Introduction

In 2012, Den Gamle By opened the ‘House of Memory’, accomodation specially furnished for sessions with people affected by dementia. It is a three-room apartment with accessibility for wheelchair users, a functional toilet and kitchen, two living rooms, a hallway and a bedroom. As collaborating partners, memory researchers from Aarhus University and the Department of Health and Care at Aarhus Municipality assisted with their knowledge. The furnishings in the flat date from the 1950s, which research has shown to be the period when the strongest memories were formed by persons who suffer from dementia today. Typically, sessions in the flat start with the elderly people arriving at the flat and being welcomed in. Coffee and cake are ready in the dining room, and while household objects from the 1950s are passed round, the elderly guests liven up and become interested. After about two hours, the session ends with singing, and as the guests leave the flat, it may be difficult to see which of them suffer from dementia (See Figure 1).1

Drawing International Attention

With its ideal setting for promoting reminiscence, the flat was soon drawing attention. It was visited in the very first week by colleagues from the large open-air museum at Beamish in the UK, who wanted to copy the programmes in Den Gamle By. Since then, visitors have come from museums and universities in Japan, China and the USA, and many European countries, as well as from several Danish museums and local authorities. Also, European colleagues from open-air museums are interested and want to learn about the experience gathered at Den Gamle By. There are currently two museums that we have dialogue with about using the open-air museum's framework in connection with reminiscence work.  Nederlands Openluchtmuseum in Arnhem is in the process of establishing a reminiscence house from 1965, which is expected to open in April 2024, and the Open-Air Museum of Lithuania is also working on establishing services for people affected by dementia.

Over the years, we have also seen that these sessions mean a lot to the elderly guests. One of our great wishes has been to document how important these programmes are for the elderly, so that both we and others can learn from them and be inspired. In recent years, projects have also been run in collaboration with CON AMORE, Centre for Autobiographical Memory Research at Aarhus University and through the Erasmus+ project Active Ageing and Heritage in Adult Learning, in which Den Gamle By took part from 2015 to 2017.

Memory Research Projects at the Center on Autobiographical Memory Research (CON AMORE)

One of the CON AMORE projects was to investigate the difference between dementia patients’ memories evoked during a visit to the House of Memory in Den Gamle By, and those from an everyday environment at the care centre (Miles, et al., 2013).

Participants had been diagnosed with Alzheimer’s disease, and in the study, both at Den Gamle By at and the care centre, the objects passed round were the same type, representing situations from daily life and special occasions. The objects at the museum dated from the time when the participants were young, while the objects at the care centre were modern. There was an older model of a telephone as opposed to a mobile phone, or old-fashioned and modern cards commemorating confirmation in church.

The conclusion was that there was no great difference in recognition of the old and the new objects, but the study showed clearly that during sessions at Den Gamle By, more memories were evoked by the older objects, and the depth and amount of detail in the reminiscences was far greater.

Another project carried out by CON AMORE led to the conclusion that continued visits to the House of Memory brought back more memories with greater detail. A group of elderly persons diagnosed with Alzheimer’s disease visited a House of Memory at Den Gamle By five times over five weeks, and their reminiscences were tested before and after the visits. The findings clearly showed a greater degree of memory after a visit, with the memories evoked in more detail. The project also included a test group who did not visit the museum and did not show the same striking increase (Kirk, et al., 2019).

These two projects have helped to establish that autobiographical memories are strengthened by the programmes in Den Gamle By. In another project, Active Ageing and Heritage in Adult Learning, in which Aarhus University also took part, the focus was more on well-being resulting from visits to the House of Memory than on memories.

Active Ageing and Heritage in Adult Learning

Active ageing and Heritage in Adult Learning was organised with funding from the Erasmus+ programme from 2015 to 2017, and its main objectives were:

• to develop programmes for elderly people suffering from dementia
• to develop programmes for relatives of dementia sufferers
• to develop programmes for care staff who work with this group
• to evaluate the type of programme for elderly dementia patients which Den Gamle By and several other open-air museums had started to organise.

The collaborating partners in the project, besides Den Gamle By, were the Jamtli museum in Sweden, the Beamish Museum in the UK, the Szabadtéri Néptrajzi Muzeum in Hungary and Maihaugen in Norway, as well as the Linné University in Sweden, the University of Newcastle upon Tyne in England and Aarhus University in Denmark. The experience gained was shared among the partners, and also presented at a seminar in Den Gamle By in April 2017 and in publications (Hansen, 2017; Djupdræt, 2018; Overgaard, 2018) (See Figure 2).

The evaluation showed that the programmes influence the elderly people’s well-being.

It was an important part of the project that as unbiased partners, the universities could investigate the elderly people’s general well-being in connection with the programmes. The method they used was the Greater Cincinnati Chapter Well-Being Observation Tool. In connection with each visit, it focused on sustained attention, the positive emotional state, interest, and self-esteem.

A total of 118 elderly persons with dementia were studied. The greatest numbers took part in sessions at Den Gamle By (32) and Beamish Museum (32), but groups were also observed at Maihaugen (19), Jamtli (18) and the Szabadtéri Néptrajzi Muzeum (17). In the study, those accompanying the dementia patients were interviewed, and at the sessions the patients’ actions and reactions were noted by an observer.

The elderly people’s interest was registered by observing whether they said words or showed active interest in other people's work or their own, and whether they made unprompted contact with others, through smiles, eye contact or conversation, and whether they accepted or gave help.

The results of the study were striking:

90.6% of the dementia patients expressed or showed positive emotions throughout the sessions or most of the time.

82% of the dementia patients could sustain attention throughout the sessions or most of the time.

84.6% of the dementia patients showed interest through contact with others throughout the sessions or most of the time.

82.9% of the dementia patients expressed self-esteem in words or body language throughout the sessions or most of the time.

Graph 1. Wellbeing during sessions.

The people accompanying the people suffering from dementia were also asked about the elderly people’s frame of mind during the sessions compared with normally. Depending on which of the four parameters were referred to (sustained attention, a positive emotional frame of mind, interest and self-esteem), satisfaction was increased by between 47% and 66%. One element that is worth bearing in mind in relation to these figures is that those answering the question were carers for the elderly persons, either care staff or relatives. Thus, the question would also imply an assessment of their own role as carers. This could have an influence on the answers.

Graph 2. Wellbeing compared to usual.

More than a hundred subjects were studied, making this the largest study of work with reminiscence at museums for elderly dementia sufferers. The results speak for themselves. The programmes have a positive effect on the elderly people’s well-being.

In interviews, the elderly clearly expresses how the sessions evoke memories, and many are also able to talk in detail about various situations in their lives. Memories were often awoken by a household object or a room in the House of Memory. It might be the bedroom, or a cream jug or a lamp. These clear moments of remembering are undoubtedly the reason for the improvement in the elderly people's well-being during the programmes. The memories remind the elderly of who they were and are, and among the memories of the past they can find their own identity and their former normal state of mind. As one of the elderly people said in an interview: “I’m still really sorry now that my wife was not there that day. She thinks I’m off my head.”

Programmes for Employees and Students

One of Den Gamle By’s contributions to the Active Ageing and Heritage in Adult Learning project was to develop programmes for employees and students in the care sector. In the last 15 years, Den Gamle By has collaborated with several social and health-care colleges, and the experience gained has formed the foundation for a new type of course developed for social and health-care students.  

This course for health sector students has two main objectives:

1. Equipping the social and health-care students to help elderly people suffering from dementia to create memories. Why, for instance, does the sight of a traditional blue coffee pot bring back memories, and how can the memories be used in the care staff’s daily routines? 
2. To give the social and health-care students an insight into what Denmark looked like from 1940 – 1960. That was the period when the elderly people were young. How did Danes live? What did they eat? What clothes did they wear? How did they amuse themselves? This is especially important for social and health-care students who may have grown up in ethnic cultures that are different from the traditional Danish culture.

The courses are structured so that the students experience for themselves what happens when memories are evoked, and they learn methods that will enable them to promote reminiscence themselves. The students are shown utilitarian objects they can remember, and in Den Gamle By they visit flats from 1974, so they have their own recognition and remembering experience. They also visit the House of Memory, where they meet a colleague who tells them about the work in the flat. In recent years, we have seen an increase in the number of visits to schools that train social and health-care workers and are now used by schools from many parts of Denmark.

After the students have completed their training, we meet some of them as social and healthcare assistants, when they come from local centres to visit the House of Memory with groups of elderly people with dementia. They often say that in their work they can make use of what they learned on the social and health course in Den Gamle By.

The courses can be included in supplementary training for care staff and training volunteers. Other professional groups in the health sector have also visited the project, wanting to learn about the methods we use in work with reminiscence. Among these are doctors and dentists, for example, who sometimes meet patients with dementia in their work (See Figure 3).

Courses for Relatives to Strengthen Social Life for those with Dementia

During the Active Ageing and Heritage in Adult Learning project, Den Gamle By also learned lessons from European colleagues. Drawing inspiration from Beamish Museum, Den Gamle By has begun developing offers for relatives of dementia sufferers in collaboration with Aarhus Municipality. When someone is diagnosed with dementia, the medical services are good at informing about the nature of the disease, how it progresses, and what possibilities are available. Aarhus Municipality wished in addition to give newly diagnosed dementia patients and their families a chance for a “new” social life. It turns out that many friends and relatives lose contact when dementia strikes. How can a newly diagnosed dementia patient be motivated to continue making contacts with others and forming new memories? How can the relatives be taught ways to help?

These programmes are held by Den Gamle By in collaboration with the Dementia Corner in Aarhus and the Church of Denmark (The Evangelical Lutheran Church in Denmark). Groups of eight people, four with dementia and four healthy relatives, meet in Den Gamle By four times during a two-month period.

During the meetings the relatives learn how to use utilitarian objects, photographs and the like as tools to create memories. There is also time for the person with dementia to have activities together, like setting the table, putting flowers in a vase, playing the piano, and the relatives have an opportunity to discuss their challenges with others in the same situation.

Apart from the sessions in Den Gamle By, the groups are encouraged to form a social network afterwards, so that they form a network of relatives. One way we try to create a bond with the couples is by having a representative from the participants' local parish visit the last session and offer the participants the opportunity to meet at the church premises, so that the participants can network in the parish.

The development of this project was supported by a public fund for disadvantaged groups.2  

Developing and Securing Services

Den Gamle By is grateful that it has been possible to attract important external funding for several of the above-mentioned projects. The museum is also continuously working on securing funds to develop further programmes for people affected by dementia.

At the same time, we have also ensured that many of the above-mentioned projects on an ongoing basis can be offered as courses that our partners are willing to purchase. Every year, elderly care services make agreements on a number of courses for citizens suffering from dementia, which helps to cover costs and make the running of these courses more financially sustainable. The same goes for our collaboration with educational institutions. This especially relates to social and health-care colleges and the many programmes that these schools purchase. By continuously being relevant to the education and healthcare sector, a number of permanent programmes can continue to be offered without other external funding.

Open-air museums appeal to all the senses and can provide a sensory and tactile experience of the past. This is something all museum visitors benefit from.3  But as this article has shown, the spaces and environments of open-air museums can also be used in a very concrete way to alleviate and help fellow citizens live a better life.

We have experienced this in the last 15 years in Den Gamle By with our programmes for elderly people suffering from dementia, and it has also been addressed in the above-mentioned studies from Aarhus University and in the large Erasmus+ project for Active Ageing and Heritage in Adult Learning, where more than 110 elderly people suffering from dementia were observed.

Reminiscence initiatives at open air museums means a great deal to elderly people suffering from dementia and helps to improve their well-being generally.

Our hope is that this is an area that will be further developed in the coming years, both through collaboration between museums and collaboration between museums, the healthcare sector and educational institutions.

• 1For more information about reminiscence work at Den Gamle By and the ideas behind it, please see these three articles in published in Den Gamle By’s yearbooks: Kryger, Lindberg and Matthiassen, 2005; Berntsen, 2012; Djupdræt and Lindberg, 2018. These articles are in Danish. More information about the museum's initiatives can also be found in English in the article: Lindberg, 2013.
• 2The funds came from the Danish Ministry of Culture's programme ”Pulje til kultur-, idræts- og foreningsaktiviteter til sårbare, udsatte og ældre under corona-krisen”.
• 3Open-air museums' sensory environments and their ability to create social spaces is further described in the article Djupdræt, 2019.