The Power Of Music In Dementia Care
This article was provided by Ellen Phipps is a gerontologist; vice president of programs and public policy for Alzheimer’s Association, Central and Western Virginia Chapter; and author of The Connections Activity Program for Persons with Dementia.
Almost daily, in my work and leisure, I am reminded of the transformative power of music.
Whether sitting at my desk at the Alzheimer’s Association reading the latest research on the therapeutic value of music for persons experiencing dementia, or visiting my father, there it is. Walking into Room 209 at the nursing home, I can see that Dad is upset.
“We need to go, we need to get the, the, the — we need to get to the table to lunch now!” “But, Dad, its only 9:30 in the morning,” I reply, knowing full well there is no point in reasoning. “Now, wait a minute — you don’t know, you don’t know; we need to do this now! I said, now!” he said.
My father, 91, once a brilliant family physician, is living with dementia and struggles to hold a conversation. As part of the disease process — probably Alzheimer’s — he no longer has the ability to reason.
He is confused; he is restless; he does not know what he is meant to do next. He is frightened when left alone. I walk over to the large computer screen we have set up in his room and quickly pull up Miff Mole on YouTube. Miff, of Miff Mole and the Molars, a once wellknown band, was my father’s trombone teacher in Brooklyn back in the 1930s.
Without saying a word, I turn up the volume and Dad joins me at the computer. A big grin replaces the worried and confused expression of just moments earlier. Sophie Tucker begins to sing, “After you’ve gone …,” and, now, Dad is not only singing along, but tapping his foot.
As I search YouTube, the next thing I find is Shirley Temple singing and dancing to “The Good Ship Lollipop.” This has worked in the past, but not today. He heads for the door. Frantically searching, I discover “Sing-Along-With Suzie.” Suzie, an attractive, middle-aged woman, is playing the piano and singing “Sentimental Journey.”
She is looking directly at Dad. He is looking back. He is smiling again. There goes the foot. I capture the moment on my camera. I reach out my hands, and he takes them in his and rises. We are now dancing. And, so, the morning continues until 11:55 a.m., when I realize we’d better hurry to the dining room or we will miss lunch.
I am reminded of my introduction to the use of music as an intervention in the healthcare setting. It was the summer of 1975, and I had just graduated from high school. I was volunteering in a nursing home. My job was to lead the patients in sing-alongs with my guitar. I approached a group of heavily medicated, often sleeping residents.
Dementia had robbed them of their verbal ability, and so I was surprised they were not only singing, but seemed to recall the words of the songs and hymns.
They laughed, and sang, and sometimes we even danced. I saw the magic firsthand. I would be forever a believer in the power of music.
Perhaps you have seen the inspiring YouTube video that shows Henry, a gentleman living in a nursing home who appears unresponsive but who “comes to life” upon hearing his favorite music from the past piped in on headphones.
The program that Cohen developed is called Music and Memory and is now being offered at more than 4,000 facilities in the United States. From the Music and Memory website: “He used to always sit on the unit with his head [down] … he didn’t really talk,” said caretaker Yvonne Russell of an elderly man introduced in the film as Henry.
Henry’s daughter describes the once fun-loving man she knew, who used to sing every chance he got, encouraging his children to sing along, even stopping sometimes to sing and swing around poles. Her memory is a stark contrast to the Henry we first see in the film, an old man who’s been in the home for 10 years and who now sits hunched over in his chair, incapable of answering questions beyond a yes or no.
But when Cohen and Sacks put their Music and Memory theory to the test, handing Henry and other patients suffering from degenerative diseases an iPod full of music, a different person emerges. “Immediately, he lights up.
His face assumes expression, his eyes open wide … he’s being animated by the music,” Sacks said, describing Henry’s reaction. He can even engage in dialogue with an interviewer who asks about the effect the music has on him.
“It gives me the feeling of love, of romance. I figure right now the world needs to come into music, singing. You’ve got beautiful music here,” Henry said, before breaking into a version of “I’ll Be Home For Christmas” by an artist he said is one of his favorites — Cab Calloway.
The documentary’s findings are not unlike previous ones. In 2010, researchers at Boston University found that music can not only arouse dormant memories, but also may help people with dementia retain new information.
Earlier this month in Charlottesville, I was invited to the Senior Center to present to the Good Life Design group on the Alzheimer’s Association’s Arts Fusion program.
Arts Fusion is a program created by the Alzheimer’s Association that offers meaningful engagement and creative expressive opportunities for persons with dementia through the arts — art, music, drama, poetry, writing and more. I had the great fortune to share my presentation space with Kate Tamarkin.
She has enjoyed a long and successful career as a symphony conductor, musician and teacher, and now serves as a therapeutic musician playing the Celtic harp at the bedsides of patients in hospice care. She is certified as a therapeutic musician through the Music for Healing & Transition Program, a nonprofit training program that requires 80 hours of study, a 45-hour intensive internship and other training.
I was interested to hear Tamarkin explain the difference between therapeutic music and music therapy prescribed by medical professionals. “A music therapist certification requires a four-year degree, and they work with patients at the bedside using music to help achieve a medical outcome,” Tamarkin explained.
With therapeutic music, “the patient can be passive. We can work with people in comas, or with premature babies. Comparing the two is a bit like comparing a physical therapist — the music therapist — to a massage therapist, which is comparable to a therapeutic musician.”
In her presentation, she explained, “To sit in a dark room, one-on-one with a person who has no idea who you are, and to play for them is one of the most fulfilling experiences you can imagine. I just try to be present, to offer a loving presence.
Music is no longer a performance in that context. It’s a service.” At the Alzheimer’s Association’s Educational Conference held this past June at James Madison University, attendees not only heard from but experienced music therapy as presented by Richard Lewellen, director of New Leaf Music.
Lewellen presented on the power of music for older adults experiencing dementia. Music therapy, he explained, is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.
According to the American Music Therapy Association Inc., music therapy interventions can be designed to promote wellness, manage stress, alleviate pain, enhance memory, improve communication, and provide unique opportunities for interaction.
Research in music therapy supports the effectiveness of interventions in many areas, such as facilitating movement and overall physical rehabilitation, increasing motivation to engage in treatment, providing emotional support for clients and their families, and creating an outlet for expression of feelings. Because music therapy is a powerful and non-threatening medium, unique outcomes are possible.
Music therapists may improvise or compose music with clients, accompany and conduct group music experiences, provide instrument instruction, direct music and movement activities, or structure music listening opportunities.
We at the Alzheimer’s Association are fortunate to have several music therapists involved with our Arts Fusion program. Through this program, we have been able to offer music programs in facilities and in several of our four regional communities throughout our chapter area.
A common theme with music as an “intervention” is the person-centered approach — that is, having the knowledge about the musical preferences of the persons you are working with.
My dad, Henry and the residents of nursing homes enjoy a positive response because the music has meaning to them.
This is a crucial point the success of any music program. According to “Alzheimer’s Association Facts and Figures (2017),” more than 5 million Americans have Alzheimer’s disease or a related dementia. We know this number is expected to triple by the year 2050.
As the incidence of dementia increases, and with no current medical cure, the need for quality, person-centered approaches such as the use of music also increases. There is no doubt about the power of music — a young high schooler with her guitar; a father and daughter at the computer; a harpist at a bedside; a music therapist; a program in a nursing home. The power of music speaks volumes.
Ellen Phipps is a gerontologist; vice president of programs and public policy for Alzheimer’s Association, Central and Western Virginia Chapter; and author of The Connections Activity Program for Persons with Dementia.