Music therapy and dementia – a world-first study is born
Professor Felicity Baker is co-director the National Music Therapy Research Unit at the Melbourne Conservatorium of Music. This week she received word that her world-first study into the use of music therapy for people with dementia has been awarded a substantial government grant. Here, she explains what she hopes to achieve.
By Paul Dalgarno
Congratulations, Felicity. You’ve just secured what looks like a massive amount of money for a research project – $1,014,430.20 to be precise. What’s the project?
The grant is from the National Health and Medical Research Council, or the NHMRC, and it was part of a special call for dementia-specific projects. The government has identified this as being an important area for our future. Music therapy has been practised in aged-care in Australia for a very long time – since I was a student, in fact. But there hasn’t been this kind of large-scale, systematic study of its use in dementia care anywhere in the world.
It’s a three-year project – what will it cover?
It’ll be a really major randomised control trial involving 500 participants from across the country. We’ll get people living with dementia to participate in small group musical experiences, singing songs, talking about what they mean, that kind of thing. And then we’ll compare it with participants taking part in choral singing, because that’s something a community musician, as opposed to a therapist, could lead. We want to see if there’s really any difference between those two approaches.
The people we’ll be working with will no longer be able to be look after themselves – they’ll be in aged-care facilities 24-hours a day, either because they’re too unwell to stay home and look after themselves or their family carers are unable to look after them properly because the level of care they require is too great for the resources they have at hand. It’ll be one of the biggest music therapy studies in history – and certainly in dementia. It’ll be a game-changer, not just for us in Australia but globally.
What’s your gut-feeling on choir-singing versus music therapy in that context?
We have a bit of a hypothesis, because we’re looking at mid- to later-staged dementia. We suspect the choir approach will suit those who are higher-functioning and less progressed in their disease. They’ll be able to independently have a conversation with the person sitting next to them about the song they’re singing. Whereas those who are more progressed in their disease will require much more focused, skilled support from a music therapist who knows how to connect with them, because that’s what they’re trained to do.
So, three years down the line, when you’ve done all the work for this, what value will it have?
From a political perspective it’ll be really important for us to show that having an intervention delivered by a trained music therapist is more effective in addressing the wellbeing of people with dementia. We’re also examining changes in the level of burden experienced by caregivers. Nurses can get very stressed when there are lots of people with dementia calling out, getting agitated, etcetera. It’s a very stressful context. We’re expecting that our intervention will help to calm those people with dementia down a bit and that this in turn will lead to reduced stress in staff. We’ll be looking at the carers’ wellbeing, number of days of sick-leave, the degree of work stress experienced, and more.
As a general approach, how does the relationship normally start up between a music therapist and someone with dementia?
Usually we start with music. One thing we know from previous research is that older people tend to remember, and have the most connection with, music from their late teens and early 20s, usually when they’re dating and going out dancing, or in other important life events where music was present. We try to work out what their musical preferences were at that time and use those as a starting point. Often these are people who are losing their language abilities and may be struggling to communicate but, after hearing those pieces of music, they might start talking, saying, “Oh, I remember when I played that to my son,” or whatever. The music stimulates those memories and with those memories comes language. If they’re in early-stage dementia, and more cognitively able, we might start with dialogue around their life and connection with music.
Do they then make their own music?
Yeah, they can. And in fact my special interest area is in using songwriting as a tool. One project I’ve been working on in a dementia daycare centre involves people with early-stage dementia creating songs. It was fascinating to hear the centre staff saying they’d never seen those people so animated. Groups of people would be having little arguments about whether someone was using the right word, or which words rhymed, in a way that was collaborative and clearly stimulating them intellectually. The other interesting thing is that these are people who are supposedly unable to learn and who are losing their memory would remember the lyrics of newly-created music from week to week. That was something new – we didn’t expect that. It demonstrates that people living with dementia can learn. And that’s because music has a unique ability to facilitate learning, even in people with declining cognitive function.
You’ve come through a career in which music therapy has gone from being a pioneering area … I mean, it still is now, but it’s developing pretty quickly into something more mainstream.
Yeah, and I would hope that one of the reasons we got the NHMRC grant is that someone is looking at music therapy and thinking there’s something there. It’s already got an emerging evidence base, and so I’m hoping it will become mainstream rather than kind of fringe. That would be ideal.
This new grant comes on the back of some other good news for you. Last month you won a World Federation of Music Therapy Award. What was that for?
It’s awarded to a person who has made a significant contribution to the development of the discipline, and, in my case I think, that I’ve really brought songwriting to the forefront of music therapy practice and explored it in ways that haven’t been tried before. I was chuffed to get it. They only started giving out these awards three years ago and they only happen every three years. I’m the second recipient, so I feel pretty special to have been nominated and then awarded it.
Take a punt. Five or ten years down the line, where would you put your own research and music therapy?
That’s a hard question. When I finished my training and became a music therapist back in 1992, I thought we’d be a lot further ahead than we actually are currently. But I think at the moment, at least with our team here, we have a lot of momentum. I really think research is going to be the key to our future expansion. The government wants to save money, not spend it, so we have to show we’re worth spending money on. In our discipline there’s also debate over whether we should be going for the sort of medical model, evidence-based research or developing theory and focusing on individuals’ unique responses. In my view, we need both. Hopefully at some point those two sides will come together and then we can really move ahead. When I arrived at the MCM from Queensland four and a half years ago, we had just five people in our department, and now it’s 11. The more people we have on our team the more work we can do to be better understand the role and impact music therapy can have on people’s lives.
Professor Felicity Baker will be joined on her project team by Professor Christian Gold (Norway), Professor Hanne Mette Ridder (Denmark), Dr Jeanette Tamplin and Dr Imogen Clark, both from the MCM.
Main image: Hartwig HKD/Flickr
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See also: Clearing the fog of dementia with song