While the benefits of music therapy are becoming more well-known, music therapist Meghan Ross says caregivers and family members of patients with Alzheimer’s disease or related dementias still are surprised when they see the results firsthand.
“A staff member recently walked by one of my groups and said, ‘I can’t believe this person was smiling and singing with you. They looked so engaged, and I haven’t seen them like that,’” says Ross, who works with residents at Oaknoll Retirement Community in Iowa City. “They got to see a resident engaging and in a bright mood when normally they are very anxious.”
Iowa communities where the study took place
Oaknoll Retirement Community, Iowa City (pilot)
Solon Retirement Village, Solon
Wilton Retirement Community, Wilton
Windmill Manor, Coralville
Ross helped facilitate the pilot of a larger study led by Alaine E. Reschke-Hernández, a University of Iowa PhD student studying music therapy. The study aims to provide evidence-based research regarding the effects of music therapy on people with Alzheimer’s disease or related dementias.
More than 5 million Americans are living with Alzheimer’s disease, including 64,000 Iowans. As many as 16 million Americans will have the disease by 2050, according to the Alzheimer’s Association. There is no cure for Alzheimer’s or most related dementias.
“After decades of pouring enormous resources and innumerable scientific studies into this problem, we still lack any effective medication for dementia and Alzheimer’s,” says Daniel Tranel, University of Iowa professor in neurology/psychological and brain sciences. “There’s really no medication that moves the needle in making people better. In the face of that, finding behavioral interventions—which are pennies on the dollar compared to medicine—that can make patients calmer, improve their quality of life, reduce their agitation, make them happier, is extremely important.”
Reschke-Hernández works in Tranel’s cognitive neuroscience lab and is trying to do just that.
“While we’re still looking for a cure and what causes dementia and Alzheimer’s, how do we help people living with this right now?” Alaine E. Reschke-Hernández says. “I want to find and improve access to services that might be helpful and see if I can help people’s quality of life even a notch.”
The Kansas City, Missouri, native planned and facilitated a study in four Iowa nursing homes to examine the effectiveness of a music therapy singing-based intervention with people with Alzheimer’s or related dementias. Music therapy is the use of music in all its forms to address the physical, emotional, cognitive, and social needs of individuals.
The study took place over summer 2018 with 37 patients at four care facilities across the state and focused on music’s impact on participants’ quality of life, mood, and social engagement. Reschke-Hernández says a growing body of research suggests that music therapy may effectively address many of these areas, but there are gaps in current knowledge, including the appropriate application of music as a form of therapy in this population.
“I thought a lot about the outcomes I wanted to look at,” Reschke-Hernández says. “What’s going to be meaningful to these people, their families, and the care staff at these facilities? We’re not going to solve their memory problems with music. But quality of life is a huge issue. Mood and whether you’re able to engage with other people are so important. These are some really basic human needs.”
“We have a chance here to have a real effect with something that is not a medicine and is cost-effective and, I think, has a lot of promise to improve the quality of life of the people who are living with these diseases.”
—Daniel Tranel, University of Iowa professor in neurology/psychological and brain sciences
In Reschke-Hernández’s study, six board-certified music therapists administered two weeks of music therapy and two weeks of verbal discussion. Each session was based on a theme, such as travel/hobbies and love/friendship. Depending on the type of session, the music therapist led the group in singing songs or initiating conversation related to the theme.
UI music therapy undergraduate and graduate students trained to be data-takers asked participants about their feelings before and after each session. They also observed emotional behaviors during the session, including facial displays of emotion and whether each participant was singing along or joining the conversation. Each week, the care team for each individual also filled out questionnaires regarding behaviors outside of the sessions that indicate quality of life and mood.
Reschke-Hernández says the initial results show that the music therapy was significantly more effective, particularly in individuals whose dementia was more advanced.
“Some critics of past research have said, ‘Well, you’re just giving them more attention, so of course they are going to do better,’” Reschke-Hernández says. “But this hints that the type of attention you give people matters as well as whether you present it in a way that they can access it given their level of cognitive decline.”
When Reschke-Hernández started her PhD at the UI, she planned to concentrate on working with children with disabilities, particularly children with autism. But a neuroscience elective graduate class taught by Tranel inspired her to change course.
“It was a mix of grad students in different disciplines somehow all connected to neuroscience, and we had really interesting conversations,” Reschke-Hernández says. “We read about a study that one of Dr. Tranel’s students had led regarding the persistence of feelings in people with dementia despite loss of the memory that caused the feeling. That particularly sparked my interest.”
After joining Tranel’s lab, she met a co-author of the study, Edmarie Guzmán-Vélez, as well as another student, Amy Belfi, who was involved in music research. They decided to replicate the initial study using music as a stimulus.
“It was a coming together of people with very different areas of expertise but a common interest in using music to help people with memory loss,” Reschke-Hernández says.
Reschke-Hernández’s latest study, in some ways, takes that research a step further.
“It’s not a surprise to most people that music is a powerful stimulus and can evoke strong memories,” Tranel says. “But we can leverage that in a more scientific, empirically supported way to develop formal treatments, interventions, and rehabilitation programs. We have a chance here to have a real effect with something that is not a medicine and is cost-effective and, I think, has a lot of promise to improve the quality of life of the people who are living with these diseases.”
Ross met Reschke-Hernández while she was a student at the UI, where she received her bachelor’s and master’s degrees in music therapy, and recommended Oaknoll Retirement Community as the pilot location for Reschke-Hernández’s study.
Ross says the study used only singing as a form of therapy to isolate the effects of that type of intervention, while she might normally use a variety of instruments or incorporate movement or dance into her other music therapy groups. The verbal discussion sessions also were a challenge for her and many of the other music therapists participating in the study.
“One of the really wonderful things about music is that regardless of how a person’s Alzheimer’s or dementia has progressed and whether they may or may not be able to talk anymore, many can still play an instrument or tap their toes or move to the music,” Ross says.
Ross says it was validating to see the difference between the music therapy and verbal discussion sessions.
“They could all engage with the music at a more similar and cohesive level, while I had to make more modifications for each person to get them to engage when we were talking,” Ross says. “More than anything, it was a validation of the power of music when it comes to Alzheimer’s and dementia.”
Reschke-Hernández says along with being a professional development opportunity for the participating music therapists, a few have told her that they shared her training materials with colleagues during staff in-service meetings or used them with their interns.
Ross says she was happy that Reschke-Hernández’s study took place in multiple Iowa communities, and in nursing homes that haven’t had a lot of access to music therapy.
“As the baby boomers age, we’re going to have more older adults in our communities, especially in Iowa, so we’re going to need many different ways to care for them,” Ross says. “I think music is going to play an important role in therapy for these older adults. I’m hopeful that once the study’s results are published, more places will find it in their budgets, not necessarily to hire a full-time music therapist, but to contract with music therapists and see the advantages it can bring to their residents.”
Tifany Rickey, director of nursing at Wilton Retirement Community, says while the facility brings in music programs with activities on the long-term care side, they don’t have as many in the dementia unit.
“It’s sometimes hard to get those residents involved in activities, so this was a good opportunity to get them involved,” Rickey says. “They seemed to really enjoy the music. Once we get the study results showing what the benefits are, it would be great to get our facility more involved.”
Reschke-Hernández says she hopes that more evidence-based research showing the effectiveness of music therapy will help convince stakeholders who make budgetary decisions that such services can be helpful.
“I’m a big fan of interdisciplinary research, so I also hope it interests other scientists to reach out and connect with the music therapy community to see how they might build partnerships for further research,” Reschke-Hernández says. “Because in the end, whether you’re doing clinical work or you’re doing research about clinical work, the end goal is the person receiving the services.”