London’s Wigmore Hall is a temple of high culture. The audience is packed with musicians. Sometimes I feel I’m the only person who couldn’t be up there performing the work. But recently I joined forty people, some able, some less able, in mind and body, for a ‘Big Sing’. Everyone seemed to feel at home. In the morning we learned to sing simple songs in four parts, and in the afternoon we went up on stage and sang them. I’m no singer but the opportunity was fun and boosted my morale. So how much more it must have done for the participants with dementia.
Everyone, everywhere, responds to music. We hear it in the womb, it accompanies the important events in our lives, it modulates our emotions. Hearing is the last sense we lose as we die. People with advanced dementia who haven’t spoken for months may perk up when they hear Vera Lynn singing The White Cliffs of Dover. They may even venture into a solo, or go to the piano and play with an ability no-one knew they had. Thinking skills may have atrophied, but musical skills remain. Given the right stimulus, they surface from the depths of a failing brain.
There is currently no prospect of effective medication for dementia. Reluctantly, we prescribe agitated patients chemical coshes. But does music sooth agitation – and more?
Neuroimaging shows that, unlike speech, music lights up lots of different areas of the brain. It finds a back door into even a ramshackle brain. Music may even help to keep neural pathways in the brain open. So far, studies of the effect of music on people with dementia, though small and short-term, are encouraging. But research projects are seeking robust evidence. Can biochemical changes be linked to our responses to music?
What psychological measures can be used to assess benefit? How can music most effectively be used? What opportunities does it offer for carers, care homes, musicians and institutions?
Music therapy is a well established profession, although few care homes can afford a therapist. But graduate courses in using performance arts to help people with brain failure are burgeoning, and charities, local authorities, music schools, music groups, orchestras, arts and religious venues are trying out different interventions. With phone calls and a few visits, I discovered how much there is on offer.
"Through music, families can glimpse the individual their relative once was: the loving partner, the caring parent, the delightful aunt, the indulgent gran. Once again they can share pleasant experiences."
Residents of care homes respond when amateur choirs come to sing. They may join in, although perhaps not singing the same song as the performers. They may rattle a teaspoon throughout the concert, or stand behind the conductor waving their arms. The benefits are fleeting, but any enrichment of barren lives, however temporary, is worthwhile.
Repetition helps. And not surprisingly, participation increases the benefits, too. So a musician, squatting down in front of a wheelchair to encourage someone to make simple music, singing or playing instruments may stir her from apathy for longer. She may start chatting. And so change the atmosphere of the home.
For people with dementia still living in the community there are ‘relaxed concerts’ where no-one minds if you are restless. Other events encourage people to take part. Alzheimer’s Society’s Singing for the Brain is a model: experienced singing leaders run weekly sessions. Volunteer helpers ensure that carers also have some fun and a break – a crucial benefit of community events. There’s a welcome, action songs, familiar numbers and new ones, opportunities to shake a tambourine, to dance, to sing a solo, followed by socialising over tea and biscuits.
An early casualty of dementia is self-worth. Taking part in events restores confidence. An art gallery invites musicians to work with local people to devise and stage musical events based on a painting. A retired doctor organises regular rehearsals for village hall concerts. The performers dress up for the occasion, their community applauds them. Everyone feels a sense of achievement.
Care home staff are poorly paid for work no-one else wants to do. It can be hard to maintain respect for people with dementia. But if music can revive the person inside the fading brain and restore some of their dignity, the job will be more rewarding. Staff retention and standards of care might improve.
Through music, families can glimpse the individual their relative once was: the loving partner, the caring parent, the delightful aunt, the indulgent gran. Once again they can share pleasant experiences.
Such events introduce new audiences to arts venues, but these must adjust to special needs. Improve the signage and make sure the locks on the loo doors are easy to manage. Don’t aim to fill the hall; people who may become disturbed need space. Explain to the audience what is going on. Incorporate toilet breaks. And, as ever, provide tea and biscuits for everyone.
Train staff. Anyone working closely with people with dementia for the first time will be apprehensive. But performing for and with people with memory problems can be eye-opening and very rewarding. A full hall of concert-goers may applaud appreciatively, but there is nothing so heartwarming as seeing someone initially crumpled and withdrawn begin to take notice, smile, and maybe join in.
Music can also help people whose dementia is so advanced they can’t take part in concerts. In Where Memories Go, Sally Magnusson, daughter of Mastermind presenter Magnus, records her mother’s dementia. It’s a heartbreaking story, but from that harrowing experience came Playlist for Life. Sally could see how, through music, her mother in some measure returned to her, and she wanted everyone living with dementia to have that opportunity. It’s a simple idea: you build up a soundtrack of a dementia sufferer’s life. They listen to it, through headphones or via speakers, and are engaged. Some GPs are already prescribing playlists and finding patients need less medication.
Building a playlist is like choosing your Desert Island Discs, but you can have as many as you want. Making one for someone else involves detective work to find the tunes that meant something to them, particularly during that crucial time of adolescence and young adulthood. The BBC’s Music Memories is a good resource. Classical, pop, advertising jingles, hymns, theme tunes, anything that provides a flashback to the past. The theme from Z Cars or Match of the Day? Twist and Shout? Bob Dylan? Miles Davis? Stockhausen? (Well, maybe not.)
Most of us won’t develop dementia - the lifetime risk of people under 65 is less than 5%, thank goodness, but as we plan for ageing perhaps should include guideposts for our own journey down memory lane. It’s never too early to start creating your own feel-good musical.
Thanks to those who gave me the benefit of their experience of music and dementia in putting together this article.
Judith Harvey was a research scientist, ran the VSO programme in Papua New Guinea and taught in a Liverpool comprehensive school before going to medical school. She has been a partner, a salaried GP and a locum and an LMC chair. She started a charity which for nine years enabled medical students to go to Cuba for their electives.
Judith is a long-time supporter of NASGP and has been providing regular articles for The Sessional GP for over 12 years, her reflections ranging widely on practical, ethical and cultural aspects of health and medicine.
Judith has now published all her articles from the NASGP website as a new book Perspectives: A GP reflects on medical practice and, well, just about everything…