There has been much talk recently about using music to help people living with dementia and this is very good to see. The only problematic thing seems to be that there are still lots of workers out there who appear to think that music resources never need up-dating. I have been present and, certainly, seen quite a lot of items on television where tunes from the First World War are played and sung. At one point in my career as a dementia specialist, I thought that if I heard ‘Pack up your troubles in your old kitbag’ one more time, I would throw something.
I have long said that residential and social care centres need to think about providing music that their residents or clients actually enjoy. For people who are being cared for nowadays, music is more likely to feature The Beatles and the Rolling Stones than Harry Lauder and other entertainers who have been dead for years. Yes, a lot of us know these old tunes but, these days, they are much less our memories than those of our parents or, even, grandparents!
The uses of music are wide and varied, and surpass putting on a concert for the old folk (although this can be good too – if you work on a suitable programme). Getting people to sing can be excellent, using instruments is super – people can often recall they used to play the piano or violin, or sing in the church choir. And they can still do it. Many people can bang a drum or play the triangle, some can blow a penny whistle or a chanter (part of the bagpipes in Scotland). It can sound like the Infants’ Band but it is fun – and it doesn’t have to…
We shall go back, for the purposes of this article, though, to two very important ideas. The first is just to say that there is a fairly simple method for working out what anyone’s preferred kind of music is. Ask them. Ask their family and friends. Try different types of music and solicit an opinion.
Write down the date of birth of the person and research what music was popular when they were 10, 15, 20, 30, 40, 50, 60, 70…try some of those and see what things it produces. Remember, though, that there are some people who do not like popular music at all (or not much). They may prefer Swing, Big Band, Trad Jazz, Gospel, R & B, Soul, Tamla Motown, Classical, Choral, Renaissance. How about that?
Secondly, have you ever thought about changing the mood of a group by music? A group may be calmed or stimulated, comforted or helped to feel a variety of emotion, simply by changing the music. Music has POWER and you need to be careful. I shall blog about this method on another occasion – so watch for it.
In the meantime, here are some thoughts about the main functions of music in working with people living with dementia. The whole subject is quite complex but fun, and very helpful, when you do it right!
The Main Functions of Music in Working with People with Dementia:
Music as pattern: In our everyday life, patterns help to make sense of things which, otherwise, would not gel in our consciousness. It is the pattern of features on someone’s face which leads us to recognise them; the things we recognise in the street which enable us to know where we live. Animal behaviourists tell us that other species use pattern in sight, scent and hearing to find and recognise others of their species. Reproduction and survival depend upon these skills. It is likely that those people with dementia who do not recognise themselves in the mirror are working on old patterns; they do not see the “self” pattern but instead may see the “mother” pattern from childhood.
We all know that we enjoy music which we recognise – and wait for the bit we know coming round again. Some music is very well known – Holst’s “Jupiter” from the Planets Suite is the sound-track to a paint advert; Hamlet Cigars was a bit of Bach; various pieces of jazz and Motown advertise other things. The pattern-aspect of tunes is clear when what used to be just an aria (although a very good one!) from Puccini’s “Turandot” became the World Cup Anthem, “Nessun Dorma” when sung by Luciano Pavarotti – springboarding the Three Tenors into a popular career on top of their distinguished operatic ones. If I am hassled and stressed J.S. Bach’s“Goldberg Variations” in the later version played by Glenn Gould[1], helps me to make sense of life; it is, for me, totally perfect, totally sensible, totally exquisite. It makes some people throw themselves from tall buildings.
Music for calming:
I happened to be in one of the day centres one day when a client was having hysterics about wanting to go home (she wanted to go home when she was at home too) – and, as these things will, she upset several other people – the famous domino effect. On the record player was one of the usual things (this was years ago), possibly Max Bygraves or songs of the First World War. I looked around, had a quick think, and sent someone out to my car. I knew that there were a few tapes there and, perhaps, we might find something calming. Rejecting a few noisy tapes, I put some Mozart early symphonies on. After 5 minutes the atmosphere became calm and people started to listen to the music, and say how nice it was.
When I talked to the staff afterwards, the senior worker who had brought in my tapes asked, “What on earth was that horrible music?”. It made him climb the walls. I’m not recommending Mozart for every situation – but if we are aware that this almost immediate calming effect can happen, we can try different things until it does!
I once gave a modified version of my MusicWorks dementia course in an evening to a group of Home Support workers managed by a colleague and friend. I did my usual introduction about musical taste and also told them that I had a wide-variety of music and that probably most kinds were covered except for Country & Western. No one said anything but, at the end, one very serious lady came up to me and asked if I minded her asking why I had no country music. I said that I didn’t mind and it was just that I hadn’t any in my collection. “You should get some,” she said, “Country music is about life!”.
Music in reminiscence:
The usual reminiscence safeguards have to apply to music too; “our” song often remembers a loved husband or wife who has died. It may be a cause of unhappiness or of comfort; you won’t know until you try it. You need good judgement to make the decision when enough is enough.
Different people like different sorts of music and that is their own business. I always tell MusicWorks classes that musical taste is very personal and no jeering at others will be allowed! Some people are narrow in their tastes; “All classical music is crap”, “Jazz makes me want to stick pins in my eyes”, “I can’t stand that beat, beat, beat”, “That’s not music, it’s just noise!”, “I hate opera!”. Some people like “anything that’s good”! The old joke about painting also applies to music; “I don’t know anything about it; but I know what I like!” That’s all that’s required.
There is music for every taste. We should remember, though, that the brain cannot feel, recall or process anything to which it has not been exposed. Don’t assume any type of music has no worth, or that the group with which you are dealing wouldn’t like it. Try stuff. Be experimental. Find out.
Music as stimulation:
I feel another anecdote coming on (“Stories from my Life no: 456”). Years ago I took part in the performance of Verdi’s Requiem and liked it so much I borrowed the tape from the local library. I played it once on the way to work and took it back the next day. The “Dies Irae” had a terrible effect on my driving.
Most dementia workers are aware of the fact that it is not wise to play a Sousa March when people are eating soup, if they don’t want a new colour scheme in the dining room. This applies to any music with a very strong beat or brass or bagpipe or organ part – and to pretty well any food.
Appropriate stimulation, though, can be very useful. Another time, when we discuss behaviour, I shall make a case for apathy being one of the worst behaviours we see (and one often ignored by over-pressed workers); and it is when clients are regularly withdrawn that stimulating music can be a godsend.
Music which people know is useful (ask for their preferences in Personal Profiles)and can be used as a springboard to other music/songs. “How many songs can you think of about different flowers?”; “What about girls’ names?”; lots of others.
Try a modified experiment with something like Mozart (no, I’m not on commission!). They did this at Stanford University in the US. Students did an intelligence test, listened to a Mozart Piano Concerto, then did a matched intelligence test. Their scores were “significantly” higher the second time – although they returned to their original level in time. So, Mozart makes you more intelligent? Don’t bank on it.
We are all programmed for listening to certain sounds and frequencies from birth. In recent years it has been acknowledged that our appreciation of music depends very much on where we were brought up and to what we have been exposed. Western music is only one kind and is based on certain conventions which we are used to. Eastern music is very different and is based on other schemes.
There is a story about the times when various members of the Beatles were travelling to the east and coming back with eastern philosophy and the Maharishi Mahesh Yogi. George Harrison had arranged for the Indian sitar player, Ravi Shankar, to play at a concert. He was deeply embarassed when the audience (conditioned to expect music unlike their usual sort) applauded Ravi tuning his instrument!
There are many kinds of music which we have to get used to before we can appreciate them properly. It usually takes repeated hearing of almost anything, to induce familiarity, before we can make sense of it. I think this is especially true of J. S. Bach’s music. We need a little preparation so that we can get the most out of it. Even realising the basic concept of having more than one “tune” going on at once, helps a lot to appreciate Johann Sebastian! I read once that someone thought Bach sounded like being hit repeatedly over the head with a teaspoon…
Some music catches you immediately, especially if it has a strong beat or dramatic opening. Beethoven’s Fifth Symphony is like this; as is Tchaikovsky’s First Piano Concerto. There are some beloved pop songs which reach out to you and stir you up – the first time I remember this happening to me was when Bill Medley (late Righteous Brother) sang “Brown Eyed Woman”; I bought it the following Saturday and still play it occasionally. It never became popular as far as I know.
More next time!
[1] Glenn Gould 1981 – Decca no:
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