Living Well with Dementia through Music

A Resource Book for Activities Providers and Care Staff

Catherine Richards

• Éditeur: Jessica Kingsley Publishers
• Année: 2020
• ISBN:
  9781784508784
• Sujet: Medicine
• Sous-sujet: Diseases & Allergies

Music is an essential tool in dementia care. This accessible guide embraces ways in which music can enhance the daily lives of those with dementia. It draws on the expertise of practitioners regularly working in dementia settings, as well as incorporating research on people with dementia, to help anyone, whether or not they have any musical skills or experience, to successfully use music in dementia care.

Guiding the reader through accessible activities with singing, percussion, sounding bowls and other musical tools, the book shows how music may can be used from the early to late stages of dementia. This creative outlet can extend to inspire dance, movement, poetry and imagery. The chapters include creative uses of technology, such as tablets and personal playlists.

The book also covers general considerations for using music with people living with dementia in institutional settings, including evaluating and recording outcomes.

Living Well with Dementia through Music is the perfect go-to guide for music-based activities with people living with dementia.

PART I

INTRODUCING THE
RESOURCE BOOK

Introduction

— Catherine Richards —

It’s official: music is beneficial for people living with dementia. Those of us who have been working in this area have known it for years, but in January 2018 came the launch of a report on dementia and music commissioned by the International Longevity Centre and the Utley Foundation at the House of Lords, headed by Baroness Sally Greengross. The report was made up of evidence collected from music therapists and music practitioners from across the UK, and was entitled: ‘What would life be – without a song or a dance, what are we?’ (Bowell and Bamford 2018). However, after exploring the benefits gained through a wide variety of music activities, it stated that in spite of these benefits, access to music was only available to residents with dementia in 5 per cent of care homes in the UK. The report called for this situation to improve, stating the need for increased levels of funding for music-related activities for those living with dementia, and for the growth of public awareness of the benefits. In January 2019, as ‘a direct and positive response’ to the report, the national campaign Music for Dementia 20202 was launched, led by the Utley Foundation.3 The aim of the campaign is ‘to make music available for everyone living with dementia by 2020’ (Utley Foundation n.d.) The message behind the campaign is that ‘For people living with dementia, music isn’t a nicety, it’s a necessity’ (Utley Foundation n.d.).

Being involved in the process of collecting evidence for the above report and attending the launch was exciting, partly as it represented a national landmark in the recognition of the benefits and need for music in dementia care, but also because it brought together those of us involved in using music to improve the lives of people living with dementia from many different backgrounds, trainings and perspectives. In the same way, this book has sought to include the experience of experts in this field from a variety of backgrounds, and there are contributions from music therapists, music practitioners, a dance/movement therapist, a philosopher-craftsman and the charity Playlist for Life.

About this book

Where this book differs from others in this field is that it is truly a resource book, with a wide-ranging variety of ideas to be used by and with people with very different interests. These include singing, using percussion instruments, methods of accessing music through technology, ways of using music to inspire other forms of self-expression, such as dance, movement, poetry and imagery, and creating and using personal playlists. It describes the use of innovations such as the Silver Song Music Box – a type of karaoke machine especially designed for older people, and Sounding Bowls – instruments especially crafted to produce a resonant tone and to make a satisfying sound when played by participants living with dementia and caregivers. Interventions are included which can be used from the early to late stages of dementia, and there is a chapter on using music in end of life care. Some activities are designed with groups in mind, while others can be facilitated on a one to one basis, and some could be used in either situation. Ideas suggested can be used in care homes, hospital wards and people’s own homes. As well as activities to encourage engagement, interaction and self-expression, there are chapters describing ways of using music to encourage increased cooperation in tasks involving daily care.

Who is the book for?

The book is for care staff, relatives, activities organisers, those providing training and all those involved in dementia care. It is designed primarily for those with no previous experience in using music. It is hoped, however, that it will also be useful in expanding the practice of experienced music therapists, music practitioners and others using music in their work. The editor has herself learned a tremendous amount from reading the work of the other contributors to this book, some of which she has been putting into practice in her own work and in training others. It is also hoped that the book will be used as part of the training of students from all professions planning to work in dementia care, as this will really help to build a culture where music is seen as an essential tool to be used by everyone involved in this area.

Why is this book important?

The reasons for putting this book together are very much in line with the aims of the Music for Dementia 2020 campaign (Utley Foundation n.d.). For too long, music provision in dementia care has been treated like the icing on the cake – a luxury to be bought in if there’s some extra money to spend. The rest of this Introduction looks at reasons why music needs be an essential ingredient in dementia care used by everyone involved, and explores some issues that prevent this from happening and need to be addressed. It gives an overview of some of the most recent research into the many ways in which music can significantly improve the quality of life for people living with dementia and their caregivers. Included in this is research around the use of music by care staff, and some recent initiatives set up in the UK to encourage more people to use music as part of the care they offer to people living with dementia. It is hoped that this next section will be read in particular by managers, budget-holders and commissioners, whose support is essential in order for the ideas put forward in this book to be carried out successfully for the benefit of the staff whom they oversee as well as people living with dementia: ‘Music is an undeniably significant part of being human. It spans different genres, cultures and eras, and it promotes bonding, communication and wellbeing’ (Bowell and Bamford 2018, p.15).

The rest of this Introduction describes research and work by music therapists and music practitioners. For a summary of the type of work of different music specialists, please see Appendix A.

Benefits of music in improving general wellbeing in older people

Research on the effects of participatory music on health and wellbeing has found that taking part in singing produces significant physiological benefits for all of us. These include: an increase in Immunoglobulin A, which helps to increase the effectiveness of the immune system and resistance to infection (Beck et al. 2006); and a decrease in levels of cortisol – a stress hormone (Kreutz et al. 2004). Grape et al. also reported an increase in oxytocin, which is associated with social bonding and the formulation of new memory, which resulted in participants experiencing increased joy and elatedness, and feeling more energetic and relaxed (2003). It was also found that, in the case of older people, a group musical activity, especially singing, provides a link to previous satisfying experiences, creating a link between younger and older life, and serves as a preventive measure against alienation (Wise, Hartmann and Fisher 1992).

A review of a randomised controlled trial evaluating the benefits to mental health and the cost-effectiveness of running singing groups for people over 60, comments on the considerable ease of recruitment to the project, suggesting that singing seems to be something which many older people enjoy and want to take part in. It concludes that:

the provision of opportunities to meet and sing together provide an opportunity to maintain and enhance the mental health of older people that is cost-effective and acceptable to the population, and should be considered as an important element in any public mental health strategy for this population. (Coulton et al. 2015)

This suggests that singing groups offered to the general population of older people could act as a preventive measure, helping to maintain wellbeing and a sense of continuity, and providing opportunities for self-expression, support and boosting self-esteem following on from diagnoses of dementia and other types of mental illness associated with aging. The cost of running the groups was calculated and found to compare favourably with other activities available to this population. It is likely that, if people’s mental and physiological wellbeing is maintained in this way, admissions to hospital or care homes following diagnoses of dementia could be delayed or possibly even avoided.

Benefits of music in the care of people living with dementia, care staff and relatives

Musical memory in people living with dementia

Music is especially beneficial in dementia care as, whilst other cognitive abilities deteriorate, musical memory remains intact. Hsu (2017) lists three different types of musical memory allowing continued engagement and self-expression even in the late stages of dementia. These are semantic memory, procedural memory and autobiographical memory. The fact that these are preserved enables a person to recognise the melody and lyrics of a song and any associated feelings, recall motor skills learned in the past which may have included singing or playing an instrument, and remember events in their earlier lives associated with particular songs or pieces of music.

The role of music therapy in reducing agitation and caregiver stress

There has been a considerable amount of new literature emerging over the past ten years demonstrating the benefits of music therapy for people living with dementia. One important theme is evidencing the effectiveness of music therapy in helping to manage agitation, thus reducing the need for psychotropic medication. Directly related to this theme is that of the positive effects of music therapy on reducing the stress of caregivers, and improving their relationships with those they care for. Two important pieces of research in these areas have been carried out by Ridder et al. (2013) and Hsu et al. (2015).

A study by Livingston et al. (2017) found that ‘86% of care home residents had dementia. Of those, 40% had clinically significant agitation symptoms and 86% had some symptoms. Those who were agitated had a lower quality of life as rated by staff and family carers.’ In an article entitled ‘Opioids for agitation in dementia’ (2015), Brown et al. state that: ‘The most significant symptoms causing patient distress and carer burden in later stages are the so-called behavioural and psychological symptoms of dementia (BPSD).’ Along with psychosis and mood disorders, agitation is identified as one of the main three BPSD syndromes (Finkel et al. 1996).

Antipsychotic drugs are often used to manage agitation in people with dementia; however, according to Ballard et al. (2009) these ‘show a modest but significant beneficial effect on aggression after short-term treatment (over 6–12 weeks) but limited benefits in longer term therapy’.

In 2009 an inde...