Baroness Sally Greengross OBE made headlines last month when she called on doctors to take the revolutionary step of prescribing music for patients living with dementia. Greengross, who has been sitting in the House of Lords for over 20 years, said that music is more “cost-effective than medication”. In urging the government to recognise “the transformative power of music”, the 86-year-old has asked the government to consider incorporating the change to the Health and Social Care Bill.
Elsewhere, Alzheimer’s Research UK has teamed up with Music for Dementia to “highlight music as a positive way to support people with dementia and inspire those who are working relentlessly on research”. Through Music for Dementia, people can access the free radio station m4radio.com. And the Alzheimer’s Society UK has supported another organisation, Playlist for Life, which encourages people to use music to connect with friends and relatives who have dementia, whether at home or in a care home.
Playlist for Life, a charity founded by the broadcaster, Sally Magnusson, has taken this idea to a whole new level. Acting on scientific research, which has found that music can offer a host of psychological benefits to those living with dementia, the Glasgow-based charity’s raison d’etre is to help everyone with dementia to create a personalised playlist.
While charities empowering those with dementia to harness the power of music, are very welcome, in dementia circles, the benefits of music have been known for a long time. Music is a medium that not only brings people together, but forms ‘a mental ladder’ to help those with dementia to re-discover memories that may have seemed lost forever.
Music as a ‘prop’
I think of music as a prop, which is the key to unlock lost memories. As music is processed and stored in so many different parts of the brain, it is regarded as an extremely effective tool, enabling a person living with dementia to re-find poignant and meaningful memories.
The use of playlists that are gathered from a wide spectrum of contributors so that the idea of a playlist is relevant to both m4d radio and for the Playlist for Life is a fantastic idea. It will really help activity providers, who understand the correlation between an individual’s musical preferences and the history of those songs and tunes that trigger memories treasured memories. Such an initiative will help activity providers to selectively use music to stimulate those memories as a reminiscence activity and by doing so, enhance self-identity.
Using the QCS PAL Instrument to get the most out of a playlist
The question is, how do carers present and engage with a person living with dementia so that person can get the most out of a music playlist? In order to address the question, it is important to recognise that those living with dementia have different levels of cognitive ability. Over two decades ago, I created the PAL Instrument, which I have further developed with Quality Compliance Systems (QCS), the leading provider of content, guidance and standards for the social care sector. The instrument, which has been renamed the QCS PAL Instrument, has been specifically designed to help professional carers and activity providers assess the level of functional ability at four different levels – planned, exploratory, sensory and reflex.
You can download the PAL Instustment for free here
At a Planned level
Many people reading this article are already familiar with the QCS PAL Instrument, but for anybody who isn’t, a person functioning at a Planned level would be capable of choosing a playlist themselves but they might require some help loading the playlist on to the device. The most fundamental point to bear in mind is that the person at this level of ability is in control of the decision-making process and is supported to master the use of the device containing the playlist. That means helping them to reach a stage where they can play a number of playlists as and when they choose to.
To enable someone at a Planned level to pick their own playlist, or to create such a list for those at other levels, is not as straightforward as it sounds. It can be a fantastic experience but it involves breaking the wider task into several smaller steps. Carers and activity providers need to be historians in the sense that they must be open to taking a journey back in time with the person in order to create a soundtrack of their lives.
At an Exploratory level
Those operating at an Exploratory level need much more guidance, which can be divided into smaller steps, than somebody who functions at a Planned level. With the support of their carer or activity provider, the emphasis is much more on supporting them to enjoy the playlist every day. From the point of view of a carer, that could entail dancing, singing with them or simply sitting with them talking about the music and the lost memories it triggers.
Placing a much greater emphasis on the transformative power of music also helps to unlock the accompanying social interactions that help to reconnect the person with others. For those at an Exploratory level, the joy of sharing music by singing, humming along to a tune, or dancing together should not be under-estimated. It enhances the mood and nurtures the spirit.
At a Sensory level
At a Sensory level, the music on the playlist is used to form a multi-sensory experience because those at such a level are engaging through their senses. Therefore, it’s important that the experience of listening to the music is complemented by other sensory experiences that integrate in order to provide a whole emotional and physical environment. So, for example, if the music being played is relaxing and calming, a carer or activity provider might also stimulate the person’s sense of smell by giving them a gentle hand massage with lavender hand lotion. Alternatively, if the music is more energetic and vibrant, a massage could still take place, but a ginger and citrus scent might be used instead to suitably stimulate the senses.
Smell of course is not the only sensation that carers supporting those with dementia can explore. Touch is another. If there is a particular song that a person liked to dance to, for instance, by understanding their life story, activity providers could create bespoke activities around the song and the fond memories are sparked. Not everyone enjoys dancing, of course. The point is to understand the person’s life history in order to provide the right musical experience for the individual. If they liked to go to the beach, the activity might encompass listening to a song, looking at seaside postcards, handling seashells and eating an ice cream. This multi-sensory experience is particularly effective because it brings all of the senses together in one single activity.
At a Reflex level
For those functioning at a Reflex level, a carer or activity provider needs to be present and fully involved in the activity process. The music might either be used to calm the person, or to help stimulate alertness. At this level, it is really important not to bombard a person’s senses with multiple sensations. That said, the person needs to be stimulated. So, it might simply be that the carer or activity provider links their arms through theirs and rocks with the person, which can stimulate the vestibular and proprioception systems. These affect movement and balance. The vestibular and the proprioception senses are sometimes called the sixth and seventh sense and are important areas for focus for people at the Reflex level of ability.
It is worth reiterating the hidden power of music. There is music that might stir negative feelings and emotions. Therefore, activity providers should always involve family and friends when creating the playlist as they know the person best. On a wider note, music is particularly empowering as it not only supports a sense of self, but also stimulates physical health – from providing rhythm for movement to providing rhythm for the heart rate. Playlists aside, care providers should carefully consider the music that they play in communal areas. For example, it is often the case that relaxing music is played in dining rooms when, actually, providers should opt for music with a faster tempo as that would support a less passive form of dining.
Cutting-edge research
Finally, how do we know that music is an effective tonic for those living with dementia? What does the science tell us? It is an area that Alzheimer’s Research UK is currently exploring. It recently began recruiting volunteers who are living with dementia to participate in a study ‘to explore music as therapy’. The project, which involves 1,000 participants that began in October 2021 and will run until June 2022, is being led by Professor Keith McAdam who is the founder of the charity, ‘Music for my Mind’. Currently, no research results are available. However, it will be interesting to see results of the study when they are published later this year.
HUG
That said, a landmark study using the QCS PAL Instrument, which assesses the level of functional ability of people with cognitive impairments, revealed that those with dementia who used the HUG device over a six-month period, which was created by the Cardiff Metropolitan Laugh Team, saw an 87% improvement in wellbeing. The weighted limbs, soft body and simulated beating heart of the HUG device, which also includes an MP3 Player to play a person’s favourite songs, mimics a human hug.
The QCS Dementia Centre
Evidence-based measures of effectiveness are important for reliable and valid findings. Take the QCS Dementia Centre, which is the realisation of a strategy that provides comprehensive ‘condition’ specific support, to QCS’s 140,000 plus customers, for example. The QCS Dementia Centre contains an evidence-based, valid PAL Engagement Measure. Providers can use it to track the extent at which any activity, including a musically focused one, makes a difference to the life of somebody living with dementia over a set period of time.
The measuring instrument is revolutionary in that it enables a carer or an activity provider to observe the cognitive and physical abilities of a person with dementia, as well as assessing their emotional and social wellbeing – all through the wider lens of the QCS PAL tool.
A specially devised assessment system based on the PAL Instrument, where providers can score the individuals they are observing, enables them to score, record and log progress, which can be shared with service users, friends and family. The PAL Engagement Measure resource is also ground-breaking in that it helps service providers to benchmark and develop team member’s care practices.
The hope is that science will continue to open doors to improved practice but it is important that research translates into practical evidence-based resources, such as those in the QCS Dementia Centre, that provide the tools that practitioners need.
Make sure you download the PAL Instustment for free here.
*This article was first published by Care Home Profession here
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