Life of the Mind

Expressively Aging

Music therapy outreach to elders

by Molly Pow

Every day we are surrounded by rhythm and music. From heartbeats to ticking clocks, calling birds to the radio, our minds are subconsciously yet consistently processing music. It is said that people are either left-brained or right-brained. The “left-brained” are assumed to be logical and mathematical, whereas “right-brained” individuals are assumed to be creative and emotional. However, science has shown that people process music using both hemispheres. For instance, in the left hemisphere, the nucleus accumbens and amygdala govern emotional reactions to music; in the right hemisphere, the hippocampus controls memory for music, and the cerebellum creates unintentional movement to music such as foot tapping and dancing. A client’s family explains why music therapy, a research-based clinical profession, was incredibly effective: “Throughout the whole time of her dementia, music was the only consistent way to reach her. During the 24 hours that she was dying, we played music the entire time. Even when she appeared to be unconscious, her toes still moved to the music.”

In music therapy, music is used as a tool. Music and music interventions are never strictly used for the sake of art or enjoyment, but always used with therapeutic intent. Listening to pre-recorded music and engaging in music activities certainly have their benefits and should be celebrated. However, for the act to be truly music therapy, a board certified music therapist must be involved. Assessments, treatment planning (including goal and objective writing), implementation of specific music interventions, and qualitative and/or quantitative data are all applied to meet the non-musical needs of the client.

Nazareth College’s Konar Music Therapy Outreach Program set out to demonstrate the value of music therapy through a research-based project that included conducting music therapy sessions and educating/advocating for the service in gerontology and dementia care. The program, which began at the Rochester Presbyterian Home in February 2014, was created by Betsey King, Ph.D., LCAT, MT-BC, and Laurie Keough, M.S.Ed., LCAT, MT-BC, both music therapy faculty at Nazareth.

The Rochester Presbyterian Home is an Eden Alternative Residence. The Eden Alternative model of care focuses on integrity, innovation, community, empowerment, and passion of elders, staff, and family. Music therapy fits naturally with this philosophy and ties in many of its principles through the goals, objectives, and music interventions targeted each session. As in the Eden Alternative, music therapy target areas focus on continued growth: cognitively, psychologically, emotionally, spiritually, socially, and physically. Both aim to achieve empowerment and improving self-esteem through successful and meaningful interventions. Both encourage communication and relationship building between elders and families, and both work toward enhancing socialization and relationship building. In fact, family members have been involved in the group and individual sessions and are always encouraged to actively participate with their loved ones.

Assessments and interviews with interdisciplinary staff helped identify participants, who were chosen based on the highest cognitive, emotional, social, psychological, and/or physical needs as well as their elder’s interest and positive natural response to music. After all, while most people enjoy music, some do not, and knowing this is a crucial part of the therapeutic process. Significant needs included loss of expressive and receptive communication, decreased socialization, boredom, lack of self-esteem and empowerment, symptoms of anxiety and depression, and self, situational, and environmental disorientation. Once the elders had been selected, the three group and two individual sessions began.

Music included popular songs from the elders’ youth and music in which they expressed interest. Such music was chosen because everyone experiences stronger emotional and neurological responses to music with which they have a personal connection. Many of the songs and interventions were repeated weekly, slowly increasing in difficulty in order to maximize opportunity for growth and improvement in the skills targeted. Songs such as “By the Light of the Silvery Moon” and “Que Sera Sera” targeted cognition, reality orientation, and expressive language abilities. “Buffalo Gals” focused on self and environmental awareness, fine and gross motor movement with the use of percussion instruments, and increased socialization. “This Little Light of Mine” addressed relationship building and creative thinking. Therapists sang greeting songs at the beginning of every session to transition into the therapy space. An adaptation of “Hail, Hail, the Gang’s All Here” required the elders to orient themselves to the group, remember faces, and practice name recollection. Intervention repetition resulted in improved facial recognition and name recollection. Elders began to interact with one another more independently and began supporting each other verbally and musically.

Processing of thoughts, actions, and emotions played a large role in each therapy session. Therapists addressed the group when one elder reacted to another by smiling or laughing; they discussed similarities and differences and validated elder-to-elder interactions. By doing this, the elders became more aware of one another’s presences, but they also created memories and bonds. Verbally and musically validating expressed thoughts allowed them to be heard and understood, to feel as though their thoughts and feelings were important and accepted by the group. These moments always ended in smiles, positive interactions, and improved relationships. Interventions such as adapted conducting, songwriting, and instrumental/vocal improvisation encouraged the elders to take control and feel empowered. Music therapy has proven a valuable, clinical vehicle that improves elder self-worth and gives them opportunities to learn, relieve their boredom, acquire new accomplishments, and improve their quality of life.

Future endeavors for music therapy at the Rochester Presbyterian Home will include music therapy sessions in which to develop, grow, and maintain healthy and positive relationships between elders and staff. The program aims to enhance elders’ quality of life and employee satisfaction through participation in meaningful interventions targeting interpersonal connecting, adapted expressive and receptive communication, and elder independence. Results are hypothesized to include fewer outbursts of anger and frustration while completing daily tasks such as bathing, dressing, and meals as well as establishing stronger care staff and elder bonds.

Fundraising is underway to continue the program in 2015–16.

Molly Pow, M.S., MT-BC is supervisor in the musical therapy clinic at Nazareth.

Molly Pow music therapy session

Molly Pow, M.S., MT-BC, leads seniors in a music therapy session as part of the Konar Music Therapy Outreach Program.