By Lindsay Zehren, Resounding Joy Chief Purpose Officer

Singing for Joy

A White Paper on the Efficacy of the Joyful Jingle Music Therapy Program on Symptom Management for Isolated Older Adults with Dementia

Abstract

Dementia, the sixth leading cause of death in the United States (Murphy, 2018), continues to become more prevalent as a large portion of the population ages (Ahn, 2016). The World Health Organization has declared Dementia as a public health priority and has dedicated resources to determine cost-effective, holistic approaches to addressing the characteristic challenges of Dementia for an increasing number of older adults (Hanser, 2020). Ahn (2016) states that music therapy has been “referenced as one of the important non-pharmacological strategies addressing dementia.” Joyful JingleÔ, a program of the music therapy not-for-profit, Resounding Joy, seeks to provide support to older adults living with Dementia through 15-minute virtual music therapy sessions tailored to address the unique needs of the individual. Joyful Jingle sessions utilize patient-preferred music from specific milestones in their lives to focus on improving behavior and mood; stimulating reminiscence, memory, and cognition; and facilitating socialization and family bonding. This white paper seeks to establish Joyful Jingle as a financially practical, accessible, and effective intervention for people living with Dementia and people caring for those living with Dementia.

Problem Statement

Dementia is a term that is used to describe a variety of diagnoses that typically affect older adults and are characterized by short and long-term memory loss, impaired cognition, changes in personality, and reduced ability to maintain daily activities of living (What is Dementia?, 2019). These diagnoses do not have a cure, and management of symptoms can be emotional, challenging, and costly.

According to the Alzheimer’s Association, an estimated 6.2 million people (one in nine people) over the age of 65 are living with Dementia in the United States (2021). As the average age of the population rapidly continues to climb, the number of individuals diagnosed with Dementia is expected to rise significantly. The World Health Organization has declared Dementia as a public health priority and projects that 8.2 million people will be diagnosed by 2030 and 12.7 million people will be diagnosed by 2050 (Hanser, 2020). Between 2000 and 2019, the death rate for those with Dementia increased by 145.2%, an even more alarming number considering that death linked to heart disease, the number one killer in the United States, has dropped by 7.3% in that same time (Alzheimer’s Association, 2021).

This crisis comes with a significant cost, both financial and personal. Caring for an older adult with Dementia costs care partners time and money and can put an emotional toll on family members and friends. In 2021, Alzheimer’s disease alone cost the nation $355 billion, a cost that is projected to rise to $1.1 trillion by 2050 (Alzheimer’s Association, 2021). The average cost for a loved one to reside at a memory care facility on average costs $5,000 per month (AARP, 2019). Most insurances do not cover the cost of memory care in a facility or at home, making cost-effective, holistic, non-pharmacological, and personalized support services for people with Dementia and their care givers vitally important (Hanser, 2020, Ahn, 2016, Alzheimer’s Association, 2021).

Background

Music Therapy, the “clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program,” (American Music Therapy Association, 2021) is one non-pharmacological intervention that may help to alleviate symptoms of Dementia (Ahn, 2016). In fact, one study shows that music therapy may even slow the progress of Alzheimer’s disease (Kayaaslan, 2019). Research shows that music therapy interventions, designed and conducted by Board-Certified music therapists, may help to improve behavior and mood, stimulate memory and cognition, and facilitate socialization and legacy building.

Music therapy has been shown to have a positive effect on behavior and mood through eliciting:

• Positive changes in mood, behavior, and neuropsychiatric symptoms (Park, 2020; Wall, 2010; Särkämö, T., et. al., 2013; Guetin, 2012; Owens, 2014; Thomas, 2017; Ueda, 2013; Han, 2010; Chang, 2015; Ray, 2015; Ray 2018; Gallegos, 2017; Lyu, 2018)
• Decreased depression and agitation (Moreno-Morales, 2020; Ray, 2015; Ray, 2018; Ueda, 2013; Han, 2010; Chang, 2015; Särkämö, T., et. al., 2013; Gallegos, 2017; Guetin, 2012; Ridder, 2013) and
• Increased quality of life (Moreno-Morales, 2020; Ray, 2015; Ray, 2018; Särkämö, T., et. al., 2013; Rubbi, 2016; Ahn, 2016).

Music therapy can affect memory and cognition by:

• Improving orientation and cognitive functioning (Breuer, 2007; Kayaaslan, 2019; Park, 2020; Moreno-Morales, 2020; Chang, 2015; Li, 2015; Satoh, 2014; Guetin, 2012; Lyu, 2018; Gallegos, 2017) and
• Improving memory (Cuddy, 2012; Moussard, 2012; Simmons-Stern, N.R., 2010; Särkämö, T., 2013; Gallegos, 2017).

Music therapy may facilitate socialization and legacy building by:

• Improving communication, enhancing language ability, and increasing opportunities for socialization (Guetin, 2012; Lyu, 2018; Matthews, 2015; Dassa, 2018; Ahn, 2016; Wall, 2010; Amir, 2014) and
• Creating emotional closeness and meaningful interactions (Ahn, 2016; Dassa, 2018; Matthews, 2015; Owens, 2014; Ross, 2017; Dassa, 2018; Rio, 2018).

Solution

When the world shut down due to the COVID-19 pandemic beginning in 2020 the need to support isolated older adults with Dementia become even more urgent than ever before. In fact, the death rate for those with Alzheimer’s disease climbed by 16% during the pandemic (Alzheimer’s Association, 2021).

In response, Resounding Joy, a national music therapy not-for-profit, created Joyful Jingle to support isolated older adults during the pandemic. Each Joyful Jingle session is approximately 15-minutes of personalized telehealth music therapy. Prior to the session, the family shares important background information and the client’s musical preferences are shared with the music therapist. This allows for the music therapist to direct all time and energy to the patient in the moment. In each session, board-certified music therapists provide support through evidence-based and research-informed interventions designed to improve behavior and mood, stimulate memory and cognition, and facilitate socialization and legacy building. The music therapist utilizes patient-preferred music and music from specific momentous occasions in the patient’s life (i.e. a song from their high school prom, the song from their wedding, or their favorite lullaby to sing to their children) as a catalyst for reminiscence and memory recall. The music therapist carefully monitors the patient’s responses to the music and facilitates discussion based on the reminiscence experience. This provides the patient with opportunities to revel in positive memories, embrace the support of loved ones from the past and present, and validates the patient’s experiences and legacy. Patients may be encouraged to sing along, dance, and/or move with the music. Following each session, the family is provided with a brief synopsis and recommendations for moving forward. This important information provides valuable insight into the moments and memories the session invoked, allowing for loved ones to have an inside look into the mind and emotions of their loved one.

For people who wish to go deeper with their loved one there is The Reflections Collection, an additional tool that consists of a workbook and journal to help guide reminiscence and legacy building. With these books, people are able to document their loved one’s life story through discussion and reminiscence centered around the music of important events in their life (i.e. awards, ceremonies, etc.). Resounding Joy also recognizes the incredible sacrifices and challenges that loved ones of people with Dementia face. To address these needs, the Realax program was created to provide self-care techniques and strategies for care partners.

Conclusion

Dementia is a rapidly growing public health concern in the United States, and those affected will continue to require creative and accessible interventions for support. Resounding Joy’s Joyful Jingle program may be an effective tool in addressing the unique needs of individuals living with Dementia. This program provides support for those living with Dementia as well as their care partners and loved ones and can be an affordable, accessible, and meaningful way to support loved ones with Dementia.

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