Background - Relation between music and people with dementia
Music interventions for people with dementia: a review of the literature
https://www.tandfonline.com/doi/pdf/10.1080/13607860310001613275?needAccess=true
Main findings in this paper:
- Qualitative review published by Brotns et al (1997) concluded that people with dementia had a positive response to music, but the reason for this remained unclear. For the future, one could investigate the influence of different variables in details such as the music modality, disease severity, type of music played, nature of the intervention, and the type of professional providing it.
- Koger et al conducted a meta-analysis to test the hypothesis that music or music therapy would be an effective intervention for use with people with dementia. Results revealed that the overall effect of music was highly significant, although the effect sizes were not constant across all studies.
This review focuses on examining the methodological and theoretical issues relating to not juts problem behaviors such as agitation, but also behaviors of engagement and participation.
A few researchers who studied the effects of music interventions on problem behaviors such as agitation outlined changes with regards to the physical and pharmacological interventions to manage dementia symptoms. Other researchers who studied the effects of music on participation and engagement highlighted the importance of improving a person's quality of life and sense of self-esteem, especially for those who are receiving long term residential or institutional care.
Most studies reported the effects of music to be effective in decreasing range of behaviors, such as, agitation, aggression, wandering, repetitive vocalization, and irritability. Music was also found to increase reality orientation scores, memory recall, time spent with one's meal, levels of engagement and participation, and social behavior. The mid range theory hypotheses that a person's most preferred music will help them to connect with the past. The music will also provide a focus for attention and a stimulus that the person is able to receive and process. The recall of the past memories will produce a soothing effect, which should prevent or reduce agitation, as the person's stress level is prevented from reaching and exceeding the threshold.
However, one study found no differences between levels of agitation during conditions of no music and music. They suggested that this was because the music was not a personal preference of those individuals. Another study found that individuals were participating more during the exercise sessions than sing along sessions. Lastly, a study found that although music significantly increased the levels of relaxation, it did not significantly reduce the frequency of aggressive behaviors.
It was noted that playing recorded music, which was selected by the individual, rendered environmental noise familiar and predictable, and provided a connection with positive memories from the past, which invoked soothing feelings in the present. Another research showed that playing recorded music created a relaxing atmosphere. The music activity was seen to be important as it placed few cognitive demands on participants and provided an opportunity for social interaction which did not rely on verbal skills.
The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists https://www.tandfonline.com/doi/pdf/10.1080/13607863.2013.875124?needAccess=true
In this study, a quantitative study was conducted to develop insights into the musical experiences of people with dementia and explore the meaning of music in their lives.
Music-based interventions are known to be beneficial for the psychological well-being of people with dementia. It is easily accessible and a stimulating medium that can be enjoyed alone or with others even when the person has severe dementia. The residents of care homes and their family members have highlighted that music listening, dancing and singing are particularly meaningful amongst all care home activities. Studies found that people were able to appreciate and engage with the music even as their cognitive functions deteriorated.
A total of six themes were discussed and evaluated. The nature of the six themes may be broadly described as: the impact of music on the individual, the effect of the impact of music, and evaluating and communicating the impact of music. Based on the analysis, it was understood that music taps into an individual's sense of self in regards to their personal preferences and life history. Thus, music is not only used as a tool to fix a behavioral problem, such as agitation, but rather is a part of a wider application of life. This can be seen as self-actualization and self-transcendence, the two highest levels of Maslow's Hierarchy of Needs.
Families, staff and therapists have highlighted the immediacy of residents' responses to musical stimuli. Families notices a visible uplifting effect on the residents' moods, an increased alertness and interest in their surroundings, whichh suggests that music has a stimulating effect. The staff realized that music had a relaxing effect on the residents' mood and thus on the care home environment. Therapists also highlighted the importance of musically matching whatever the clients said here and now, including repetitive vocalization, crying or wandering, which are perceived as challenging behaviors in other circumstances.
The choice of music was highly personal. Every person had a musical identity that was often closely linked to different life events, personal and cultural identity, and a particular era. It was also noticed that people with a late stage of dementia found it emotionally meaningful when they recognized familiar music. One resident said that he was able to recognize songs from his childhood even though he often forgets things. So this helped support his personal identity.
Many people recognize themselves as independent individuals who are now dependent with a terminal illness or disease. The process of deconstruction and reconstruction of identity has a huge impact on personal psychology. Music may help to protect the identity of a person or support the process of redefining their identity through positive person work. Music therapy seemed to encourage clients to share their challenges of living with dementia verbally and non-verbally during group music making.
Carefully planned music interventions will provide opportunities to support the personal psychology of the person with dementia and help sustain a good social psychology in their care settings. All in all, it was found that music has a positive impact on a self of self, helped to protect self-identity, lessened feelings of isolations and loneliness, helped the development of connecting with other people and provided an experience of spirituality. The musical identity of an individual and the need for shared meaningful musical experiences is retained through the ageing process, even in the context of dementia.
About Music and how we used it
Several non-pharmacological interventions to prevent people with dementia from wandering already exist. By engaging PwD in social activities, navigation and monitoring technology, or environmental modifications, it has been tested in studies, if PwD could be prevented from wandering and getting lost [1]. However, not all of these methods seem successful or harmless (e.g. thinking of tracking systems).
Especially activities related to music have a positive effect on the mood and emotion of PwD. Certain music or songs can trigger mutual, emotional memories [2]. Therefore, it is not far-fetched to take advantage of these positive effects and also use music to keep people from wandering. Lancioni et. al. (2011) found out, that during activities like coloring or listening to music, PwDs tend to start wandering less than if they did not perform these activities [3]. Non the less, these social activities can not reliably prevent wandering at all times. In case the activities do not distract PwD enough and he/she still heads to the exit door, these methods are powerless to prevent them from leaving.
In the study of Lancioni et. al. (2011), music was used as a distraction activity. In our project, we are going to make use of the positive effects of music as well but in a different way. In our case, the music should not avoid the original thought of going out, but deflect when the person comes up with that thought. This means, that the person is trying to leave the care home, but will be interrupted at the door. At this point the music is used to take their mind off leaving.
Aim of the use of music
What we want to achieve with music are in general two things:
- Distract from the original idea to leave the house
- Remind the Person, that there is no reason to leave the house
The first goal can be achieved by introducing certain activities that are related to music, e.g. dancing. The robot starts playing dancing music and invites to join for a dance. By executing this task the PwD is distracted and not longer thinking about leaving.
Another possibility to use music is to remind the person of their surroundings and situation. Some patients don't consider the nursing house as their home. If a certain song is connected to a room in the care home, this brings the patient back to reality and reminds of being in the care home. This could be a song they normally sing before lunch, the opening song from their yoga lesson or just a short jingle of their favorite tv program.
Choice of music
The selection of music should always depend on the reason for leaving and mood of the person. Therefore it's relevant, that a broad selection of music is available. In further development an individual playlist for each patient could be created in an introduction session with the robot. Due to lack of time, we are providing one general playlist with only one song for each situation - mood combination.
[1] MacAndrew M, Brooks D, Beattie E., NonPharmacological interventions for managing wandering in the community: A narrative review of the evidence base. Health Soc Care Community. 2019;27:306–319. https://doi.org/10.1111/hsc.12590
[2] Peeters M.M., Harbers M, Neerincx M A., Designing a personal music assistant that enhances the social,
cognitive, and affective experiences of people with dementia. Computers in Human Behavior. 2016;63:727 - 737 https://doi.org/10.1016/j.chb.2016.06.003
[3] Lancioni, G. E., Perilli, V., Singh, N. N., O’Reilly, M. F., & Cassano, G., A man with severe Alzheimer’s disease stops wandering during a picture colouring activity. Developmental Neurorehabilitation. 2011 14(4), 242–246. https://doi.org/10.3109/17518423.2011.575439