by Deborah Wolff-Baker MSN, ACHPN, FNP-BC

“The past which is not recoverable in any other way is embedded, as if in amber, in the music, and people can regain a sense of identity. . .” — Dr. Oliver Sacks (Neurologist, author and professor of neurology at New York University School of Medicine).

According to the National Alzheimer’s Association, in 2011 there were an estimated 5.4 million Americans of all ages with a diagnosis of Alzheimer’s disease.  Currently, 1 in 8 people over the age of 65 have Alzheimer’s disease.  By 2030, the number of people aged 65 and older with Alzheimer’s disease is estimated to reach 7.7 million — a 50 percent increase from the 5.2 million aged 65 and older today.

Most of our LTC facilities as well as our society in general are not fully equipped to handle the associated behavioral and psychiatric symptoms of dementia (BPSD).  These symptoms include:  agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It has been estimated that BPSD affects up to 90% of all dementia patients over the course of their disease progression.  These symptoms are associated with poor outcomes, including patient and caregiver distress, hospitalization, misuse of medication, and increased health care costs.  BPSD are a source of significant distress and poor quality of life for both dementia patients and their caregivers (Karttunen et al., 2011).

Given the latest research and guidelines on treating dementia patients with BPSD including eliminating or severely curtailing the routine use of atypical antipsychotic medications as well as other drugs which have burdensome side effects and limited evidence of efficacy or safety, caregivers and family members may feel they are left with little that assists them in caring for their loved one with dementia.

The newest endorsements for treatment of BPSD are non-pharmacologic, including behavioral strategies such as identifying triggers or underlying causes of the behavior and how the symptom may relate to the experience of the person with Alzheimer's; or by changing the environment to resolve challenges and obstacles to comfort, security and ease of mind.  Interventions that are tailored to an individual’s background and preferences are beneficial in reducing BPSD. This type of holistic person-centered engagement has emerged as the most promising trend for dementia care.  One of the most promising tools offered to date of this type comes in the form of Personalized Music Therapy.  

This past September 4th Dr. Gieseke and I had the distinct pleasure of an invitation to preview a 2014 Sundance Film Festival Award Winning Documentary entitled, “Alive Inside:  A story of music and memory”.  This documentary produced by Michael Rossato-Bennett was based on the work done by Dan Cohen, an MSW, who is the founder and Executive Director of Music & Memory.  Dan Cohen has worked with hundreds of residents in long term care facilities with dementia who have responded in amazing ways to the application of headphones attached to an iPod with a personalized music playlist.  Watching the film and seeing the results of his work with music and dementia patients electrified the whole room of over 100 providers of geriatric care, not only because of the simplicity of the approach, but the possibility of using this therapy with our own patients to address their isolation and improve their quality of life!

In the film, patients who had not spoken words in years, those who had apparently lost all sense of role or identity, were brought out of their nearly catatonic state and began talking, singing and remembering.  A richness and enthusiasm took over.  Music had a way of connecting people to who they had been, and touched them in ways simple words could not.  Redirecting behavior, connecting to feelings of happiness and self-identity, music engaged residents and brought them into the present moment.  According to Cohen, in addition to reducing the need for the use of psychotropic drugs, other benefits of personalized music therapy have included:

• Residents are happier and more social.  

• Relationships among staff, residents and family deepen.  Everyone benefits from a calmer, more supportive social environment.  

• Caregivers regain valuable time previously lost to behavior management issues.

The research goes on.  Dan Cohen’s organization “Music & Memory” continues to work to bring music to residents in over 140 facilities throughout the U.S. and Canada – 22 are Certified Music & Memory facilities in California.  

In other research, Dr. Oliver Sacks, a neurologist, author and professor of neurology at New York University School of Medicinewww.youtube.com/watch?v=MdYplKQ4JBc, and Dr. Laura Mosqueda, Director of Geriatrics at the University of California – Irvine  www.youtube.com/watch?v=tUENRJZlOkg have both demonstrated the benefits of music on memory in their work with dementia patients using a scientific neuropsychological foundation as a basis for their research on how our brains respond to music.

It is obvious, personalized music therapy is patient-centered and of benefit to patients with dementia. View the film, check out the Music & Memory website, and look into the benefits of using personalized Music and Memory techniques in your facility.  The transformation may be miraculous.  The link below is one example.  In this video segment from the film you will meet Henry, a non-verbal dementia patient, who spent years in a facility as he listens to his personalized Music & Memory playlist:  www.youtube.com/watch?v=NKDXuCE7LeQ

As producer Rossato-Bennett says, “It is not a cure.  It is not a drug, - but we can use music to make people happier, to make them age in place easier, to make caring for them easier - which music does.”

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