A first-of-its-kind study has shown how and why music is able to reduce distress and agitation for people with advanced dementia.
Led by Naomi Thompson, of Anglia Ruskin University (ARU), the research reveals the benefits of music therapy and identifies mechanisms to explain why music can have these effects.
Making music in a nursing home
The study, published in the journal Nature Mental Health, provides a blueprint for implementing effective music therapy for people with advanced dementia.
An estimated one million people live with dementia in the UK and more than half are diagnosed with advanced dementia, which can require specialist care. It is often accompanied by behaviour such as agitation, aggression, wandering and resistance to care.
Music therapy is delivered by trained therapists and can include singing, playing or listening to music. Therapists can also identify specific ways that music can be used by families and carers in an individual’s daily care routine
The research, the first music therapy dementia care realist review, combines academic research with stakeholder input to develop guidelines for personalised interventions.
It shows that if music therapy is designed to individual needs, it can deliver an immediate, short-term reduction in agitation and anxiety for individuals with advanced dementia, and can improve attention, engagement, alertness and mood.
Musical interactions can also help people feel safer and more orientated in their surroundings, reducing distress and improving wellbeing.
This is caused because music, whether you are playing, singing or listening, delivers cognitive and sensory stimulation.
It activates networks across both sides of the brain, enabling an individual to access their remaining abilities and memories, and helps people manage their emotions and remain calm.
Music can also be tailored to reduce physiological stress, notably in the autonomic nervous system.
Naomi, from ARU’s Cambridge Institute for Music Therapy Research, said: “With an aging population and increasing numbers of people diagnosed with dementia, music is a relatively straightforward and cost-effective way of improving the quality of life of those affected.
“Our study not only shows why music therapy is successful – including meeting the person’s need for stimulation, supporting familiarity through memories, encouraging relationship and emotional expression, and crucially helping with the reduction of distress and anxiety – it also paves the way for its wider use in dementia care.
“Music, in particular recorded music, is an accessible way for staff and families to help manage distress, and music therapists can advise on tailoring music for individuals. Just as a doctor prescribes medications with a specific dose and frequency, a music therapist can outline an individualised programme, setting out how music should be used throughout someone’s day to reduce distress and improve their wellbeing.”
Memories evoked with music, especially those triggered by familiar music, are recalled more quickly and are more positive and specific than memories recalled without music, and often relate to earlier moments in an individual’s life.
Songs from when a person was aged between 10 and 30 years old are found to be the most effective.
One benefit is that music, as a form of nonverbal communication, is accessible regardless of cognitive impairment or musical ability, and provides opportunities for social interaction with staff, carers and fellow patients or care home residents.
The ARU study recommends that music therapists train other professionals to ensure that all staff involved in the care of people with advanced dementia can use music, regardless of their experience.
Resources, such as musical instruments and information about how to produce personalised playlists, should be made available, it suggests, and families should be encouraged to use music to support their relatives.
The researchers say engaging in music may also benefit care staff and family members, cutting stress levels.
It can provide meaningful moments different to a carer’s usual interactions and foster empathy, and it can also help staff better engage with a person with dementia, especially amid times of increased distress.
The research involved interviewing staff and music therapists on inpatient mental health dementia wards at Cambridgeshire and Peterborough NHS Foundation Trust, a systematic review of research and a national survey of healthcare professionals. The researchers also collaborated with the dementia specialist nursing charity Dementia UK.
Co-author Dr Ben Underwood, research and development director at Cambridgeshire and Peterborough NHS Foundation Trust and associate professor at the University of Cambridge, said: “People with advanced dementia can sometimes become quite distressed and we need to find the best ways to help them. Music is one thing which can help, and so I am excited to see such high-quality work being done in partnership to see how we can bring music therapy to NHS dementia patients.”