Published March 2023
Clinical linguist Dr Lucy Dipper from City University researches the power of storytelling to improve older adults’ communication skills and wellbeing. She and her team set out to design and test the best way of supporting care homes to deliver storytelling activities for their residents.
Storytelling can be used as a clinical tool for speech and language skills but also for its power to help older people in their everyday life.
Being able to communicate and have meaningful conversations plays a huge role in the wellbeing of older adults. As we age, however, aspects of our speech and language skills can start to deteriorate because of changes in our physical health or cognition. For example, it can become harder to remember words and structure sentences, or to hear others and use our voices as effectively.
Older adults can also find themselves having fewer opportunities to have engaging conversations, particularly those who live in residential care homes.
Communication and telling stories about ourselves is a central part of making friends. That’s why we designed Storytelling for older Adults in Residential Settings (STARS), a unique, group intervention for older people to practice telling their personal stories. We felt storytelling can be used as a clinical tool for speech and language skills but also for its power to help older people in their everyday life.
However, STARS had only been tested in a community setting so we needed to work out how best to run it in a residential care home. We set out to test its feasibility in a busy care home environment, its acceptability to residents and staff, and whether it could improve older people’s communication skills, wellbeing and friendships.
Co-designing storytelling activities with care home residents and staff
Communication and telling stories about ourselves is a central part of making friends. That’s why we designed Storytelling for older Adults in Residential Settings (STARS).
Firstly, we reviewed the existing evidence base to compare our ideas with what’s already been researched. While using storytelling as a speech and language intervention has been investigated before, storytelling and working in a group were elements that hadn’t been previously combined. We wanted to learn what elements made other group programmes successful in care homes and implement these in STARS.
Next, we adapted the STARS programme by co-designing it with key stakeholders. It was really important to bring people along with us throughout the project. We interviewed and surveyed speech and language therapists, care home managers and activity coordinators, residents and their families to better understand what they thought about introducing STARS to a care home setting and how best to run it.
We collected invaluable input on the most effective speech and language exercises to incorporate, how sessions could fit alongside other activities, and how to support and train staff to run STARS themselves.
Some of our most insightful interviews were with residents and their families. As well as asking how interested they were in storytelling activities, we explored what kinds of stories residents might like to share. People taking part in STARS were asked to pick one story to work on. There were a number of occasions where residents suggested stories that their family members had never heard before, because they were thinking about aspects of their identity that they might have not thought about for a while.
Using what we learned from the evidence base and co-design input, we designed four 90-minute STARS sessions which would run once a week in a residential care home. We trained an activity coordinator who then led these sessions, with support from one of our researchers, for a group of five residents.
Sharing personal stories to improve communication skills
The relationship you have with your funder is so important and you can tell the DMT really cares about and listens to their grant holders.
To determine how effective STARS was, we looked at a number of measures before and after the intervention. We measured changes to residents’ language and communication skills by assessing their storytelling and measured their wellbeing to see if there were any effects on how they felt in the home.
Even though this test was with a small group our results were encouraging. The range of vocabulary residents used got wider and richer after the programme and they added key pieces of information to help people follow along. The wellbeing measure also improved after the intervention but not as much as expected. This is something we would like to test further as it was unclear how the ongoing COVID pandemic might have affected the wellbeing scores.
Overall, we demonstrated that it is feasible to run STARS in a residential setting and that, with the right support, it’s possible to recruit participants and train staff to deliver sessions without the need for a speech and language therapist present. The intervention was also considered acceptable to residents and staff as we had high attendance rates and almost everyone completed all the assessments.
What was most profound, however, were the peer-to-peer interactions and social benefits of taking part. Residents found the storytelling enjoyable – often more so than other activities in the home – because of the opportunity to talk to each other, as well as about themselves, the stimulation of memories and the chance to address and process emotions.
When someone began to deviate from their original story, the group were excellent at reminding each other what they were working on and sharing encouragement. Residents told us they felt more connected to their peers because the stories helped them to become more interested in each other.
Next steps in storytelling
We’re working on a number of ways to develop and test STARS further. With funding from City University, we’re disseminating our findings and lessons learned to the care homes that helped us throughout the project. We’ve been to several staff training days to present and discuss our results and share other examples of how to support communication skills more generally.
Next, we’re working with My Home Life to explore how STARS can be rolled out across their network. Care home staff and activity coordinators are incredibly busy so how can we make STARS more sustainable for homes to implement? We’re planning more research to answer this and thinking about how we can build it into work experience for student speech and language therapists or nurses, intergenerational linking or community volunteer programmes.
Due to COVID, we had to adapt and change our project plan several times. We wouldn’t have been able to run this project through the pandemic if it weren’t for the support we got from the DMT which was unfailingly helpful. The relationship you have with your funder is so important and you can tell the DMT really cares about and listens to their grant holders.