Progress in Tourism ManagementTourism as a dementia treatment based on positive psychology
Graphical abstract
Introduction
Dementia is a syndrome featuring multiple cognitive deficits (e.g., memory impairment, aphasia, and the inability to engage in complex behaviour) resulting from neurodegenerative disorders or traumatic brain injury. The condition is usually progressive and can be fatal (Liu, Zhao, Wang, & Wang, 2018; Russell, 2017). Aging and dementia are global concerns, with roughly 46.8 million people worldwide estimated to have the illness; the population of people living with dementia is expected to double every two decades to reach 131.5 million by 2050 (Connell & Page, 2019). Alzheimer's disease accounts for 60–80% of dementia cases and is the leading form of dementia, projected to cause the mortality of 42.40/100,000 persons across the United States in 2023 (Zhao et al., 2021). Vascular dementia, which results from microscopic bleeding and blood vessel blockages in the brain, is the second most common form. Most dementia patients are elderly (i.e., 65 years or above), and comorbidities are common; physical and mental conditions increase the risk of this disease (Zhang et al., 2020, 2021). Impaired mental and physical functioning can further interfere with one's exercise or social activities (Ejaz, Wang, & Lang, 2020). The growing number of patients with dementia poses a major healthcare challenge (Chan, 2013)—the condition is a key cause of dependency among older adults and greatly affects patients' and caregivers' life quality (Isik, Soysal, Solmi, & Veronese, 2019).
Meanwhile, healthcare systems are becoming increasingly complex and may preclude access to evidence-based diagnosis and care for people with dementia and their families (Plsek & Greenhalgh, 2001). Dementia symptoms can be controlled with medication and other interventions (Grand, Caspar, & MacDonald, 2011). Non-pharmacological treatments are generally preferred due to a lower rate of side effects (Gill, 2007). Examples include exercise, music therapy, and transcutaneous electrical nerve stimulation (Meyer & O'Keefe, 2020). The medical literature has emphasised the importance of dementia treatment; however, as the global cost of the condition is estimated to be US$818 billion (Pratchett, 2015), alternative cost-effective care is needed to improve patients' quality of life.
Exploring novel methods to help people with dementia is essential and both medical practitioners and social scientists could each contribute to the development of these methods, as both academics and practitioners are keen to identify solutions to aging-related issues. Travelling offers one possible way to improve well-being (Smith & Diekmann, 2017). McCabe and Johnson (2013) described vacations as instances where “people can enjoy quality time amongst families and friends and [where] times/activities undertaken are often linked to personal growth and fulfillment” (p. 61), thus enhancing well-being and life quality (Su & Zhang, 2020). Certain non-pharmacological interventions for aging-related issues, such as exercise, may correspond to tourism (e.g., walking while visiting attractions). Exercise offers an array of health benefits: lower blood pressure, reduced oxidative stress and inflammation, and improved endothelial function. The resultant maintenance of appropriate cerebral perfusion pressure—the balance between supply and demand for nutrients to the brain (Smith & Ainslie, 2017)—can positively influence dementia patients' cognition (e.g., Davenport, Hogan, Eskes, Longman, & Poulin, 2012). Tourism scholars have explored the effects of movement-based tourism engagement, such as yoga (e.g., Su & Zhang, 2020), on typical travellers’ well-being—but few have considered such engagement among vulnerable populations, such as tourists with disabilities. These visitors remain an obscure segment both statistically and economically, and travellers with dementia are one such understudied market.
In terms of aging-related social issues, vacationing boosts travellers’ physical and psychological well-being (Smith & Diekmann, 2017). Senior travellers, compared with same-aged non-travellers, reportedly feel better about themselves and their lives during leisure activities (Wei & Milman, 2002); however, seniors—especially those with dementia—may face trip-related challenges. According to Page, Innes, and Cutler (2015), although aging generations expect to be able to participate in leisure and tourism activities, the onset of dementia can impede such opportunities. Various constraints can prevent affected individuals from travelling independently or with companions (e.g., family members or caregivers) (Asghar, Cang, & Yu, 2020). More research is needed to develop strategies to overcome trip-related challenges for vulnerable populations and to determine how tourism can contribute to the well-being of travellers with dementia.
To rectify knowledge gaps in tourism and medical science, this study explores the potential impacts of tourism engagement on dementia patients’ well-being by investigating travel as a non-pharmacological aspect of dementia treatment. To achieve these aims, positive psychology is introduced as the theoretical underpinning of this interdisciplinary study. Bridging travel and positive psychology has sparked humanistic research on people and tourism (Filep & Laing, 2019). An approach blending the social and medical sciences situates dementia interventions within the tourism context to offer interdisciplinary theoretical and practical implications. The research objectives are as follows:
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To propose a potential nexus between tourism experiences and dementia interventions;
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To explore the role of positive psychology in dementia patients' tourism experiences as a potential dementia treatment; and
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To enrich the medical science and tourism literature by introducing tourism as a revenue source for dementia interventions.
We are confident that this manuscript presents conceptual insights as defined by Gilson and Goldberg (2015, p. 128) in that we “bridge existing theories in interesting ways, link work across disciplines, provide multi-level insights, and broaden the scope of our thinking.” This work represents a springboard for future analytical approaches and data collection, which forms the heart of conceptual research (Kirillova & Yang, 2022).
Section snippets
Definitions of tourism and its role in society
Tourism is a globalised phenomenon of worldwide socioeconomic importance (Darbellay & Stock, 2012). Smith's (1988) question of “What is tourism?” remains hotly debated, and definitions of tourism continue to emerge across research contexts. The United Nations World Tourism Organization (2019) defined tourism as visiting places outside one's everyday environment for no longer than a full year. Tourism more broadly reflects individuals' travel motivations, which may not necessarily involve
Methodology
This paper is part of a large research project funded by the European Commission Horizon. The project was led by 12 internationally renowned scientists in disciplines spanning neurology, public health, epidemiology, dementia, eHealth, and lifestyle intervention in the Netherlands, the United Kingdom, China, Sweden, France, and Luxembourg. The funded project aims to develop mobile phone applications for dementia prevention and treatment. Monthly research team meetings have been held since March
Proposed nexus between tourism experiences and non-pharmacological interventions for dementia
The varied nature of tourism experiences offers many opportunities to facilitate dementia treatment. According to Godovykh and Tasci (2020), the tourism experience can be divided into four components: affective, cognitive, conative, and sensorial (Table 1). This paper addresses the proposed nexus between each of these components and applicable non-pharmacological interventions for dementia (Fig. 1). Twelve non-pharmacological interventions are profiled.
Conclusion
Tourists with psychological disorders (i.e., dementia) have been largely neglected in the tourism literature. To the best of our knowledge, this article is one of the first to conceptually discuss the potential nexus between tourism experiences and dementia interventions through the lens of positive psychology. We employed Godovykh and Tasci's (2020) tourism experience framework (affective, cognitive, conative, and sensorial) to explore respective relationships with 12 non-pharmacological
Future research directions
The current study is exploratory, presenting a conceptual foundation for future research. Interdisciplinary work could follow several avenues. First, although it is difficult to study vulnerable groups such as dementia patients (due to ethics and access to target respondents), empirical studies on tourism interventions are needed to gather first-hand evidence. Research designs combining clinical experiments involving dementia patients who do and do not engage in tourism could identify
Author contribution statement
Dr. Jun Wen: conception and design; data collection; data analysis; manuscript drafting; critical manuscript revision; final submission approval. Dr. Danni Zheng: conception and design; data collection; data analysis; manuscript drafting; critical manuscript revision; final submission approval. Prof. Haifeng Hou: conception and design; critical manuscript revision; final submission approval. Prof. Ian Phau: manuscript drafting; critical manuscript revision; final submission approval Prof. Wei
Impact statement
No research in tourism or medicine has addressed the potential relationship between travel and medical treatment of dementia. This interdisciplinary study is a first attempt to rectify knowledge gaps in tourism and medical science by investigating travel as an aspect of dementia treatment. The study reveals that tourism is proposed as a possible way to improve dementia patients’ well-being as an adjunct to non-pharmacological interventions. Accordingly, a conceptual framework is proposed to
Acknowledgement
This work was supported by the National Natural Science Foundation of China [grant number 72102045], and European Commission Horizon 2020 [grant number 779238-PRODEMOS].
Dr Jun Wen is a lecturer in tourism and hospitality management in the School of Business and Law at Edith Cowan University. His current research interests lie in Chinese outbound tourism marketing, behaviours, and other related aspects.
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Dr Jun Wen is a lecturer in tourism and hospitality management in the School of Business and Law at Edith Cowan University. His current research interests lie in Chinese outbound tourism marketing, behaviours, and other related aspects.
Dr Danni Zheng is an Assistant Professor in the Department of Tourism at Fudan University, China. Her research interests include sociopsychology of tourism, medical tourism, crisis tourism management, prosocial behaviours and digital cultural tourism.
Dr Haifeng Hou is a Professor in epidemiology in the School of Public Health at Shandong First Medical University. His current research interests lie in Epidemiology of Chronic Diseases, Evidence-Based Medicine, and Glycomics.
Dr Ian Phau is John Curtin Distinguished Professor at Curtin University, Australia. His research interests include luxury branding and hospitality, country image and tourism.
Dr Wei Wang is a Professor in public health in the School of Medical and Health Sciences at Edith Cowan University. His current research interests lie in Molecular Epidemiology, Genomics and Glycomics.
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Note: Dr. Jun Wen and Dr. Danni Zheng contributed equally to this manuscript and should be considered as co-first authors.