January/February 2015

Music and Art in Memory Care
By Caroline Edasis, MAAT
Today's Geriatric Medicine
Vol. 8 No. 1 P. 10

According to the US Census Bureau, by 2025 roughly 20% of the population will be over the age of 65. The Alzheimer's Association states that one in nine, or an estimated 5 million American older adults have Alzheimer's disease, while the Aging, Demographics, and Memory Study (ADAMS) estimates that nearly 14% of people aged 71 and older in the United States have dementia. The Alzheimer's Association predicts that by 2050, the prevalence of Alzheimer's disease in the United States will expand to between 13.8 million and 16 million.

Dementia impacts multiple functions, including memory, communication and language, attention, reasoning and judgment, and visual perception. Individuals progressing through the stages of dementia eventually lose the ability to communicate verbally, may be unable to recognize longtime friends and family members, and will ultimately need help with even the most basic activities of daily living.

With no identified cure and no medications available that can permanently halt disease progression, there are limited treatment options. Finding ways to alleviate the day-to-day struggles of dementia is critically important, and focusing solely on providing physical care is not enough. Person-centered care approaches improve quality of life through creative interventions that allow individuals to connect with personal meaning, express feelings and experiences, and feel connected to others in the present moment.

Retained Abilities
People living with dementia may lose the ability to express themselves verbally, but may sing with great gusto upon hearing a familiar song. An individual who has lost the ability to write may be able to paint an image filled with color, or representing a childhood home. A resident in a wheelchair who can no longer waltz across the floor can still lift her arms, conducting in time to the rhythm.

Among the last remaining abilities in those living with dementia are musical aptitude and appreciation. Because our connection to music remains long after other abilities have passed, music is a compelling way to see beyond the disease process to reach the individual. Combining music with art therapy can further enrich the experience.

Mather LifeWays, an Evanston, Illinois-based, award-winning nonprofit organization founded in 1941, serves more than 40,000 older adults each year through senior living residences, its Institute on Aging, neighborhood outreach, and Mather's—More Than a Café. Mather LifeWays art therapists use the arts to facilitate creative expression and connection for residents living with dementia, built on the belief that self-expression through the arts is a fundamental psychosocial need rather than simply a recreational activity. Through interacting with art materials, individuals living with dementia can engage in a strengths-based, present-moment experience operating primarily on an emotional level. Making art allows for self-expression and connection with others, even when language and memory are impaired.

The Mather LifeWays art therapy program embraces collaboration with local arts organizations, believing these collaborations can further enhance quality of life for residents living with dementia. Collaboration brings new creative voices and diverse forms of expression, such as music, dance, theater, and poetry, into the art therapy program, while nurturing intergenerational relationships and generating powerful artworks that contribute to social awareness of creativity and purpose in later life.

In one such related experience, we sat in a circle of wheelchairs in the art studio of a memory care unit in Evanston, Illinois. Amy, a young violist, slowly lifted her instrument to her shoulder. Joan, sitting quietly in her wheelchair, opened her eyelids, and her hand started tapping in her lap. Ellen began to sing along, "Just direct your feet to the sunny side of the street …" Her voice was shaky but powerful, the tune flowing through her mind and out into the room with such familiarity. Across the circle, Rita clutched the arms of her wheelchair, but as I reached for her hands, we began to move together in time to the song. Amy lowered her viola and the residents were smiling and clearly more alert and engaged.

"What do you love about music?" I asked the group. Ellen said, "I enjoy songs that I heard years ago, and songs that are coming across me now. … I went to the symphony once, and they played, oh … I can't remember …" She struggled to describe the experience, then began singing, "Going home, going home … I can't sing the song without it bringing tears. ..." Amy echoed the Dvorak melody on her viola, and within moments, on an iPad we found a boy's choir performing the piece. I turned to Rita, who struggled with language, but had retained a powerful sense of rhythm. As the clear voices of the choir drifted over us, Rita's trembling soprano appeared, growing stronger and stronger. Her voice gradually transformed from song to a spoken stream of consciousness. Our hands moved together in time with her words; she rhymed, then counted, and eventually erupted in laughter, and we applauded her remarkable contribution.

Rita, Joan, and Ellen's story is a moment taken from a creative collaboration. In 2014, Mather LifeWays collaborated with the Negaunee Music Institute at the Chicago Symphony Orchestra (CSO) as part of its ongoing Citizen Musician initiative to "bring music to life" for residents living with dementia. According to the CSO website, "The Negaunee Music Institute at the Chicago Symphony Orchestra engages more than 200,000 people every year, igniting sparks of curiosity about music that lead to transforming experiences."

The Citizen Musician initiative works "to sustain and expand the role of music in civic and cultural life by creating and enhancing communities through music." It is designed to transcend technique, create empathy, and direct the value and relevance of music toward positive social change. The initiative stems from the belief that music can bring beauty and hope to people's lives and create connections between people.

In early 2014, CSO Mead Composer-in-Residence Anna Clyne approached Mather LifeWays with the goal of exploring how music can impact memory. As we sat brainstorming in the art studio, I told Anna about a resident who had described feeling "flooded" with songs from her past. Anna and I decided to frame our project around this theme, the "flood of music." The Mather LifeWays and CSO collaboration included three musicians from the Civic Orchestra of Chicago: Emma Koi on flute, Amy Hess on viola, and Desiree Miller on cello.

Creating a Connection
Over the course of several weeks, the musicians interacted with small groups of residents with dementia, utilizing live music, singing, reminiscence, movement, and improvisation. The first session began with a performance of classical pieces and a variety of jazz and popular standards relevant to the residents' lives. The musicians then engaged individually with residents through conversation, movement, and gentle touch. Each week, a musician returned to provide live music within a small group session.

As an art therapist, I invited the musicians and residents into relationship and creative expression, with no idea where the music would take us. One song often led to another, or one resident's reaction inspired a response in his or her neighbor.

During one session, Emma lifted her flute to her lips and began playing "Ave Maria." Clyne later shared that she had been sitting next to a resident who initially had appeared very withdrawn. "She had very little mobility, but when Emma started to play 'Ave Maria,' she took all her strength to reach for my hand, lifting it to her eyes to wipe her tears," Clyne says. "It was incredibly moving, and I felt a deep connection in that moment."

Each weekly session was recorded, including the full range of responses by residents as they engaged with the music. Clyne then wove those recordings into an arrangement of music and memories.

During the days between these sessions, I brought the "flood of music" theme into group and individual art therapy. We talked about bodies of water, painted waves, and created creatures to live underwater and boats to ride above. Side by side in the art studio, Rita and I once again sang "Going Home," and her beautiful trembling melody again appeared. Tapping out the rhythm, I placed a paintbrush in her hand. Rita began dabbing at the surface in time with our words, with blue paint gradually building in small swoops like a dancer's footsteps or a conductor's baton colorfully put to paper.

We put together a visual presentation to accompany the final audio composition, arranging images to illustrate the residents' stories. The presentation included resident artwork, as well as my own artwork to further bring to life our water voyage metaphor and the residents' voices.

Program Rewards
"The most satisfying part of this process was sharing the work with the residents, their families, and the staff at Mather. It became clear that this work can touch a lot of people and can bring a voice to people for whom words can only take them so far," Clyne says. "Music and art are the languages that can move beyond these barriers, which makes it even more vital that we utilize these mediums to help facilitate communication and to capture beautiful moments expressed by loved ones. This project has certainly enriched and inspired my work as a composer."

The project also featured the work of Nhyta Taguchi, a young composer at the Merit School of Music in Chicago, who composed "Pitter Patter," also inspired by the "flood of music" metaphor. In the project's culminating event, the Civic musicians performed Taguchi's piece as a prelude to Clyne's "Mather Suite," which combined the audio track of residents' voices with the live accompaniment of arranged pieces and projected visual imagery. Our audience comprised residents, families, professional caregivers, and volunteers.

Even after an individual with dementia has lost his or her ability to effectively communicate verbally, the sharing of familiar music often can trigger positive shared responses. One family member remarked that he had grown up sitting next to his mother on a piano bench in their home. He shared with us that hearing her voice rise through the music allowed him to feel powerfully connected with the woman he had known and the woman she still was at her core. Sharing the Mather performance with his mother was gratifying and transformative.

"Programs of the Institute are designed to create entry points to the extraordinary musical resources of the CSO for people of all ages with diverse backgrounds," says Jonathan McCormick, associate director of Institute Programs. "Through our work with Mather LifeWays, we found it very moving to connect with senior citizens who were so open to sharing their stories through the creation of original music and visual art.

The successful Mather LifeWays and CSO collaboration prompted significant positive feedback from family members and staff who expressed surprise at the performance's emotional impact.

— Caroline Edasis, MAAT, is the manager of art therapy at Mather LifeWays in Evanston, Illinois.