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Music matters: The role of music for people with dementia

Dr Simon Proctor, Director of Music Services for Nordoff Robbins, the UK’s largest music therapy charity, considers the role of both music therapists and wider staff members in making music’s opportunities as available as possible to people in care homes.

Music unites

Music is often thought of as something that only exceptionally trained and talented people can do. However, music has also always been a part of everyday life for most people. It can be a means of pleasure, identity, and in certain respects, communication. We learn through music, we manage our emotions using music, we find reassurance through music and we interact with others through music. Most parents who don’t consider themselves musicians nevertheless sing their children to sleep or use action songs to help them tie their shoelaces or brush their teeth. The role of music as something that people do together has come to the fore during the Covid-19 pandemic, with considerable media coverage of musical initiatives to reunite people who are separated by distance, or to reassure people that others in their community are with them despite the isolation of lockdown.

Music and dementia

Music and movement are our earliest means of relating to others – for most people, it is in our parents’ arms as they sing to us that we learn who we are, that we are safe and loved, and that interaction with others is possible. Developmental psychology, and especially the field of communicative musicality1, show that as infants we actively stimulate our caregivers to interact musically with us and that this is how we develop, relate and learn to find satisfaction as people. Likewise, as dementia progressively deprives us of the capacity to interact verbally or use complex ideas, our capacity to use music as a non-verbal but effective means of communication and interaction is generally unaffected. This means that even for people with late-stage dementia for whom verbal communication and complex cognitive processing is significantly impeded, music remains a way of interacting and of being oneself.

That’s why music has such a significant role to play within dementia care services. However, it also points to the important issue of age appropriateness: people with dementia are not children and whilst songs from their childhood might be useful ways to lead to interaction in some cases, it is important that music is not used in patronising or infantilising ways.

Music can’t halt or reverse dementia; but it can enable people to live well post-diagnosis and also help carers and family members to interact with relatives who have dementia by enabling them to experience being valued, being responded to, being cherished and even having moments of fun and playfulness in a life otherwise dominated by loss and disorientation.

One of the key features of shared music making is its ability to root a person in the present moment: musical beat, a sense of harmonic direction and the arc of melody, all serve to hold and sustain joint attention between people, something that is particularly valuable as people find it harder and harder to sustain meaningful interaction with others.

Building connections

Music therapists are trained to hear everything people offer as music, so they can work meaningfully with care home residents who might otherwise be making habitual sounds or who don’t seem musically communicative. They can work to build connection, even where this might be fragmentary, and they can work musically in ways that allow plenty of time and space for people to respond in ways that are physically possible and emotionally meaningful for them. These trainings are approved by the Health and Care Professions Council (HCPC) and qualified music therapists must be registered with the HCPC in order to practice in the UK.

Music therapists in a care home work individually with residents who seem particularly in need due to isolation, lack of communicative abilities, or a tendency to be distressed, or because musical engagement is clearly important and helpful for them. They also run small musical groups, often including singing, which seek to build a sense of community amongst residents, enabling them to experience each other as able and each other’s company as supportive. Music therapists also look for ways to engage people in music making as part of the wider project of ‘musicalising’ the home and this may involve more able residents in putting on specific musical events etc. Music therapists actively seek to engage carers and visitors wherever possible. This is often particularly important for family members: getting to experience mum as ‘mum again’ – shared music making can be a very powerful experience.

Clearly, this is skilled work and there is no expectation that care home staff should replicate the work of a trained music therapist. Nevertheless, many carers have natural musical skills or backgrounds as musicians themselves. There is huge potential for these skills to be used sensitively with residents, helping them feel listened to and respected, putting them at ease and reassuring them, as well as fostering a warm, creative atmosphere within the home. Just a small amount of training to raise staff awareness and to empower staff members’ natural musical instincts can make a significant difference to everyday life in a care home.

Evidence

There is considerable documented evidence for the usefulness of music therapy provision within dementia care environments, as summarised in the most recent edition of the Cochrane Library Systematic Review.2 The National Institute for Health and Care Excellence (NICE) recommends that people living with dementia should be offered active creative activities including music therapy that can help promote wellbeing, as part of their updated Quality Standard on dementia (NICE 2019).

However, music therapy is not simply a medical intervention – it is interpersonal and seeks to engage not just individuals but also the community. This ‘ripple effect’ can be powerful but hard to capture and qualitative research, which pays close attention to people’s lived experience, is required to illuminate its usefulness.3 Music therapy can make a real difference to the daily life of a care home as a whole, not only to individual residents4 and the embedding of music therapy within a care home or service can make a significant contribution to meeting the expectations of the Dementia Strategy5 .Contrary to popular conceptions that all musical work in dementia care needs to be song-based, research also shows the real value of improvisational work in this field.6

Modes of service evaluation for music therapy that enable service user contribution has been developed7 and so have specific tools of assessment applicable to music therapy processes in dementia.8

Cis’s story

Ci's story

Joan’s mum Cis was diagnosed with dementia. She explains:

‘It really is so very hard to see your loved one’s abilities and memory, their personality, fading in front of you. But then music therapy came into our lives. When we walked into the room for our first session there was a lovely warm feeling. People were relaxed, they made space for us to sit and there was a feeling of true acceptance; no questions asked, no judgements made.

‘So, the singing started – at first mum didn’t join in, but she looked like she was enjoying herself. Then John, the therapist, played the opening chords to ‘Over The Rainbow’ and just like that, mum burst into song. Music therapy made her simply shine with confidence. John would play so many songs from mum’s era and it was wonderful watching her remember them; it would bring a tear to the eye.

‘Looking after someone with dementia can be a very lonely place: conversation is limited and repetitive, worrying about this or that health issue. Music therapy was our special time together – the only outing we could do on a regular basis. I loved the friendship and the support of the group; it gave me comfort, made me happy.’

Campaign insight

Grace Meadows, Programme Director at Music for Dementia, tells us more.

It’s been the strangest of years in so many ways; however, Music for Dementia adapted swiftly to encourage care settings to use different and varied approaches to musical activities in the absence of in-person services.

Throughout the year, we told stories of how people were using music to connect and manage the impacts of the pandemic, to help inspire, motivate, and bring joy in some of the darkest times. To help people make music a part of their care, we produced a series of resources and events. Our Musical Map quickly converted to a ‘virtual map’ while we continued to promote events and musicians that had shifted online, giving residents and carers many alternatives. This complemented our Musical Guide with tips on how to use music during COVID-19.

In June we launched m4d Radio, bringing decade-specific music direct into people’s homes, so providing carers with a meaningful 24/7 resource to share with residents. The Musical Care Taskforce (MCT), a joint initiative by Music for Dementia and Live Music Now, held a productive meeting in the autumn to support care settings on how to keep music going, providing information, training opportunities and links to providers. MCT also teamed up with several care organisations to create two leaflets: Keeping Singing Going (how this might be done safely) and A Dose of Music with your Vaccination. More recently, our £500k Paul & Nick Harvey Fund will shortly be awarding grants to grassroots music service delivery organisations to continue their great work in the field of music and dementia.’

Useful resources

  • Music for Dementia is a campaigning body which seeks to achieve access to music as an integral part of its care for everyone with dementia.
  • Live Music Now is among a number of organisations which provide non-therapy musical services to people with dementia and/or the care home community.
  • The Alzheimer’s Society has a useful collection of music-related resources designed for people with dementia and their carers, including information on their local “Singing for the Brain” groups:
  • Playlist for Life encourages people with dementia and their families to build playlists of their favourite music:
  • For more information about the profession of music therapy in the UK, contact the British Association for Music Therapy (BAMT)
  • For more information about Nordoff Robbins, and to view videos of music therapy in action, please visit their website.

Suggested further reading

  • Aldridge, D. (ed.) (2000) Music Therapy in Dementia Care. London: Jessica Kingsley Publishers
  • Baird, A., Garrido, A. & Tamplin, J. (eds) (2019) Music and Dementia: From Cognition to Therapy. New York: Oxford University Press
  • Richards, C. (2020) Living Well with Dementia through Music: A Resource Book for Activities Providers and Care Staff. London: Jessica Kingsley Publishers

Dr Simon Procter is a music therapist and music sociologist who works as a Director of Music Services for Nordoff Robbins. Email: musicservicesadmin@nordoff-robbins.org.uk  Twitter: @simon_procter @nordoffrobbins

How has your care setting incorporated music and has its involvement been more crucial during the pandemic? share your comments below the article.


References

  1. Malloch, S. & Trevarthen. C. (2008) ‘Musicality: communicating the vitality and interest of life’. In S. Malloch & C. Trevarthen (eds) Communicative Musicality: Exploring the Basis for Musical Companionship, pp. 1-11. Oxford: Oxford University Press.
  2. van der Steen , J.T., Smaling, H.J.A., van der Wouden, J.C., Bruinsma, M.S., Scholten R.J.P.M. & Vink, A.C. (2018) Music‐based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews 2018, Issue 7. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub4. Accessed 31 March 2021.
  3. Pavlicevic, M., Tsiris, G., Wood, S., Powell, H., Graham, J., Sanderson, R., Millman, R. & Gibson, J. (2015). The ‘ripple effect’: Towards researching improvisational music therapy in dementia care-homes. Dementia: The International Journal of Social Research and Practice, 14(5), 659-679.
  4. Powell, H., & O’Keefe, A. (2010). Weaving the threads together: Music therapy in care homes. Journal of Dementia Care, 18, 24-28.
  5. Spiro, N., Farrant, C., & Pavlicevic, M. (2015). Between practice, policy and politics: Music therapy and the Dementia Strategy, 2009. Dementia: The International Journal of Social Research and Practice, Advance online publication. doi: 10.1177/1471301215585465
  6. Parsons, J. (2018). Reconstructing the Boundaries of Dementia: Clinical Improvisation as a Musically Mindful Experience in Long Term Care. Voices: A World Forum for Music Therapy, 18(2). https://doi.org/10.15845/voices.v18i2.943
  7. Powell, H. (2006). The voice of experience: Evaluation of music therapy with older people, including those with dementia, in community locations. British Journal of Music Therapy, 20(2), 109-120. 8. McDermott, O., Orrell, M., & Ridder, H.M. (2014). The development of Music in Dementia Assessment Scales (MiDAS). Nordic Journal of Music Therapy, 24(3), 232-251.
  8. McDermott, O., Orrell, M., & Ridder, H.M. (2014). The development of Music in Dementia Assessment Scales (MiDAS). Nordic Journal of Music Therapy, 24(3), 232-251.

 

 

 

 

About Dr Simon Procter

Dr Simon Procter is a music therapist and music sociologist who works as a Director of Music Services for Nordoff Robbins.

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