Institutionen för klinisk neurovetenskap / Department of Clinical Neuroscience
Abstract
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
