How music could revolutionise dementia care

Music is the medicine of the mind. So said American politician and soldier John A. Logan more than a hundred years ago.

Nowadays, most of us accept that music in its many forms has the power to move us, make us feel strong emotions and take us outside ourselves, even for a moment. But the largest music therapy study in the world is going a step further, to bring music to the forefront of treatment options for people with dementia.

“Songs can represent your identity, and when you write songs, they can tell your story,” says Professor Felicity Baker, who is spearheading the research.

“One of the beautiful things about music is that it takes participants in an agitated state back to safe and pleasurable memories, helping to bring them out of their shells.”

Dementia steals a lifetime of memories; those cues that tell you who you are, where you’re from, how you got here. It can take your confidence, rob you of your emotions, turning joy into depression and family into strangers.

For the 50 million people living with dementia globally, it’s a day-to-day reality.

In the face of these growing numbers, many experts are exploring how we can ensure a sustainable, good quality of life for people with dementia.

And that’s where music comes in.

The power of song

Professor Baker is an expert in neurorehabilitation and dementia, and Head of Music Therapy at the University of Melbourne and Director of International Research Partnerships for the Creative Arts and Music Therapy Research Unit.

The focus of her latest research is on the depression that often comes hand-in-hand with dementia. According to Dementia Australia, depressive symptoms occur in approximately 40 to 50 per cent of people with Alzheimer’s disease, and people in long-term residential care appear to be particularly at risk.

“This is an area of research that’s getting stronger and more compelling,” says Professor Baker.

“Depression keeps coming up. It doesn’t matter what population we’re working with, it’s the thing that music is having an impact on.”

The new global study involves 1,500 participants across nine countries currently living with dementia. A third of these participants will be from Australia, with the University of Melbourne working with 500 participants across 40 residential aged care facilities in Melbourne, Sydney and Brisbane – none of which currently offer structured music therapy as a treatment option.

“The study basically has four arms to it. The first looks at current standard care. Then we have what we call a ‘small group music therapy’ arm – these are groups of between eight to 10 residents with dementia who also have depression.

“In these groups, the music therapist uses specialised techniques with music at the centre to emotionally and relationally connect with the person,” she says.

“These music experiences can include singing songs and then talking about their significance and what memories they may evoke and playing some instruments. There might also be some gentle movement to music because music does make us move.

“The therapist’s role is to attune to the emotional state of the clients to establish a relational and safe connection,” says Professor Baker.

“We then have recreational choir singing - this is a large-group singalong with about 20 people that’s not facilitated by a music therapist but by a community musician.

“And then there’s the fourth arm which is a combination of small group music therapy and the larger recreational choir singing.”

The team, which includes a neuropsychologist working alongside the therapists, will continue with the same groups for around 12 months to measure the impact of music therapy over time. Like any medical treatment, the effect of dosage will also be monitored, including what happens when the music therapy stops.

“Participants start off with two sessions a week for three months and then we drop down to one session a week for three months. The study will go for six months and then we take it away, we come back six months later, and we have a look at what’s going on,” says Professor Baker.

The aim of the research is to thoroughly assess and measure the long-term impact of a range of different music therapy techniques.

“Our focus here is on tracking the effects over a long time, because you can see the instant effect of music on people with dementia and depression. But we need to know, is that effect sustained? And are there any cumulative effects over time?

“So, it’s what happens afterwards. Do these people go back to displaying the same symptoms of dementia they did before, or are their severity lessened?

“We’re studying a degenerative disease so we are not expecting people to recover, but are the levels of distress associated with their dementia lessened for them and for those around them such as family? And are they less severe when we compare its impact alongside people who are not receiving the music interventions?”

A high note of success

The new international study follows an earlier pilot study Professor Baker’s team has been running at Caladenia Dementia Care in Melbourne over a period of ten weeks. Many day patients there have responded positively to music therapy, often within minutes.

One of them is Nora.

She has dementia and says the music therapy has helped her empathise more with her fellow patients.

“When you make a song, some of the things you write about must be important to other people, otherwise you wouldn’t write it. It really makes you think about the ups and downs in life,” she says.

Many of those taking part say the sessions have increased their sense of empowerment, accomplishment and pride, as well as boosting their confidence, empathy and sense of belonging. But they’re also challenging the misconception that people with dementia can’t make new memories.

“Experts say that it’s very difficult for people with dementia to learn new things,” says Sylvia, a staff member at Caladenia. “But it’s always been obvious to me that they can, and this group has learned those songs, the tunes, and how to act and feel comfortable in these sessions.”

Professor Baker says the progress can be marked.

“Participants are calmer, better-engaged with other people, and seemingly happier,” she says.

This study joins the ranks of research around the world who are making strides in other facets of music therapy. There is the potential for this research to ripple out into other fields, bringing music therapy to the forefront of treatment options in aged care around the world.

“It’s actually quite massive and it’s sometimes a little bit overwhelming to be honest, to be running something as massive as this,” says Professor Baker.

Music as medicine

Music therapy has the potential to revolutionise aged care in Australia and beyond. From alleviating the symptoms of depression to enabling genuine reconnection with community - music therapy is giving some a chance rediscover what has been taken; the person behind the dementia.

A key issue included in the new study is a cost-benefit analysis, to see if music therapy could provide a more cost-effective way of improving quality of life in residential care; ideally reducing the default to medication as well as the costs associated with stress incurred by both clinical staff and visiting family.

“It’s accessible and it’s low cost, and if you can get people to access it, I mean that’s really what we want,” says Professor Baker.

“So, we’re looking at “are their agitated behaviours reduced?” If that’s true, then staff are more able to manage the patients, there’ll be less staff stress and possibly less medication.”

Although the study is not looking to cure dementia, researchers hope to alleviate some of the symptoms, including depression, as well as stimulate learning and cognition, foster collaboration and connection, and ultimately improve patients’ quality of life and lower costs for everyone involved.

“We hope the project will demonstrate how group music therapy reduces levels of depression, agitation and apathy in people living with dementia,” says Professor Baker.

But for Professor Baker, what’s really important is the power of music to make people happier.

“Music can bring people together, and this new study is really about improving quality of life for patients, their families and carers - through music.”

Banner image: University of Melbourne