Breaking down barriers to using music in dementia care

‘There are 850,000 people living with dementia in the UK, with numbers set to rise to over 1 million by 2025.’(1)   ‘Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year.’(2)  

Catherine Richards shares her top tips and the multiple benefits of using music as part of the care of people living with dementia.

Using music as part of the care we offer to people living with dementia has a number of proven benefits. The introduction to ‘Living Well with Dementia’ outlines research demonstrating that the use of music can reduce agitation and thus the need for psychotropic medication, reduce stress for caregivers, help to maintain a sense of identity, act as a medium through which people can communicate and express themselves in the “here and now”, enable an increasing sense of connectedness with those caring for them, support their relationships with their spouses, help to improve the caregiving skills of those who care for them, and help caregivers to facilitate daily living activities more easily. Also demonstrated are the potential of regular music interventions in helping to delay admissions to hospitals or care homes, and to reduce staff sickness. With the quality of life of so many people living with dementia and those who care for them at stake, the question needs to be asked: “Can we afford not to fully integrate music provision into the daily care of people living with dementia?”

In many cultures around the world, everyone takes part in making music. I remember being fascinated by the examples of different cultural attitudes to music described by Christopher Small (3)  and John Blacking (4)  when studying music in the early ‘80s. In our Western culture, however, there is often a clear distinction between those who can sing or play musical instruments and those who cannot. In my work, I have come across many professionals, care staff and relatives who feel that it would not be right for them to use music as part of the care they offer as they are “not musical” or “can’t sing”. Some were thrown out of their school choir, or told to mime. There are some places in our culture where it is acceptable to sing, regardless of a lack of musical training and whether or not we have a “good voice”. These include football and rugby matches, church, parent and baby/toddler groups, and live rock/pop/folk concerts or gigs. I hope that one day this list will include care homes, hospital wards and private homes where people living with dementia are being cared for.

Living Well with Dementia through Music” is for anyone caring for someone living with dementia, and assumes that readers do not have any musical training. It aims to break down barriers to using music in dementia care by providing a number of ways that music can be used by non-musicians. There are chapters showing you how to run singing groups and compile personalised song books. If singing is out of your comfort zone though, perhaps you’re more relaxed around technology? Music therapist Alison Acton has written a chapter on using iPads as a music tool. Or you might want to create a playlist for someone to use at particular times when they tend to become agitated. If you are more visual by nature or enjoy poetry, you can create posters or poetry inspired by music together with those you care for, which can be displayed and be used to initiate conversation with friends, relatives and staff. Those of you interested in the benefits of sound therapy might be interested in purchasing a Sounding Bowl, a plucked stringed instrument with extra resonant qualities which have evoked a positive response from many people living with dementia. Or you might be struggling to facilitate daily personal care tasks such as washing or getting dressed. Music has been proven to help with this too, as described in chapters by Harriet Powell, and Maggie Grady and Ruth Melhuish.

I was asked to give some “top tips” for using music as part of the care of people living with dementia for a feature on the book on the website Music for Dementia 2020, which campaigns to make music available to all those living with dementia by 2020, and feel it would be useful to include these here too. 

Top Tips:

(i) Think about which aspects of music described in the book you enjoy and would feel most comfortable using, and take the time to explore a little by yourself first before introducing any new ideas to someone else. If you feel confident and relaxed, the person you are caring for is more likely to be receptive to the intervention.

(ii) Think about how you are going to use an intervention to meet the needs of the person you are caring for. For example, there are several reasons why you might want to use music as a means of encouraging dance/movement: to maintain physical fitness and movement in limbs, joints and fingers etc; to engage someone and help to lift their mood as it is an activity they enjoy; and/or to encourage reminiscence and rekindle affection for a partner, remembering times when they used to dance to music earlier in the relationship. There is a chapter in the book about using music to inspire movement and dance by Dance/Movement therapist Nicola Jacobson-Wright.

(iii) Be prepared to try new things, and for the possibility that something might not work to begin with. If the person is giving clear signs of displeasure, just stop, and think about the possible reasons for their negative response – talk with them about this if possible. It may be that they have something else on their mind, that they were hungry, needed the toilet or were feeling unwell, and that they might respond better another time. They may not feel comfortable in that particular space, and respond better in another room. Someone I am currently working with gets cross when I come onto the ward and refuses to join in with the music, but thoroughly enjoys coming to another group I run in a different building. It may be that they need time to get used to something new, and can only manage a short amount of time to begin with. Or it may be that they just don’t like that particular intervention, and that you need to try something else. Trial and error is key, and you will be learning all the time.

(iv) Be prepared to be flexible, and for benefits to be gained from introducing music into the care of someone living with dementia that you didn’t expect!

The message behind the campaign Music for Dementia 2020 takes its lead from the report “Without a song or a dance what are we”, commissioned by the Utley Foundation (5): ‘For people living with dementia, music isn’t a nicety, it’s a necessity’. I hope this book goes some way towards breaking down the barriers preventing people from getting their needs met through music, so that by the end of the year 2020, more people truly are “living well with dementia through music”.

Catherine Richards

Get your copy of Living Well with Dementia through Music, here.

References
1. Alzheimer’s Society (n.d.) ‘Facts for the media’. Accessed on 03/06/19 at www.alzheimers.org.uk/about-us/news-and-media/facts-media

2. World Health Organisation (2019) ‘Dementia’. Accessed on 03/06/19 at www.who.int/news-room/fact-sheets/detail/dementia

3. Small, C. (1977) Music, Society, Education, Great Britain, John Calder Ltd.

4. Blacking, J. (1976) How Musical is Man, London, Faber and Faber

5. https://ilcuk.org.uk/wp-content/uploads/2018/10/Commission-on-Dementia-and-Music-report.pdf. Accessed on 09/03/20

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