The question guiding this
review is:
‘What is the value of arts and culture for people living with a dementia?’ The methods used to investigate this question are qualitative. These comprise a conceptual and critical review of existing evidence concerning the impact of arts and culture on people living with a dementia.

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The Elderflowers visit Braeside House.

The Organization

Hearts and Minds is the largest, longest-lasting and most soundly based clowning organization in the UK, possibly the world. It has been in existence for fifteen years in terms of its Clowndoctors programme for children in hospitals; Elderflowers, its strand for older people with dementia, began in 2001. It is funded from a variety of sources, including trusts and foundations, the Scottish Government, Creative Scotland, the NHS and private benefactors. Its work is currently undertaken in twenty-seven locations covering fourteen local authorities; its income in the year 2012/13 was almost £300,000. There is currently a roster of sixteen clowns working across the two strands. Once a new hospital is approached, the understanding is that the relationship entered into will be maintained over the months and years.

Magdalena Schamberger, the Chief Executive and Artistic Director, has just been awarded £250,000 from the Paul Hamlyn Foundation, to look at some new approaches, including setting up an experimental training course for people with dementia and their families in theatre and community settings.


The Visit

The researcher accompanied the Elderflowers practitioners Ben Winger (Handsome Elderflower) and Suzie Ferguson (Bonnie Elderflower) on a day visit on 11th June 2014 to one of eleven hospitals which Elderflowers currently services fortnightly. We were also accompanied by Zoe Darbyshire (Health Care Unit Liaison Officer). Zoe covers both Clowndoctors and Elderflowers in a mentoring role.


The Elderflowers first met with the staff to receive Referrals; this takes the form of an update on who is in the unit, and any particular needs the staff have identified in individuals which might be met. They  changed into their costumes (eccentric but not too clown-like to reflect their respective personas, but both wearing red noses). Bonnie and Handsome then entered the main part of the Unit where interactions could take place: basically a long corridor, with two small lounges leading off it. They were both singing, and Handsome was playing his ukulele; this constitutes a bizarre spectacle in a medicalised setting.


After a number of interactions in both of the lounges and the corridor, involving joking, serious conversation and singing, it was time for lunch. Then, in the afternoon, a similar procedure was followed. Finally came the filling in of the Report Forms. Both Bonnie and Handsome wrote descriptions of the interactions which had taken place, commented on any breakthroughs they considered had occurred, and quoted what had been said by some of the participants. There were no staff available for a meeting so the forms were left on a desk. The Elderflowers had interacted with everyone on the Unit in one way or another.



Amongst the characteristics noted by the researcher were the following:

1)   The way  humour was used as the ‘calling card’ for communication: playfulness broke down the barrier with individuals and allowed a connection to be made;

2)   The way humour modulated into serious conversations on subjects of interest and concern to individuals and then effortlessly became jokey again;

3)   The highly developed sensitivities of the Elderflowers to general atmospheres and the individual psyches of the patients (to them ‘ladies and gentlemen’) so that they could moderate their own responses; perhaps this is what Kitwood  was referring to when he spoke of ‘ordinary faculties raised to a higher level’ in relation to what was required of us in this work;

4)   The way the personalities of the Elderflowers seemed to take on a new dimension of openness and attractiveness when their personas were adopted; qualities which were present but subdued or masked in ordinary interactions;

5)   The way this project is meeting the challenge of communicating with and relating to those individuals who pose the greatest difficulties — a challenge which most arts projects designed for people with dementia seem to avoid.