Update on “Alive Inside”

by Timothy Gieseke MD, CMD

At this year’s annual AMDA meeting in Orlando Florida, attendees heard an exciting presentation on the “Alive Inside” Music and Memory project.  One of the sad aspects of SNF living is the lack of resources for individualized meaningful activities throughout a resident’s day.  As I make rounds on my long-stay residents, I see many of them up in chairs waiting for something meaningful to happen.  I commonly hear patients verbally and non-verbally acknowledge they are “bored.”   For me, music has always been a big part of my life, having grown up in a singing family and currently singing in the local symphonic choir.  While Christmas caroling in NFs, I’ve seen aphasic patients from CVA’s or dementia join the caroling with gusto.

The Music & Memory program (http://musicandmemory.org/) has matured over the past 4 years with amazing results in multiple states across our country.  Personalized music delivered by headsets is more effective than our usual group activities programs by reducing competing sounds and unfamiliar music that doesn’t quickly engage the cognitively impaired mind.  However, as the mind is engaged, the mind seems to awaken and other cognitively dependent activities are enhanced.  Areas seen to improve include things like dancing (mobility), meaningful verbal communication, improved affect, and reduction in falls, aggressive behaviors, and rejection of basic care activities.   Residents undergoing rehab for hip fractures recover more quickly and residents with dysphagia have improved nutrition with less staff time.  In all of these ways the resident’s quality of life is improved.  Caregivers find caregiving to be more predictable and effective.  

This is not an easy program to implement, but is worth overcoming the barriers.  Civic organizations have funded the IPODS.  It’s legal to program the IPOD’s off of 1 computer.  The playlist for unbefriended patients can be defined using services of Pandora, Slacker, etc., starting with the genre prevalent at the time they were teenagers.  Typically, the activities director is in charge of the program, but the devices need to be available for CNA use 24/7 including the weekends.  KOS disposable headsets are available for ~$3.  Waterproof headsets are also used during shower times.

In California, CAHF (California Association of Health Facilities) received a grant using Civil Monetary Penalty (CMP) funds through CDPH for a Music & Memory pilot study.  CAHF is the lead agency and UC Davis is supplying the research arm.  There are currently 50 NHs in the pilot test with another 150 NHs in recruitment for phase 2 of the study.  In phase 3, yet another 100 NHs will be added, SNFs don't have to be CAHF members to participate in the project.  The study is collecting data on behaviors and antipsychotic use as well as the ways facilities are implementing and sustaining their Music & Memory programs.  For this study, a customized QAPI tool has been developed to track these data.  Please see the news release on this project (https://www.ucdmc.ucdavis.edu/publish/news/newsroom/10684 ) that includes a picture of our CALTCM President, Dr. Deb Bakerjian, as the co-investigator for this study.

UCD researchers and HSAG have submitted a grant proposal to CDPH in hopes of further expanding this study.

While we await the new knowledge from these studies, please don’t stay on the sidelines.  Visit http://musicandmemory.org/  as well as the CAHF website https://cahf.org/AboutCAHF/MusicMemory.aspx  for more details and resources.