Golf in Society (Dementia Golf):

Project Report

By Amie Prickett, Ellena Bennington, Gemma Mumby, Heather Pettit and Zoe Hopewell.

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Contents Page

Introduction 3-4

Project Rationale 5-7

Methodology 8-9

Results 10-20

Conclusion 21-22

References 23-24

Appendix 25-26

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Introduction

This report documents the work conducted by third year Sport, Development and Coaching

students with the organization Golf in Society. The group conducted interviews with carers,

participants, golf centre staff and the organisation workers of the Dementia Golf program.

The project group also conducted observations of the participants in action. These methods

allowed the opportunity to identify how life with Dementia is and how it affects them daily.

The aim of the project was to use the qualitative methods to evaluate what effects Golf in

Society has and how sport, specifically golf is impacting all individuals involved. Research

suggests combining all three lifestyle components (social, psychological and physical) are

beneficial effects on cognition for somebody who has symptoms or have been diagnosed, and

are a protective effect against dementia (Fratiglioni, Paillard-Borg & Winblad, 2004).

What is Dementia?

Alzheimer’s Society (2018) describes ‘dementia’ as a set of symptoms that include:

• Memory loss

• Difficulties with thinking

• Problem-solving

• Language

These symptoms can affect an individual’s everyday life routine such as cooking for their

families and friends, putting clothes on both in the morning and at night, and having a

rational conversation with family, colleagues and friends etc.

Alzheimer's Disease

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Alzheimer’s disease is the most common cause of dementia. Upon a person’s diagnosis and

throughout a person’s journey with the disease, a protein builds in the brain to form structures

called ‘plaques’ and ‘tangles’ (Alzheimer’s Society, 2018). This leads to the loss of

connections between nerve cells (which can lead to the death of the nerves) and a loss of

brain tissue. Symptoms of Alzheimer’s disease include losing everyday items (e.g. glasses

and keys), forgetting people’s names and taking part in substantial (long lasting)

conversations, getting lost in places that before were familiar and losing track with what day

and date it is (Alzheimer’s Society, 2018).

Vascular Dementia

Vascular dementia is the second most common type of dementia affecting around 150,000

people in the UK. The symptoms of this form of dementia occur when the brain is damaged

due to problems with the supply of blood to the brain. Symptoms of Vascular Dementia

include problems with planning, organisation and solving problems that could be simple but

very difficult for the effected individuals. A person with this type of dementia can have a

slower speed of thought, problems with concentration and a sudden spout of confusion

(Alzheimer’s Society, 2018)

Lewy Bodies

Lewy bodies is a type of dementia that shares symptoms with both Alzheimer's disease and

Parkinson’s disease. This dementia is very difficult to diagnose and can often be mistaken for

Alzheimer’s disease. Symptoms of Lewy bodies include hallucinations and delusions,

movement problems, sleep disturbance and some people who have a more serious case of this

type of dementia can lose their sense of smell, have issues with constipation and urinary

incontinence (Alzheimer’s Society, 2018).

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Project Rationale

The project was based around evaluating a dementia golf programme. This programme

consists of participants with dementia coming together for three hours every Thursday at

Lincoln Golf Centre. During their time at Lincoln Golf Centre, the participants get the

opportunity to play golf, have golf competitions, practice putting and using the driving range.

The project groups aim was to identify the benefits and possible improvements that the

programme offers. The importance of the project is to identify the effects the programme has,

is it positive and to what extent, identifying how to progress the programme in ways such as,

could the project be used in more county's and across the nation to impact more people? And

is the project worth more input of time and money?

Ageism and Sport

Ageism identifies certain aspects and ways of living with an age group as a general discourse,

implying that everyone in that category is the same. ‘Older people (usually seen as those over

the age of 55 years), on the other hand, are traditionally characterized as weak, less able, and

less powerful’ (Dionigi and O’Flynn, 2007, p.360). In relation to ageism in sport and the

Marxist theory, an ideology has been formed from previous generations around being ‘old’

meaning ‘weak, frail and inactive’. This affects society because there are less opportunities

for the older population to take part in sports, as they are believed to be incapable of doing so.

In relation to Golf in Society, this gives that opportunity for the older population to continue

in a sport they love or even take up a new sport as they get older. It is understood that people

change as they age, however sports should still be available through a modified format,

making them inclusive for all, for example the golf played within the organisation, isn’t

performed at the same speed and level as other golfers at the club, but it is still the same game

and rules.

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Disability and Sport

Disability, meaning ‘any restriction or lack (resulting from an impairment) of ability to

perform an activity in the manner or within the range considered normal for a human being’

(Craig and Beedie,2008, p.119). This links with the ideas of ageism and opportunities for all,

as well as posing health benefits. Previous studies have found that physical exercise has

benefits to individuals with dementia. Findings from Brett, Traynor, Stapley and Meedya

(2018) highlighted benefits of physical exercise for individuals living with dementia, related

to mobility, independence, pain, mood, cognition, and agitation (Brett, Stapley, Traynor &

Meedya, 2016; Forbes, Thiessen, Blake, Forbes, & Forbes, 2013). The dementia golf project

provides this opportunity where physical activity can have an impact on not only the physical

health of participants but also psychological. Physically it can improve the mood, pain and

mobility of an individual, along with psychological benefits to both the participant and their

partner, creating an escape from the disability. By offering more programmes like Golf in

Society in sport, it can create a better life for people with dementia in terms of enjoyment and

social aspects.

Feminism and Sport

Feminism is about ‘how ideologies of masculinity and male power are produced and

reproduced in sport. The ambition is to realign ideas about sport in the modern world and

achieve equality of both sexes and gender’ (Craig & Beedie, 2008, p.105). Knowing this can

allow the project group to predict what to expect from the research being carried out.

Considering the inequality in sport, it is important to acknowledge how females are viewed in

sport. ‘Female athletes are often defined as invaders. Girls and women in sport increasingly

threaten the preservation of traditional ideas about gender’ (Craig & Beedie, 2008, p.104).

The dementia golf project supports this notion due to the makeup of the participants, which is

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predominantly made up of men. This then links to the ideology of gender roles being adhered

to. Society has determined gender roles, set characteristics, attitudes and behaviours to each

gender, leading to stereotyping (Craig & Beedie, 2008). Females are also typically associated

with being nurturing wives and mothers, organisers and in sporting terms spectators. In

comparison to males, who are associated with being the bread winner, leaders and in sporting

terms, the players. This creates stereotypes in sport such as men are better than women. The

dementia golf programme and the individuals involved support these stereotypes through the

fact that men play golf (the sport) and the women do the nurturing and spectating (through

their role as carers).

The justification for the need of this study in relation to literature, shows how by analysing

this project, it can be identified how it is affecting society in positive ways through the issues

such as ageism and disability. This information can be used in providing more opportunities

and greater benefits for people to be involved in sport, and use it to benefit their health and

wellbeing. ‘Having an ‘active’ lifestyle, exerting oneself to prevent illness and the deleterious

effects of ageing.’ (Collinet & Delalandre, 2017). The evidence found in this area has led to

physical exercise becoming a part of specific and dedicated treatments for health conditions

in senior citizens. The use of this as a way of prolonging a healthy and happy lifestyle, shows

the importance for opportunities for the ageing population to be involved in sport and

physical activity in the community.

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Methodology

This project utilized interviews and video analysis. These methods were used to gather

information from participants, carers/partner, golf organisation and golf staff members. The

interviews used within the project were conducted both individually and in focus groups. The

interviews were structured in a semi-structured format; a semi structured interview allows

unfolds in a conversational manner allowing the participants to discuss and explore issues

they feel are important with what’s being spoken about (Longhurst, 2003). When

interviewing the carers/partners, this was done individually allowing them to feel comfortable

when answering questions, additionally by interviewing them individually it allowed for

emotions, thoughts and opinions to be displayed in a subjective form.

The questions asked during the interviews were all different for each group interviewed.

Questions that were asked to the participants were focused around their name, age, favourite

sport and favourite memories. By doing this, it allowed for further information of the

participants memories to be gathered. Questions asked to the carers/partners were focused

around the relationship they have with their partners, how they deal with certain situations

and the effects that Golf in Society has on their lives. The questions asked to the golf

organisation were focused around dementia golf and what is involved within the programme.

For the full list of pre-planned questions, see appendix.

A second method used during the project was video analysis. Video analysis is a form of

qualitative observation, that involves watching and recording what people say and do (Mays

& Pope, 1995). The use of video analysis during the project allowed for further information

to be gathered regarding the participants, such as, when achieving a successful shot and the

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reaction they gave, the social interaction that each participant had with not only themselves,

but the organisation workers (activators) as well.

Results

All the interviews were transcribed verbatim and put into tables, showing key themes that

were identified along with quotations from what the individuals said.

Carers/Partners

Firstly, the findings from the carers/partners interviews will be discussed. There were five

main themes that occurred throughout the carers interviews, these were; medication,

behaviour, advertisement, barriers and benefits. Links to feminism where also identified in

relation to the carers part of this research.

Within society and sport, gender inequality has been a long-lasting issue, with the idea of the

two sexes having specific roles and traits in relation to both masculinity and femininity.

Based on the participants who took part in this research, it appears that the roles within

society and sport are reinforced. This is through the fact that women are thought to have

nurturing, caring and supportive characteristics, all of which are shown by the carers/partners

of the participants involved in this research. Knowing this and that all the carers/partners

were women, reinforced the idea of feminine characteristics in women. Additionally, due to

all the participants being male, and the idea in society of sport being a male dominated area

filled with masculine characteristics such as strength and power, the participants within this

organisation are supporting the idea of masculinity in sport.

Most carers stated that their partners can be aggressive and very stubborn, due to becoming

frustrated as they are unable to do things they used to be able to do. However, the carers

believe that Golf helps to control the participants with dementia behaviours, and channel it in

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a more positive way. This was shown specifically when one carer said: “he would refuse to

get up some days, refuse to shower and refuse to dress but on a golf day he was up!”

In terms of medication; medication is mostly prescribed for the use of calming or reducing

symptoms, rather than benefiting the individuals’ lifestyle. One carer said: “medication was

basically calming them down, you knew the effects of the Parkinson’s if he didn't have it he’d

be shaking but the actual dementia medication you could see what it was doing.” This

revealed that even though medication was calming, it was physically benefiting or helping in

relation to aspects of social interactions.

Two main barriers arose when interviewing the carers, these were; advertisement and

performance. They stated the lack of advertisement is apparent, the main thing is word of

mouth however there needs to be more. Performance also is being thought of as a barrier as it

could lead to demotivation. Thus, the participants get frustrated with their golfing ability,

leading to demotivation.

The main benefit identified within the carers interviews is that the participants changed

positively in terms of their behaviour and attitude. They make it clear that the participants

love coming to golf and one states that it has ‘transformed’ him, “when he came down here, it

was just incredible to see the transformation, he absolutely loved it and I had two hours away

which was fantastic but I can’t express just what it did for him, it was… fabulous.”

Additionally, they believe that the participants benefit socially by being with the men. One

said, “He couldn’t hold a conversation I should say, but when he got here the banter! And he

would come out with jokes, lines, repartee. It sparked life into him, he just became the person

that he used to be when he was here!” Finally, the carers portray their benefit of respite. This

is the only organisation that their partners can come to and the carers can go elsewhere,

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knowing they’re in safe hands. Overall, there were more positives/benefits mentioned in all

the carers interviews in regard to negatives.

Participants

Secondly, the participant’s interview will be discussed. The main themes consisted of; sports,

background, social aspects, barriers and benefits to Dementia Golf. The project group found

that talking about sports and the participant’s background (schools and holidays) enabled the

conversation to flow smoothly allowing the participants to feel comfortable in order to

elaborate further later on in the interview. Prior to starting the interview, the project group

were warned that the participants may not communicate or interact much with them or the

process, however to contradict this, the participants were interacting and even guiding the

conversation at points by asking the group questions.

Disability is thought to be an impairment that prevents and holds back an individual from

completing a specific task, or the ability to interact properly with others. Knowing this and

the way in which this organisation is ran and set up, it is clear to understand that the dementia

golf sessions tackle this notion. This is because instead of preventing the participants who

have a mental illness from performing and partaking in golf, it is encouraged and supported.

The idea of social interaction is also supported and encouraged, meaning that these

individuals can return to something that gives them enjoyment, rather than being told they are

incapable of doing something.

One of the main barriers that was found is that golf is an expensive sport to fund, however

despite this, Lincoln Golf Centre provides both golf clubs and golf balls to those who don’t

have these, to ensure that all individuals can still participate. Another barrier is that some

participants find golf to be a slow game, compared to the sports that they have previously

played, this could potentially lead to individuals becoming disinterested.

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One of the main benefits that raised during this process for the participants, was having this

type of therapy has also provided the opportunity for these individuals to experience a sport

that they haven’t previously, or expand on their skill set in golf. It was also found that the

participants enjoy coming to Lincoln Golf Centre to participate, and that they like the people

who they work with and who support and run the activities. One participant said, “I’ve played

more golf here in the few weeks I’ve been coming here than I have played in the rest of my

life.”

Organisation Workers

The themes that were found in the organisation workers interviews were; carers reactions,

training, advertisement, barriers and benefits. Firstly, they stated how positive the carers are

about this organisation and how much they benefit. They said, “the reaction we have got from

the carers is absolutely brilliant, it is just as rewarding helping them as it is helping the

golfers.”

Training is thought to be important when working with individuals who have dementia. This

is because these individuals can be easily triggered and difficult to handle at times, therefore

all members of staff needed to know the correct procedure to ensure that all participants are

in safe hands.

The main barrier that occurred was funding. Funding was identified to be an issue for

Dementia Golf, due to the organisation workers identifying this organisation as being too

small compared to others that receive large amounts of funding. One said, “in terms of

government funding, big lottery funding we have nothing at all, I think the reason for that is

because we are too small we are not a big organisation.”

Three benefits were identified; value for money, health benefits and social, physical and

mental stimulation. Compared to other places, this organisation covers support to both the

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participants and partners, making the money spent help two instead of one. It was identified

that Dementia Golf can increase muscle strength and improve balance for the participants

(which is said to be crucial). Finally, this organisation doesn’t just target one attribute (like

physical activity), it is also thought to benefit social interaction and mental stimulation to

allow the participants to get back to them old selves.

Golf Centre Staff

Finally, from interviewing the golf centre staff, the themes found were; advertisement,

training, equality, barriers, benefits and next steps. Lincoln Golf Centre does not advertise for

these dementia golf sessions specifically. The only advertisement that occurs is typically

through word of mouth and on the organisation leader’s webpage. This lack of advertisement

could have negative repercussions on the sessions, due to numbers not always being as high

as they could be but also people who may benefit from this, not being aware of its

availability.

Dementia Golf is an organisation that tackles the ideas of ageism within society. Ageism is

the idea of individuals above the age of 55, being thought to become weak and incapable,

therefore being considered as useless to society. Dementia Golf instead of viewing

individuals as useless and incapable, promotes them and offers the opportunity for them to

continue to grow and develop (through promoting muscle strength and increasing balance –

things vital for this age range), allowing the participants to still feel wanted and valued.

Two barriers were revealed from this process, in regard to the golf centre staff, it was

identified that funding and expansion of the organisation would be difficult, due to the lack of

funding provided by the government (meaning that this organisation needs to be ran like a

charity). One said, “government hasn’t got the money…things like this do rely on funding

and it’s like a lot of charitable work it does rely on funding and this does really, there would

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need to be an investment in there…there would definitely need an investment to be able to

roll it out nationwide.” The second barrier is that other golf centres are afraid of the idea of

having this type of session being ran at their centres, based on health and safety issues that

may arise.

The benefits that were highlighted from this process is that the carers receive a respite period,

meaning that they can go away and have precious time to themselves. One said, “There’s as

much benefit if not more for the carers, because the carers get that respite…they can go away

for a period and know that their partners are in safe hands.” Additionally, the participants

always have a smile on their face and enjoy their time here, that in a way can work as a

distraction and getting the participants outdoors and in the fresh air. One said, “it just gives

them something else to focus on, they’re in fresh air, sunshine, birds singing, carers doing

something else I think all the way around there’s benefit, benefit, benefit.” These are all

factors that can only be provided from this kind of therapy and not achieved solely through

medical drug use.

In terms of next steps, the organisation wants to develop further across the country. One said,

“So next thing that to benefit people would be to roll it out throughout counties throughout

the country and make it nationwide.”

Additionally, to interviews, the project group used video analysis. Through this, they found:

many positive reactions from the participants playing successful shots, a large variety of

social interactions between the participants, organisation staff, project group and participant

enjoyment. All these things support what was found in the interviews too.

Links to Other Research

Considering the findings, methods used and he general project in relation to other research,

both similarities and differences were found. Similarly, to the findings from the project

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group, other research has identified that there are both physical and psychological benefits

from using physical activity for individuals with a mental health problem or even dementia

specifically. Callaghan (2004) found that physical activity benefited these individuals

through ‘reducing hallucinations’ and ‘muscle tension’ along with improving ‘sleep’,

‘general behaviour’ and ‘self-esteem’. Additionally, further research by Heyn, Abreu and

Ottenbacher (2004) has also identified that exercise (especially for patients of dementia) will

boost ‘physical fitness, behavioural symptoms, functional and cognitive performance’.

Knowing that other research has suggested that physical activity can benefit people with a

mental health illness and the evidence found from the project group around the participants

change in behaviour, mental and physical stimulation and social interaction. From this is

suggests that physical activity is having a majority positive impact.

Focussing more on the project in general in relation to other projects that have been evaluated

within research, it was found that the time length and number of sessions ran for dementia

golf are like that of similar projects. Heyn, Abreu and Ottenbacher (2004) identified that

generally these types of sessions for individuals with a mental health issue, typically occur

between 1-6 times a week and usually last anything between 20-150 minutes. Knowing from

attending several sessions of dementia golf, typically, a dementia golf session will last

between 1 hour 30 and 2 hours, meaning that dementia golf is operating in the standard time

recommendations for these types of sessions, however extra time is used for social

opportunities over drinks and food at the beginning and end, making the sessions last around

3 hours in total.

Despite all the similarities, considering research two main differences was identified, these

being the type of methods used for analysis and the sports being used for these types of

sessions. Within both Callaghan (2004) and Heyn, Abreu & Ottenbacher (2004 research, two

different types of analysis were used; meta-analysis and narrative analysis. Using meta-

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analysis allowed the researchers to compare their findings to pre-existing research and

identify the truth in their data, whereas narrative analysis allowed them to find regular themes

that occurred within the stories retrieved from their participants. This differs from the

analysis used by the project group, as the analysis methods used were thematic and

observations through video analysis.

Looking in more detail at the type of sports used within similar programmes to dementia golf,

Callaghan (2004) identified that; Bike, ergonometry, walking, callisthenics, flex and stretch

exercises, aerobic workouts, and non-aerobic stretch and co-ordination was all used.

Considering these sports/physical activities, it is clear to notice that many different types of

sports are able to be used to promote physical benefits for the individuals who suffer with a

form of mental health, along with revealing that there is a variety of sports/physical activities

that these individuals are capable of performing.

What is being taken from this research?

After considering all the data collected, five main positives and two main negatives have

been identified from the evaluation of dementia golf. Focussing on the positives, this

organisation is allowing support to not only the participants but also the carers/partners of the

participants. It was found within the data that the carers/partners are receiving just as much, if

not more benefits from these dementia golf sessions through the form of respite. This respite

allows the carers/partners to have precious and valuable time to themselves, to complete tasks

like going shopping or to have their hair done that they cannot do whilst taking care and of

their partners with dementia.

The second main positive identified is that dementia golf offers the

opportunity for social interaction through physical activity. Due to the sessions being ran in

groups means not only does this allow for the development of muscle strength and

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improvements in balance, but it also offers the opportunity to boost self-esteem as the

individuals taking part will communicate (through encouragement, praises, jokes and stories

from their younger lives) allowing the individuals to feel more like themselves and feel a part

of a group. The third positive is related to the opportunity to play sport. As stated previously,

these sessions run using physical activity (specifically golf), which provides the opportunity

for these individuals to partake in sport, something that society usually doesn’t support them

with. It was identified that most of the participants have previously played a form of sport

throughout their lives, so having this opportunity to continue to be active allows them to

continue to develop but also bond through something that they all clearly enjoy.

Value for money is the fourth positive to be found in the

data collected. This organisation is thought to be good value for money due to not only

offering support and benefits to the participants but also to the carers/partners (through

respite), therefore providing the price of support and benefits for two rather than one, which

is something that according to the carers/partners, no other organisation they have come

across can offer. The final positive is that all the participants do enjoy the sessions and enjoy

coming, even if they cannot fully remember it each week by the time they get home. From

the observations made and the interviews conducted, clear joy and benefits is evidenced

throughout. Despite the positives, as mentioned previously,

two negatives were identified. These negatives however are areas in which can be amended.

Throughout most of the interviews conducted, both advertisement and funding appeared to be

the two areas that needed development. Advertisement was identified as something that could

be done more to help raise awareness of the organisation leading to hopefully an increase of

numbers that regularly attend the sessions. Funding on the other hand, was found to be a

weakness through the fact that this organisation received little, even though funding is

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something that would only benefit this organisation through allowing the opportunity for

further development and expansion.

Areas for Additional Research

Based on the findings, further areas have been identified to need more research, to allow this

organisation to develop and expand further. These areas can be seen listed below;

• More quantitative data – for example the use of physical health tests, to identify any

physical benefits that are being gained by the participants being involved in dementia

golf.

• Research into the support that the carers receive. – This being both from the

organisation specifically but also every day support from the government and other

organisations linked to dementia. Doing this will reveal if there is a need for further

support for these individuals.

• Research into how this type of programme would work with other sports – Other

research has found other forms of physical activity to have other benefits, but what if

this kind of programme was ran with sports such as rugby, football, cricket,

badminton, sports that individuals typically are involved in throughout earlier life.

Having this variety may lead to more attendance and awareness.

• Research into health and safety procedures within mental health patients. – It was

stated during an interview that other golf clubs fear this type of organisation with

links to health and safety concerns for the participants, if this area was researched and

a solution identified for this problem, this could help the organisation be expanded

and implemented further.

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• Research into the different triggers that promote conversation and social interaction

between the participants (for example school, work, sport, holidays). – During the

interview with the participants and other conversations generally, the exampled areas,

were the main subjects that triggered a good conversation with the participants who

have dementia. Research into identifying why these are things that trigger

conversation could help in the development of social interaction further.

• Research into gender specific needs to identify how to increase female participation. –

One thing that was noticed through observing the sessions was that all the participants

were male, despite the fact that the organisation do offer this to both genders,

therefore research into how to increase the number of female participants would be

beneficial.

Next Steps

Considering the findings and research, four suggested next steps have been identified to help

move this research further and benefit the organisation. The first recommendation would be

to increase the amount of advertisement for the sessions. Increasing the amount of

advertisement would allow the organisation to increase the awareness of the organisation to

the public (Brown, 2003). If the public is more aware of the support being offered, it is likely

that the number of regular participants would increase leading to the expansion of the

sessions. Advertisement could be increased by using platforms such as; radio, television,

newspapers, magazines and social media.

The next recommendation would be to increase the amount of funding that the organisation

receives. Having more funding as stated previously, would allow the organisation to develop

further through an increase in sessions and an expansion into other golf clubs.

Understandably gaining extra funding is difficult, however this could be done through regular

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fund raisers and additional research to support as evidence when approaching larger

companies.

The third next step identified would be to take this research completed by the project team

further, and introduce additional methods of analysis, such as meta-analysis. This would

allow the organisation to highlight the truth found in this evaluation in relation to other

research out there, providing a much larger and more detailed overall view of the field.

Finally, the last next step would be to bring in experts in the different fields (such as

psychologists). Having the experts come and provide support and research into the

organisation would allow the identifying of specific benefits, with the opportunity of more

statistical data to be produced. This kind of data would be more likely to support the

organisations reasoning when applying for further funding or wanting to expand further.

Conclusion

Overall, Golf in Society has more positives than negatives regarding what is attained from

this evaluation. An example of these positives is represented by the story given to the group

shown below:

“Previous participant did that all the time and it helped him stop taking what he described as

his funny pill, and when he used to really get bad, he was prescribed a pill, since he started

playing golf, he no longer needed that pill”

Having outcomes like this where Dementia Golf is having such a large impact on these

effected individuals and their families, just shows the importance of an organisation like this,

and why it has the potential to become a programme/therapy used all over the country and

potentially worldwide.

One Word Descriptions

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We asked the individuals for one-word descriptions on how they feel about this organisation,

and these are the kind of powerful responses we were given, these are:

Phenomenal

Miracle

Worthwhile

Enjoyable

Rewarding

Respectful

Supportive

Satisfying

Life saver

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Appendix

Guided questions used during the interview process:

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