Skip to main content

Singing to people who have dementia

This month’s American Journal of Alzheimer’s Disease & Other Dementias offers us something unusual but highly relevant . Chatterton, Baker and Morgan give a review of the literature on singing to people with dementia and they find that singing to people who have dementia improves quality of life for both the people with dementia and their caregivers.

Singing to people who have dementia improves quality of life for both the people with dementia and their caregivers.

Their finding bears repeating. It particularly bears repeating because of information that cannot be included in their exhaustive review of the gerontology and music therapy literature. When we drop below the altitude of the lit review, we find stories, images and songs. When we look closely at the men and women involved in relationships impacted by dementia we witness just how important, and beautiful, music can be in creating relationships in end-stage dementia.

In their systematic literature review, the authors offer us a birds-eye introduction to the ways in which singing has been studied. They do an excellent job in picking out the best of both bodies of literature, focusing on the work of Alicia Ann Clair, PhD, in music therapy (at the University of Kansas) and Eva Götell , PhD, in gerontologic nursing (at Mälardalen University in Sweden). Because of the format of this article, though, we miss some of the most eloquent pieces of their research. In the Oxford Handbook of Medical Ethnomusicology (2008), Clair has used case studies to explore the transformative nature of singing at the end of life in dementia. Götell has wonderful video footage of Swedish grandmothers singing along and laughing with their caregivers as they sing the drinking songs of their youth, and the folk songs that they learned as children.

Götell and Clair’s work resonates with my own doctoral research, which is based on longitudinal participant-observation of people in a nursing home. For two years, I watched and interviewed, sang and played flute, in order to uncover the ways in which people use music to create meaning. I found that caregivers intuitively reach out for moments in which they can create a connection with people who have been been silenced by dementia.

And one of the most exciting discoveries has been learning that none of this work requires a PhD. We can all use music to improve quality of life with a few simple steps:
  • Take a risk and actually sing while you’re at a nursing home, whether or not you think you have a good voice
  • Do a little homework. Ask a family member what kind of music Mom or Dad (Aunt or Uncle) sang in the kitchen when they were little.
  • Remember, we have all known comfort through music, and therefore it should not be a surprise that anyone can use songs to create a moment of peace during dying, and a moment of connection despite dementia.
The authors conclude that a key part of music therapy is actually the act of encouraging caregivers to sing. I’m not a music therapist, but as a caregiver, I agree wholeheartedly.

by: Theresa Allison

Comments

medwinsl said…
After my mother lost most of her language to a stroke, I intuitively turned to music as a channel to tune her in. In fact, it started when she was hospitalized for pneumonia and gasped for breath during one of my visits. As her eyes widened in a panic, I began to sing. When she began to hum along with me, her breathing relaxed.

If her pre-dementia days featured little music, her last 2 years made up for the deficit. Hoping to trigger memories of happier days, we sang along with Frank Sinatra, Louis Armstrong, Porgy and Bess, and Barbara Streisand. Then we moved on to Broadway musicals, belting out a perfectly spelled round of "Oklahoma" at least once a day.

The day she died opened with a raspy and labored rendition of "Oh What a Beautiful Morning," but we got through every verse, even with her eyes closed.
Alex Smith said…
Thank you for that moving story, medwinsl.

Popular posts from this blog

Dying without Dialysis

There is a terrific article in this weeks Journal of Pain and Symptom Management by Fliss Murtagh of King's College in London about the epidemiology of symptoms for patients with advanced renal failure who die without dialysis.  This study is important because while we know that patients with advanced renal failure have a limited life expectancy and the average age of initiation of hemodialysis is increasing, we know little about the alternatives to hemodialysis.  Specifically, we know nothing about symptoms affecting quality of life among patients who elect not to start dialysis (so called "conservative management" - is this the best label?).  This article provides a terrific counterpoint to the article in last years NEJM showing that nursing home residents who initiated hemodialysis tended to die and decline in function (see GeriPal write up here). 

The study authors followed patients with the most advanced form of chronic kidney disease (the new name for renal failu…

The Dangers of Fleet Enemas

The dangers of oral sodium phosphate preparations are fairly well known in the medical community. In 2006 the FDA issued it’s first warning that patients taking oral sodium phosphate preparations are at risk for potential for acute kidney injury. Two years later, over-the-counter preparations of these drugs were voluntarily withdrawn by the manufacturers.  Those agents still available by prescription were given black box warnings mainly due to acute phosphate nephropathy that can result in renal failure, especially in older adults. Despite all this talk of oral preparations, little was mentioned about a sodium phosphate preparation that is still available over-the-counter – the Fleet enema.

Why Oral Sodium Phosphate Preparations Are Dangerous 

Before we go into the risks of Fleet enemas, lets spend just a couple sentences on why oral sodium phosphate preparations carry significant risks. First, oral sodium phosphate preparations can cause significant fluid shifts within the colon …

Does “compassionate deception” have a place in palliative care?

by: Olivia Gamboa (@Liv_g_g)

There is broad consensus in the medical community that lying to patients is unethical.  However, in the care of patients with dementia, the moral clarity of this approach blurs.  In her recent New Yorker article, “The Memory House,”  Larissa MacFarquhar provides an excellent portrait of the common devices of artifice, omission and outright deception that are frequently deployed in the care of patients with dementia.  She furthermore explores the historical and ethical underpinnings of the various approaches used in disclosing (or not) information to patients living with dementia.

Ms. MacFarquhar introduces the idea of “compassionate deception,” or the concept that withholding truths, or even promoting outright falsehoods, is a reasonable and even ethical choice for those caring for patients with dementia.  To the extent that it helps a person with dementia feel happier and calmer, allowing them to believe in a gentler reality (one in which, say, their spo…