Bringing Personalized Music to Long-Term Care
Dementia is not a specific disease; rather, it is a general term associated with a wide range of symptoms; thus, treating the varying presentations of dementia can be difficult. In some cases, dementia can cause aggression, agitation, or psychotic symptoms such as delusions. Antipsychotics are often used to calm and control patients with these symptoms.1 Although these treatments can help in certain cases, they can cause side effects such as shakiness, falls, blood clots, and stroke when taken for long periods of time. Too often, physicians use antipsychotics as a first-line treatment instead of developing an individualized treatment plan for each individual presentation of dementia. Indeed, two-thirds of prescriptions for antipsychotics are unnecessary or inappropriate, and only one antipsychotic (risperidone) is actually licensed for use in older adults with dementia.1
Alternatives to antipsychotic medications for dementia include cholinesterase inhibitors, memantine, and preventative strategies such as modifying the environment or modifying tasks for adults with dementia.2 But one alternative is increasingly becoming a key feature in dementia care: music.
According to researchers, music can have an incredible effect on those with Alzheimer’s disease and related dementias, even in late stages of the disease.3 When utilized appropriately, “music can shift mood, manage stress-induced agitations, stimulate positive interactions, facilitate cognitive function, and coordinate motor movements.”3
Music & MemorySM is a nonprofit organization that brings personalized music into the lives of the elderly and infirm in nursing facilities through digital music technology. The organization trains nursing home staff and other elder care professionals, as well as family caregivers, on how to create and provide personalized playlists on iPods for each individual resident.
The idea for the organization was brainstormed in 2006 by Daniel Cohen, MSW, an avid music-lover, when he discovered that none of the long-term care facilities (LTCFs) in the United States utilized iPods for residents. Mr Cohen took the initiative to call an eldercare facility in Long Island, NY, and convinced administrators to let him try a volunteer program. Beginning with only a laptop and three iPods, he worked with a few patients to create their own playlists with at least 100 songs per device, returning every two weeks to better customize the playlists. Since then, the Music & Memory program has been implemented in thousands of care facilities in the United States, Canada, Europe, and other countries throughout the world.
Annals of Long-Term Care: Clinical Care and Aging spoke with Mr Cohen to learn more about the program, its effects on residents, and to gain more insight into what happens behind the scenes of the organization.
When you created the Music & Memory program in 2006, what was your background and current occupation?
Even though I have a Master of Social Work degree, I have a background and career in technology companies. Introducing new technology into long-term care is as challenging as in any organization or business. Even though the use of iPods in nursing facilities seems straightforward, it still has its obstacles. For example, young staffers at facilities generate positive results when setting up iPods for a handful of residents, but they often hit a wall of institutional resistance if they try to scale up. It’s that scaling part that I focused on when I began this organization; what would it take to generate enough excitement and acceptance to make sure people received their favorite music with no less assurance than they received their meals and medications?
What is the difference between personalized music vs standard music programs that LTCFs provide?
Dr Al Power, a prominent geriatrician and author on dementia (also on Music & Memory’s Medical Advisory Board) says that the 50-song loop of standards so often played in LTCFs just becomes background noise to residents. I mean, how likely is it that people who don’t know our own music preferences would play our favorite music? When I ask this question to audiences, the answer is: extremely unlikely. Playing popular genres of music used to be best practice, but no longer. It can be difficult to learn what music holds personal meaning to someone who can’t tell you, but we’ve figured out an approach to facilitate that learning process. Results are often noticeably different when people have the music that truly resonates with them.
What impact has personalized music had on those in LTCFs without dementia? Has it improved any other common aging problems, and how?
Personalized music has been used to lessen perception of pain, ease anxiety, promote relaxation and sleep, lower blood pressure and respiration rates, reduce swallowing difficulties, and improve rehab outcomes. Familiar music activates cognition, speech, motor actions, emotions, and creativity. Sometimes, it can even improve gait, balance, range of motion, and coordination in older adults. Long-term care administrators tell us that personalized music is as effective for those with a variety of psychiatric diagnoses as it is for their residents with dementia.
Can you describe the most moving encounter you have personally had with an older adult who experienced his or her own personalized music for the first time?
I had the most disruptive resident in a large facility, previously cursing and swinging, calm down in an instant when we put on patriotic music. We didn’t know much about him; all we knew was that he was a veteran.
Can you describe some of the barriers to the implementation of Music & Memory in LTCFs?
We learned early on that if the facility trained only one person (typically from the activities staff) and that person became overwhelmed or left the facility, the program would stop in its tracks. That’s when we decided that this program needed to be “owned” by nursing facility staff in coordination with the theraputic recreation, life enrichment, and activities departments. This way, when someone is screaming in the middle of the night, staff can have access to the music and use it as therapy instead of calling for an antipsychotic in the morning.
How have the earliest participating LTCFs fared since you brought personalized music to them?
The earliest programs from 2006 and 2007 are still going strong. All homes that have implemented Music & Memory benefit from a huge marketing advantage. One study showed that prospective families want more than just their parent to be taken care of medically and to be safe—they want to know that their mood and cognition are maximized as much as possible. Research has shown that people select homes with Music & Memory 83% of the time over homes without it.
Is the program typically maintained consistently, or do LTCFs run into funding or participation issues? Who typically updates the iPods with new music content and software?
This is a very low cost program. But it does take time and effort to implement. We encourage the use of volunteers to help share the tasks. The community will support your program if the community knows what you’re doing!
You are now broadening your approach to serve individuals in hospice care, adult day care, assisted living, hospital, and home health care. About how many facilities do you currently work with, and are they typically private or state-run facilities?
Music & Memory currently runs in more than 3200 skilled nursing facilities, assisted living facilities, hospices, hospitals, home care, and adult day programs in all 50 states and across Canada and 7 other countries. Our sites are evenly divided between for-profit and nonprofit/government.
How will the new types of settings affect your current strategy of implementation? What challenges or benefits do these settings pose?
The logistics might vary, but the basics are the same. In hospice care, a system has to be ready-to-go quickly since the time serving the individual is short. Adult day programs use this for those who are more isolated. Hospitals have opportunities for improving care and quality of life throughout their system. The NYC Health and Hospitals Corporation, the largest public health system in the United States, is running Music & Memory in nine hospitals focused on persons with dementia, behavioral health, and rehabilitation medicine.
For health care professionals reading this, how can they help your cause or start the process to get Music & Memory in their facilities?
Health professionals who champion the program learn from our website how others have made this happen and do the same. I’ve even had staff, doctors, families, or management pay for the program’s starting costs themselves in order to get those they serve the benefits that are immediately available with this approach, transforming quality of life and quality of care more significantly than any other approach (as they tell us).
1. Alzheimer‚ Society. Antipsychotics. Alzheimer‚ Society Web site. https://www.alzheimers.org.uk. Accessed June 14, 2016.
2. Mayo Clinic. Dementia: treatment. Mayo Clinic Web site. http://www.mayoclinic.org/diseases-conditions/dementia/diagnosis-treatment/treatment/txc-20198533. Updated April 5, 2016. Accessed June 14, 2016.
3. Alzheimer‚ Foundation of America. Education and Care: Music. Alzheimer‚ Foundation of America (AFA) Web site. http://www.alzfdn.org/EducationandCare/musictherapy.html. Updated January 28, 2016. Accessed June 14, 2016.
