Dementia is a difficult and challenging degenerative condition that will affect one in 10 people. There is little that can be done to prevent it. It degrades the functions of the brain, damaging memory, mood, and cognitive functions. And sadly, there’s no cure for it.
Treating dementia is a complex problem, due to the nature of the damage it causes. One’s memories and sense of self are eroded. Some who live with dementia don’t even recognize their family members.
However, people can live, and live well, with dementia, with mental stimulation and support helping them connect with their life history and cherished memories. There’s a novel way that this is happening right now, and it’ll likely surprise you…
It’s the humble iPod.
The Power of Music
It may sound strange, but music is an incredibly vital tool when it comes to supporting those living with dementia. It has been shown time and again that when provided with music that was an important fixture in a person’s life, they see a marked improvement. Memory improves. They become more lucid. They even become more communicative.
You may have already seen this video; it went viral a couple of years back. It shows Harry – an elderly man living with Alzheimer’s in a nursing home in America. When you see him for the first time, you can see he’s not very well. He struggles to communicate, cannot recognize his daughter, and is very withdrawn.
British-American neurologist Oliver Sacks describes Harry as “… inert, maybe depressed, unresponsive and almost un-alive”. But when he’s given an iPod shuffle packed with some of his favorite music — mostly religious and biblical music — he radically transforms.
He starts to sing, and to rock. His eyes open. He is, as Sacks points out, almost “being animated by the music”. It’s both remarkable, and deeply moving.
What’s especially interesting is what happens when the music is removed. Harry is now alert. He’s communicative. While at one point he was responding in short, non-sentences made up of very few words, he’s now answering questions in great detail. When asked if he likes music, he says “… Yeah, I’m crazy about music. If you play beautiful music, beautiful sounds… Beautiful…”.
When asked an autobiographical question about his past (“do you play music? Did you like music when you were young?” – remember, dementia damages memory), he responds in the affirmative, and mentions going to dances.
He can even recall his favorite singer from when he was growing up – Cab Calloway, a popular jazz singer in the 1930s, 40s, and 50s.
All of this from nothing more than an iPod shuffle and some carefully chosen music. So, what’s the science behind this phenomenon?
The Science Behind Music and Dementia
It’s strange. The brain is the organ we’re singularly most dependent upon. It defines who we are. Our personality, and our very being. But it’s also the organ we understand the least.
It’s for that reason why a cure, or at least a viable treatment for dementia, is so long overdue. We simply don’t understand the brain well enough.
But we do know something about the progression of dementia. Alzheimer’s, especially, which accounts for around 70 percent of all cases of dementia.
We know, for example, that although Alzheimer’s can destroy our faculties for short-term recollection, cause mood swings, and result in disorientation, our ability to appreciate and engage with music is one of the last abilities to go. Neuroscientists are uncovering the astonishing effects of music on virtually every region of our brain.
This is why music can have such a profound impact on the physical and emotional well-being of those living with dementia.
In the later stages of dementia, patients frequently lose the ability to share their emotions. They lose the ability to articulate their thoughts and feelings, and display gestures of affection to those they love.
But the ability to follow a rhythm, and engage with music, remains. According to the Alzheimer’s Foundation of America, when music is played, and someone living with dementia is allowed to “couple dance” with someone they know, it can evoke an emotional, affectionate response.
“Ambulatory individuals can be easily directed to couple dance, which may evoke hugs, kisses or caresses; those who are no longer walking can follow cues to rhythmically swing their arms. They often allow gentle rocking or patting in beat to the music and may reciprocate with affection.”
As we have already mentioned, dementia damages memories. But there are some songs that we closely associate with the most memorable, formative moments of our life. When played, music can allow the person with dementia to recall these memories. According to Oliver Sacks:
“Music imprints itself on the brain deeper than any other human experience… Music evokes emotion, and emotion can bring with it memory… it brings back the feeling of life when nothing else can.”
Nobody is calling music a panacea. But it’s something that is having a profoundly healing effect on the lives of people living with dementia. Consequently, there are charities both in the United States and the United Kingdom, which aim to pair those living with dementia with their own iPods featuring the soundtracks of their lives. I met the founder of one such charity.
Meeting Playlist for Life
Outside of the U.K., the name Sally Magnusson might not ring a bell. But here, she’s a household name. Throughout a long and acclaimed career, she has fronted a number of shows on the BBC (British Broadcasting Corporation), including Reporting Scotland, Breakfast Time, and Songs of Praise.
Magnusson herself is intimately familiar with the powerful effect of music on dementia, as her own mother was unfortunately diagnosed with the condition. It was then that she learned how music can be used to support those living with the condition, and she even wrote about it in an acclaimed book “Where Memories Go – Why Dementia Changes Everything“.
So convinced was Magnusson of the power of music, she launched her own charity called Playlist for Life. This aims to provide those living with dementia with their own personal music players, and their own personal playlists. This, she says, has resulted in people “accessing their musical past, and rediscovering who they are for periods at a time”.
Earlier this month, Magnusson launched her first online training program for family and professional carers of people living with dementia at Carlingwalk House – a care home in Castle Douglas, Scotland. The program aims to teach the fundamentals of creating playlists that can evoke memories and promote well-being.
I was fortunate enough to speak to Magnusson, and learn more about how iPods are changing the lives of those living with dementia.
When I spoke to Sally, I still had that video of Harry in my mind. I was curious as to whether Playlist for Life had any standout stories of transformation to share.
“To be honest, every person is different. Everybody that we have supported to develop a personal playlist to has had their lives improved in some way. It’s easy to point to some dramatic effects. But it’s a very person focused thing, it differs from person to person.
Someone here at Carlingwalk said the music she plays her husband (his playlist) makes him happier and more attentive. She even said that it makes him look better. Another person said ‘When my wife has her music on, she sits more quietly and I can stroke her face. But other times (when she isn’t listening to music), she’s more restless and I can’t get near her.’
If this is sustained and offered on a regular basis, then there’s an amazing animating and energetic effect.”
Magnusson personally saw the powerful effects of music when her mother was living with dementia.
“My mother was somebody who was a warm, funny natured person. She always loved to sing and had a great repertoire from her youth – the things she’d sing at parties and Hogmanays. As her dementia advanced, we found ourselves singing these songs with her. As she became more difficult to engage and comfort, the songs she was familiar with made her more engaged, and even allowed her to use words again.
There was much that was going on in her brain that music opened a window to. That continued until her death. After she died, and I was writing my book (Where Memories Go), I thought I’d look into music and write a chapter about it. In doing this, I was flabbergasted to find out how amazing it is, and the impact that scientists are finding it has on the brain.
As a result of that, I had to tell people. How do you get music to them? This is where technology provides the answer. This is how you scale it up. I took it from there, and it’s exploded. The success, and number of people using it (Playlist for Life), has exploded.”
I wanted to find out about the logistics of creating a playlist. Are there any songs that repeatedly find their way onto these playlists?
“I don’t look for that, because looking for that is the wrong way round. Everything is personal. It has to be person first”.
So, I wanted to find out, how are they created? How do you handle the technological aspect, especially for people who aren’t comfortable with technology?
“One of the biggest thrills is the idea that we can bring the benefits of modern technology to the generation that has largely missed out on it. This is a generation that, by and large, missed out on the mobile phone.
Technology is only a barrier if you let it be. We just released a DVD for families that explains the process and technology. We also have a strong emphasis on getting young people involved, too. Getting them to do things, and to showing the spouse of the person with dementia how to use the technology.
The other thing that we insist on is a playlist has to have a lot of thought put into its compilation. We hope that everyone will think about their Playlist for Life now, not when dementia strikes.
For those with dementia who can’t explain the music that matters to them, there’s some detective work to do. Once you’ve got the answers to this playlist, you can start building to it.”
Right now, Playlist for Life is working on its own mobile application. This app won’t just be an avenue to the music that matters, although it’ll certainly contain that. Instead, it will be the digital identity for that person, containing photographs, videos, and autobiographical data. These can be created upon diagnosis, reducing the amount of memories that get lost.
Dementia damages the ability to communicate. This app, when it’s released, will contain information about how each person communicates through non-verbal means (for example, signaling when they’re hungry), allowing that person to live with a greater degree of dignity.
Development of the application has been made possible thanks to grants from the Edinburgh and Lothian Health Foundation and the Ena and Gordon Baxter Foundation. They’re building it in partnership with Glasgow Caledonian University, and it will be founded on rigorous research, and tested with carefully selected subjects living with dementia.
But the fundamentals of this app will inevitably be centered around music.
Creating Your Own Playlist
Having read about the power of music, if you know someone who lives with dementia, you may be tempted to compile them their own playlist. If so, there’s some guidance that’s worth following in order to create the most effective listening experience.
First, make sure that the music matters to the person listening to it. According to Playlist for Life, the most effective playlists are the ones that mean something to the listener. It must be uniquely personal for it to work.
It’s this personal nature of music that triggers autobiographical memories, and has the all-important therapeutic qualities. To accomplish that, there’s some useful advice for building a truly personal playlist.
First, when the music is from is really important. Research suggests we generally build close bonds with music when we’re young, usually between our teenage years and early twenties. Although, it’s worth pointing out that this is not an absolute. Music from before and after that period of someone’s life can still be significant.
When you think about music, don’t just think about popular songs. Take into account the theme tunes from the individual’s favorite movies, television shows, and radio programs. If the person was religious, consider church hymns. If the person fought in the war, consider adding some wartime tunes.
But above all, don’t be afraid of seeing what works through trial and error. As a result of the degenerative nature of dementia, it can be hard to find out what songs matter. It’s quite often the case you can’t just ask the person. Don’t be afraid to test songs out before committing them to the playlist.
The easiest and most obvious way to do this is with Spotify, which has a catalog of songs that stretches back as far back as the early 1900s. Apple iTunes also allows you to listen to a 90-second sample of songs, and boasts a large and impressive catalog reaching back decades.
Some old music has since lapsed into the public domain. These can be found on Archive.org (also known as The Internet Archive) and YouTube, and can be freely downloaded.
Once you have created your playlists, you’re going to want to structure them in a way that’s most effective. The guidance from Playlist for Life suggests that the best playlists aren’t too short, but aren’t too long either. The ideal length for a playlist is somewhere between 70 and 100 songs.
Ideally, the playlist would have a variety of artists. It’s best not to have more than between five and seven songs from a single artist. The only exception is unless you’re absolutely certain each one has a deep, personal relationship with the listener.
So, how often should you listen to your playlist? According to Playlist For Life, it’s all about playing it in structured, sensible intervals.
“Structuring the listening to occur 15 minutes at a time throughout the day has been shown to increase the beneficial effect. Alternatively an hour or so would be a good session of passive listening.”
It’s also important to remember that playing music to someone living with dementia can produce a reaction that isn’t wholly positive.
People who have been previously unaware of their surroundings may find it jarring to be put into an environment that they don’t recognize, as their cognitive abilities improve. They may cry, become upset, or otherwise agitated. If that happens, the advice is to stop listening to the music, and be with the person as much as possible in order to ease the transition.
As Playlist for life says:
“Music is powerful. Using it intensively to affect emotions and memory is a delicate matter. There are no rules. In every instance this is about responding lovingly to a unique individual and taking our cue from them.”
Music Is Powerful
Music is almost universal, with most cultures throughout history enjoying some form of music. It’s a presence that stays with us throughout our lives, and the bonds we make with it are deep and almost unbreakable. As we have discovered, these bonds are so firm, even dementia can’t break them.
It’s truly remarkable to see how something as simple as music can have an impact on the lives of people living with dementia. And it’s all thanks to the dedication of organizations like Playlist for Life, which is helping change lives for the better.
The beauty of this therapy is that it’s incredibly cheap to implement, easily scalable, and doesn’t require any special training or education. You simply need to know about a person’s favorite songs. Perhaps eventually it will become an accepted, commonplace way of treating dementia, as used in hospitals, hospices, and care homes worldwide.
Have you got any stories about the therapeutic power of music? What do you think of Playlist for Life and the work it’s doing to ease the pain associated with dementia? Please share any and all thoughts you have on the matter in the comments below.
(Full Disclosure: Matthew Hughes’ brother works for Community Integrated Care – a partner organization of Playlist for Life, and the operator of Carlingwalk House).