Dementia: When music is the only way in – An emergency intervention: Innovative Practice

Background

Music holds the possibility of effectively capturing and sustaining the engagement of all listeners – even those who are in a highly disturbed or anxious state (Aragon, Farris, & Byers, 2002; Sacks, 2007). This paper describes an ‘emergency’ music intervention I was requested to conduct for a person whose dementia sometimes took him to a very dark place. At the time of this intervention, I was conducting fieldwork for my PhD (Garabedian, 2014; Garabedian & Kelly, 2018). On this particular day, having exhausted all previously successful ways of connecting with Robert (pseudonym), the care home manager telephoned me with an urgent request that I come and play music for Robert. An accomplished amateur musician himself with a keen affinity for music, we had previously created a good bond with one another. I arrived at the care home to find Robert pacing the corridor, unshaven and red-eyed from an apparent lack of sleep. Staff explained that no one had been able to get close enough to Robert to provide crucial care. They hoped that as Robert was especially fond of music, my playing the cello for him could successfully connect with and engage him – thus providing a way out of his current state and eventually to being approached and cared for by staff. I greeted Robert and invited him to come listen to me play music for him in his bedroom – to which he readily assented. While I quickly unpacked my cello, Robert perched himself on the edge of his bed, tightly holding onto his ‘mouthy’ (harmonica). After a brief chat, I began playing fast-paced, upbeat Scottish and popular tunes. I chose this type of music because I was well aware that my only hope for capturing his attention was through ‘entrainment’ – playing music matching his current agitated state (Khalfa, Roy, Rainville, Dalla Bella, & Peretz, 2008). Almost as soon as I began playing the cello, Robert was robustly tapping his feet and thumb while nodding his head along with the music. We engaged with one another in this manner for some time, with only a brief break while his keyworker ‘Sharon’ came in and offered him some juice and ‘crispies’ (cereal). Resuming my playing of fast-paced upbeat music, Robert recommenced engaging with both me and the music (robustly tapping his feet, nodding his head, and sporadically singing along), while intermittently drinking juice and taking small bites of cereal. Once I felt that Robert and I had become fully connected through the fast-paced music I was playing, I began gradually slowing down the tempo of the music; aiming to gradually calm Robert. Although Robert did slow-down his foot tapping, and even briefly closed his eyes in alignment with the slowing pace of the music, whenever there was a momentary break in the music, he reverted to vigorous foot tapping while energetically rapping his spoon on the side of his cereal bowl.

After over an hour of playing music for Robert, he appeared to be considerably calmer, so I quietly packed-up and went to my car. However, coming back inside just a few moments later, I found Robert pacing the corridor, saying things such as, ‘I know what you’re doing!’ – ‘I’ll get you!’ and threatening to ‘beat me’ etc. His expression made it evident that Robert was not actually seeing nor speaking to me; rather, he seemed to be addressing someone or something outside of present time – perhaps related to a distant and presumably unpleasant memory. Equally, I was aware that I was standing very near to him and that his actions were not at that time predictable; I chose to hold my ground, calmly suggesting he re-join me in his room to listen to some more music – which he again readily accepted. I quickly took-out my cello and resumed playing fast music – which Robert again instantaneously engaged with by tapping his feet, humming along, and maintaining eye-contact. However, his jaw remained notably clenched. We continued in this manner for some time. ‘Evelyn’ (the care home manager) quietly entered the room accompanied by his regular doctor, who stood in the doorway watching Robert interacting with the music and gradually growing calmer as I played successively slower-paced music. I eventually took a short break to allow the doctor to ask Robert a few questions and examine his tongue. Evelyn later informed me that this doctor who was quite familiar with Robert’s circumstances, and had been tremendously moved by what she had witnessed, saying that though she had read about the potential benefits of music particularly for people with dementia, this was the first time she had directly observed this phenomenon.

I commenced playing fast-paced music for Robert once his doctor had left – with him again tapping his feet along with the music. However, he was now also frenetically rubbing his hands, which is a recognised sign of agitation (Cohen-Mansfield, 1997). Evelyn soon returned and sat beside Robert on his bed, joining him in a ‘sing-song’ while I continued playing fast-paced and upbeat tunes. Robert again gradually grew calmer alongside the gradual slowing-down of the pace and mood of the music; indeed, he became peaceful enough that his long-time keyworker was able to sit beside and feed him and provide the care he needed. Nearly three-hours after I initially began playing music for Robert, I left him smiling, happily partaking of food and receiving much needed care from his long-time keyworker – with a feeling of relief and gratitude that Robert was at least for the moment in more peace.

Evelyn said of this intervention:

… a phone call that I gave you because staff were finding it very problematic to actually calm this person down … when you came in and went into his room – and it was a brave thing that you did, because not everybody could have gone into that room where that gentleman was at that precise moment in time. When you walked into that room, what he gained from the music that you gave him, and that you played, brought him back to down where he lives in here. Rather than the place that he was experiencing, which was very frightening … and one in which we couldn’t bring him out of. But you managed through music …

Music can connect with persons who may not be reached through more conventional methods (e.g. verbal communication). All that is required of the recipient is some level of hearing and a willingness to receive the music being played; all that is required of the person(s) providing the music is appropriate training and prior experience working with this specific population. Medical and care home professionals who work most closely with people living with dementia are beginning to recognise music’s potential for helping especially people living with advanced dementia to have a better quality of life through engagement and connection. This emergency intervention highlights the need for further research towards fostering this emergent relationship between medical professionals and trained music practitioners/therapists, with the aim of increasing the use of music within acute and chronic institutional and domiciliary dementia care.