Benefits of Music Therapy for Dementia Patients

Introduction

 Music has the ability to bring you back in time. You are able to relive moments from your past and feel all the emotions as you did when the event first occurred. When hearing a particular tune, you find yourself going back in time to that vacation you took to Florida with your friends, or to the time when you were 5 years old dancing around the kitchen with your grandfather, banging pots and pans while singing at the top of your lungs. While you are remembering those happy times in your life, your grandparents may be beginning to lose their memories from the past as a result of dementia.

 Music has many benefits to offer those who are living with a dementia diagnosis. Within the early stages of the disease, music can be used to help recall important life events. “Musical memories are generally often longer preserved than non-music memories” (Vink, 2013). Music therapy has also been known to provide a relaxation to those in the more advanced stages of dementia. It can be seen as a way of reducing anxiety and creates a calming lullaby. In the last phases of dementia, music “is one of the last cues which can be perceived” (Vink, 2013). A Musical therapist’s job would be to sing and play music for their patients and observe their heartbeats to see if the client is responding to the music, whether it is relaxing them or creating a verbal response such as talking about memories from the past.

 The purpose of this research is to understand what music therapy is and its ability to create expression in cognition, social and emotional functioning, where it gives a voice within groups of people in any stages of dementia. Also, how musical therapy is a potential non-pharmacological treatment for the behavioral and psychological symptoms of dementia within a health care setting.

What is Music Therapy and How does it help dementia patients?

 To begin, the definition of music therapy is “the skillful use of music and musical elements by an accredited music therapist to promote, maintain, and restore mental, physical, emotional, and spiritual health” (Canadian Association for Music Therapy, 1994). Over the centuries, music has been used in a therapeutic manner. While in a health care setting, music is provided for relaxation purposes or to relieve pain in some cases. Back in World War II, musicians were asked to play for the wounded soldiers within the crowded hospitals and played for recreational purposes. The music was known to bring forward emotions within the soldiers and since that time, music has been used therapeutically.  Music therapy has been used to improve the health and wellbeing of patients who are diagnosed with a variety of disorders which include Alzheimer’s disease and dementia as well. This therapy has been seen to evoke positive responses to its listeners. Some positive outcomes include “increased self-esteem and motivation, enhanced socialization and communication, improved expression of emotions, and improved transference of information related to relaxation” (Mays, Clark and Gordon, 2008). Traditionally, music therapy is conducted by a music therapist and is often combined with other types of care. However, some programs do not use a music therapist to implement the activities. This method allows patients to listen to their own music of something they would be able to recognize and enjoy.

Music Therapy for Elderly People with Dementia

 In 1906 when dementia was first diagnosed, Alzheimer’s disease was considered a rare disorder. Today, “Alzheimer’s disease is the most common cause of dementia” (Vink, 2013), and it affects more people each day due to the increase in life expectancy. There have been many medical tests on patients diagnosed with dementia, where it reduces the major behavioral issues that are associated with the disease. Due to this, there has not been much research done on the non-pharmaceutical approaches like music therapy. Svansdottir and Snaedal (2006), and Vink (2013), recommend music therapy within geriatric care as it reduces the need of taking medications that are paralyzing to patients. It is also important to look at other methods such as improving the quality of life for those patients and the amount of contact dementia patients have with other patients, support networks and health care staff. According to Vink (2013), “Music therapy is believed to be an effective intervention which can improve the quality of life and can relieve the major behavioral symptoms associated with this disease” (Vink, 2013).

 Many musical abilities seem to be preserved in dementia patients while their language and cognitive functions deteriorate over time. Even within the last stages of dementia, patients seem to continuously respond to music and continue to sing those songs from memory, dance the way they used to, and remember past times all while listening to a familiar tune. Finding factual information about this discovery is difficult and many aspects of what effects music has on older persons with dementia are unknown. According to recent day research, what is known is that music therapy benefits elderly people with dementia. Dementia patients “lose their verbal skills first, but both general musical and rhythmic skills remain for a long time” (Brotons and Koger, 2000). In relation to cognition, social and emotional functioning and behavioral disorder, the following overview will describe these studies in the area of music therapy.

Music Therapy and Cognition, Social and Emotional Functioning

 A study was conducted where behavior was observed and recorded to determine the effects music therapy had on patients with dementia and their behavioral patterns. The conductors of the research were Gerdner and Swanson (1993), and they discovered that when they compared baseline levels of agitation with agitated levels during music therapy, it was shown that there was a reduction in agitation when music was playing. More so when it was music that patients recognized from their past. These results showed that there was some delay to the intervention and many patients reacted hours after the study took place. They concluded that this was because Alzheimer’s patients have a delay in reaction time and take a substantial amount of time to process the music. How musical memories are stored in our brains have a significant effect on those elderly patients with dementia. With interpreting music and listening to the sounds and lyrics, it involves all cognitive functions of our brain. Both language and music are complex processes that are affected by dementia. Vink (2013) speaks about our two cerebral hemispheres and how each hemisphere “receives sensory information and controls movement on the side of the body opposite its location” (Vink, 2013). Music skills are often preserved where care takers and health professionals note that music seems to stimulate verbal functioning as well.

 Dementia causes a progression in language deterioration including comprehension and production. It is unclear if it is direct or indirect due to short term memory. “language may become emptier in persons with dementia because of short-term memory deficits, reflected by an increase in perseverations” (Brotons and Koger, 2000). According to authors Broton and Koger (2000),  and Vink (2013), the type of language that relies on needing a strong cognitive processing are the first to decline and therefore programs that involve prolonging this decline should incorporate music therapy to promote speech interaction and reading of music and lyrics to keep a strong connection towards language skill development. 

 It is difficult to engage with dementia patients and create a pleasant environment for them, nursing staff and care givers. As dementia progresses, it become difficult to have patients be a part of the social activities or interact with others. Incorporating music within these patients care plans can help bring them out of their shell and engage them within the activities. “Music provides an opportunity for people to engage socially, from which persons who are not able to speak any more can benefit too” (Vink, 2013).  Patients who have lost the ability to speak are often seen as being able to still sing and remember lyrics from that particular song. It is therapeutic to sing a familiar song especially during programs with other patients or with staff during one-on-one therapy sessions. These results conclude that music therapy has a positive effect on the emotional well-being that helps to increase social responses and prevent social isolation with the elderly in all stages of dementia.

Music Therapy and Behavioral and Psychological Problems

 “Music therapy increases the level of tolerance to stressful environmental stimuli that may trigger symptoms” (Gallego and Garcia, 2017). Music is seen as a pleasant stimulus where those who are also living with anxiety and depression along with dementia, evokes positive emotions. There is an occurrence of behavioral and psychological issues, and it is a major concern within all stages of dementia. Usually, symptoms of behavioral or psychological distress is treated with pharmaceutical medications including “neuroleptics, sedatives, and antidepressants” (Raglio, Bellelli, Traficante, Gianotti, Chiara, Villani, Trabucchi, 2008), however, there are many side effects. Nonpharmaceutical approaches are known to be more of a useful treatment method such as music therapy for those with moderate to severe dementia. “It is based on the systematic use of musical instruments to improve communication between music therapist and patient” (Raglio, Bellelli, Traficante, Gianotti, Chiara, Villani, Trabucchi, 2008). Music therapy is now seen as a useful method of treatment towards those patients with dementia, mostly with those who are agitated or are aggressive. There are flaws towards music therapy that limits research found to this approach, however there are trials that are used to evaluate the effectiveness of music therapy among subjects with moderate to severe dementia.

One of many behavioral issues with dementia patients is wandering behavior. Patients are seen pacing in nursing home within the hallways. Within these care facilities, doors need to be locked and supervision is on a 24-hour loop. Wandering patients are more prone to falling and injuring themselves, especially when they gain access to areas that they are not familiar with. This behavior is only a small section of the many behavioral problems associated with dementia. Music therapy has been used for this behavioral issue where during therapy sessions, patients were remaining in their seats and did not move while the music was being played. Several studies were conducted on this theory where the wandering behavior decreased due to music intervention and therapeutic programming.  

Conclusion

Music therapy affects identities, behavior, communication, social interaction, emotions and psychological functioning. There is no doubt that health practices are rooted in everyday activities and the non-pharmacological practices are based around arts and culture. The evidence presented shows that music is important in human development and influencing individual’s health conditions. Therefore, when it comes to patients with dementia, incorporating non-pharmacological methods should be considered as a universal resource to promote the health and well-being of others. Music therapy can be incorporated within a wide variety of client populations and developed through many mechanisms. It can be a unique implementation to each individual’s preference and acts as a stimulus towards feelings and emotions causing mental and emotional responses towards the body and mind. However, it is recognized than their needs to be more research conducted on the effects and benefits of music therapy with specific conditions. The research presented shows a glimpse of the effect’s music therapy has, however it is not something that is set to cure the disease fully, only prolonging the symptoms. The implementation of music programs is not used in many care facilities due to the lack of evidence-based research.  Music therapy has the ability to create expression in cognition, social, and emotional functioning where it gives purpose to dementia patients in any stages of the disease and provides evidence in promoting positive mental health, even if it is for a short period of time. Within those moments, the disease does not defy the individual and somewhere deep down, they are still who they used to be.

References

• Canadian Association for Music Therapy/ Association de Musicotherapie du Canada Annual General Meeting, Vancouver, British Columbia, May 6, 1994
• Brotons, M., Koger, S. (2000). The Impact of Music Therapy on Language Functioning in Dementia. Journal of Music Therapy. Retrieved from: http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.1027.2158&rep=rep1&type=pdf
• Evans, D. (2002). The effectiveness of music as an intervention for hospital patients: a systemic review. Retrieved from: https://journals-scholarsportal-info.libaccess.lib.mcmaster.ca/pdf/03092402/v37i0001/8_teomaafhpasr.xml
• Gallego, M., Garcia, J. (2017). Music therapy and Alzheimer’s disease: Cognitive, Psychological, and Behavioral effects. Neurologia. Retrieved from: https://reader.elsevier.com/reader/sd/pii/S217358081730072X?token=540ABAEEE03ED0E92A75257E658F230CED6EF17025400BED811EC0C41BFA43BA7C9804A4B3C6A784CD57A10A626F3E4D
• Mays, K., Clark, D., Gordon, A. (2008). Treating Addiction with Tunes: A Systematic Review of Music Therapy for the Treatment of Patients with Addictions. Retrieved from: https://journals-scholarsportal-info.libaccess.lib.mcmaster.ca/pdf/08897077/v29i0004/51_tawtasttopwa.xml
• Ragoli, A., Bellelli, G., Traficante, D., Gianotti, M., Chiara Ubezio, M., Villani, D., Trabucchi, M. (2008). Efficacy of Music Therapy in the treatment of behavioral and psychiatric symptoms of dementia. Retrieved from: https://pdfs.semanticscholar.org/0f53/3691d0f631f6e9bbd93711343087119ec502.pdf
• Svansdottir, H., Snaedal, J. (2006). Music Therapy in moderate and severe dementia of Alzheimer’s type: a case-control study. International Psychogeriatric Association. Retrieved from: https://www.hirsla.lsh.is/bitstream/handle/2336/6259/music-therepy.pdf?sequence=3
• Vink, A. (2013). Music Therapy for Dementia. University Medical Center Groningen. Retrieved from: https://www.rug.nl/research/portal/files/14427178/volledigedissertatie.pdf