CNS Long-Term Care. Same publication, different look.

Cnsltc.com Summer 2004 Vol. 3. No. 3

Music to Their Ears:
Reaching the ElderlyThrough Song

Heather Davidson’s voice is the last one some patients at Silverado Senior Living hear before the pass away Ms.
Davidson isn’t a physician, a nurse or a member of the clergy.

She is a music therapist.

In her role at the southern California nursing facility, Ms. Davidson sings for—and with—the residents, plays guitar, dances and sometimes just hums quietly. Her presence elicits emotional responses and abilities that sometimes surprise even the clinicians at Silverado, nurturing a connection with individuals who may otherwise feel little link to the outside world.

As one of 5,000 certified music therapists in the United States, Ms. Davidson is not alone. Music has long played a role in clinical settings to improve mental, physical, social and emotional functioning. Studies—albeit often small and quite general—report positive effects in the context of dementia, agitation, cardiac rehabilitation, terminal cancer, palliative care and even osteoarthritis pain.

And because melody is independent of language, music may be even more beneficial in long-term care, promoting personhood by providing social interaction opportunities for cognitively impaired patients. “Music is a very profound medium when working with these patients,” Ms. Davidson said. While they may speak in word-salad, they can remember and sing all the words to old familiar songs.

An understanding of exactly what types and presentations of music produce optimal affects, however, has been elusive. A recent meta-analysis of 21 empirical studies in dementia concluded that although music shows positive effects, a systematic evaluation of protocols—such as whether the intervention was active or passive, whether the music was live or taped, whether sessions were led by a trained music therapist, and length of treatment, for example—is needed to determine the most effective techniques (J Music Ther. 1999;36:2-15).

A new study may lead the way in targeting at least one of those specifies. Hoping to determine whether live or recorded music fosters greater engagement and promotes well being in people with dementia, researchers at the Gloucestershire Partnership NHS Trust and Lancaster University in the United Kingdom conducted a three-month observational study in 24 patients. Using a repeated-measures design, with each subject as their own control, they compared behavioral outcomes of three conditions: no music; a taped selection of commercially recorded music, and a live performance of the same music performed by the same musician (Aging Men Health. 2004;3:233-241). Response frequencies associated with meaningful activity and extreme well-being were greatest during the live music condition.

I’m not at all surprised,” Ms. Davidson commented, noting that in her experience, live music has been likely to encourage active participation. “The majority of the music they enjoyed when they were young was live; families would gather around the piano after dinner and sing together, and they would go out for a Sunday drive and sing. As teenagers, they would frequent dances featuring live bands…engaging them in live music as elders reminds them that they are still alive and have much to offer.”

—Jennifer Kulpa and Irene S. Levine, PhD

To find a music therapist in your area, Contact:

American Music Therapy Association, Inc.
8455 Colesville Road, Suite 1000
Silver Spring, MD 20910
Phone: (301) 589-3300
Fax: (301) 589-5175
Email: findMT@musictherapy.org

Benefits of Music Therapy:

· Anxiety and stress reduction

· Awareness of self and environment

· Emotional intimacy

· Memory recall

· Mood and emotional elevation

· Nonpharmacologic pain management

· Sense of control

· Social interaction

· Stimulation

· Structure

· Verbal fluency

Selected Readings

Brotons M, Marti P. Music therapy with Alzheimer’s patients and their family caregivers: a pilot project. J Music Ther. 2003:40188-150.

Clair AA. The effects of music therapy on engagement in family caregiver and care receiver couples with dementia. Am J Alzheimers Dis Other Demen. 2002:17:286-290.

Emery CF. Hsiao ET, Hill SM, Frid DJ. Short-term effects of exercise and music on cognitive performance among participants in a cardiac rehabilitation program. Heart Lung. 2003:32:368-373.

Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. 2303:40:113-137.

Gregory D. Music listening for maintaining attention of older adults with cognitive impairments. J Music Ther. 2002:39:244-264.

Hagen B, Armstrong-Esther C, Sandilands M. On a happier note: validation of musical exercise for older persons in long-term care settings. Int Nurs Stud. 2003:40:347-357.

Hilliard RE. The use of music therapy in meeting the multidimensional needs of hospice patients and families. J Palliat Care. 2001;17:161-166

Krout RE, Music therapy with imminently dying hospice patients and their families; facilitating release near the time of death. Am J Hosp Palliat Care. 2003;2-“129-134

Krout RD. The effect of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. Am J Hosp Palliat Care. 2001;15:165-173.

Lou MF. The use of music to decrease agitated behaviour of the demented elderly: the state of the science. Scand J Caring Sci. 2001;15:165-173

McCaffrey R, Freeman E. Effect of music on chronic osteoarthritis pain in older people. J Adv Nurs. 2003;44:517-524

Remington R. calming music and hand massage with agitated elderly. Nurs Res. 2002;51:317-323

Suzuki M, Kanamori M, Watanabe M, et al. Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia., Nurs Health Sci. 2004;6” 11-18.