Infographic: Using Individualized Music in Dementia

If you like this infographic, be sure to check out my full article on

  Individualized Music in Preventing and Soothing Agitation in Dementia

Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.

Meaningful Activities for Persons Living with Dementia: Why and How

In his book A Life Worth Living: The Eden Alternative in Action, Dr. Bill Thomas (1996) states "Loneliness, helplessness, and boredom are impervious to the silver bullets of modern medicine" (p. 25).  In other words, there is no pill for the three conditions that he calls the "nursing home plagues."   These plagues, however, are not reserved for nursing homes or facilities only.  They appear in many private homes daily.

One important strategy to counter institutionalization in any environment is to offer meaningful activities.  Not just bingo. Not just shuffleboard. Not just folding laundry. Think individual interests.  

Geriatrician and colleague of Dr. Thomas, Dr. Allen Power (2010) discusses the role of engaging persons living with dementia in his book Dementia Beyond Drugs :

         A simple pleasure is just what the name implies: a simple activity one engages in regularly that     brings pleasure and satisfaction.  Everyone has one or more of these. The key is that each person's simple pleasures are highly individualized and often carry special meaning for the person. In fulfilling a simple pleasure, it is critical to obtain all of the little details that make it a special experience. (Power, 2010 p. 93 kindle)

A 2009 article by Kolanowski and colleagues discusses the use of recreational activities to reduce "behavioural symptoms" that typically frustrate both family and professional care partners (Kaolanowski, 2009 p27) rather than drug interventions.  Let's not forget the frustration of the person living with dementia. The symptoms include screaming, kicking, elopement (i.e. wandering).  They present evidence of past studies demonstrating that activities can reduce psychotropic medication use. One must truly partner with the person to try this change for the better.

Now, there are whole books written just on choosing the right activity and adapting it for the person's retained abilities.  This article will introduce discovering the interest behind activities, with future posts expanding on more details (but start implementing now with your instinct).

In order to find meaningful activities, we should look at a person's entire lifespan or career, hobbies, passions, and interests.  This may sound like a daunting task, and it sure could be!

Wouldn't it be great to have a list of topics that help to discover personal interests so you could offer something to counter loneliness, helplessness, and boredom?

Enter the Farrington Leisure Interest Inventory (FLII).  Professor Marianne Smith and her colleagues at the Iowa Geriatric Education Center (IGEC) collaborated with Dr. Linda Buettner to adapt a version for use in IGEC's activity-focused dementia training program.

This checklist of over 150 items will allow you to ask your loved one or client about activities that may pique their interest. My hope is that YOU will consider using this free resource to discover things that will delight your loved one or client.

"But I know everything about ...my Dad, Mom, Husband, Wife, etc..." you say?

Consider these points:

1. The human life is so rich, complex, and interesting; there are likely things that we do not know about each other.

2. Perhaps the person living with dementia is on a Trip Back in Time to their childhood with hobbies that you do not know about?  How will you discover them?

3. You may be a professional Care Partner just meeting a client with dementia with little or no access to the person's family.

4. Perhaps you will uncover an interest that they never had a chance to explore in their busy life.

Professor Smith tells the story of a woman with whom she was reviewing the FLII. When they got to the topic of motorcycles, the woman told the story of how she traveled cross-country on a motorcycle.  Who would have known?!  Of course, she is probably not going to be riding a Harley soon, but there are other enriching activities that can be created around motorcycles of that era.

Not only will this survey help uncover topics of meaningful activities, but it could also create a stronger bond between professional Care Partner and client. As the Care Partner goes through the Farrington Leisure Interest Inventory, he or she will start to see the whole person with decades of life and experience.

This FLII asks one question regarding enjoyable music, which is a very rich topic deserving its own assessment.  I recommend reading my article on preventing and soothing agitation in dementia that includes a music assessment.

As always, be cautious of overwhelming the person living with dementia (or anyone). Break up the FLII over time if needed. Also, the music preference survey may be offered another time.

Now it is time to put this knowledge to use and create Peace with Dementia. Tell us about your experiences with meaningful activities and when you use the Farrington Leisure Interest Inventory.

If you appreciate this article, don't keep it all to yourself.  Please share so that more persons living with dementia can benefit!

Update: In the original version of this article, I stated that Professor Marianne Smith and her team at Iowa Geriatric Education Center created the Farrington Leisure Interest Inventory.  This was my mistake when I misread Dr. Smith's email to me. As Professor Smith says in the comments section below, she and her team "collaborated with Dr. Linda Buettner to adapt a version for use in our activity-focused dementia training program." This post has been corrected.

In Peace, 

Matt

Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.

Literature cited:

Kolanowski, A., Fick, D. M., & Buettner, L. (2009). Recreational Activities to Reduce Behavioural Symptoms in Dementia. Geriatrics and Aging, 12(1), 37-42. Retrieved May 1, 2016, from https://healthplexus.net/files/content/2009/January/1201dementia.pdf.

Power, G. Allen. (2010). Dementia Beyond Drugs: Changing the Culture of Care. Baltimore, MD: Health Professions Press. 

Smith, M., Buckwalter, K., Buettner, L., & Seydel, L. (2010). Farrington Leisure Interest Survey from Dementia Training to Improve Involvement in Meaningful Activity. The Iowa Geriatric Education Center, The University of Iowa: Iowa City. 

Smith, M., (2010). Non-Pharmacological Management of Behavior Problems in Dementia [iTunes U Podcast]. The Iowa Geriatric Education Center & The University of Iowa College of Nursing, The University of Iowa: Iowa City. Retrieved from http://itunes.apple.com.

Thomas, William. (1996). A Life Worth Living: The Eden Alternative in Action. Acton, MA: Vander Wyk & Burnham.

Individualized Music in Preventing and Soothing Agitation in Dementia

They say that music is the soundtrack of our lives. Most probably, this strikes a chord with you. Do you ever hear a song on the radio or television that for a moment transports you back to a distant place and time? Perhaps the memory is pleasant and reminds you of event like courting your spouse or your wedding.  A song may also bring back a painful memory such as a bad relationship or breakup. It could even be bittersweet, reminding you of a loved one who is no longer physically in your life. This blog post will tell you how music can create Peace with Dementia. As always, I offer some action steps if you are committed making Peace.

Music is a powerful thing.  According to Professor Linda A. Gerdner at the Stanford Geriatric Education Center, music can be used to sooth persons with dementia when they are agitated.  Agitation is a term used to describe "inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion per se" (Cohen-Mansfield & Billig, 1986, p.712) as documented in Dr. Gerdner's presentation mentioned in the next paragraph.  When someone has a dementia, their "stress threshold" is lower, meaning that it takes even less distraction and disruption to become agitated (Richards-Hall & Buckwalter, 1987) as documented in Dr. Gerdner's presentation. Where you and I today may have a strong ability to keep our cool,  we will generally be set off more easily if we have dementia.  Using music in the proper way can help prevent agitation and also help calm someone down when agitated.

Dr. Gerdner has been studying the benefits of music for persons with dementia for 25 years. In 1996, she published her original evidence based guidelines which is in its 5th edition. In early 2015, Stanford uploaded this Dr. Gerdner presentation that you will enjoy.  I highly recommend viewing the presentation and focusing on these key points from Dr. Gerdner's research:

• It is important to know this a "music intervention" that can be used by family members and staff who follow Dr. Gerdner's evidence-based guidelines. This is not "music therapy" that is offered by therapists. 
• For music to effectively create peace, select songs and artists that you know are special to the person with dementia.
• Dr. Gerdner has developed two (2) assessments to assist you in exploring song selection.
• One (1) assessment is for persons in the early stages of dementia - Page 16 of the guidelines
• One (1) assessment is for a family care partner and/or professional care partner- Page 18 of the guidelines.
• Prevention of agitation is optimal. Dr. Gerdner recommends playing music 30 minutes prior to the time of day when it appears.  This takes looking for patterns and sources of agitation. 
• The only way to know if this will work for your loved one or a client is to try the selected songs and takes notes on progress.  When a songs works, write that down. When a song does not work, write that down. Discontinue songs that create more agitation.  The person with dementia is the expert from whom we take our cues.
• If music from a music player bothers other people, try comfortable headphones with a safe volume. Remember the person will like have different hearing ability as you, and not necessarily worse if they have a hearing device.
• Dr. Gerdner's research also discuss ethnic music that can be very powerful if they have not heard it in a very long time. Her above presentation includes two powerful examples of this.
• Naomi Feil, creator of Validation Therapy, is seen on this popular video of utilizing music to communicate with someone in repetitive motion and non-verbal.
• Here is a popular example of a gentleman coming alive with the help of his favorite music.

Action items for you to create Peace with Dementia:

• Review the PDF of Dr. Gerdner's Evidence Based Guidelines.
• Visit her Stanford page.
• Consider the idea of using individualized music to communicate with your loved one or client.
• Add a comment or question. 
• Like us on FB and visit our website for a list of support groups and services.

Matt Estrade, MBA, CAPS is the Founder and Chief Mentor at Care Partner Mentoring, LLC in Covington/New Orleans, LA, USA. A more extensive biography can be found here.