Reactions of Persons with Dementia to Caregivers Singing in Morning Care Situations

’Music therapeutic caregiving’, when caregivers sing for or together with persons with severe dementia during care situations, has been suggested as a way to reduce problematic behaviors in dementia care. The present study implemented this technique as an intervention in dementia care. Six caregivers participated in group interviews about their experiences of morning care situations without and with’Music therapeutic caregiving’. Through a qualitative content analysis two themes emerged.’Being in a different reality’ was based on’usual’ morning care situations. The caregivers’ experienced the persons with dementia as absent-minded; communication and cooperation were difficult. The second theme,’Being present’, was based on morning care situations with the intervention. The caregivers described communication as enhanced; the persons with dementia expressed themselves more appropriately, making cooperation possible. The results indicate that’Music therapeutic caregiving’ might lead to a more positive experience of the person with dementia and seems to increase receptivity to caregiving

Improving mental health and reducing antipsychotic use in people with dementia in care homes: the WHELD research programme including two RCTs

BackgroundThe effective management of agitation and other neuropsychiatric and behavioural symptoms in people with dementia is a major challenge, particularly in care home settings, where dementia severity is higher and there is limited training and support for care staff. There is evidence for the value of staff training and the use of psychosocial approaches; however, no intervention currently exists that combines these elements into an intervention that is fit for purpose and effective in these settings based on evidence from a randomised controlled trial.ObjectiveThe objective was to develop and evaluate a complex intervention to improve well-being, reduce antipsychotic use and improve quality of life in people with dementia in care homes through person-centred care, management of agitation and non-drug approaches.DesignThis was a 5-year programme that consisted of six work packages. Work package 1 consisted of two systematic reviews of personalised psychosocial interventions for behavioural and psychological symptoms for people with dementia in care homes. Work package 2 consisted of a metasynthesis of studies examining implementation of psychosocial interventions, in addition to developing a draft Well-being and Health for people with Dementia (WHELD) programme. Work package 3 consisted of a factorial study of elements of the draft WHELD programme in 16 care homes. Work package 4 involved optimisation of the WHELD programme based on work package 3 data. Work package 5 involved a multicentre randomised controlled trial in 69 care homes, which evaluated the impact of the optimised WHELD programme on quality of life, agitation and overall neuropsychiatric symptoms in people with dementia. Work package 6 focused on dissemination of the programme.SettingThis programme was carried out in care homes in the UK.ParticipantsParticipants of this programme were people with dementia living in care homes, and the health and care professionals providing treatment and care in these settings.ResultsWork package 1: reviews identified randomised controlled trials and qualitative evidence supporting the use of psychosocial approaches to manage behavioural symptoms, but highlighted a concerning lack of evidence-based training manuals in current use. Work package 2: the meta-analysis identified key issues in promoting the use of interventions in care homes. The WHELD programme was developed through adaptation of published approaches. Work package 3: the factorial trial showed that antipsychotic review alone significantly reduced antipsychotic use by 50% (odds ratio 0.17, 95% confidence interval 0.05 to 0.60). Antipsychotic review plus social interaction significantly reduced mortality (odds ratio 0.36, 95% confidence interval 0.23 to 0.57), but this group showed significantly worse outcomes in behavioural and psychological symptoms of dementia than the group receiving neither antipsychotic review nor social interaction (mean difference 7.37 symptoms, 95% confidence interval 1.53 to 13.22 symptoms). This detrimental impact was reduced when combined with social interaction (mean difference –0.44 points, 95% confidence interval –4.39 to 3.52 points), but with no significant benefits for agitation. The exercise intervention significantly improved neuropsychiatric symptoms (mean difference –3.58 symptoms, 95% confidence interval –7.08 to –0.09 symptoms) but not depression (mean difference –1.21 points, 95% confidence interval –4.35 to 1.93 points). Qualitative work with care staff provided additional insights into the acceptability and feasibility of the intervention. Work package 4: optimisation of the WHELD programme led to a final version that combined person-centred care training with social interaction and pleasant activities. The intervention was adapted for delivery through a ‘champion’ model. Work package 5: a large-scale, multicentre randomised controlled trial in 69 care homes showed significant benefit to quality of life, agitation and overall neuropsychiatric symptoms, at reduced overall cost compared with treatment as usual. The intervention conferred a statistically significant improvement in quality of life (Dementia Quality of Life Scale – Proxy z-score of 2.82, mean difference 2.54, standard error of measurement 0.88, 95% confidence interval 0.81 to 4.28, Cohen’s d effect size of 0.24; p = 0.0042). There were also statistically significant benefits in agitation (Cohen-Mansfield Agitation Inventory z-score of 2.68, mean difference –4.27, standard error of measurement 1.59, 95% confidence interval –7.39 to –1.15, Cohen’s d effect size of 0.23; p = 0.0076) and overall neuropsychiatric symptoms (Neuropsychiatric Inventory – Nursing Home version z-score of 3.52, mean difference –4.55, standard error of measurement 1.28, 95% confidence interval –7.07 to –2.02, Cohen’s d of 0.30; p

Acquired and congenital disorders of sung performance: A review.

Many believe that the majority of people are unable to carry a tune. Yet, this widespread idea underestimates the singing abilities of the layman. Most occasional singers can sing in tune and in time, provided that they perform at a slow tempo. Here we characterize proficient singing in the general population and identify its neuronal underpinnings by reviewing behavioral and neuroimaging studies. In addition, poor singing resulting from a brain injury or neurogenetic disorder (i.e., tone deafness or congenital amusia) is examined. Different lines of evidence converge in indicating that poor singing is not a monolithic deficit. A variety of poor-singing "phenotypes" are described, with or without concurrent perceptual deficits. In addition, particular attention is paid to the dissociations between specific abilities in poor singers (e.g., production of absolute vs. relative pitch, pitch vs. time accuracy). Such diversity of impairments in poor singers can be traced to different faulty mechanisms within the vocal sensorimotor loop, such as pitch perception and sensorimotor integration

Singing, background music and music-events in the communication between persons with dementia and their caregivers

The overall aim of this thesis is to illuminate the impact of singing and music on persons with dementia and their caregivers, and to describe a concept based on caregiver singing. The aim of Study I was to illuminate the importance of music events and the reactions and social interactions of patients with dementia or suspected dementia and their caregivers before, during and after such events, including the reminder of the day. The ethnographic method was used. Patients displayed the ability to sing, play instruments, perform bodily movements and make jokes during the music events. While singing familiar songs, some patients recalled distant memories, which they seemed to find pleasurable. During and after the music events, the personnel experienced a bonding with the patients, who seemed easier to care for. In Study II, the aim was to examine the employment of active music‑making by caregivers during the course of their actual caregiving activities, focusing on verbal communication. The phenomenological-hermeneutic method was used. In the absence of music, patients communicated with cognitive and behavioral symptoms associated with dementia. During caregiving activities, the caregivers devoted their verbal communication to narrating and explaining the activities to the patients. However, the patients and the caregivers had difficulties understanding one another. When background music was playing, caregivers reduced their verbal instructions and narrating, while the patients communicated with an enhanced understanding of the situation, both verbally and behaviorally. When caregivers sang to the patients, a paradoxical influence was observed. Despite an evident reduction in the amount of verbal narration and description by the caregivers, the patients tacitly understood what was going on. In Study III, the aim was to illuminate the movement and sensory awareness characteristics of persons with dementia and their caregivers during usual morning care sessions, morning care sessions with background music playing, and morning care sessions in which caregivers sang to and/or with patients. Qualitative content analysis was used. It revealed that during the usual morning care session, patients exhibited slumped posture, sluggish and asymmetric motion, listlessness, minimal awareness of both their egocentric and physical environment, and a poor ability to perform activities necessary for personal care to completion. Both background music playing and caregiver singing had a strong influence on body and sensory awareness. Particularly during caregiver singing, patients displayed straight posture, strong and symmetric movements, and greatly increased sensory awareness of themselves and their environment. In Study IV, the aim was to illuminate vocally expressed emotions and moods between caregivers and persons with severe dementia when caring for patients during usual morning care sessions, morning care sessions with background music playing, and morning care sessions in which caregivers sang to or with the patients. Qualitative content analysis was conducted. Emotions/moods and vitality were interwoven. It sounded as if the patients regained vitality when listening to music and caregiver singing. In one group, positive emotions were dominant from the start and were enhanced when listening to background music and singing. Between one caregiver and patient, negative emotions and moods were dominant from the start and intensified during music listening and caregiver singing. Study V is a description of an active way of singing by caregivers, and patients are invited to sing along, but they can also respond in a receptive way and just listen to the singing. Conclusions: Listening to background music and particularly caregiver singing had a positive influence on the patients and caregivers

The Use of Music and Music Therapy in Ameliorating Depression Symptoms and Improving Well-Being in Nursing Home Residents With Dementia

Background: Studies have shown music therapy can improve depression symptoms in dementia and the use of music activities show promise to have positive impacts on wellbeing. However, few studies show the influence of a music intervention led by certified nursing assistants (CNAs) trained by music therapists to address depression symptoms and wellbeing in individuals with dementia.Methods: Credentialed music therapists (1) administered 2-weeks of music therapy, (2) a 3-days training to CNAs, (3) followed by 2-weeks of music activities, singing and music-with-movement, led by CNAs for 62 nursing home residents with moderate dementia, (4) then measured depression symptoms using the Cornell Scale for Depression. We obtained video consent for 26 of the 62 residents who were video recorded receiving CNA-led music-based caregiving activities. Using the Music in Dementia Scale, over 200 h of video data was observed and raters measured changes in well-being, e.g., levels of enjoyment, mood and engagement in the residents, during the CNA facilitated music activities.Results: A repeated measures ANOVA revealed that mean depression scores differed statistically significantly between time points, p ≤ 0.001. Residents' baseline depression symptoms significantly declined following 2 weeks of music therapy, p ≤ 0.001, increased during a 2-weeks wash-out period, p = 0.389, but appeared to stabilize following the 2-weeks music activity, p = 1.00. A video analysis and paired sampled t-test demonstrated a significant improvement in wellbeing in residents who engaged in music with movement, p = 0.003. Wellbeing improved slightly, but not significantly for residents who participated in the singing intervention, p = 0.165.Conclusion: Findings suggest that music therapy can significantly decrease depression symptoms in nursing home residents with dementia. Music activities designed by music therapists and facilitated by CNAs may help sustain the reduction of depression symptoms and improve wellbeing in nursing home residents with moderate to severe dementia

Vårdarsång - En kommunikationsmetod med fokus att främja komplexa omvårdnadssituationer i vård av personer med demenssjukdom

This article is a review of studies with Music Therapeutic Caregiving (also known as Caregiver singing) in the care of persons with dementia. The term Music Therapeutic Caregiving, in Swedish, Vårdarsång, was developed in 2001 with the definition ”when caregivers sing for or together with persons with dementia during care”. Persons with dementia have difficulties in communicating, which commonly results in resistive behaviors or verbal or physical aggressiveness in interaction with others. These behaviors mainly occur during care situations that threaten integrity for example in various bathroom situations. Research of Music Therapeutic Caregiving has in research shown to solve these situations, as it becomes a way to communicate and thus a way for the person and caregivers to encounter and cooperate.Denna artikel sammanställer genomförda studier om Vårdarsång inom demensvård. Begreppet Music Therapeutic Caregiving, på svenska Vårdarsång, myntades år 2001 med definitionen ”när vårdare sjunger för eller tillsammans med personer med demenssjukdom under omvårdnad”. Som en del av sjukdomen har personer med demenssjukdom svårigheter att kommunicera. Detta resulterar ofta i beteenden som motsträvighet och verbal och fysisk aggressivitet i interaktion med andra. Dessa reaktioner är vanliga under vardagliga integritetshotande omvårdnadssituationer, såsom hjälp med kroppshygien och toalettbesök. Forskningresultat med Vårdarsång har visat sig kunna underlätta dessa situationer, då vårdarens sång för eller tillsammans med den demenssjuka ger förbättrad möjlighet till kommunikation, samarbete och genomförande av omvårdnadshandlingar