NHS England’s National Clinical Director for Dementia and the Deputy Chief Allied Health Professions Officer look at how music can trigger golden memories and benefit people with dementia:
Listening to, and enjoying music, is a universal experience.
It reflects and directs our mood, and now innovative and more convenient ways of delivering content makes it easier to listen to music and enjoy it at our convenience.
Music and memory have a powerful connector. Music lights up emotional memories – everyone remembers songs from their past – the first kiss, the song at a wedding, seeing their parents dance and we often use music to remember people at funerals.
Music can have many benefits in the setting of dementia. It can help reduce anxiety and depression, help maintain speech and language, is helpful at the end of life, enhances quality of life and has a positive impact on carers.
There are three main ways in which people with dementia their families and carers can enjoy and benefit from music.
The first, and potentially the most important, is that listening to music provides a ready resource for enjoyment and entertainment, especially when shared with families and loved ones in a shared experience.
A bit like walking, it is something everyone can do for little or no cost. It should be managed carefully, and having indiscriminately piped music in the background of, say, a care home would not be appropriate. Music should be specifically tailored to the choices of individuals and people with dementia are well able to express those preferences. Care and attention should be paid to people with hearing loss, a point which was underscored in a recent blog.
Second, there are a number of initiatives specifically developing bespoke playlists for carers and loved ones for people with dementia. This can facilitate sharing and very positive interactions and there is increasing evidence that musical memory may be different to the kind of day-to-day memories that can be affected in dementia. There is some evidence that retaining memory for music enjoyed between the ages of 10 and 30 is much more enduring. Rekindling these can have a beneficial effect.
There are many stories and examples where music in care homes and in institutions is extraordinarily effective at bringing people together and stimulating memories. Memorable stories of individuals who were withdrawn and apathetic who have been brought back to life by listening to their favourite music, and most people will be aware of the positive benefits of “Singing for the Brain”. Music can go to places where other things do not and the shared experience and friendships can have a positive benefit.
Thirdly, in terms of expert musicians, there are famous examples: Aaron Copland and Ravel who suffered from dementia and more recently Glenn Campbell, one of the world’s most famous country and western singers, was able to perform relatively late into his illness.
Musical memory is a form of implicit memory, usually hardwired into the brain unless prone to the changes in the brain which usually herald dementia. There is evidence from scientific studies that listening to music lights up the brain in many places, reaching the parts that others can’t. The recent All-Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) showed the benefits of music.
Music therapists hold a postgraduate clinical qualification as well as a degree in music and are regulated by the Health and Care Professions Council. They may work with individuals and groups, with family carers, with other health and care staff and with musicians to introduce music as a vehicle to address needs of individuals who are living with dementia.
Many organisations, such as the Methodists Homes Association, employ music therapists specifically to engage with people with dementia. There are other Allied Health Professions (AHPs) who may use music to enhance the benefits of their interventions. For example occupational therapists advise, train and mentor carers and care and support workers to use music and singing for reminiscence, physiotherapists provide balance and stability exercises to help reduce the risk of falling and may use music to aid movement as part of regular exercise routines.
In addition, in terms of prevention, there is evidence that learning to play a musical instrument later in life hones cognitive and fine motor skills and could have a role in prevention. A study of twins from the United States showed that, after taking into account other variables, people who learn to play a musical instrument later in life were a third less likely to develop dementia.
The International Longevity Centre has recently launched a Commission into Music and Dementia highlighting many of the key aspects of the link and the potential to exploit it for the benefit of people with dementia, their families and carers. In care homes it is estimated that 80% of people have dementia or very significant memory problems but only 5% have access to art and music. There are powerful examples of where music can change lives
The evidence base, looking at randomised control trials, shows there are gaps that are yet to be filled. There are very few, very good quality trials to show the benefits of music but there is some evidence to suggest that music is beneficial for improving psychological symptoms such as depression, agitation or aggression. But the evidence is less so in terms of other improvements in other areas such as memory. The benefits of music to people dealing with dementia are clear, as well being available at little or no cost to patients and the NHS.
The universal nature of the ability to enjoy music provides a very powerful tool to enhance the quality of life of people with dementia. It will be for everyone to, at least, read the International Longevity Centre’s excellent commission on dementia and music report, to become aware of the issues, to be more cognisant of the potential for music to improve the lives of people with dementia and to build on existing evidence and structures.