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ADvancing Care Newsletter  
   October/November 2011    

  October/November 2011
 
Reconnecting with Musical Memories:
The Song Remembers When


No matter what our age, it’s a safe assumption that music plays a significant role in our lives. From the earliest nursery rhymes we learned as toddlers through the rebellious teenage years and on to romantic and family relationships over the decades, hearing a familiar melody can instantly bring us back to another time and place.

Long-term care facilities are well aware of its benefits, often scheduling a variety of musical entertainment programs for residents. But not everyone’s experience is always positive. Persons with Alzheimer’s may lose the capacity to understand or distinguish various sounds in their environment, leading to more confusion or agitation; and they may have difficulty with appreciating music in a group setting. Additionally, they may not like or be familiar with the styles of music played in the facility. Research on the brains of people with dementia, however, has shown that, even when someone is no longer able to communicate verbally, he or she will still respond to favorite music, often dramatically. Dr. Connie Tomaino, world-renowned pioneer and leader in music therapy, has conducted a significant body of research in this area over the last 30 years. As she describes it:

“Most times, people with Alzheimer’s have trouble with didactic memory—facts, names, places, what we call things. What they don’t lose is a sense of familiarity with something…Emotional memories are very well preserved in Alzheimer’s Disease—love, affection, etc., so songs that carry those emotional memories are the best retained. The amazing thing is that people can’t recall other information, but they can sing along with the lyrics…Chaotic brain activity diminishes as a song holds their attention. It pulls everything together so the person is fully whole, centered in the moment, enabling the person to be more themselves.”
Obviously, the optimal solution to reconnecting persons with Alzheimer’s with beloved musical memories would be to provide their favorite music at desired times. That might seem a daunting task for the typical long-term care facility. But it didn’t stop Dan Cohen, a Long Island social worker, who, in 2006, envisioned creating iPod playlists for residents of a local nursing facility. When this proved tremendously successful, reducing agitation, improving behavior, mood and social interaction, he set out to formalize the program, establishing Music and Memory, a non-profit organization dedicated to improving the quality of life by mainstreaming and promoting the use of personalized digital music. As he puts it:
“When people are no longer speaking or recognizing their relatives, play the right song, and they will sing the words to just about perfect rhythm…their eyes will open up, and they’ll be happy. Everything will stop around them because everyone will be enjoying watching someone have that reaction."
Mr. Cohen’s pursuit of research led him to the Institute for Music and Neurologic Function (IMNF), member of the Beth Abraham Family of Health Services, dedicated to advancing understanding and applying the power of music to promote healing and wellness, and its Executive Director, Dr. Tomaino. IMNF and Music and Memory are now collaborating very closely in this work.

One of the institutions that has enjoyed great success with the program is Cobble Hill Health Center in Brooklyn, NY. Their Director of Therapeutic Recreation, Louise Dueno met with Dan Cohen in 2008 to set up a project utilizing iPods. They started with a laptop computer, iTunes library, 25 iPods and technical support from Dan. Presentations were then made to their Leadership Team and to the interdisciplinary team on each community (unit), resulting in the creation of an Individual Personalized Music Policy. The TR staff received training in the use of iPods so that they could develop (by meeting with residents, families and staff to discuss music preferences), download, and update individual playlists.

As Louise relates: “One of the first residents selected had a history of challenging behavior, particularly with morning care. He had a military background, so patriotic/military songs were loaded on his iPod. The first thing he did upon hearing the music was stand up and salute. He then remained calm for the next half-hour.” Another resident with significant dementia listened to gospel music, shouted “Hallelujah, Amen!” and started to conduct his own celestial choir.

The program has since grown to 64 iPods that have been used by over 100 residents. The iPods are numbered and assigned to residents; some are stored in the recreation office, others on the communities. Cobble Hill has now compiled some 6,000 songs in their music libraries and now buys iTunes songs as needed. Families also supply favorite CDs to be downloaded.

Although the program requires some initial set-up time and dollars, the process is relatively simple, and the long-term benefits should outweigh potential concerns about staff time and budgets. The required elements are a laptop computer to set up an iTunes library for programming, iPods with headphones, and iTunes cards to buy additional songs. Costs can be lowered in a number of ways, however: Drives can be conducted to collect used iPods through local schools, libraries, community service organizations and families of residents. One iPod can be used by several residents at different times of the day (with individual headphones), a volunteer can program the iPods and maintain the central library. Existing music collections from the facility and/or families can form the foundation of the library, and donations of iTunes gift cards can also be encouraged. At this point, there can be no denying that the program works. The Music and Memory program is currently in 19 nursing homes and will be rapidly expanding in the next year.

The bottom line for staff is easier interactions with residents, less resistance to care and transitions, plus the enjoyment and reward of seeing the person doing better and responding to the positive power of the music. Families are also heartened that this helps their relative maintain their identity when other connections may be fading or gone. As Dan Cohen so aptly summarizes: “It’s a big win—people are stimulated, engaged, more alert for longer periods of time and want to share the music, creating a real spike in social interaction.”
     
     
Resources

Music & Memory
www.musicandmemory.org
For information, contact Dan Cohen: (917-923-5636) or email dcohen@musicandmemory.org

Institute for Music and Neurologic Function (IMNF)
www.imnf.org
For more information on the programs and services offerred, email imnf@bethabe.org.

Cobble Hill
www.cobblehill.org
For more information, contact Louise Dueno at 718-855-6789 or email ldueno@cobblehill.org.

NY State Dept. of Health’s Electronic Dementia Guide for Excellence (EDGE)
Recommendation for individualized music interventions, with guidelines and suggestions.
http://www.health.ny.gov/diseases/conditions/dementia/edge/

     
Alzheimer's Association

Our vision is a world without Alzheimer's
Formed in 1980, the Alzheimer's Association is the world's leading voluntary health organization in Alzheimer's care, support and research.