Music and Memory
Can music be the language of care for the 21st century?
Hampshire 2013 JNSA shows there are an increasing numbers of people over retirement age and that an ageing population is associated with 'increasing mental frailty'. Caring for more people with dementia is therefore a huge challenge in the context of reducing resources. Music therapy based approaches can enable people to live safer and happier lives at home or in residential care. Using evidence based therapeutic approaches to the delivery of music for people with dementia is a cost effective way of improving wellbeing for carers and the cared-for.
The therapeutic benefits of music and singing in reducing agitation in people with dementia are well documented (1). Group music therapy, typically using familiar music, can bring benefits in improved mood and cognition at all stages of dementia. Group music therapy can also enhance the relationship between carers and the person they care for as it can be a mutually enjoyable shared activity. The provision of open group music therapy for people with dementia and their carers should be a part of modern evidence-based service provision.
There are increasing numbers of people with dementia living with their carer and living alone. Caring for more people with dementia - both self funding and local authority funded through personal budgets - is a key commissioning challenge for delivery of the strategy action plan. Music therapy can enable people to live safer and happier lives at home or in residential care. Using evidence-based therapeutic approaches to the delivery of music for people with dementia is a cost effective strategy that should be implemented.
The therapeutic benefits of music and singing in reducing agitation in people with dementia are well documented (1). Group music therapy, typically using familiar music, can bring benefits in improved mood and cognition at all stages of dementia. Group music therapy can also enhance the relationship between carers and the person they care for as it can be a mutually enjoyable shared activity. The provision of open group music therapy for people with dementia and there carers should be a part of modern evidence based service provision.
Music and memory is a complimentary programme of personalised music to improve the lives of people with dementia. The music preferred by the person is downloaded onto an iPod that can be used at any time by the individual. Playlists can be sorted into music with different moods to engage and activate or to calm.
This has been shown to improve mood and should be seen as a cost-effective intervention that will not only reduce costs (drugs and care staff time) but also improve quality of live for people living with dementia. This is an individual home based intervention.
The music can be offered as the person asks for it or as the carer sees the need. Personalised music can be offered 30 minutes before a predicted peak in agitation.
In the early stages of dementia, music which calms or relaxes people is useful. In advanced dementia music from the era of the youth of the person, which has personal meaning to the individual, most of the time brings pleasure.
The numbers of people that can be reached through this type of receptive music therapy can be scaled up though the use of digital technology. Personalised playlists have been shown to improve the lives of people with dementia and as there is a rapid rise in the numbers being diagnosed, this is an intervention that could keep pace with this rise and so is a sustainable and beneficial option.
In the USA Dan Cohen noted that residents in care homes spend 90% of time idle. Many have no visitors. He has provided iPods for residents in care homes with personalised playlists and seen benefits including reduced agitation and improved awareness and engagement. The personalised music also reduces the experience of isolation. These results have been replicated in various settings and are now being more widely implemented (2).
Personalised music can enhance the effectiveness of music therapy which is used to promote engagement and communication in people with dementia (3). Using the iPods before the music therapy session increased the participation in the group.
Accessing personalised music for 20-30 minutes before activities can improve engagement in the activity. If the person has visitor expected offering the iPod before they arrive can improve the mutuality and enjoyment of the visit for both parties (4).
Any down side?
Issues in implementation include compiling and updating the playlist. This is easy if the person is able to say what music they like, if not, it is a more complex process. This is where family should be most involved. A legal issue exists around files sharing and the costs of downloading for therapeutic purposes. iPods need charging and may be at risk of theft or loss. Staff may not have the time to offer the person their iPod and some people may not feel comfortable wearing headphones. If the music is increasing agitation, switch it off and carers need to try a different selection the next day. If the music fails to produce pleasure it should not be forced on the person.
Generally from the trials there is measurable staff satisfaction with the intervention and this produces improvements in the safety and wellbeing generally in the care home. Contented staff deliver better quality of care.
There can be intergenerational activity involved with the provision of ipods as younger family members, schools and colleges, can partner with individuals or homes to fund raise for the iPods and to help find and download the music. Sitting together and listening to the music can be fun too.
Developing a personalised playlist is a realistic early intervention that will improve the quality of life of the person with dementia. In addition, this will enable people to remain in the community for longer as there is evidence for reduced agitation and improved wellbeing for people with dementia and their carers.
References can be found here.