A new study has demonstrated for the first time how and why music can reduce distress and agitation for people with advanced dementia.
There are an estimated one million people living with dementia in the UK and over half are diagnosed with advanced dementia, which can require specialist care and is often accompanied by behaviour such as agitation, aggression, wandering, and resistance to care.
Published in the journal Nature Mental Health , the research reveals the different benefits of music therapy, identifies mechanisms to explain why music can have these effects, and provides a blueprint for implementing effective music therapy for people with advanced dementia.
Music therapy, delivered by trained therapists, can include singing, playing or listening to music. The therapist can also identify specific ways that music can be used by families and carers in an individual's daily care routine.
The new study, led by Naomi Thompson of Anglia Ruskin University (ARU) in Cambridge, England, is the first music therapy dementia care realist review, which combines academic research with stakeholder input to develop guidelines for delivering personalised interventions.
The research shows that if music therapy is designed to individual needs, it can deliver an immediate, short-term reduction in agitation and anxiety for individuals with advanced dementia, and improvements in attention, engagement, alertness and mood. Musical interactions can help people feel safer and more orientated in their surroundings, which can lower levels of distress and improve wellbeing.
This effect happens because music, whether playing, singing or listening, delivers cognitive and sensory stimulation, activates networks across both sides of the brain enabling access to the person's remaining abilities and memories, and helps people manage their emotions and remain calm. Music can also be tailored to reduce physiological stress, specifically in the autonomic nervous system.
Music-evoked memories, especially those triggered by familiar music, are recalled more quickly and are more positive and specific than memories recalled without music, and often relate to earlier in the person's life. Songs from when the individual was aged between 10–30 years old are found to be the most effective.
As a form of nonverbal communication, music is accessible regardless of cognitive impairment or musical ability, and provides opportunities for social interaction with staff, carers and fellow patients or care home residents.
The study recommends that music therapists train other professionals, ensuring all staff involved in the care of people with advanced dementia can use music, regardless of their experience. Resources, including musical instruments and information about how to produce personalised playlists, should be available, and families should be encouraged to use music to support their relatives.
Engaging in music may also benefit care staff and family members by reducing their levels of stress and improving their wellbeing. It can deliver meaningful moments that may be different to the carers' usual interactions, it can foster empathy, and it can help staff better engage with the person with dementia, especially during times of increased distress.
The study involved interviews with staff and music therapists on inpatient mental health dementia wards at the Cambridgeshire and Peterborough NHS Foundation Trust, a systematic review of published research, and a national survey of healthcare professionals. The researchers also collaborated with the dementia specialist nursing charity Dementia UK.
Lead author Naomi Thompson, of Anglia Ruskin University's Cambridge Institute for Music Therapy Research , said: "With an aging population and increasing numbers of people diagnosed with dementia, music is a relatively straightforward and cost-effective way of improving the quality of life of those affected.
"Our study not only shows why music therapy is successful – including meeting the person's need for stimulation, supporting familiarity through memories, encouraging relationship and emotional expression, and crucially helping with the reduction of distress and anxiety – it also paves the way for its wider use in dementia care.
"Music, in particular recorded music, is an accessible way for staff and families to help manage distress, and music therapists can advise on tailoring music for individuals. Just as a doctor prescribes medications with a specific dose and frequency, a music therapist can outline an individualised programme, setting out how music should be used throughout someone's day to reduce distress and improve their wellbeing."
Co-author Dr Ben Underwood, Research and Development Director at Cambridgeshire and Peterborough NHS Foundation Trust and Associate Professor at the University of Cambridge, said: "People with advanced dementia can sometimes become quite distressed and we need to find the best ways to help them. Music is one thing which can help, and so I am excited to see such high-quality work being done in partnership to see how we can bring music therapy to NHS dementia patients."
