There is a substantial body of research that provides evidence of the crucial role that music plays in support of people with dementia, writes Diana Kerr.
We all respond to music. Mothers sing to their newborn babies to calm and make them feel secure; adults turn to music to express emotions, reflect feelings, to make them happy and to make them sad. Music is a core element in all our lives.
This is no less the case for people with dementia. As other experiences become confusing and communication becomes difficult, the role and experience of music gains importance. Music stays with us long after speech and other skills have gone. Anyone who has worked with people with dementia will have witnessed people who have lost the ability to speak coherently, or find words at all, sing an entire song perfectly. It is not only the words but the musical memory that stays, so people will hum or whistle a tune even when the words to the song have gone.
One of the important aspects of supporting people with dementia is to minimise the impact of their losses and to play to their strengths. If people can sing then we should be encouraging this, so as to maintain the skill and the sense of achievement and joy that goes with it.
There is a substantial body of research that provides evidence of the crucial role that music plays in support of people with dementia.
We know that music is effective in reducing a range of challenging behaviour. Playing calming music will reduce agitation (although, music should not be played for more than 20 minutes at a time as research shows it can become a source of irritation and carers need to monitor this); music can reduce aggressive behaviour, ‘wandering’, repetitive vocalisation and irritability.
We know that if caregivers sing to people with dementia when carrying out intimate tasks the incidence of challenging behaviour can be significantly reduced. This may be the result of a number of factors. For the caregiver the mere act of singing reduces stress in them and this will be transmitted to the person with dementia. Also, the sound of the person singing may be calming because it is reminiscent of the mother singing to the child.
If we play the right music at mealtimes people will be more relaxed, will sit longer at the table and will eat more. Given that people with dementia have problems with eating, this appears to be an opportunity not to be missed. Remember to use music that is important to the person with dementia. Different people respond to different music. There is evidence that we remember best the music we heard between the ages of 16 and 24.
Using music appropriately can lead to an improvement in reality orientation scores, memory recall and social behaviour. The use of music will often trigger communication. It may trigger speech but it can also allow the person with dementia to sing something that reflects their mood or articulate something they want to say but can only sing. The lady who sang to me ‘Show me the way to go home’ is an excellent example of that.
Even at the end stage of the condition, when people are close to death, music will reach them. It is important not to assume that the person lying inert and apparently not responding is oblivious to the sound of music. Play or sing to people at end stage and you will see changes in their facial expression, even vocal activity and physical movement. Music can provide one last way to reach the person and enable them to respond at an emotional level.
Music can awaken our senses; it can give us energy and stir memories. This is as true for people with dementia as it is for those of us without the condition.
The following story is a wonderful illustration of this.
Malcolm heard of a music group being set up in his local community for people with dementia and their carers. His wife Isobel, who had dementia, had not spoken for the last five months. She no longer showed any facial expression and seemed to be in a world of her own.
With great trepidation Malcolm brought Isobel to the group.
To begin with Isobel appeared agitated and just sat and stared as the singing got underway. Slowly her hand started to tap her thigh, then she moved her body, then she began to make some humming noises. By the end of the session Isobel was singing and smiling.
The next morning she woke up and said to her husband ‘I think we should bake a cake today’ and they did!
It would be foolish and wrong to pretend that music always leads to such dramatic events.
My experience is that this is not uncommon, but even small changes are to be valued. Even if the person with dementia forgets that they were singing soon after the event, this does not negate its worth. They will still feel good, even if they cannot remember why. People with dementia live much in the moment so we should try to make as many of those moments as possible good ones. Music undoubtedly achieves this.
We know that singing and listening to music can make us feel happier. If you are not using music either as something to listen to, dance to, or sing along to, then people with dementia are being deprived of a wonderful, core human activity that will enrich their lives.
Diana Kerr is a practitioner and educator in the field of the care and support of older people. She is an associate consultant of The Dementia Centre, HammondCare.