The Arts and Dementia: how might the arts contribute to the creation of more inclusive ageing societies?

Japan is described as a 'super-ageing society', with 27% of people aged 65 or over (data: World Bank.) An additional challenge is the incidence of dementia; the World Alzheimer Report 2016 stated that 4.6 million Japanese are living with dementia, rising to 7 million by 2025. This demography is already paralleled in other countries in SE Asia, with populations in the West predicted to move towards the Japanese situation within the next 30 years. With no effective treatment or significant breakthroughs in prevention or cure for the dementias, more attention must be given to the ways in which people can be cared for. We must consider how ingrained public attitudes, dominated by the perception of those with dementia as a burden and unable to participate as citizens can be challenged. As stated in Japan's Orange Plan (2015), we must 'realize a society where one's will shall be respected, and one can live in pleasant and familiar surroundings as long as possible.'

There is convincing evidence that demonstrates the importance of the arts for people with dementia and their effectiveness in enhancing wellbeing, health and cognitive function. Our interest is in how the co-creative arts can challenge the commonly held perception that people with dementia are non-creative and dependent. We are defining the co-creative arts as privileging process over product, valuing all contributions equally, and where there is no distinction between the producer and consumer. Co-creativity can promote agency and community and is also a powerful way of working for families and carers. We propose the establishment of an interdisciplinary network to conduct research into the ways in which co-creative work by artists, social scientists, care practitioners, and people living with dementias can help societies re-envision the place of those made vulnerable by their condition and experiences. We will draw on expertise developed in both the UK and Japan. UK research into arts practice for people with dementia is recognised to be relatively advanced. In Japan, the inclusion in society of those with dementia is recognised as an urgent issue with which academics, policy makers and the third sector are all engaging.

Our network will be distinguished by its inclusion of people with dementia, who at all stages will inform our activity. The Principle Investigator and Co-Investigator have extensive experience of working closely with people with dementias - a mode of working which colleagues in Japan are enthusiastic to learn from. The network will combine practical work with critical dialogue across disciplinary and cultural boundaries. It will be established through a series of exchanges, sharing practice and approaches first-hand. For instance, as part of their residency at Wellcome (www.createdoutofmind.org), the UK researchers developed a new way of gauging wellbeing and agency with people with dementia, using music and dance. This innovative work will be shaped and refined with our Japanese colleagues. The extent to which these measures and practices can be extrapolated into Japanese culture and society will be explored. UK scholars can learn from Japanese expertise in measuring the impact of arts-based interventions. We will also scope areas where collaborative research can be pursued. It is anticipated that new understandings of the ways in which the arts can help to re-envision more inclusive societies will emerge through these critical dialogues, producing outcomes that will inform and positively impact both policy and practice in dementia care. The findings of the network will be translated into outcomes that can be understood in both countries and have relevance beyond academia. Our findings will be disseminated in articles, online and in the media, paving the way for further collaborative research. Our proposal is an opportunity to influence practice and policy in the care of people living with dementia in ways which will have global significance.

People living with dementias: the enhanced understanding of the lived experience of those affected by this condition will positively affect public perception and attitudes, and support the aspiration expressed in both the UK and Japan to create dementia-friendly societies. The use of co-creative approaches in the arts, in communities and in care has the potential to positively affect wellbeing and quality of life for people with dementias.

The Care Industry: our findings will enable those caring for people living with dementias to develop new understanding of the positive role that the co-creative arts can play in supporting agency and wellbeing, especially in the case of those living in residential care. The benefits will be relevant on an organisational level, as well as informing approaches towards day to day interactions between carers and people living with dementias (West, Zeilig 2016.)

Medical and health care professionals: our work will inform this area by offering these fields new thinking from the fields of gerontology, social science, medical humanities, philosophy and the Arts.

Policy makers and civil engineers: in both the UK and Japan there is a drive to encourage and develop dementia-friendly communities, e.g., London (Mayor of London, 2018), Manchester (Ward et al 2017), and cities and towns in Japan have declared their ambitions to become dementia friendly cities. Those responsible for planning the development of these initiatives will be able to take the findings of the proposed network, and the principles of a co-creative approach into account.

Students: at institutions in the UK and in Japan will benefit from receiving education and gaining practical experience of working co-creatively with people with dementias through training programmes which will form part of this programme, take part in workshops, and attend seminars.

Artists: A significant field of practice and research exists which considers the role of the 'artist as citizen', using the applied arts to empower vulnerable and excluded people by enabling their voices to be heard through artistic mediums (Boal 1979, Higgins 2012, Renshaw 2013.) Historically, artists working in this area have tended not to engage with those living with dementias. Artistic practice with people living with dementias is emergent in both the UK and Japan, but there is little awareness of the extensive research and theory that has been developed in this area. For historic and societal reasons that are systemic, the practice of artists working with people living with dementias tends to be characterised as 'Art as medicine', with a focus on the supposed instrumental benefits of the arts. A co-creative, approach focusses instead on the intrinsic value of the Arts, and the importance of the subjective experience. The proposed network will examine approaches to leadership, and especially a co-creative approach, where the artists' skills and knowledge are dispersed. The approach calls upon artists to develop their skill and capacity to improvise, something which is increasingly recognised as being of great value to society as a whole when used as a model for understanding creativity and imagination (Sennett 2018.)

The findings of the proposed network will be widely disseminated through web pages which will share information about our activities, discussions and reflections, as well as documenting co-creative sessions with people with dementias. Our findings will also be communicated through presentations at conferences and seminars, and articles in non-academic publications.

The proposed network therefore has the potential to create significant impact in the UK, Japan, and globally, positively influencing public knowledge and attitudes towards people living with dementias, and providing research-informed recommendations and strategies for public expenditure to promote the sustained inclusion of those affected by the condition.