How to use music in the care of people with dementia - some practical suggestions

To mark Dementia Action Week, we are very grateful to Dr Fiona Costa for writing this guest blog on practical suggestions for using music in the care of people with dementia. 
​
Dr Fiona Costa originally trained at the Royal College of Music. Her lifelong interest in music, together with a calling to a ministry with older people, has led to a range of different initiatives and interests. As a research fellow at the University of Roehampton, her principal research interest is the effect of music on the wellbeing and quality of life of older people. Her PhD and subsequent research projects have studied how music can alleviate pain, stress, anxiety and depression. Her most recent work focuses on the use of music to assist in maintaining memory and the ability to communicate in people with dementia.
​

Dr Costa writes:

Music is a wonderful resource for anyone involved in the care of someone with dementia. There are so many different ways that it can help – from reducing anxiety and depression to improving confidence, triggering memories and enabling better communication. Even for those with severe symptoms, music is something that many people with dementia can still engage with and respond to. 

Music can make a real difference. But we need to learn how to use it effectively. 

You may be a full-time carer for your partner or a family member, you may be a friend or visitor. Or you may be working in a care home. Here are some ways of getting started. No specialist music knowledge or training is needed, these ideas are for anyone to try out. ​

A Christmas Concert organised by Fiona

One way of engaging with music is simply to listen to it.

People often ask me what music they should choose for people with dementia to listen to. What is most effective? This is a key question. And the answer lies with each individual person. What music do they enjoy? What music have they listened to throughout their lives? There is no point playing them some Bach or Mozart if they have never shown any particular liking for that music. They may hate classical music. Instead, try to find out what music they have experienced through their life and what music they love.

Here are some questions you can ask – either of the person you are caring for, or if that is not possible, their friends and family. 

• What music genres do they like?
• ​What music did they listen to when they were in their teens and early 20s?
• Are there particular musicians who they like?
• If they are churchgoers, do they have favourite hymns? If you need some suggestions, call the free phoneline Daily Hope on 0800 804 8044 and listen to the options ‘Hymn line’ and ‘Hymns we love’.
• There may be special events in the person’s life where music played an important part. This might be the music played at their wedding, or a birthday party or some other memorable event in their lives. See if you can find out.
• There may be music associated with particular seasons in the year. For example, they may have favourite carols at Christmas time. 
• Do they like musicals? 
• Do they have a CD collection – this may give you some ideas.
• What are their favourite films or TV shows? – they may enjoy some of the tracks or the theme tunes.
• What music don’t they like? This may seem a strange question, but it is important. Playing music that someone doesn’t like can spark irritation or even aggression. 

By asking questions such as these, you can start to put together a playlist of music that means something to the person or people that you are looking after. Try and find music with different moods – some more lively music and some calm music. They can be used in different situations. 

Here are some websites that can help you:
www.playlistforlife.org.uk  
www.musicandmemory.org 
https://app.musicformymind.com 
https://musicmemories.bbcrewind.co.uk 
https://open.spotify.com/user/playlistdementia 
https://m4dradio.com/

Once you have a playlist, what is the best way of using it?

Here are a few ideas. Every person is different, so try them out and see what is most helpful for your situation. Think about the mood of the music that you select – different situations require different moods. And individuals may have particular preferences.

• Set aside a regular time for the care recipient to listen to some of their playlist. Start with a 20–30-minute session, don’t let the music go on for too long. Notice their reactions, both positive and negative, and adjust the choice of music accordingly. If you can, listen together, so that you can talk about it afterwards - talking is often easier after a music session. You could also add some visual aids e.g., album covers, magazines and photos.
• If there are situations which are particularly stressful, such as getting washed and dressed, play some calm music in the background. This may also be helpful before and during mealtimes and to help with sleep. 
• In situations where the care recipient needs to be stimulated, choose more lively music from their playlist and play it in the background.
• Encourage participation – this could be singing, humming, tapping to the beat, clapping and for some people, dancing. 
• If there are songs or hymns on the playlist, encourage the care recipient to join in. In fact, you could sing them together. It is highly likely that they will be able to remember the words and this can give them a great boost of confidence. 
• Some of the music will elicit memories of past events or people in the person’s life. If you are a family member, the music may produce shared memories and you will both have a connection to the music. This may open up conversations so be prepared to spend some time talking. 
• If they are able to, encourage the care recipient to choose the music that they want to listen to. 
• Once you are familiar with the playlist, you could choose particular songs for different times of day or different activities. This can help the care recipient understand, for example, when it is a mealtime. 

You may find that listening to music in these ways brings a range of benefits. Some can be observed straight away, some accrue over time. For example, there may be an improvement in mood, a lessening of anxiety, an increased awareness of other people and their surroundings, and even some temporary improvement in understanding. Of course, everyone is different and some people will respond more positively than others. You may also find that, over time, your own wellbeing is improved, both from the music itself and from a lessening of the caregiver burden. 

A few notes about how to listen to the music. 

• Make sure that the volume is set to the right setting for the person. 
• Be aware that some people like to listen with headphones, others don’t, particularly if they wear hearing aids. 
• Make sure you can easily access the chosen music (e.g., Spotify; Amazon Music on Alexa).
• If the care recipient is able to operate a music device, below are some easy-to-use examples, all available from Amazon.

Geemarc Viso Tempo MP3 music player. Two buttons, with volume lock and 8GB memory (1000 songs).

Koto MP3 player for dementia. 4GB storage and a pre-set volume. Lift and close the lid to stop and start the music.

One-button radio - Ravencout Living OBR-1

Caregiver Singing

The ideas above just relate to listening to music. Of course, there are other activities that you can try which involve more participation. Here is just one of them. People with severe dementia who have lost the ability to interpret spoken instructions may respond better if instructions are given in song. You could, for example, sing an instruction for them to stand up (or whatever it is that you are asking them to do) – either by putting the words to a well-known song or by making something up on the spot. It doesn’t have to be a masterpiece! Called caregiver singing, recent research studies have shown promising results. It is definitely worth a try. 

Find out more - free information packs

These ideas are just a start. I have concentrated on those suitable for someone caring for an individual person with dementia – for those working in care homes, there are so many other ideas and activities that you can try in group situations and in the wider community. If you are interested in discovering more, I have some simple, easy to follow, information packs that my colleague Professor Adam Ockelford and I have put together. If you would like a free set, please email me at [email protected] and I will send you one.