10
Music
What is your favourite piece of music? Why? What emotions does the piece evoke in you?
Music is a primal and fundamental part of all human cultures, and some researchers have argued that music developed before language did. We haven’t figured out why music and accompanying dance developed. Competing theories are that music evolved as a way of increasing sexual attractiveness (like the songs of songbirds), promoting group bonding (like singing a team song) or as an accidental artefact of our brains’ tendency to see patterns, causing us to interpret regularly timed noises as rhythms or repeated pitches as melodies.
When we make music we usually have our attention focused in the moment even if we’re drawing on information stored in our memory. Music is almost always associated with emotions, sometimes more strongly and sometimes more weakly.
I have met people with dementia who do not talk but can sing, and people with dementia who have very poor memories but who play complex pieces on the piano from memory. This is because singing a song or playing the piano uses procedural memory for music. Since procedural learning is relatively intact in people with dementia, they can also learn how to sing a new song more easily than may be expected. Choirs for people with dementia often include a mix of traditional and new songs, and the people with dementia learn to sing the new songs. Many people with dementia forget that they can make music. We once filmed a lady with dementia playing the piano. When we showed her the video later, she was surprised that it was her playing, and both proud and impressed at her own accomplishment!
If the person with dementia you care for used to play an instrument, they might still be able to do this. I would encourage you to facilitate the opportunity for them to try to play; we have seen some people become themselves again for the minutes they are playing. However, do not be disappointed if they refuse or are unable to play.
Music is a good technique for connecting with people with moderate to severe dementia who are less able to communicate verbally. Research suggests that people with dementia benefit from music more when they are actively participating, by which I mean singing, clapping or moving to the music in some other way. Getting the person with dementia physically involved makes them use their brain and their body more than if they were just passively listening.
Music is a powerful way of encouraging reminiscence. When we hear certain songs they take us back to situations when we previously heard them—a dance song reminding us of our teenage years, Christmas carols reminding us of family sing-alongs around the piano, a lullaby reminding us of our mother or our children. After participating in music, people with dementia may want to talk about the music itself, memories relating to the music or the content of the songs. Or they might be more stimulated and chatty generally.
Choosing music
Many of us have strong opinions about what music we like and dislike. Many people with dementia will too. Most of us like music that was popular around our formative years—age ten to 25—though we may also enjoy a diversity of music from other styles and eras. The internet has made it much easier to access old music and lesser known music. Local libraries also have music collections of varying size and depth. This makes it much easier for us to find music that a person with dementia may relate to.
There are many ways of deciding what music to use with the person with dementia you care for. If you know them well, you might already know what musical genres and particular pieces they like. If not, ask them or their family about what music they like. If you get vague answers, ask them more specific questions: What music was popular when you used to go to dances? What did you dance to with your husband? Were there any songs you used to sing as a child or when you were younger? What music was played at your wedding?
If you can’t get specific information about the music that a person with dementia likes, then you have to go on a musical detective hunt. Try playing music they may have a connection with and watch for their reaction. Make sure that you watch for their reaction during the most catchy or memorable part of the song, such as the chorus, rather than during an instrumental introduction or verse. Once you have discovered one or two pieces that they like, you can try different pieces of the same style, or same artist or same era. You could start by trying music that was popular in their country of birth during their formative years (when they were aged between ten and 25) or songs that many people may know because of high popularity such as childhood songs, Christmas carols, hymns, traditional songs and classical music. There is a list of these pieces of music for English-speaking countries at the end of this chapter.
Case study
Brian
Brian is attended to but not warmly spoken of by the care staff. When they interact with him, he is either minimally responsive or irritated. He demonstrates little warmth or humour with them.
One of the care staff looking after Brian, Angie, decides to try to connect with him through music. She tries to find out what kind of music he likes but June and Gary don’t know. She tries music from his youth such as Motown and Big Band but he doesn’t respond much. One day she notices him tapping his foot to a country and western song that plays as the background music to a television program. So she borrows an old country and western CD from the library. She plays it for him and he taps along. He starts singing along to The Days of Old Khancoban by Smoky Dawson; he continues to listen and react to the rest of the music. At the end of the CD, Angie plays The Days of Old Khancoban for him again and once again he sings along, and she tries to hum along with him. Angie says: ‘Do you like this music?’ to which Brian responds, ‘A great song.’
‘Would you like to listen to his music again tomorrow?’ asks Angie. ‘Yes,’ says Brian, and he gives Angie a big smile, which is unusual from him.
From then on, whenever Angie is working she plays old country music to Brian. He seems to like Smoky Dawson and Slim Dusty best, but enjoys modern country such as Keith Urban as well. The other staff remark about how Brian seems to be more relaxed and comes out of his shell more when the music is playing. If he is in a cranky mood he might continue to pace and hum and tap along, but the music seems to calm him down. So, when Brian is uncooperative with showering or dressing, Angie sings The Days of Old Khancoban to him, and often he sings along and becomes more agreeable. Sometimes she encourages him to clap or tap the table in time to the music, and he often goes along with this.
Angie talks with Gary and June about Brian enjoying music, and writes down a list of music that he seems to particularly like. June puts the songs on Angie’s list onto an iPod. They try several sets of headphones before they find a pair that is comfortable enough so that Brian won’t pull them off. Every day staff put the music on for him, and he seems to know what it means when he sees the headphones, most times accepting them and enjoying listening to the music. This continues even when his dementia deteriorates.
The above example shows how an observant carer who spends time with a person with dementia can find out the type of music that interests them. It shows how Angie was able to interact with Brian through music and build their relationship. Systematic observation (and possibly documentation) of a person’s reactions to music can help create a tailored playlist for them. It shows that when staff see a person with dementia as having an interest or hobby, it can make them seem more like a person, in the same way that finding out some personal information about a stranger can make you feel more familiar with them. It also shows the benefits of setting up a system so that all staff could give Brian access to his music. This illustrates how good communication and responsiveness between family and professional carers helps in developing and delivering activities.
Residents who are more cranky or behaviourally challenging, or who demand more time than staff can give, may receive less affection from staff. If a resident responds easily when spoken to or touched, and the carer gets some satisfaction from the response, the resident receives more attention and responds even more positively. On the other hand, if the resident does not respond easily to staff, he or she receives less attention. If staff find or are shown a way to interact with residents so that they are responsive, the resident may receive more positive attention. Staff might think that residents will only response positively with family because they have an established relationship, but if they see other staff members having positive interactions with the resident they might be more likely to try to interact with them in an engagement-focused rather than a task-focused way.
Sourcing music
If you are in luck, the person with dementia might already have an old record collection that you can rummage through, in which case you just need to locate a working turntable and you’re in music. If you’re looking for specific pieces of music or lyrics for songs, these may be available on iTunes, on YouTube or other sites on the internet. If you’re looking for genres of music, or music from specific artists or eras, you may also be able to find these pieces through your local library. There may also be free-to-air or internet radio stations playing music of specific genres or eras.
When looking for music, if there is an ‘original’ version of a song that the person would have listened to a lot, preferentially use that over a cover version.
Remember that you carry a musical instrument around all the time—your voice! Some of you might think that you can’t sing. You can sing, though you might not like the sound of your own singing. The point of singing to, and hopefully with, a person with dementia is not to put on an award-winning performance. Your singing will almost certainly be good enough for the person with dementia—and if they are critical of your singing then you’ve provoked a response, though perhaps not the intended one! Singing is a really convenient way of engaging a person with dementia when you’re doing another task with them. Professional carers have told me about how when they sing with the person with dementia, they are happier and more cooperative when getting dressed or having a shower.
Presenting music
You can use music to stimulate, energize and activate the person with dementia, or to distract and calm them down. You can choose different music depending on what your intention is, or you might find that the same pieces work for both situations. Use the same pieces of music repeatedly; as the person becomes more and more familiar with the music they will relax into the music even more. If you’re going to use a portable music player and headphones, as have been shown to be effective for nursinghome residents in providing diversion and enjoyment, make sure you use comfortable headphones fitted to the person and that the volume is at an appropriate level for their hearing.
Sing
Sing together, either a capella or to recorded music. If you don’t know the words, hum along, look them up or make them up. It doesn’t matter if you think you have a terrible voice or you think you can’t hold a tune—as long as the person with dementia doesn’t complain about your singing then keep doing it!
If the person with dementia can’t sing the whole song, he may be able to sing the chorus or just parts of the chorus, in which case cue them into their part. For example, as part of the song He’s Got the Whole World in His Hands he might sing ‘in his hands’.
Move
When singing or just listening to music, encourage the person to move to the music. Model the movements you want them to do and get him to copy you—some of these can be done either standing or sitting, and you can do a combination of these. The person is exercising their brain when copying your behaviour, coordinating their movements and synchronizing them to the music. For example:
Case study
Joy
Bernie has dusted off their old record collection and taken out the turntable. After changing the needle he pulls out one of Joy’s old favourites, Ella Fitzgerald Sings the Cole Porter Song Book and puts it on. The chorus starts for the first song: ‘All through the night, I delight in your love, All through the night you’re so close to me! All through the night!’ Joy comes in humming and Bernie spontaneously grabs her hands and pulls her into a dance hold. They start dancing together and dance through the whole of the first side.
After the last dance, they collapse onto the lounge.
The above example shows how music led to spontaneous dancing (exercise!), reminiscence and physical and emotional closeness. Putting the music on took them out of their routine interactions and stimulated some old memories and associated romantic feelings.
Popular songs from the past
Here is a list of artists and songs from the 1930s, 1940s and 1950s. Pick songs from the era when the person was aged between ten and 25 years. I’m aware that this is a very Western-centric list, and that people from other cultures might have different music they will have listened to during their youth.
Other popular songs
Here are some other popular genres and songs you might like to try:
Nursery rhymes
- Ring a Ring a Rosie
- Baa Baa Black Sheep
- Old McDonald Had a Farm
- Hickory Dickory Dock
- Row Row Row your Boat
- Twinkle Twinkle Little Star
Christmas carols
Traditional songs
- Waltzing Matilda
- When Irish Eyes are Smiling
- Scarborough Fair
- Danny Boy
- The Road to Gundagai
- Yankee Doodle
- She’ll be Coming Round the Mountain
- When the Saints Come Marching In
Hymns
Classical music
There are many, many pieces of classical music to choose from: here are just a few. I’ve chosen these because they have immediately familiar beginnings, are heard regularly on classical channels and on advertisements and television, and have regular rhythms and are easy to clap or hum to.