Why music works in dementia care

By Bev Foster

Music accompanies us on our journey and connects us to people, places and events in our lives. It is cross-coded into life passages and is a powerful stimulus for the brain, both emotionally and cognitively. When it comes to memory care – when semantics, comprehension, working memory and processing are getting muddled and lost – music reaches into places where neural activity may still be intact or least somewhat active.

There are lots of reasons why music is a natural choice in supporting persons living with dementia (PWD). For example, lyric recall and musical melodies may be remembered when names, faces, and menus are forgotten. Neuroscience teaches us why. Music gets stored in both sides of the brain; music gets processed in the brain in many places. For example, melody gets processed in one place, words are stored in another, various parts of rhythm like tempo, duration, metre, in other places, harmony somewhere. This may be why in dementia, one is able to retain musical events because they are stored beyond an impacted area.

New songs and musical skills, even language recovery may be learned because of neuroplasticity. Neurons find a way to connect around a blocked or damaged area in the brain making it possible to form new neural pathways. This may be possible for some PWD.

Music triggers and helps PWD recollect events, people, and places which have emotional connections that have been important and meaningful. When memories are first stored, feelings are often attached with that memory. We know that memories are stronger when attached to emotions.

Music acts as a form of non-verbal communication and a way to express in dementia care.  Dr. Naomi Feil, founder of validation therapy demonstrates this well in her encounter with Gladys Wilson. Music powerfully reframes what would be considered a responsive behaviour. Gladys’ tapping action which moves in exact time with the rhythm, becomes an opportunity for connection, intimacy and communication. https://www.youtube.com/watch?v=CrZXz10FcVM

Research shows that familiar music has the greatest impact on health and well-being. Not that other music can’t be used, but to optimize impact, preferred music works best.  Personalized music may reduce agitated or combative behaviors. Individualized music helps to restructure identity and preserve the self in a PWD.

Carryover effect, that is impacting connections and appropriate behaviours because of musical engagement may last from one hour up to 6 weeks. While carryover effect does not occur every time, music has the capacity to reconnect neural pathways, and wake up that which may be broken, lost, or dormant.

Doing music together contributes to quality of life. This may happen through music listening, music-making or engaging in musical conversations.  In this way, key psychosocial needs in PWD, identified by Kitwood, like inclusion, attachment, occupation and comfort, may be met.

Caregiver-implemented musical activities rather than therapist-led sessions may reduce frustration for a PWD. Participating with family members, especially singing, is a very accessible way for meaningful interaction to occur. Singing can be performed by care staff when administering medication, bathing, portering, transferring etc.

Music is an activity that can be used throughout the dementia trajectory. While in early stages, music may stimulate a recollection or memory, in mid-stage, singing helps in cognition. Singing is recommended as an integral part of any programming provided for persons in late stage dementia. At end of life, music provides beauty and aesthetic as well as comfort, and intimacy.

Music may be used with other modalities such as dance, art, cooking, drama, crafts etc. It can provide a soothing or stimulating background when working in tandem. Music by itself or used in a co-modal way offers meaningful activity to PWD.

Bev Foster, MA, BEd, BMus, ARCT, AMus, is Executive Director of the Room 217 Foundation, a social enterprise dedicated to care through music. For more information on Room 217 resources and music care training, visit www.room217.ca.