Back in 1997 Harvard scientist, Steven Pinker referred to music as nothing more than ‘auditory cheesecake’. A nice to have that tickles our pleasure system but has no real evolutionary purpose. Although over the last 20+ years, neuroscience, psychology, sociology, and evolutionary research has uncovered that music is one of the most powerful stimuli humans can experience and it has convincing social implications. Thus, a more contemporary theory might suggest music is more of a neuro-superfood than a decadent dessert.
Music stimulates widespread brain activity which can improve communication and cognition, change the structure, and make up of our brains (at all ages), as well improve psychological wellbeing, and motor functioning[i]. Music effects our mood, senses, identity, behaviour, focus, sleep, relationships and can even make us more empathetic, trusting, and cooperative[ii],[iii],[iv]. It’s clear music is important, so why in residential aged care do we see: the removal of musical choice; over and under use of music; misuse of music; lack of clinical oversight; and general acceptance that music is auditory cheesecake, a nice extra when we have time. We can to do better.
“Music should not just be a nice-to-have, or an ‘add-on’. It has tangible, evidence-based benefits, such as helping to minimise the behavioural and psychological symptoms of dementia, tackling depression and anxiety, and, importantly, helping to improve quality of life,”[v] said Neil Utley as an outcome of the UK’s Commission on Music and Dementia in 2015.
Indeed, music is a powerful stimulus which means while there is value in almost all musical experiences, for people with cognitive differences such as dementia, Parkinson’s disease, acquired brain injury or mental illness (e.g., depression), we must understand a person’s unique needs and vulnerabilities when engaging with music to maintain positive wellbeing outcomes[vi]. With more than 52% of Australia’s current aged care residents diagnosed with dementia[vii] and many experiencing depression, music should be a fundamental and non-negotiable component of service delivery and its implementation must be carefully considered and guided by appropriated qualified personnel.
As a non-pharmacological approach to support people living with dementia there are many ways music is used. Music therapy is a research-based allied health profession where a Registered Music Therapist (RMT) uses music to support people improve their mental and physical health, functioning and wellbeing and enhance quality of life.
Choirs, music & movement groups, and silent discos are types of music engagement, usually facilitated by community musicians, volunteers, or therapy assistants. The groups bring people together through music and leverage the social and emotional therapeutic benefits. Music entertainment through live or recorded concerts are common, as well as personally listening to preferred music, often with headphones, which can evoke personal memories and have therapeutic benefits. Environmental music refers to music in common areas, which may be live or recorded (think background music).
So, how do we maximise music use in aged care?
Autobiographical memories connected to music can be retained as dementia progresses[viii], providing a unique opportunity for a person to connect to their identity and others. Nonetheless, whilst studies indicate positive outcomes of personalised playlists for agitation, anxiety, behaviour, and the use of antipsychotic medication[ix], a review found that the education provided to staff implementing these music activities varies[x] and outcomes include negative responses[xi].
Thus, when using music to support people living with dementia, staff need to understand which music, when, how, for how long, and why to use music. This is where RMT’s can offer clinical guidance and recommendations. Commissioner Briggs of the Aged Care Royal Commission even recommended it be mandatory for all residential aged providers to employ or engage the services of a registered music (or art) therapist[xii].
Whilst RMT’s often address behavioural and functional goals, they are also experts in optimising positive experiences, sustaining identity and relationships through music. The importance of which has been emphasised by people living with dementia through qualitative studies[xiii]. This shift from music being important for people to manage negative symptoms; to music used with people in a way important to them to increase shared positive experiences and deepen relationships is an important one.
When staff understand which music, how, when, for how long and why to use music, the experience can be positive for all involved. Residents may be more relaxed and easier to care for[xiv], whilst staff may feel more energised, less stressed, and more closely connected to residents[xv]. It is reasonable then infer these positive experiences will have a flow on effect to carer job satisfaction, and thus care quality and workforce retention, which are critical industry wide issues.
So, when we move beyond seeing music as a nice to have, auditory cheesecake, to a neuro-superfood that is a fundamental and non-negotiable component of aged care service provision, we have the potential to improve resident and workforce wellbeing and functioning. We must commit to clinically robust, evidence-based use of music to improve relationships, restore personal identity, and create environments of connection & safety where quality of life is prioritised and maximised.
Hayley Antipas, Director of Attuned Health. Registered Music Therapist, Neurologic Music Therapist and PhD candidate at the University of Melbourne.
[i] Magee, W. (2020). Why include music therapy in a neurorehabilitation team? Advances in Clinical Neuroscience and Rehabilitation, 28(1), 10–12. https://doi.org/10.1177/0269215512466252
[ii] DeNora, T. (2000). Music in Everyday Life. Cambridge, United Kingdom: Cambridge University Press
[iii] Greenberg, D. M., Decety, J., & Gordon, I. (2021). The social neuroscience of music: Understanding the social brain through human song. American Psychologist. Advance online publication. http://dx.doi.org/10.1037/amp0000819
Harvey, A. (2020) Links Between the Neurobiology of Oxytocin and Human Musicality. Frontiers in Human Neuroscience, 14(350), 1-19. https://doi.org/10.3389/fnhum.2020.00350
[iv] Rickard, N. (2012) Music Listening and Emotional Well-Being. In Rickard, N., McFerran, K. (Ed.), Lifelong Engagement with Music: Benefits for Mental Health and Well-Being (207-238). New York, USA: Nova Science Publishers, Inc.
[v] Bowell, S., & Bamford, S. M. (2018). What Would Life Be – Without A Song Or A Dance, What Are We? A Report From The COmmission on Dementia And Music. London. Retrieved from https://ilcuk.org.uk/wp-content/uploads/2018/10/Commission-on-Dementia-and-Music-report.pdf
[vi] Clements-Cortes, A. (2020) Understanding the Continuum of Musical Experiences for People With Dementia. In Baird, A., Garrido, S., & Tamplin, J. (Ed.), Music and Dementia: From Cognition to Therapy (3-23). New York, USA: Oxford Univeristy Press
[viii] Bowell, S., & Bamford, S. M. (2018). What Would Life Be – Without A Song Or A Dance, What Are We? A Report From The COmmission on Dementia And Music. London. Retrieved from https://ilcuk.org.uk/wp-content/uploads/2018/10/Commission-on-Dementia-and-Music-report.pdf
Cuddy, L. L., & Duffin, J. (2005). Music, memory, and Alzheimer’s disease: Is music recognition spared in dementia, and how can it be assessed? Medical Hypotheses. https://doi.org/10.1016/j.mehy.2004.09.005
Cuddy, L. L., Sikka, R., Silveira, K., Bai, S., & Vanstone, A. (2017). Music-evoked autobiographical memories (MEAMs) in alzheimer disease: Evidence for a positivity effect. Cogent Psychology, 4(1), 1–20. https://doi.org/10.1080/23311908.2016.1277578
[ix] Gerdner, L. A. (2012). Individualized music for dementia: Evolution and application of evidence-based protocol. World Journal of Psychiatry, 2(2), 26–32. DOI:10.5498/wjp.v2.i2.26
Raglio, A., Bellandi, D., Baiardi, P., Gianotti, M., Ubezio, M. C., Zanacchi, E., … Stramba-Badiale, M. (2015). Effect of Active Music Therapy and Individualized Listening to Music on Dementia: A Multicenter Randomized Controlled Trial. Journal of the American Geriatrics Society. https://doi.org/10.1111/jgs.13558
Ridder, H. M., Stige, B., Qvale, L. G., & Gold, C. (2013). Individual music therapy for agitation in dementia: An exploratory randomized controlled trial. Aging and Mental Health, 17(6), 667–678. DOI:10.1080/13607863.2013.790926; 10.1080/13607863.2013.790926
Sung, H., Chang, A., & Abbey, J. (2006). Application of music therapy for managing agitated behavior in older people with dementia. Journal of Nursing, 53, 58–62
Thomas, K., Baier, R., Kosar, C., Ogarek, J., Trepman, A., & Mor, V. (2017). Individualized music program is associated with improved outcomes for US nursing home residents with dementia. The American Journal of Geriatric Psychiatry, 25(9), 931-938
[x] Garrido, S., Dunne, L., Chang, E., Perz, J., Stevens, C. J., & Haertsch, M. (2017). The Use of Music Playlists for People with Dementia: A Critical Synthesis. Journal of Alzheimer’s Disease. https://doi.org/10.3233/JAD-170612
[xi] Garrido, S., Dunne, L., Perz, J., Chang, E., & Stevens, C. J. (2018). The use of music in aged care facilities: A mixed-methods study. Journal of Health Psychology, (February). https://doi.org/10.1177/1359105318758861
[xii] Royal Commission into Aged Care Quality and Safety. (2020). Recommendations. Retrieved from https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf.
[xiii] McDermott, O., Orrell, M., & Ridder, H. M. (2014). The importance of music for people with dementia: The perspectives of people with dementia, family carers, staff and music therapists. Aging and Mental Health. https://doi.org/10.1080/13607863.2013.875124
[xiv] Götell, E., Brown, S., & Ekman, S. L. (2002). Caregiver singing and background music in dementia care. Western Journal of Nursing Research, 24(2), 195–216. https://doi.org/10.1177/01939450222045833
Götell, E., Brown, S., & Ekman, S. L. (2003). Influence of Caregiver Singing and Background Music on Posture, Movement, and Sensory Awareness in Dementia Care. International Psychogeriatrics, 15(4), 411–430. https://doi.org/10.1017/S1041610203009657
Götell, E., Brown, S., & Ekman, S. L. (2009). The influence of caregiver singing and background music on vocally expressed emotions and moods in dementia care. International Journal of Nursing Studies, 46(4), 422–430. https://doi.org/10.1016/j.ijnurstu.2007.11.001
[xv] Särkämö, T., Tervaniemi, M., Laitinen, S., Numminen, A., Kurki, M., Johnson, J. K., & Rantanen, P. (2014). Cognitive, emotional, and social benefits of regular musical activities in early dementia: Randomized controlled study. Gerontologist, 54(4), 634–650. https://doi.org/10.1093/geront/gnt100