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Music Therapy in Dementia Care

br2001_02FSAldridge, David (ed) (2000): Music Therapy in Dementia care London and Philadelphia: Jessica Kingsley Publishers.

Reviewed by Tone Sæther Kvamme.
Music Therapist. Worked from 1991 -98 at Økern Nursing home in Oslo.
Master degree student at Norwegian State Academy of Music,Oslo.

This book consists of eleven articles written by contributors from many parts of the western world, for instance Germany, United Kingdom, USA, Australia and the Netherlands. The contributors are mainly music therapists or music therapist teachers. Some of them have long practical experience in the field and some are well-known and acknowledged authors of books and scientific articles like for instance the editor David Aldridge, Alicia Ann Clair and Concetta M. Tomaino.

I looked forward to reading this book. There are not many books written about music therapy in geriatric care. Apart from Ruth Bright’s book (1998). Music Therapy and the Dementias, which mainly contains material on music therapy theory, I don’t know of any other entire book about music therapy and dementia.

The articles contained within the book are varied. We can for instance read about the importance of singing, the problem of agitation and how music can help, improvisation as assessment, creative music therapy as a method, how music can expose recollection and images and there is an overview of the music therapy literature relating to elderly people in the period from1980 – 88.

I found many of the articles very interesting and well written. What they mainly have in common is that they show that music (or other creative art therapies) in important in many different ways in the treatment of demented people and to increase their quality of life. Or as David Aldridge says: “The message of this book is: While the memory of the source fails, the music lingers on.”

I think it is difficult to place the book in a genre. Some articles are quite typical academic or scientific articles, some have more anecdotal or narrative features and some are more like a schoolbook (lærebok). The language and content varies between easy reading (for instance about singing) and more complicated texts (like Gudrun Aldridges article on assessment). I understand that Aldridge wants to reach many people. Both caregivers, families of dementia sufferers, music therapists and all those involved in psychogeriatrics are mentioned as target groups. I’m sure some parts are interesting for all those mentioned, but generally I believe one needs to know alot about dementia and music therapy to be able to appreciate the whole book. All in all, I regard it as an academic book for skilled music therapists working in geriatric care.

I expected that because the book contains contributions of people from different parts of the world, there would be a wide range of the current methods, theories and ideas on the subject in the book, or that it would go deeper into one of these areas. I don´t think it quite fulfils any of those goals. There are many references to studies and research (mainly quantitative), and there is some information about new science from psychology and medicine, but there are no discussions concerning music therapy results, methods or theoretical approaches. There is one description of a music therapy method, the Nordoff/Robbins “creative music therapy”. Apart from this one and a general underlining of how it important it is to use familiar music for dementia sufferers, no other music-therapy methods are described.

The book doesn’t quite fulfil my expectations, and this is one of the main reasons. Four out of eleven articles do not contain music-therapy in dementia care. Two are about other creative arts therapies, one is about treating war memories with elderly german people (but not really involving demented people) and one is about singing, with only a few pages about dementia. I found those articles interesting to read though (in fact I probably found the one about making poems the most touching and inspiring of them all), but they don’t really belong in this book. This makes me wonder whether there is enough interesting music therapy material on the subject in the world to make a whole book. I find this quite odd because Annemiek Vink tells us on page 120 that in 1996, 52 music therapists worked among Alzheimer- patients in Canada, 697 music therapists worked in the geriatrics in the USA in 1998, approximately 20 in Australia in 1992 and about 60 in psychogeriatrics in the Netherlands in 2000.

I think that the articles have too little in common. I miss some logical connection between them and a more clear formulated purpose or intention with the book. What does the author really want to express? I get the impression that the articles are selected quite randomly. I think that the lack of coherence is reflected in Aldridge’s introduction article called: “Overture: It’s Not What You Do But the Way that You Do It.” His article contains a little bit about a lot of different subjects related to music therapy and dementia, but they are not a connected whole.

All the references are collected on the last pages. In each article we find references in the text. I miss a list of references after each article. Then it is easier to sort out what kind of theoretical material each author has used.

The articles are so different from each other that I find it hard to comment more generally about them. Each article should be reviewed separately. I have chosen to describe two of them more closely. I find these two interesting from a professional point of view.

The first one is Annemiek Vink’s article called: “The Problem of Agitation in Elderly People and the Potential Benefit of Music Therapy” and the second one is Concetta M. Tomaino’s “Working with Images and Recollection with Elderly Patients”.

Annemiek Vink is a psychologist and she works as a music therapy teacher in the Netherlands. She is the author of two articles in the book. This article consists of “agitation” in people suffering from dementia. Agitation is defined as an inappropriate verbal, vocal or motor activity that is not judged by an outside observer to result directly from the needs or confusion of the agitated individual. This kind of activity can for instance be restless wandering, yelling or physical aggression like hitting or spitting. One supposes that as many as 90 per cent of elderly patients with dementing illnesses demonstrate such behaviour. Vink refers to a study done by Cohen-Mansfield, Marx and Rosenthal in 1989. In a total of 408 nursing home residents it was found that 93 per cent of them demonstrated one or more agitated behaviours at least once a week.

Vink mentions that causes of agitation mainly arise from cognitive impairment, disturbed sleep patterns and boredom. She says that observations are crucial to interpret agitated behaviour. She also claims that music therapy, with its non-verbal qualities, is especially suitable for these patients whose verbal activities are declining.

Vink refers to studies showing that music therapy can reduce wandering, increase the time when patients sit down quietly and contribute to a decrease of aggressive behaviour during bathing, during mealtimes and so on. Specific behaviours that have been found to decrease are vocally disruptive behaviour, hitting, wandering, crying and pacing and an increase in hours of sleep.

I find it inspiring to know that music therapy can give such results. But I miss descriptions on what kind of music therapy has been used? Is it the music itself that caused the change, the relation to the therapist, the patient being active instead of bored or combinations of these or something else?

I find this article to be kind of superficial. The symptoms of agitation are the main issue. I miss different theoretical views on how to understand agitation or at least some arguments for why the author chose her angle. I miss for instance some discussion on the connection between the patients life-story and agitation, how does the current environment, conditions and communication at the nursing home have influence on agitation behaviour? What kind of role does the music therapist have among the rest of the caring-staff and in what ways do they cooperate?

Concetta M.Tomaino is the Director of Music Therapy and Neurologic Function at Beth Abraham Health Services. Her article is mainly based on her doctoral dissertation called: “Music on their minds: a qualitative study of the effects of using familiar music to stimulate preserved memory function in persons with dementia.

Tomaino says that who we are as individuals is so linked to our memories and recollections of the past that it is difficult for us to understand the loss that the demented experiences. She defines memory as the comparison, both conscious and unconscious, of verbal and affect responses to previous life experiences. She has experienced how familiar music (music of personal significance) can stimulate responses, memory and improve reminiscence abilities to persons with dementia. She claims that such music can reach the “sense of self” that is still preserved. She describes her practical work with three demented women and shows how familiar songs can trigger associations and memories where mere words or photos cannot. She discovered that many seemingly lost memories still exist and can be stimulated with familiar music.

I think that Tomaino’s article is one of the best in this book. She bases her hypothesis and assertions on theory, references, good examples and personal experiences.

Final views/comments:

Music Therapy in Dementia Care holds many interesting and well written articles. I think those which describe what happens to demented people when they participate in music therapy sessions, are the best. When those stories are well told, like for instance the case-study on Edward in Fraser Simpson’s article: “Creative Music Therapy: A last Resort”, the reader gets an increased intellectual and emotional understanding on what it is like to be demented and how music therapy can help.

When I consider the book as a whole, I regard a lack of context as a major problem. The text goes too directly into music therapy work with demented people without putting this into any sort of frame. From my point of view this makes it too narrow-minded. Both music therapy and the demented become something quite isolated from the rest of the world. What kind of theoretical angles or views do the different authors have? I miss descriptions of the demented person in her environment, and I miss descriptions of the music therapist in a working fellowship. What role and function has the music therapist in a hospital or a nursing home? How does she cooperate with the caring staff or for instance the physical therapist or the occupational therapist. How are the conditions for demented people in the society? All in all I miss theoretical, philosophical, political and historical frames of references.

I do realize that if a book on the subject dementia and music therapy shall fulfil all my expectations, it may become incredibly long. Or maybe there needs to be many more books. I hope for many more books.

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