Music Integration in Nursing Home Care Routines
Music is making inroads into nursing homes and other facilities that serve people with dementia. The goals are ambitious, and it’s not just music therapists who are involved. Music is being used to aid memory, learning, and functional capacity. It’s also being used to soothe challenging behaviors like apathy, agitation, and even aggression. Agitation, frequently associated with dementia, and can make caregiving difficult.
Nursing homes are integrating music programming with daily activities that are challenging for residents, such as routines associated with bathing. Research indicates tremendous potential, though results of large-scale implications are mixed. Results reflect in part how well programs are implemented – and how much buy-in there is from caregivers.
The potential won’t be obvious or intuitive to many. Dementia is a complex neurological issue and music, too, has complex neurological underpinnings. Healthcare professionals and caregivers may discover the benefits by reading about the neurobiology of music – or by witnessing music in action in their own facilities or on video. The US-based organization Music and Memory has provided links to current research on the brain basis of musical interventions (https://musicandmemory.org/music-brain-resources/current-research/).
And for those who are convinced? It’s not just music therapists who are involved – far from it. There is a place for involvement at many levels, from figuring out how best to implement programs to carrying them out one-on-one in the context of direct care.
Personalized music playlists are at the forefront of the movement. Nursing facilities are also implementing – and researching — other activities such as singing.
Music and Dementia-Related Agitation
A meta-analysis in Frontiers in Psychology explores the role of music in reducing agitation and concludes that it has efficacy as a nonpharmacological intervention (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5432607). A case report in Annals of Long-term Care demonstrates how striking changes can be in some instances. The article describes an Alzheimer’s resident in her 80’s whose episodes of evening agitation worsened over time from “verbally offensive“ to “physically aggressive” and who was placed on antipsychotics (https://www.managedhealthcareconnect.com/article/effect-personalized-music-playlist-patient-dementia-and-evening-agitation). A nursing student found music that reached her on a deep level. “Ain’t No Mountain High Enough” had her singing and dancing in her seat. What’s more, music had a role in increasing her communication – and thus in helping those at the nursing home provide other effective behavioral intervention. The nursing home was again able to care for the woman without resorting to antipsychotic medications.
The best known program for personalized music, at least in the United States, is Music and Memory. The documentary “Alive Inside” played a role in bringing it into the public consciousness. The goal is to create a playlist that speaks to a person’s own musicality and own memories. Songs are typically selected from a person’s youth and young adult years, but demographics alone can’t predict what will reach an individual.
It can be especially difficult when one is working with individuals who have little or no verbal capacity. Volunteers may be used to spend multiple sessions with individual residents, looking for clues about musical preferences and watching for reactions when they play snippets of song. Ultimately, a very personal playlist may be created. A person’s playlist can be played by caregivers at whatever times it has been determined to be useful.
Some states have implemented Music and Memory. In 2019, Tennessee is in the process of large-scale intervention; the goal, over the next three years, is to reach residents at 147 facilities (https://nasaa-arts.org/newsletter/2019-nasaa-notes-issues/february-2019-nasaa-notes/tennessee-music-memory-tennessee/).
A separate organization, Playlist for Life, operates in the UK. Playlist for Life has a number of resources available on their website. Among the resources is a workbook for “young music detectives” who want to help elders capture their musical memories. The BBC Music Memories website may be used as a starting point for discovering playlist songs (https://musicmemories.bbcrewind.co.uk/). Play for Life has produced a number of videos to show their program in action (https://vimeo.com/playlistforlife).
Wellspring Village (a Brightview Senior Living dementia care program) utilizes a trademarked Mind and Music program with several components. Residents have personalized playlists. They also enjoy group musical experiences. Music is played in common areas. Local musicians help create programming. Experiences are varied, from drum circles to singing.
Issues in Program Implementation
Research is ongoing. A recent study even suggests potential benefits in swallowing.
Some studies of course don’t find results at the level hoped for. Wisconsin is among the states that has implemented Music and Memory on a wide scale. In 2016 publications, researchers at the University of Wisconsin-Milwaukee considered reasons for what could be considered a disappointing showing, among them, staff buy-in and other aspects of implementation (https://www.dhs.wisconsin.gov/music-memory/research.htm). Facilities were not equally affective in personalizing playlists or playing music at times it would be useful. Among the hurdles was the time required for affective implementation. Evaluators noted, too, that some individuals were less likely to be impacted by music than others; intervention could be more strategically targeted.
Some recent research has explored use of student volunteers. A video on the Wisconsin Department of Health Services website introduces very young volunteers who participate in a program for future healthcare professionals (https://www.dhs.wisconsin.gov/music-memory/student-volunteer-program.htm). Some were also pursuing CNA training, and the program added a new dimension to a curriculum that might otherwise be skewed toward meeting basic physical needs.
Are there any concerns besides the fact that not all implementations are equally effective? Yes. Sometimes musical experiences lead to overstimulation. Music that’s not personalized and that’s playing throughout a common area can lead to increased agitation if it’s not a type that a particular resident enjoys. On the other hand, group music experiences can be enjoyable to people with dementia if they wish to participate.
Even personalized music – or music that seeks to be personalized – can stir negative emotion. Playlist for Life refers to Red Flag Songs: songs that distress particular people (https://www.playlistforlife.org.uk/use-music-safely). The organization has tips for avoiding this pitfall.