As a geriatrician, a friend and colleague of Music and Memory founder Dan Cohen, and an alumnus of the Alive Inside documentary on the subject, I can enthusiastically attest to the value of personalized music in improving the well-being of people living with dementia in all environments. There are countless examples, not only of improved engagement, but also improvements in memory and communication during and after the use of such music, and I have seen it myself many times.
The largest study of this approach, conducted by researchers at Brown University was just published in the American Journal of Geriatric Psychiatry (http://www.ajgponline.org/article/S1064-7481(17)30285-3/pdf). In this 6-month study, comparing the residents of nearly 100 US nursing homes that had instituted the M&M approach, compared with a similar sample of homes that had not done so, some positive results were seen.
The homes that participated in M&M showed a greater discontinuation rate of antipsychotics (increasing from a discontinuation rate if 17.6% to 20.1% during the study) than the control homes (15.9% to 15.2%). The discontinuation rate of anti-anxiety drugs went from 23.5% to 24.4%), while the control homes showed a drop in the rate from 24.8% to 20.0% over the same 6-month period (there are a lot of double negatives here, so a higher number over time is better).
The M&M homes saw an increased rate of reduction of “behavioral problems” from 50.9% to 59.5%; the control homes remained level, from 55.8% to 55.9%. There was no significant improvement in depressed mood seen with the program.
So there was some benefit shown, though it appears to be quite modest, and perhaps somewhat disappointing to those of us who have seen some amazing changes in people. Why did such a large study not show more impressive results? I think we need to put all of this into some context.
It’s been 20 years since Tom Kitwood spearheaded the “person-centered care” movement, but many of his visionary words have still not penetrated the deeper cultural ether. In 1997, Kitwood wrote that it is very hard to study a multifactorial approach to dementia with traditional methodology. As I wrote in Dementia Beyond Drugs;
“… The experiential approach requires a wide range of transformative interventions happening concurrently. It would be futile to try to break them into separate parts for study because that is not the way the model is intended to operate.
“Again, Kitwood supports this argument: ‘A better research strategy, I suggest, involves assessing the consequences of a pattern of care practice taken as a whole, without attempting to subdivide it minutely into separate variables.’ He goes on to say that even a ‘discrete’ intervention, like music therapy, ‘involves many different types of interaction’ (1997, p. 100).”
So what Kitwood was trying to tell us is that an approach like Music and Memory can be an important and valuable tool for engagement for people living with dementia; but too often we apply it incorrectly, and study it incorrectly as well.
Using the Eden Alternative Domains of Well-Being as a framework (identity, connectedness, security, autonomy, meaning, growth, and joy, as I have applied to dementia in my book Dementia Beyond Disease), one can see that personalized music feeds into many of those aspects of well-being at once, which is why it is so powerful. Unfortunately, it is easy to be seduced by the “awakenings” we see and not understand the larger context.
In our long-term care system, which still remains stubbornly task-focused, there is too often a tendency to grab onto Music and Memory as an “intervention” (a) without adequate attention to the larger framework of care, and (b) without taking advantage of the benefits that this increased engagement creates. Let’s look at each of these:
The “intervention” mindset continues to use such approaches like pills—i.e., applied at regular intervals or else in response to an episode of distress. But what else is being done for the person’s overall well-being? If you are supplied with a personalized playlist, but you have no choice or input into your daily life, it will fall short of sustained success. If your carers are rotating, causing you to be supported by relative strangers whom you do not know well (and vice versa), it will fall short of success. If you have improved ability to communicate, but those supporting you do not improve their communication and understanding skills, it will fall short. If your carers have all the best intentions, but work in an inflexible system that doesn’t enable them to engage the person as she needs, it will fall short.
You get the idea.
The second point is one that I have made repeatedly, ever since doing a talkback for the film at our local theater. Here’s my usual comment: “What I would hate to see is people getting an iPod and headphones put on their heads and being left in a corner of their room all day, thinking it’s going to improve their lives. If the use of personalized music improves people’s memory retrieval and their ability to communicate and engage, this is a magic moment that should not be ignored. Use these periods of heightened ability—to converse, find out more about the person, understand her needs, and cultivate your relationship. Once music opens that door to improved engagement, you have to use it!”
By now, the drawbacks of our typical research methodology should also be clear. A controlled, single-intervention trial across large populations of homes that may or may not be employing these deeper approaches along with the music will likely give less impressive results than we would like to see; and more importantly, such research starts with a premise that reinforces this overly simplistic and uni-dimensional view of dementia and aged care.
I know you are all crying out for more “evidence,” but we have to accept that there are a lot of reasons why traditional research approaches cannot provide this. (I’ll have another post on issues around “evidence-based research” coming soon.)
So to summarize, Music and Memory is a great tool for engagement for people living with dementia (and everyone), within the context of a deeper transformational approach to support and care. It is not a magic bullet, and we need to stop expecting to find a magic bullet. There is no substitute for relationships, meaningful engagement in all aspects of life, and shifting our systems to support different ways of living and caring.
I’m a student in AGNG 320 at the Erickson School of Aging. I enjoyed reading this post, to be honest, I never thought that music can help improve memory and communication of a person with dementia. After reading this post and watching the video, it really got me thinking that music is not just for entertainment but can also help improve memory. I was amazed to see when Henry, who is diagnosed with dementia. At the beginning of the video when Henry’s daughter came to see him, he could not even recognize her but when he heard his favorite song his respond and start singing. Even his caretaker was amazed to see his reaction, but he would avoid interacting with other people. music is a great source to reduce stress and improve mood. We all listen to music and every time we listen to music; we start dancing to beat and a smile comes on face. We forget about all of our problems and just enjoy the music. I think if the nursing home should definitely using music to treat dementia patients along with medicine because it will be very beneficial for dementia patient. Music will help improve make them happy and help build the relationship with the patient. It makes it easier for patients and caretakers to communicate with each other. Because they will have more topics to talk about it and their brains will be functioning, thinking, etc.
Ramish Qutab says
Im a student in AGNG 320 at the Erickson School of Aging. I really enjoyed reading this post and I agree with the idea of music improving the memory and communication of a person with dementia. After learning about dementia, I have learned that one of the best ways to communicate with the patient is to use the music they enjoy. It calms the person and reduces their behavioral problems and the need for anti-psychotic drugs decreases, as mentioned in your post. In AGNG 320, we learned about Henry who is diagnosed with dementia. Henry is not very willing to communicate, but when his favorite music was played for him, he opened up and started speaking. As he listened to the music he enjoyed, his mood changed and he answered all the questions he was asked. This shows the huge difference music makes in communication. This also correlates with a patient we learned about who had Alzheimer’s. She would also respond well to a song that was sung for her and she would start singing along. Music definitely triggers the memory and makes its easier to communicate with patients that have dementia or other problems.
I am an AGNG 320 student at the Erickson School of Aging. I agree with your stand on how music can be more beneficial among dementia patients if it is administered along with social engagement. An experimental research design is not possible in this study, and the results contain many extraneous variables. This lack of concrete data may lead to disbelievers regarding the effectiveness of music therapy among those with dementia. I feel that individuals who have relationships with their care givers and are given social support will most likely have greater results from the Music and Memory approach. I have seen the impact that music along with social interaction has in a video titled “Alive Inside” depicting a man named Henry with dementia who became increasingly vibrant and coherent as familiar music was played for him (Haber, 2016). In this video Henry is asked questions and is able to experience social engagement which seemingly heightens his revitalization. My great grandmother was a dancer for many years and always had a deep connection to music. When she was diagnosed with dementia we often found that we could make her happy and more sociable if we played one of her favorite tunes. Music is an incredible tool to increase the happiness of those with dementia, but it is far from an alternative treatment without additional psychological needs being taken care of. Thank you for your insight on this topic.
Haber, D. (2016). Health Promotion and Aging: Practical Applications for Health Professionals. New York, NY: Springer Publishing Company.
Joanne Mahoney says
I have a loved one in the late stages of dementia. At this point, it is wonderful when we can find any glimmer of a smile or response. We have seen this with music. How or why music taps into a memory is for the researchers to find out. Speaking as a family member, it is a heart-warming moment to see a smile and an acknowledgement, however brief.
Al Power, MD says
Thanks for your comments. I have also heard back about the confusing nature of the data I reported. Just to clarify, I recorded the outcomes exactly as per the published paper. I am not sure why they chose to measure “double negatives”–maybe to account for the the populations changing over time. But I am not sure they captured those who were newly started on medication as well as those discontinued. I wonder if total numbers on the pills might not have been just as good, or some more detailed analysis of numbers of people put on vs. taken off.
But the numbers were not the point of my post, so for those who are still confused, I would just explain it as follows: The study purported to show that the homes that engaged an M&M program seemed a bit more likely to take people off of antipsychotic and anti-anxiety meds, as opposed to those homes who didn’t use M&M.
Lots of other factors in there, however, and I am not convinced that this study of a non-medical approach to dementia was conducted with enough detachment from over-medicalizing the issues at hand to tell us a lot. (For example, it is hard for me to believe that a study that reports the level of “behavior problems” has a true understanding of the effects of personalized music and other approaches on well-being and the individual’s experience.)
As for the other topic, I have worked with both Dan and Michael and am not privy to the specifics of the legal proceedings, so I will refrain from commenting on that. Music is healing for all, as Susan’s clips so beautifully showed.
Susan Macaulay says
Yep. I agree, and I too find it hard to “believe that a study that reports the level of “behavior problems” has a true understanding of the effects of personalized music and other approaches on well-being and the individual’s experience.”
Wayne Mesker says
As the Founder of the Rock Against Dementia Movement ( on March 26,2014- the day I saw Alive Inside at the Cleveland International Film Festival ) it became my mission to spread the AI & Music & Memory message. I attended Summer NAMM in Nashville that year to start recruiting , believing that musicians would “Get It” & Support It as well as promoting the idea that young Musicians & Music Educators would benefit from involvement . Knowing that Caregivers are often poorly trained & even the best of them can be overburdened with other tasks it only made sense that “outside” help could offer better results. Michael Rossato Bennett’s idea of establishing a connection between the generations was pure genius & my belief that kids with a music education background could find what I called a #PurposeBeyondPerformance has been my motivation since I was appointed the Outreach & Advocacy Director for AIF in 2014.
Imagine my dismay & sadness when I heard of the Legal action that Dan Cohen has been taking against Michael since before Sundance in 2014 in an effort to stop us from doing that.
Sadly we recently had to make that Public knowledge.
The Rock against Dementia Movement in 2016 through connection with friends of mine in the UK with a group of Global Ambassadors became the World Rocks Against Dementia Movement & I’m honored to say that with collaboration between the Alive Inside Foundation , The Purple Angel Dementia Awareness Campaign Ambassadors & Alzheimer’s Disease International there were 76 #RockDementia17 events held between March 17th & March 24th in 12 Countries on 3 Continents.
When I met Dan Cohen in September of 2014 at an Alive Inside screening in Columbus,Ohio he expressed no interest in who I was or what I was doing to help spread the word about his work & his organization. That was his loss.
Fortunately, being involved in the Music & Entertainment Industry since September of 2008 I have been blessed to recruit many of my friends to support us & the list is growing .
Susan Macaulay says
Al, I have lots of feedback with respect to this post.
First, on the subject of music. My experience is much more limited than yours of course. However, I can say with certainty that the “healing” music sessions Mom and I enjoyed on a weekly basis for about a year provided me a huge amount of insight into the impact of music on her. I have no doubt the same wonderful effects may be achieved with other PLWD.
I observed a “halo effect” in my mother’s ability to process thoughts, link ideas together, and articulate what she wished to communicate. It was also easier for her to move, get up and down, and walk. This readily observable effects of the halo usually lasted for several hours after each hour-long session.
Here is one example of her communicating how she felt about the music sessions about 30 minutes after we had finished one of them (listen to the one-minute audio clip):
As you are a firm believer that people with dementia are the experts, you in particular will appreciate my mother’s testimonial with respect to the positive impact music had on her in the later stages of the disease.
These sessions were much more dynamic than simply putting on iPod her head, which undoubtedly has some benefits, and which, as you rightly point out, cannot be measured in isolation and should not be used as a substitute for comprehensive person centred care. Our sessions were highly interactive and tailored specifically to meet Mom’s needs on any given day–whatever her flow was in the minute, we went with it.
Here are a few examples:
In addition to these weekly sessions, mom and I sang together every single day for four years up until a couple of days before she died. I’m just so grateful for music and what it enabled us to do together. At the risk of putting WAY too many links in this comment, here are some of the things I learned: