
people
with
dementia
and
their
carers
in
order
to
stimulate
personal
reminiscences
on,
and
connected
with
football.
A
wide
range
of
material
is
available
from
this
unique
national
archive,
such
as
programmes
with
team
line-‐ups,
adverts
from
football
grounds,
footballs,
and
strips.
The
material
is
of
both
national
interest
and
specific
to
regional
teams.
For
the
purposes
of
this
project
an
understanding
of
reminiscence
as
‘general’
reminiscence
work
is
appropriate.
Gibson,
(1994)
describes
this
as
‘well-‐
prepared
work
that
uses
a
variety
of
multisensory
triggers
to
stimulate
shared
conversation
on
an
agreed
topic
or
theme
which
relates
loosely
to
the
known
background
and
interests
of
the
participants’
p.
47.
The
stimulation
of
previous
interests
is
recommended
for
people
with
dementia
as
a
means
of
enhancing
their
quality
of
life
and
well-‐being
(Scottish
Intercollegiate
Guidelines
Network,
2006).
Glasgow
Caledonian
University
was
one
of
several
partners
in
this
national
project.
Others
included
Alzheimer
Scotland,
Culture
and
Sport
Glasgow,
the
Scottish
Library
and
Information
Council
and
a
number
9
of
football
clubs
from
around
Scotland.
The
role
of
Glasgow
Caledonian
was
to
evaluate
the
benefits
of
the
specific
football
material
to
people
with
dementia
and
their
carers.
10
Section
2
Aim
of
the
evaluation
To
evaluate
the
provision
of
the
specific
football
reminiscence
activity
in
terms
of
its
benefit
to
people
with
dementia,
family
carers
and
care
home
carers,
over
the
period
August
2009
to
January
2010.
‘Benefit’
is
understood
and
interpreted
for
this
project
as
improved
well-‐being
demonstrated
by
observed
and/or
reported
positive
change
in
mood,
behaviour
and
engagement
during
the
reminiscence
activity,
in
anticipation
of
the
activity,
or
outside
the
reminiscence
activity,
as
reported
by
the
person’s
family
member,
carer(s)
or
facilitator.
Objectives
1. To
examine
the
nature
of
the
reminiscence
work
and
patterns
of
participation
and
engagement.
2. To
discover
whether
the
context
in
which
the
material
is
used
influences
the
outcome
in
terms
of
participant
engagement
with
the
material.
3. To
ascertain
whether
selected
participants
indicate
a
preference
for
particular
types
of
material.
4. To
gather
selected
facilitators’
views
on
using
the
material
and
their
perceptions
of
its
effect
on
participants.
5. To
find
out
what
people
with
dementia
have
to
say
about
the
specific
football
reminiscence
activity.
6. To
find
out
the
views
of
selected
family
carers
or
care
home
carers
(for
care
home
residents)
in
terms
of
the
immediate
and
lasting
effects
of
the
football
reminiscence
activity
for
people
with
dementia.
11
Section
3
Project
procedures
The
reminiscence
material
was
made
available
for
downloading
from
a
password
protected
website
to
care
homes,
day
centres,
community-‐based
groups,
and
individuals,
in
selected
geographical
areas
or
hubs
within
Scotland:
North
East,
Glasgow
and
the
West
of
Scotland,
Falkirk,
and
Edinburgh.
Each
hub
had
a
lead
that
was
a
member
of
the
Scottish
Football
Heritage
Network.
The
heritage
network
member
liaised
with
interested
groups
and
individuals
to
support
the
use
of
the
reminiscence
material
and
took
on
the
role
of
reminiscence
work
facilitator.
All
of
the
four
hubs
took
part
in
the
pilot
evaluation.
The
researcher
liaised
with
the
hub
lead,
reminiscence
facilitators
and
the
local
Alzheimer
Scotland
link
worker.
The
role
of
the
Alzheimer
Scotland
link
worker
was
to
refer
people
with
dementia
who
they
believed
would
benefit
from
football
reminiscence
and
to
support
the
reminiscence
work.
Individuals
were
selected
to
take
part
in
the
evaluation
according
to
the
extent
of
their
involvement
with
the
project.
Steering
for
the
project
was
provided
by:
members
of
the
Scottish
Dementia
Working
Group;
Bernie
Arigho,
The
Age
Exchange
Reminiscence
Centre;
William
McDonald,
Lecturer
in
Mental
Health
Nursing;
Dr.
Jayne
Brown
and
Professor
Debbie
Tolson
from
Glasgow
Caledonian
University.
Evaluation
Methods
Bornat
(1994)
suggests
that
much
evaluation
of
reminiscence
has
been
carried
out
through
experimental
studies,
following
short
periods
of
observation
in
controlled
conditions.
Outcomes
have
been
determined
therefore
through
formal
measurement
of
behaviour
traits,
anxiety,
self-‐worth,
cognitive
levels
and
depression.
Buchanan
&
Middleton
(1997)
however,
argue
that
a
focus
on
individual
psychological
processes
ignores
the
value
of
reminiscence
as
an
essentially
social
and
relational
activity
reflecting
the
day-‐to-‐day
lived
experience
of
the
people
with
dementia
and
their
families.
The
descriptive
evaluation
methodology
(Ovretveit,
1998)
used
in
this
present
evaluation
recognises
that
delivering
a
reminiscence
activity
involves
many
different
components,
including
the
physical
environment
in
which
it
takes
place.
The
approach
also
acknowledges
‘that
it
is
impossible
to
separate
the
intervention
in
itself
from
the
personal
and
moral
qualities’
(Kitwood
1997
p.100)
of
the
people
who
facilitate
it.
The
methodology
enables
the
comparison
between
settings
and
includes
the
views
of
participants
and
their
family
members.
12
As
the
reminiscence
work
in
this
project
was
carried
out
in
a
range
of
different
environments
with
different
facilitators
and
with
a
wide
variety
of
material,
it
was
necessary
that
the
approach
to
evaluation
accounted
for
the
complex
relationships
between
the
context,
the
facilitation
of
reminiscence,
the
use
of
the
football
specific
materials
and
the
outcomes
achieved.
An
illuminative
approach
based
on
realistic
evaluation
(Pawson
&
Tilley,
1997)
was
adopted
in
order
to
take
account
of
this
complexity.
Patterns
of
relationships
between
context,
mechanism
and
outcomes
were
sought
through
examination
of
a
number
of
cases
studies,
which
included
established
reminiscence
groups
and
recently
commenced
groups
and
one-‐to-‐one
sessions.
The
descriptive
case
studies
were
analysed
in
terms
of
their
context
and
mechanisms
and
the
outcomes
that
were
achieved.
Examples
of
contexts
were
care
homes,
community
groups,
or
people’s
homes.
Mechanisms
were
groups
with
facilitators,
or
one-‐to-‐one
sessions
and
the
type
of
material
selected
from
the
project
website.
For
example,
material
could
be
specific
to
the
game
of
football
or
to
social
life
in
general.
Outcomes
resulted
from
the
interventions
-‐
the
effects
of
a
particular
mechanism
in
a
given
context.
Positive
outcomes
of
reminiscence
for
a
person
with
dementia
could
be
increased
alertness,
increased
attention
span,
engagement,
increased
responsiveness,
talk
directed
towards
facilitator
or
other
group
members,
and
reduced
agitation.
In
order
to
promote
confidence
in
the
researcher’s
interpretation
of
the
findings,
a
draft
of
the
report
was
made
available
to
participants
for
their
comments.
Data
was
collected
as
follows:
Observation
Observation
of
and
recording
of
reminiscence
activity
using
a
small
digital
voice
recorder
provided
data
on
context,
mechanisms
and
outcomes.
The
observation
involved
an
evaluation
of
the
conduct
and
expertise
of
selected
group
facilitators
in
terms
of
their
creative
use
of
material,
and
facilitation
skills
appropriate
to
people
with
dementia.
Session
observations
were
made
after
4
to
6
weeks
of
offering
weekly
sessions,
or
at
other
times
appropriate
to
the
frequency
at
which
they
are
offered.
Participants
were
observed
in
terms
of
their
contributions,
energy
level,
interaction
and
relationships,
interest
and
participation,
enjoyment
and
satisfaction
(Thorgrimsen
et
al.,
2002a).
Interviews
Interviews
with
people
with
dementia,
family
and
other
carers,
facilitators
and
hub
leads
provided
data
on
the
‘mechanisms’
through
which
outcomes
were
13
achieved
(See
Appendix
1
for
example
interview
guide).
Interviews
were
carried
out
with
group
participants,
family
and
other
carers,
facilitators
and
helpers
in
three
of
the
four
hubs
and
audio
recorded
where
appropriate.
Interviews
began
with
persons
involved
in
well-‐established
groups
such
as
those
in
south-‐
west
and
central
Scotland.
This
strategy
allowed
time
for
new
reminiscence
facilitators
to
access
the
web-‐based
material
and
to
begin
to
use
it
in
reminiscence
work.
Interviews
with
family
carers
were
carried
out
by
telephone
in
order
to
make
it
as
easy
as
possible
for
them
to
take
part
in
the
evaluation.
Data
analysis
Transcribed
or
partially
transcribed
recorded
interviews
and
field
notes
from
observation
sessions
were
analysed
in
order
to
provide
data
on
context,
mechanisms
and
outcomes
and
to
examine
what
works
for
whom
and
under
what
conditions.
Ethical
considerations
and
practicalities
in
gaining
the
views
of
people
with
dementia
Approval
was
sought
from
the
Glasgow
Caledonian
University
Ethics
Committee.
The
provisions
of
the
1998
Data
Protection
Legislation
was
observed.
All
participants
received
written
information
on
the
research
study
(see
Appendix
2
for
example),
a
letter
of
invitation
(see
Appendix
3)
and
verbal
explanation
prior
to
signing
a
consent
form
(see
Appendix
4
for
example).
All
documents
were
specific
to
the
person’s
role
and
there
were
ten
documents
in
total.
People
at
varying
stages
of
dementia
were
key
participants
in
this
evaluation
study.
Members
of
the
Scottish
Dementia
Working
Group,
which
consists
of
people
who
have
early
diagnosed
dementia,
scrutinised
the
information
sheet
to
check
that
it
could
be
read
easily
and
understood.
For
participants
who
did
not
have
capacity
for
consent,
Welfare
Guardians
or
the
nearest
relative,
were
contacted
to
request
their
proxy
consent
(Adults
with
Incapacity,
(Scotland)
Act
2000).
Drawing
on
the
experience
of
Murphy,
(2007)
it
was
important
to
devote
some
time
initially
to
establishing
a
connection
with
the
individuals
and
groups
who
took
part
in
the
evaluation.
This
involved
visits
to
explain
the
project
to
carers
or
facilitators
and
to
meet
the
reminiscence
group
participants.
Explanations
were
given
and
consent
was
gained
from
the
participants
with
dementia
guided
by
and
working
closely
with
facilitators
and
Alzheimer
Scotland
link
workers.
The
interaction
with
participants
was
directed
in
the
style
of
a
conversation
as
opposed
to
the
usual
interrogative
style
of
an
interview
14
(Murphy,
2007),
whereby
people
might
feel
under
pressure
when
asked
formal
questions.
The
conversations
with
the
reminiscence
group
participants
took
place
immediately
before
or
after
the
reminiscence
group,
under
the
assumption
that
being
in
the
same
venue
and
close
to
the
time
of
the
group
meeting
would
compensate
for
short-‐term
memory
loss.
Following
the
suggestion
of
a
group
facilitator,
a
group
volunteer
sat
in
on
the
conversation
with
three
participants.
At
the
beginning
of
conversations
with
the
participants
who
had
dementia,
their
initial
and
ongoing
verbal
assent
was
obtained
and
they
were
observed
carefully
for
signs
of
fatigue,
unease
or
desire
to
end
the
involvement.
It
was
assumed
that
the
person
with
dementia
implied
assent
by
continuing
to
respond
to
the
interviewer.
It
was
further
assumed
that
a
lack
of
response
signalled
an
inability
or
refusal
to
do
so.
There
were
no
set
questions
and
the
conversation
began
with
the
open
ended
question:
‘I’d
like
to
hear
what
you
have
to
say
about
the
football
group.’
It
is
acknowledged
that
reminiscence
sometimes
triggers
the
recall
of
sad
memories.
Although
reminiscence
on
the
subject
of
football
may
seem
innocuous,
it
is
possible
that
in
the
process
of
reminiscing,
memories
associated
with
unpleasant
or
upsetting
events
could
be
triggered.
As
in
the
Ibrox
disaster
in
1971
for
example,
when
a
stand
collapsed
killing
66
spectators.
The
researcher
was
prepared
to
address
these
by
acknowledging
the
person’s
feelings
at
the
time.
In
rare
cases
it
may
necessary
to
explore
with
the
individual
themselves
or
their
carers
whether
there
is
a
need
for
skilled
therapeutic
follow-‐up
support
(Gibson,
2004).
There
was
no
necessity
to
do
this
in
the
present
study.
15
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