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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.

References

Ahn, S.N. & Ashida, S. (2016). Music therapy for dementia. Maturitas, 71: 6-7. Retrieved from: https://www.maturitas.org/action/showPdf?pii=S0378-5122%2811%2900363-X

Alzheimer’s Association. (2021). Alzheimer’s Disease Facts and Figures. Alzheimer’s Dementia 2021, 17(3). Retrieved from: https://www.alz.org/media/documents/alzheimers-facts-and-figures.pdf

American Music Therapy Association. (2021). Retrieved from: https://www.musictherapy.org/

Amir, D. & Dassa, A. (2014). The role of singing familiar songs in encouraging conversation among people with middle to late state Alzheimer’s disease. Journal of Music Therapy, 51(2): 131-153. https://doi.org/10.1093/jmt/thu007

Breuer, R.A., et al. (2007). The temporal limits of cognitive change from music therapy in elderly persons with dementia or dementia-like cognitive impairment: a randomized control trial. Journal of Music Therapy, 44(4): 308-328. https://doi.org/10.1093/jmt/44.4.308

Chang, Y.S., et. al. (2015). The efficacy of music therapy for people with dementia: A meta-analysis of randomized controlled trials. Journal of Clinical Nursing, 24: 3425-3440. doi: 10.1111/jocn.12976

Crouch, M. (2019). Memory Care: Specialized Support for People with Alzheimer’s or Dementia. AARP. Retrieved from: https://www.aarp.org/caregiving/basics/info-2019/memory-care-alzheimers-dementia.html

Cuddy, et al. (2012). Memory for melodies and lyrics in Alzheimer’s disease. Music Perception, 29(5), 479-491. https://doi.org/10.1525/mp.2012.29.5.479

Dassa, A. (2018). “Opening Our Time Capsule” – Creating an Individualized Music and Other Memory Cues Database to Promote Communication Between Spouses and People with Dementia During Visits to a Nursing Home. Frontiers in Medicine. https://doi.org/10.3389/fmed.2018.00215

Gallego, M.G. & Garcia, J. G. (2017). Music therapy and Alzheimer’s disease: Cognitive, psychological, and behavioural effects. Neurologia, 32(5): 300 – 308. DOI: 10.1016/j.nrl.2015.12.003

Guetin, S., et al. (2013). An overview of the use of music therapy in the context of Alzheimer’s disease: a report of a French expert group. Dementia (London), 12(5): 619-634. DOI: 10.1177/1471301212438290.

Han, P., et al. (2010). A Controlled Naturalistic Study on a Weekly Music Therapy and Activity Program on Disruptive and Depressive Behaviors in Dementia. Dementia and Geriatric Cognitive Disorders, 30: 540-546. https://doi.org/10.1159/000321668

Hanser, S.B., et al. (2020). Editorial: Music Therapy in Geriatrics. Frontiers in Medicine, https://doi.org/10.3389/fmed.2020.00087

Kayaaslan, B. & Lock, N. (2019). The effect of music therapy on cognitive functions and adaptation in Alzheimer’s patients. International Journal of Depression and Anxiety, 2 (14). https://doi.org/10.23937/2643-4059/1710014

Li, C.H., et al. (2015). Adjunct effect of music therapy on cognition in Alzheimer’s disease in Taiwan: a pilot study. Neuropsychiatric Disease and Treatment, 11: 291-296. DOI https://doi.org/10.2147/NDT.S73928

Lyu, J., et al. (2018). The Effects of Music Therapy on Cognition, Psychiatric Symptoms, and Activities of Daily Living in Patients with Alzheimer’s Disease. Journal of Alzheimer’s Disease, 64(4): 1347-1358. doi: 10.3233/JAD-180183.

Matthews, S. (2015). Dementia and the Power of Music Therapy. Bioethics, 29: 573-579. https://doi.org/ 10.1111/bioe.12148

Moreno-Morales, C., et al. (2020). Music therapy in the treatment of dementia: a systematic review and meta-analysis. Frontier in Medicine, 7: 160. https://doi.org/10.3389/fmed.2020.00160

Moussard, A., et al. (2012). Music as an aid to learn new verbal information in Alzheimer’s disease. Music Perception, 29(5): 521-531. https://doi.org/10.1525/mp2012.29.5.521

Moyle, W., et al. (). Dementia and loneliness: an Australian perspective. Journal of Clinical Nursing, 20: 1445-1453

Murphy, S. (2018). San Diego County Faces Rise in Dementia Patients. City news Service, Retrieved from: https://www.kpbs.org/news/2018/apr/20/studies-show-san-diego-county-to-be-impacted-by/#:~:text=San%20Diego%20County%20leaders%20and,soar%2036%20percent%20by%20the

Owens, M.L. (2014). Remembering through Music: Music Therapy and Dementia. Age in Action, 29(3): 1-5. Retrieved from: https://scholarscompass.vcu.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1059&context=vcoa_case

Park, J., et al. (2020). Perceived benefits of using nonpharmacological interventions in older adults with Alzheimer’s disease or dementia with Lewy Bodies. Journal of Gerontological Nursing, 46(1): 37-46. https://doi.org/10.3928/00989134-20191217-01

Ray, K.D. (2015). Music Therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia. Dementia (London, England). 9. https://doi.org/10.1177/1471301215613779

Ray, K.D. & Gotell, E. (2018). The Use of Music and Music Therapy in Ameliorating Depression Symptoms and Improving Well-Being in Nursing Home Residents With Dementia. Frontiers in Medicine, 5: 287. https://doi.org/10.3389/fmed.2018.00287

Ridder, H.M.O., et al. (2013) Individual music therapy for agitation in dementia: an exploratory randomized controlled trial, Aging & Mental Health, 17(6): 667-678. DOI: 10.1080/13607863.2013.790926

Rio, R. (2018). A Community-Based Music Therapy Support Group for People with Alzheimer’s Disease and Their Caregivers: A Sustainable Partnership Model. Frontiers in Medicine, 5: 293. https://doi.org/10.3389/fmed.2018.00293

Ross, M. (2017). A Resource-Oriented And Relationship Based Music Therapy Approach For Persons Living With Dementia. [Unpublished Master’s Thesis]. Concordia University. Retrieved from: https://spectrum.library.concordia.ca/982324/1/Ross_MA_S2017.pdf

Rubbi, I., et al. (2016). Efficacy of video-music therapy on quality of life improvement in a group of patients with Alzheimer’s disease: a pre-post study. Acta Biomed, 87(4-S): 30-37.

Särkämö, T., et al. (2013). Cognitive, Emotional, and Social Benefits of Regular Musical Activities in Early Dementia: Randomized Controlled Study. The Gerontologist, 54(4): 634-650. https://doi.org/10.1093/geront/gnt100

Satoh, M., et al. (2015). Music Therapy Using Singing Training Improves Psychomotor Speed in Patients with Alzheimer’s Disease: A Neuropsychological and fMRI Study. Dementia Geriatric Cognitive Disorders Extra, 5: 296-308. https://doi.org/10.1159/000436960

Simons-Stern, et al. (2010). Music as a memory enhancer in patients with Alzheimer’s disease. Neuropsychologia, 48(10): 3164-3167. Retrieved from: https://doi.org/10.1016/j.neuropsychologia.2010.04.033

Thomas, K., et al. (2016 – 2017). Individualized music program is associated with improved outcomes for U.S. nursing home residents with dementia. The American Journal of Geriatric Psychiatry, 25(9): 931-938. https://doi.org/10.1016/j.jagp.2017.04.008

Ueda T, et al. (2013). Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and meta-analysis. Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Review. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK138433/

Wall, M. & Duffy, A. (2010). The effects of music therapy for older people with dementia. British Journal of Nursing, DOI: 10.12968/bjon.2010.19.2.46295

What is Dementia? (2019). Retrieved from: https://www.cdc.gov/aging/dementia/index.html