Rhythmix: Music and Dementia.

Rhythmix: Music in Healthcare. Alzheimer’s and Dementia.

 

Would you like to dance? Not a question I get asked every day, especially in a ward full of elderly patients living with dementia. I looked around at the staff for signs that this maybe a bad idea, maybe I had to decline politely? The participants and staff did not seem shocked or bothered by the question. In fact, many were displaying sly smiles. Courteously I obliged, standing up I thought about how I would handle the situation. I must be gentle, I scanned the make shift dance floor trying to note potential hazards, trying to make sure that the dance would end with us both on our feet. Gently I took her hand and the musicians started up a rousing version of She’ll Be Coming Round the Mountain.  I was twirled and controlled and made to perform as if I was in some late night barn dance. My head was spinning and my partner was less than impressed with my lack of coordination. “Come on” she said. “Keep up”. Throughout the song I was thrown, spun and contorted in all directions. I was given a dance lesson as well as an amazing display of energy and vitality. When the song ended my head spun and I couldn’t comprehend what had happened. I felt like I had stepped off an amusement ride at Brighton pier. As a reward my partner gave me a cheeky pat on the backside as I sheepishly sat back down. My partner continued with her lively and rousing dancing on her own. I wasn’t good enough.

This was my introduction to music in healthcare in a setting for people living with mid to advanced stage dementia.

I was privileged to be allowed to observe five music sessions in an assessment unit for people with dementia. I was not privy to any confidential information nor did I see the patient’s outside the one-hour music session each week. This account is what I witnessed and observed.

According to the NICE report. “Group activities such as singing will prevent a decline in independence and support mental wellbeing”. [1]

The report also goes onto say that: It is unclear whether it is the singing itself, the group based activity or something else that produces the benefit”[2]

What is that something else?

During the five weeks I witnessed some of the most humane and emotional moments, too many to mention them all but some will forever stick with me. During my last few weeks I sat beside the patients and talked to them during the sessions helping them with rhythms, encouraging them with singing and generally being someone to chat to. I had a conversation with a patient who admitted that she could remember no music, could not sing and was generally nervous about the group. I gave her some percussion and allowed her to explore the instrument in her own way. There is no need to play or sing correctly, that fabulous word, “Musiking”[3]was always in my mind. The lady in question was soon requesting songs, singing what she could remember and at one point after a version of “We’ll meet again” she began to cry.

She told me about her memories of her sister who has since passed and her sisters love for the song. “Music aids reminiscences and memories which can be emotional in nature to be revisited.”[4] The inclusion of music in healthcare settings can help with Reminiscence Therapy.  Reminiscing which music can be an aid for can improve mood, wellbeing and can improve mental abilities such as memory. By talking about who they are It can focus the patient on memories and what they can do rather than what they can’t.  She shared a few stories about her sister and her obvious longing for her. Music helped with a cathartic release in a consequence free context.[5] In non-scientific terms, she felt better after a good cry. [6]

Another incident was the final session for one lady whose husband joined her for the music session. As they sat holding hands singing Que Sera, Sera.  The inexorable meaning of the lyrics and the music said more about the situation than any essay, report or observation ever could.  The song also allowed the spritely personality of that one patient to be revealed again to her husband as they sat enjoying the group sing along in the supposed sterile environment of a ward.

It is a sensitive and difficult approach whether to play sad music in such a setting, but the human obsession with sad music will never disappear. Some of the biggest and most popular pieces are sad songs that deal with lost loves, unrequited loves and the Requiems of Classical music. These subjects and pieces will continue to remain popular and if a cathartic and positive release can be gotten from them then why not use them?[7] The music sessions are a space to remember memories happy or sad with the musicians, nurses and OT are there to provide support when needed. Music can induce involuntary autobiographical memories which can help well-being and help with creative thoughts.[8]

Not every session had such melancholy moments. Most of the sessions were full of wonderful happy, humane moments. Every week the same patent thanked the leaders and myself for coming. She joined in with an enthusiasm that was infectious, no matter what the tune she joined adding her percussive element and creativity. For the hour each week those who attended, despite being highly individual, came together in unison through rhythm and song, they worked as a collective to encourage the sharing of old memories and to create new ones.

The repertoire was mixed and varied from war songs, classic pop tunes to obscure show tunes. Choosing a repertoire to satisfy such a group is an unenviable task and one that I thought the leaders managed with great skill and sensitivity. Each week they had a new tune to add or a song that was requested the previous week. The research and dedication to finding a tune for each patient was admirable and highly person centred the musicians have done a great job of bonding with each participant making sure to take an interest in the patient’s musical taste.

One lady who did not want to take part in the session as she only listened to classical music. Ignorantly I put this down to musical snobbery. I could not have been more wrong. To strip one of their preference of music is to take away their sense of identity already being peeled away by their stay in the hospital, their connection to life outside the hospital setting maybe defined by their love of classical music. I played in future sessions a brief snippet of Lute Suite in E major by Bach, unfortunately the lady had been discharged when I got round to playing it. With the development of music technology and apps on I-pads it is now possible for everyone to play. If only the lady had of been willing to explore the technology available to allow her to play strings or brass on the I-pad allowing her to create in the musical genre she loved.

The work carried out by the musicians crosses many boundaries form community music to music therapy. A study by psychologist Laura Mitchell[9] found that music if being used for a therapeutic reason should include the persons preferred music. “Music therapy for a heavy-metal fan should include heavy-metal.”[10]

The musicians performed the repertoire and the participants joined in rhythmically, orally, with movement or some listened. The musicians were the facilitators and spurned the session on. One instance which happened quite fortuitously was maybe my favourite moment of all.

The song being performed did not come to its natural cadence. Every participant throughout my observations recognised the cadence in every tune naturally and musically, every song ended with grace and with minimum effort from the group. For one reason or another the musician forgot to play the cadence and the rhythm kept going. For around two minutes’ the rhythm kept up, there was no defined performer, no facilitator, no structure, no restrictions. There was a great amount of eye contact between everyone and smiles when it was agreed non verbally to carry on. The room was in unison, concentrating together to carry the pulse and rhythm, everyone’s contributions could be heard, all contributions were unique, individual and valid. Without speaking everyone had found their voice and had added to a spontaneous group composition. When it came to an end it ended with satisfied silence, everyone had connected through music.

A cliché and overused quote by Victor Hugo. “Music expresses that which cannot be put into words and that which cannot remain silent.” Perhaps this unspoken communication is the something else? Music is part of our lives from birth to death. Throughout life we create our own personal soundtrack, we imprint music with our own personal journeys. Music is not only inside us all, Music has the power to reflect who we are and music defines us. [11]

Perhaps that something else is the humane and inclusive moments, the sharing of memories and the connection and bond you feel and create with others as you partake in a musical activity.

 

Gary Cunningham.

[1] Older people: independence and mental wellbeing. National Institute for Health and Care Excellence

[2] Ibid pg23

[3]To music is to take part, in any capacity, in a musical performance, whether by performing, by listening, by rehearsing or practicing, by providing material for performance (what is called composing), or by dancing.

[4] Victoria Williamson. You are the music. Icon books. London, 2014

[5] Tom Service, the listening service. BBC3 Why Music Moves us. First Broadcast 2/7/2016

[6] Ibid

[7] ibid

[8] Marianne Abbott, Brain world. Issue 4 Summer 2016

[9] Laura Mitchell, music therapy study. Retrived from The New Yorker, July 4th 2016

[10] Ibid pg 66

[11] Tom Service, the listening service. BBC3 Why Music Moves us. First Broadcast 2/7/2016

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