Music and memory will explore how music enriches the lives of people with dementia

 

 

Introduction

          This page will review some of the current research and one music program designed to help people with dementia.  I will post pictures, videos, and articles related to music and memory.  Our favorite music is somehow hard wired into our long term memory.  Music touches several different parts of our brain and takes us back to times past.  Even the most forgetful person can remember music lyrics and their related memories.  Music has an amazing ability to spark our consciousness.

     The Music and Memory  program is a program that provides personalized iPods to people with dementia and other age related issues.  It was founded by a man named Dan Cohen and has spread like wildfire across the country  http://musicandmemory.org/   This link outlines the history of the program and what they do.  It is is very helpful because it explains the origins of this program and the good they do.

 

 

     Utah is unique in the Music and Memory world because it has a coalition that coordinating a state wide effort to take the program to nursing homes, assisted living facilities and private homes across the state.  The coalition is made up of all the major players in the field of aging including state agencies, private agencies, and the University of Utah.  The Utah Music and Memory Coalition also has an interesting website that outlines its mission http://aging.utah.edu/musicandmemory/ .  This website lets us know what it happening with the program in Utah right now and how people can get involved.  Utah is also unique because Jewish Family Services in Salt Lake City delivers the Music and Memory program to people in private homes.  There are only a handful of agencies in the country who provide this service to private homes, typically it only is administered in nursing homes.

     

Objectives

• To explore how music can bring someone with Alzheimer's back to the person he once was. 
• How music can wake up people who are otherwise forgetful. 
• To examine the benefits of music for the patient on caregiver stress. 
• Is caregiver stress lessened when the patient is engaged in listening to music?

 

                  

 

Background

      The Music and Memory program is a program designed to help people with dementia.  The program was started by a man named Dan Cohan in New York (Music and memory, 2015).  He hoped that when he got older that he would be able to listen to his favorite music on his iPod.  With all of the technology at our disposal, and a general love of music, he wondered if personalized iPods might bring joy to people with dementia.  He did some research and found that none of the 16,000 long-term care facilities in the U.S. used iPods with their residents. Using his background in leveraging technology to benefit those who otherwise had no access, he volunteered at a local nursing home in Greater New York, creating personalized playlists for residents. The program was a hit with residents, staff and families, and was the beginning of the Music and memory program. Two years later he received funding to purchase more equipment and was able to buy 200 iPods.  He brought them to residents of four New York long-term care facilities and was able to test the program on a larger scale. It was a success and the program grew from there.

     Mr. Cohen found that personalized iPods had many benefits including increased awareness, improved cognition, improved engagement, reduced anxiety and agitation, improved communication, and reduced problem behaviors.  Music is linked with personal memories.  Tapping into the brain’s long term music storage brings people a renewed sense of self.  People connect with their past in a very personal way and become more interactive with the music and the people around them.  In this way, the music, “wakes up” people with dementia (Alive inside, 2012).  Unresponsive patients listen to their favorite songs on their personalized I-pods and immediately start moving and humming along.  Sometimes they are better able to communicate with caregivers.

 

 

 

     There is a documentary about the program called Alive Inside (2012).  The film premiered at the Sundance Film Festival January 2014.  It is currently showing on Netflix.  The film showed a man who was unresponsive when he was asked simple questions.  After listening to his favorite music he was able to answer questions and talk about the music.  Since the film premiered, the Music and Memory program has been implemented throughout the country.  The State of Utah has a Music and Memory Coalition that is bringing music to persons with dementia in nursing homes, assisted living facilities, and private homes.  The Music and Memory program in Utah is unique because the coalition is coordinating a state wide effort to provide iPods to anyone with dementia whether at home, in assisted living facilities, or in skilled nursing facilities.  Several states are following the Utah model for a coordinated state-wide effort.

 

 

This is a wonderful clip from the Alive Inside documentary.  It is six minutes and shows the story of Henry.  After hearing his favorite music he "wakes up", becomes more responsive, and is more the man he used to be.  It is very inspiring.

 

 

 

 

Current Research

            Everyone has their own favorite music.  Music has been a part of life throughout time.  Music brings out our full spectrum of emotion (El Haj, Postal, & Allain, 2012).  The memories music evokes are coupled with our emotions.  Music stirs our emotions.  A particular song takes us back in time to an experience that may be forgotten without a musical trigger.  Emotional autobiographical memories are easier to remember than unemotional ones (Comblain, D'Argembeau, & Van der Linden, 2005).  We remember events from our lives more vividly if they are coupled with emotion whether positive or negative.  Older adults tend to view negative memories in a more positive way.  Autobiographical memories are easier to recall when participants listen to their favorite or chosen music.  There is clearly a relationship between our favorite music and our memories.  Music reminds us of enjoyable times in our lives.  Music can also enhance memory (Deason, Simmons-Stern, Ally, Frustace, & Budson, 2012).  Hearing our favorite music reminds us of former places and times.

     Music memory can be preserved in Alzheimer’s patients through the mild and moderate stages and in some cases even in the severe stages (Cuddy et al., 2012).  Patients remember and respond when they hear their favorite songs.  There is something about music that stays with us even when we become forgetful.  Emotional memories that are associated with music seem to be protected from Alzheimer’s disease (El Haj, Postal, & Allain, 2012)   The music memory areas of the brain are in some ways protected from the forgetfulness of Alzheimer’s disease.  Even though a person may forget many other things, somehow they can still recall lyrics and autobiographical memories after listening to their favorite music.

        Another aspect of music memory that seems to be preserved in Alzheimer’s disease patients is with music lyrics.  Alzheimer’s disease patients can recall the lyrics to favorite songs and sing along even into the more severe stages of the disease (Cuddy et al., 2012).  Cuddy cited a case of a woman in the late stages of Alzheimer’s disease who spent the day with a blank stare.  When they played her favorite songs for her, she was able to sing along even after the music stopped.  Omar (2012) called this recall an “island cognitive preservation”.  There is something literally memorable about favorite songs.  Alzheimer’s disease patients can remember song lyrics even when they cannot remember the day of the week or the names of loved ones.  Music touches us in many ways and is somehow preserved in the memory banks of Alzheimer’s disease patients.

         Alzheimer’s disease patients often feel anxiety with daily living.  Anxiety related problematic behaviors occur in over 80% of dementia patients.  These symptoms are often treated with antipsychotic medications (Gallagher, 2011).  Being forgetful is very confusing and can be alarming.  Music can be a calming influence.  Listening to music can cause a significant reduction in anxiety (El Haj, Postal, & Allain, 2012).  The Music and Memory program provides personalized iPods to people with dementia and other age related ailments.  They have found a reduction in anxiety and problem behaviors in people that received the program (Music and memory, 2015).  Favorite songs can have an awakening effect, whereas unfamiliar songs may have little or no effect on the affect of the listeners (Cuddy et al., 2012).

 

Discussion

     I work with the Music and Memory program through Jewish Family Services and am on the Utah Coalition for Music and Memory.  I make and deliver personalized iPods to older adults.  I have personally seen unresponsive people light up when they hear their music.  No matter their physical or cognitive level, each recipient smiles and starts moving to the beat.  It is incredible to watch.  I have delivered many iPods to many different people with different age related issues.  Without fail each time a recipient puts on the headphones and turns on the music, they light up, start moving, and hum along to the music.  Everyone loves it. 

     The first thing I do when someone is interested in receiving an iPod is interview them to determine their musical taste.  The interviews are conducted in the client's home, senior center, or at the Jewish Family Services (JFS) office.  I ask about the music they love, what music they used to dance to, and what music they played at their wedding.  We review many genres of music as well as particular artists and songs.  I have learned that everyone loves The Sound of Music and the Battle Hymn of the Republic by the Mormon Tabernacle Choir.  After I have a thorough list of music and a sense of what they like I return to the Jewish Family Services office and create a playlist.  The office has a computer dedicated to music with a library of about 6000 songs.  JFS was certified in the Music and Memory program and is allowed to use its library of songs to create as many playlists as they have clients interested in iPods.  I use the library to create an individualized playlist for each client.  If we do not have a particular song we buy it from iTunes.  After building the playlist and loading the iPod, I deliver the iPod to the client and instruct them how to use it.  It takes about two weeks between the music interview and delivery. 

     The Music and Memory program relies on donations.  The iPods are almost all donated.  People donate iTunes gift cards so that we can purchase songs.  Skullcandy has donated hundreds of pairs of headphones to the program.  JFS charges a one time $50 fee to each client to support the program.  If you were to add up the iPod, music, and headphones, it would come to about a $450 value.  It is a great deal.  If a person cannot afford the $50 we use a sliding scale and adjust the fee accordingly.

 

These are the Skullcandy headphones we use

 

 

     For people with dementia we use the iPod shuffles.  They hold around 130 songs and have one button to push.  They are easier to use and hold the right amount of music so as not to overwhelm the client.  In addition to people with dementia we provide the program to any older adult with  an interest.  I present information on the program to senior centers in the valley and often many of the attendees are interested in receiving an iPod.  I have given iPods to people with Parkinson's disease as well as many healthy older adults.  Everyone loves to hear their favorite music and most of the older adults that I work with are not familiar with iPods.  For recipients who do not have cognitive decline we use iPods that hold more songs and are slightly more complicated to use.  The people I have worked with have been very enthusiastic about learning to use this new form of technology.

 

We give iPod Shuffles to dementia patients because they are easy to use

 

 

Examples  (names changed)

 

Case Study One:

     I met Gary and Betty at a Parkinson's disease support group where I presented a lecture on the Music and Memory program.  They were very interested in the program.  They each wanted a personalized iPod but for different reasons.    I conducted their music interviews and created their personalized play list.s.  Gary has Alzheimer's disease and Betty has Parkinson's disease.  Gary loves music but can no longer remember names of artists, song titles, or names of songs.  He is still very high functioning and was very enthusiastic about the program.  He cannot wait to receive his iPod.  Betty has Parkinson's disease.  She is hoping that her iPod can help her with her exercises and keep her body strong.  They were a wonderful couple and each will use the iPods in an individual way.  We will give Gary an iPod shuffle because it is easier to use.  We will give Betty an iPod with a screen because she is able to use a more complicated device.

     Betty said;  " This project has blessed my life.  You are making a difference in our lives as we prepare to use music to enhance our precious time together". 

 

Case Study Two:

     I met Jan and Eric after a presentation I gave at a senior center.  Eric has Alzheimer's disease.  He was able to tell me a little bit about his favorite music and his wife Jan filled in the gaps.  I put together a personal iPod shuffle for him and mailed it to them.  Typically we deliver the iPods to the person's home and teach them how to use it.  Because of his medical problems they asked that it be mailed.   After he received the iPod he had knee replacement surgery.  He is currently on pain medication.  I phoned Jan for a follow up interview and she said that when she put the headphones on him and turned on the music he cried.  He was very overwhelmed and could not handle the experience.  His dementia, recovery from surgery, and pain medication were very confusing to him.   She said that after the recovery they will try again with the music.  She is very enthusiastic about it and will reintroduce the device when he is feeling better.

 

Case Study Three:

     I met Dennis and Maria at another senior center after I gave a presentation on the program.  They were a very active senior couple and spent a lot of time at the senior center.  Neither one has dementia.  Dennis teaches the exercise classes there.  Dennis approached me first.  He was excited to get an iPod.  He planned to use it for personal use and his exercise classes.  I conducted the music interview, created his playlist, loaded his iPod,and introduced it to him.  He told me that after his wife it was the best thing that had ever happened to him.  He was a very kind man.  Later he contacted me and asked for an iPod for his wife.  I prepared one for her and she was very excited.  Her primary language was Spanish and I was able to put some Spanish music on it for her.

 

Kurt Bestor is the spokes person for Music and Memory program in Utah.  This is a video he recorded.

 

 

 

My Research

       For my master's project I am studying whether or not caregivers find relief when their loved one who suffers from dementia listens to their own personalized music.  Caregivers have such a difficult time when caring for a person with dementia.  It is a very stressful job.  Most often this burden falls upon the spouse.  They are heartbroken as they watch their life time partner slip away into forgetfulness.  They also have a difficult twenty four hour per day job.  It is very demanding and very frustrating.  Can they get a break when their loved on listens to his or her own music?  This is what I will try to find out.

     There are more older adults now than ever before in our history.  As the population continues to age, the number of older adults requiring care increases (McNally, Ben-Shlomo, & Newman, 1999).  The majority of the burden of care is placed on family members.  There are personal costs associated with caregiving.  The demands of caregiving can take a toll on a person mentally, physically and financially.  Taking care of loved ones is a very demanding job.  When the loved one has dementia it can be even harder.  It can be very frustrating taking care of adults with dementia.  They tend to ask questions repeatedly and need constant supervision.  Often the caregivers are spouses who are also older and have their own health issues.  It can be very challenging and stressful.

       Many programs have been designed to help alleviate caregiver stress.  There is respite care, senior day care centers, and the Music and Memory program to name only a few (Salt Lake County aging services, 2015).  Respite care can include in home programs or nursing home help.  Older individuals can have respite workers come to their homes while the caregiver goes out or the older person can check into a nursing home for a short period of time while the caregiver goes on vacation or takes a break (McNally, 1999).  Respite care can provide the caregiver much needed time off and relaxation time.  Senior day care centers are also a good resource for caregivers.  Seniors can attend the day care centers during the day while the caregiver works or takes care of other business.  Senior centers have activities and meals to stimulate the patrons.  There are many benefits for seniors in day care centers including well-being, relieving loneliness, less depression, and greater life satisfaction (Taylor-Harris & Zhan, 2011). 

        Family members caring for an older adult report planned relief from their duties is the most needed benefit (Lund, D. A., Utz, R., Caserta, M. S., & Wright, S. D. 2008).  Sometimes it is not possible to physically leave the residence but there are programs that can provide the much needed relief to the caregivers. The Music and Memory program provides personalized music to people with dementia and other age related issues in the home.  It provides an enjoyable activity for seniors and a break for their caregivers.  While they are listening to music, the caregivers can have a short break to accomplish other tasks or simply rest. 

     I have created a nine question survey to give to the caregivers.  I will ask questions about whether or not they  felt relief when their loved one listened to the music.  I will follow up with the clients with whom I have already developed a relationship.  They will be qualitative questions that will give us some insight on the music program.  We hope that this insight will help us as we continue to develop and deliver the program throughout the state.

 

Questionnaire for the Caregiver

 

 

1-What have been the benefits of the Music and Memory program to the listener?

2-What have been the benefits of the Music and Memory program to you as the caregiver?

3-Did you get some respite time from you duties as caregiver while your loved one was listening to their music?

4-In what ways was that helpful to you?

5-What have been the challenges to using the I-pod?

6-How often is the device utilized?

 

Based upon your observations of the Music and Memory recipient after a session of listening to their playlist, please rate the following categories:

 

                                                Improved          Same             Deteriorated

 

1-Relaxation/ Calmness

2-Communication

3-Anxiety/ Agitation

 

Comments or Remarks:

 

Future Trends

         The University of Utah Center for Alzheimer's Care, Imaging and Research is conducting a study right now about how the Music and Memory program helps the brain.  They take an MRI of an Alzheimer's patient before he receives the music.  Then the patient is presented with a personalized iPod with his favorite music.  He is instructed to listen for one hour per day for two weeks.  After that the patient and caregiver identify his favorite five songs the songs that evoked the most emotional responses.  After the two weeks the patient goes back for another MRI.  They run the test while he listens to his favorite songs and again with either no songs or random, non-favorite songs.  They will measure if there are any changes in brain activity during this experience.  They will examine whether or not preferential music affects the brain.

     Another current study at the University of Utah involves psychotropic medications for people with dementia.  Because dementia patients feel disoriented and out of control sometimes they can be combative and even aggressive.  Typically they are treated with medications that help to calm them down.  The University of Utah is examining whether or not personalized music can help calm them down and even reduce their anti-anxiety medications.  Can you imagine the enormous benefits to music instead of pharmaceuticals?

     The Utah based company, Skullcandy has been very involved with the Music and Memory program.  They donated thousands of dollars worth of headphones to the program.  Right now they are trying to develop a specialized set of headphones specifically for the program.  They are making headphones for dementia patients.  They are hoping to work with the University of Utah CACIR study on this.  How amazing is that?

 

Conclusion

     Music touches our hearts and minds in a way that is unique and precious.  We all have our favorite songs and albums.  We all can hear a song and be taken back to another place and time.  The fascinating thing about music and the brain is that it can actually bypass the dementia and even the most forgetful people can be quickened.  People with dementia can be awakened by their favorite songs.  They become more conversant, more engaged, and happier.  The Music and Memory program is a marvelous way to bring joy to older adults.  It is exciting to be a part of it.

 

 

 

 

 

References

Comblain, C., D'Argembeau, A., & Van der Linden, M. (2005).  Phenomenal characteristics of autobiographical        memories for emotional and neutral events in older and younger adults. Experimental Aging Research, 31(2),      173-189. doi: 10.1080/03610730590915010

 

Cuddy, L. L., Duffin, J. M., Gill, S. S., Brown, C. L., Sikka, R., & Vanstone, A. D. (2012). Memory for Melodies and      Lyrics in Alzheimer's Disease. Music Perception: An Interdisciplinary Journal, 29(5), 479-491. doi:      10.1525/mp.2012.29.5.479

 

Deason, R. G., Simmons-Stern, N. R., Ally, B. A., Frustace, B. S., & Budson, A. E. (2012). Music as a Memory      Enhancer: Differences Between Healthy Older Adults and Patients With Alzheimer's Disease.      Psychomusicology: Music, Mind & Brain, 22(2), 175-179. doi: 10.1037/a0031118

 

El Haj, M., Postal, V., & Allain, P. (2012). Music Enhances Autobiographical Memory in Mild Alzheimer's Disease.      Educational Gerontology, 38(1), 30-41. doi: 10.1080/03601277.2010.515897

 

Gallagher, M. (2011). Evaluating a protocol to train hospice staff in administering individualized music.      International Journal of Palliative Nursing, 17(4), 195-201.

 

Lund, D. A., Utz, R., Caserta, M. S., & Wright, S. D. (2008). Examining what caregivers do during respite time to      make respite more effective. Journal of Applied Gerontology.

 

          Man In Nursing Home Reacts To Hearing Music From His Era: video retrieved from:                 https://www.youtube.com/watch?v=fyZQf0p73QM

 

McNally, S., Ben-Shlomo, Y., & Newman, S. (1999). The effects of respite care on informal carers' well-being: a      systematic review. Disability & Rehabilitation, 21(1), 1-14. doi: 10.1080/096382899298043

 

Music and memory.  (2015).  Our mission and vision.  Retrieved from http://musicandmemory.org/about         /mission-and-vision/

 

          Music and Memory Utah Coalition: video retrieved from https://www.youtube.com/watch?v=8kooGv5ph7U

 

Salt Lake County aging services. (2015). Caregiver support.  Retrieved from http://slco.org/aging-adult-services         /caregiver-support/

 

Taylor-Harris, D., & Zhan, H. J. (2011). The Third-Age African American Seniors: Benefits of Participating in Senior      Multipurpose Facilities. Journal of Gerontological Social Work, 54(4), 351-371.