Music Therapy in Dementia Treatment — Recollection Through Sound

By Juliann Schaeffer

People of all ages relate to and enjoy music, making it a universal language, of sorts. However, its value can go far beyond simple listening.

Most people enjoy music, but can it actually make the mind “move”? Absolutely, according to Kimmo Lehtonen, PhD, professor of education at the University of Turku (Finland) and a clinical music therapist for more than 25 years. In fact, therapists have been using music therapy to promote memory and a sense of self in the treatment of older adults with dementia.

Music and Emotion
Music therapy is a target-oriented and purposeful activity in which therapists work with individuals or groups, using musical expression and the memories, feelings, and sensations it evokes. It has been found to be particularly beneficial for older adults with various types of dementia. “Music therapy has many faces,” says Lehtonen. “With older adults, I mainly use old wartime songs, which seem to bring many lively memories to their minds. Music has a close relationship with unconscious emotions, which are activated by musical movement. To me, music represents a microcosmos which has a close relationship to our inner feelings. These feelings are so strong, they’re meaningful even if patients cannot remember who they are.”

John Carpente, founder and executive director of the Rebecca Center for Music Therapy in New York and a licensed, board-certified music therapist, describes the center’s music therapy program for older adults: “Meeting individually and within a group, elder clients express themselves and recall the memories that music sparks and stimulates. By listening to live music and being involved in live music-making experiences, a greater quality of life is possible.” This, he believes, empowers clients to emerge from the isolation imposed by Alzheimer's disease and dementia. He notes that program therapists use music therapy to improve the overall physical and mental wellbeing of dementia patients, including the following:

• memory recall;
• positive changes in moods and emotional states;
• a sense of control over life;
• non-pharmacological management of pain and discomfort;
• stimulation that promotes interest even when other approaches are ineffective;
• structure that promotes rhythmic and continuous movement or vocal fluency as an adjunct to physical rehabilitation; and
• opportunities to interact socially with others.

Basically, Carpente says, music is used with older adults to maintain or increase their levels of physical, mental, social, and emotional functioning. Music used as a sensory and intellectual stimulation can help maintain a person's quality of life or even improve it.

Memory in Sound
Although music therapy is used for people of all ages, it is especially beneficial for older persons with dementia who may be unable to communicate in another way. “Music can function, for instance, as an interpreter of the [patient‘s] world picture without the problem essentially connected with verbal interaction,” says Lehtonen.

Since dementia is a degenerative condition, expressing basic needs and being understood can become problematic and lead to a complicated feeling of isolation for sufferers, says David Aldridge, chair of qualitative research in medicine at the University Witten Herdecke (Germany) and editor of Music Therapy in Dementia Care. “Using songs in a therapy setting promotes communication,” he says. “Singing has many functions; it offers a communicative structure, stimulates and regulates, and enables dialogue.”

Alicia Ann Clair, PhD, MT-BC, director of music education and therapy at the University of Kansas/Lawrence, says that making music and listening to it provide ways to employ cognitive skills to avoid losing them. “When older persons are interested in learning to make music or are looking for ways to rejuvenate skills learned in the past, many programs are available,” she says. “Opportunities for learning music that were once accessible only during childhood are now available throughout the life span, either through group lessons or private instruction.” Resources include local music stores, professional music education venues, and private teachers.

Music therapy can promote communication between therapists and patients in individual settings or among patients in group settings. “Undoubtedly, it’s one of the most engaging and emotionally powerful stimuli,” says Carpente. “Listening to music can have strong effects on people's moods, thinking, and even their physiology, which constitutes a probable reason certain songs remind us so vividly of a specific memory. That being said, memory is a mental system that receives, stores, organizes, alters, and recovers information from sensory input. Emotions and memory are very much linked, and because music is charged emotionally, it can trigger past memories, good and bad.”

This same triggering of memories via music can also promote communication within the older patient, essentially giving him or her a renewed sense of identity. “I have one particular experience, which was very strong and beautiful,” Lehtonen recalls. “I used to work as a supervisor of music therapy research. The therapist had a video camera set up in every session and afterward, we would analyze the tapes. In this case, the therapist sang old Finnish folk songs to an over 80-year-old man with dementia. After every song, the man sang his own song in a broken voice. He sang old Italian romantic songs, which were quite difficult. He exactly remembered melodies and words, and he sang many songs during these sessions. His voice and expression were so strong and authentic they put a shiver down my spine. I checked his personal history. This old man, who hardly remembered his name, had spent his best years in Florence, where he worked as an interior architect.”

Lehtonen believes music therapy can be used not only to treat elders with dementia but also to prevent the disease. “In Finland, the after-war generation is getting old, and there are more and more elderly people who are in a relatively good condition both physically and psychically. I think this kind of remembering through music is a good way of keeping people happy and active.”

Physical Aspect
For patients who suffer from only mild or occasional dementia, Clair notes that music can be a factor in helping elders get regular exercise. “Obviously, there’s strong evidence that people who regularly exercise are healthier and have better physical function than those who don’t,” she says. “This may be apparent in measures of bone density, muscle strength and flexibility, heart and pulmonary function, weight, and other physical capacities. Of course, there are physical disabilities that influence which exercises are appropriate, but physical functions that have been lost due to lack of activity can be restored through an appropriate exercise program. And it’s never too late to begin; even those who become physically frail can benefit from exercise. That’s where music can come in, but not just any music is suitable.”

Rather, she explains, it needs to be carefully selected music or specifically designed to support each particular exercise by cuing the pace, force, direction, and number of repetitions. In addition, because music makes exercise seem shorter and more pleasant, people—older or younger—tend to stick with exercise programs where music is included. However, she notes, it’s important to obtain a physician’s approval before starting any exercise program.

A Little History Plus
How deep are the roots of music therapy’s use in the treatment of older adults with dementia? Surprisingly, more than 2,000 years. The idea of music as a healing influence able to affect health and behavior is as least as old as the writings of Aristotle and Plato, says Carpente. “The 20th century discipline began after World War I and World War II when community musicians of all types— amateur and professional—went to military hospitals around the country to play for the thousands of veterans suffering both physical and emotional trauma.

Their physical and emotional response to music led doctors and nurses to request the hiring of musicians by the hospitals. It was soon evident that the musicians needed some prior training before playing in hospitals, and so the demand grew for a college curriculum.”

The world’s first music therapy degree program was established in 1944 at Michigan State University. The American Music Therapy Association (AMTA) was founded in 1998 as a result of a merger between the National Association for Music Therapy and the American Association for Music Therapy. According to the AMTA, there are currently 75 institutions nationwide offering bachelor’s or master’s degrees in music therapy and approximately 100 internationally.

With the continuing increase in the United States’ older adult population, professionals may want to tune their clients and patients in to a therapy that fosters an enhanced recall of their forgotten histories. “The future of music therapy is promising,” says Carpente, “because state-of-the-art music therapy research in physical rehabilitation, Alzheimer's disease, and psychoneuroimmunology is documenting the effectiveness of music therapy in terms that are important in the context of a biological medical model.”

—Juliann Schaeffer is an editorial assistant at Aging Well.