Public interest in the benefits of music for people with dementia has increased over the years. Social media often highlights how music awakens strong emotional reactions in people with dementia. Music activities are generally regarded as inclusive and enjoyable for all, and there is a strong sense among the general public that “music is good for people with dementia”. However, is it simply: “more music, the better”?
The increasing popularity in the use of music in dementia care has led to many positive outcomes, but it also highlights the need to ensure safe, informed use of music with people with dementia. “Therapeutic music activities” can be un-therapeutic if facilitators do not pay sufficient attention to the mood and preferences of people with dementia in that moment. Playing someone’s preferred music is often considered beneficial but playing it repeatedly without interacting with the person won’t be helpful.
Many people with moderate to severe dementia have limited communication skills to express their likes and dislikes. However, this does not imply they lack preferences. A study on the importance of music for people with dementia found close links between music, personal identity, and life events. The study also highlighted that musical preferences in people with dementia often remain despite progression of the disease.
Music activities are not meant to be “one size fits all,” but they provide opportunities to learn about the uniqueness of each individual and build two-way relationships. So how do we ensure facilitators of music activities are sensitive to the needs and preferences of people with dementia and develop sufficient skills and self-awareness to be helpful?
Music therapists, who often find themselves having to extend their roles to meet clinical, cultural, political, financial, and organizational needs, may be key through offering what we have termed “indirect music therapy.” For dementia care, “indirect music therapy practice” includes promoting informed use of music and encouraging regular mentoring/supervision for music activities facilitators.
This often involves “music therapy skill-sharing.” Here, trained music therapists work with staff, families, friends, and volunteers to support them to use music as a resource in their everyday lives. Skill-sharing can include practical advice on implementing everyday use of music (what), and should also highlight the importance of attuning to whatever the person expresses (how). In other words, the focus of indirect music therapy is to support the interpersonal process between carers and people with dementia through music, rather than directly addressing clinical needs of clients (people with dementia), as is the case in traditional “direct” music therapy practice. However, the ultimate focus of indirect music therapy in dementia care remains the wellbeing of people with dementia.
Interventions to support carers of people with dementia are not new in dementia psychosocial research, but it is still relatively new to music therapy research. One study recently published explores the use of therapeutic songwriting for carers to support them in their role as carers. The intervention is important to sustain their emotional wellbeing because it allows them “to explore the journey of being a carer. This is different from other carer interventions where the focus is on managing dementia symptoms and associated daily challenges. This is not to say therapeutic songwriting is superior to these other longer-established approaches; rather, it illustrates songwriting is a holistic intervention to enhance carers’ wellbeing and strengthen their relationships with family members with dementia.
Indirect music therapy practice is not a substitute for direct music therapy practice, as music therapists still need to maintain their traditional clinical role (e.g., by working with care home residents with persistent behavioral and psychological symptoms of dementia). Nevertheless, if we are to promote a person-centered approach, music activities facilitators need to move beyond simply providing enjoyable music activities and develop the skills and awareness of how to “meet the person in the moment.” Music therapists can help by supporting facilitators to ensure the therapeutic use of music.
Featured image credit: Piano time by Tadas Mikuckis. Public Domain via Unsplash.