In a stroke of what could be pure genius, Swansea’s Cefn Coed Hospital in Wales, United Kingdom began a unique program for male dementia patients. With the goal of preventing sundowning, late afternoon confusion and agitation associated with dementia, hospital staff built an in-house pub to entertain and replicate the former routines of patients residing there. The pub, named The Derwen Arms, appears as an authentic lounge and is even equipped with beer mats. On any given evening, patients of the Derwen dementia ward can be found drinking non-alcoholic beer, throwing darts (plastic), or shooting pool in the pub. (1)

Despite the lack of conventionality, this hospital program has found immense success among patients, staff, and the public. Within The Derwen Arms, patients feel relaxed, socialize, and avoid the symptoms of sundowning. Ward manager Kath Protheroe shares, “There is evidence that the quality of care and patient engagement have improved, and pharmacological intervention has reduced as a result of this initiative.” (1) Recognizing there are growing challenges in the provision of dementia care, many wonder if innovative programs like The Derwen Arms will become the new standard of care.

Sundowning And Cognitive Decline

Dementia is a progressive disease most prevalent among people 65 years and older. (2) Though presentations of dementia are diverse, the most common signs of dementia include memory loss, inability to perform activities of daily living (ie. feeding, bathing, and dressing), behavioral changes, and sleep-wake disturbances. (2, 3) Sundowning, a combination of behavioral changes and sleep-wake disturbances, can be the most disconcerting for caregivers and indicate worsening dementia. Patients experiencing sundowning will inadvertently place themselves at higher risk for injury and can put additional strain on caregivers who seek to maintain their safety throughout the night. (2)

Growing Care Needs For Dementia Patients

Dementia is already a widespread disease impacting over 5 million Americans. (3) However, by 2060 this number is expected to increase to 13.9 million and burden a greater number of ethnic minorities. (3) At the level of the individual, caring for a loved one with dementia is life-changing, tiresome, and difficult work with the ability to harm caregiver health and well-being. (3) As a result, societal institutions tend to take over care of dementia patients as the disease advances and they become unmanageable at home. (2) If these projections are accurate, more than doubling the number of patients who require dementia care in the next 30 years could surge the demand for institutional dementia care. (2) Institutional caregivers, who are subject to the same hard work and harms as personal caregivers, will be needed and must be retained to meet this growing demand.

Emerging Innovations

Managing dementia symptoms, at home or in a facility, is not a straightforward process for caregivers. To provide more effective and efficient dementia care, numerous innovative projects have been implemented in facilities caring for dementia patients like The Derwen Arms. The primary motivation behind these innovative programs appears to be healthcare professionals and researchers striving to connect the past lives of patients with their current reality. The documentary Alive Inside: A Story of  Music and Memory outlines a program in New York that provides dementia patients in nursing homes with their favorite music via an iPod. In listening to beloved songs, these patients have experienced relief from sundowning and other dementia-related symptoms. (4) Likewise, painting classes held with dementia patients at a senior’s center in Toronto, Canada have reduced agitation and improved engagement with peers. (5)

Seeing the benefits of innovation in dementia care, institutions are encouraged to reach for the sky and experiment with new means of helping dementia patients. Though caution should not be thrown to the wind, any enhancements to the life of patients and families living with the devastating disease of dementia are welcome and needed to overcome future challenges in institutional care.