Aging in Style with Lori Williams
Aging in Style with Lori Williams

Episode · 8 months ago

043. Explaining Music Therapy for Seniors With Dementia

ABOUT THIS EPISODE

Music is popular for people of all ages, even seniors. 

For those with dementia, music has the power to stimulate memories of the past and ease their troubled minds. Some may even be able to play the piano though they’ve lost the ability to speak.Dr. Nicki Cohen is an expert music therapist who began her career in 1978, when the specialty was still relatively new. She explains how music therapy is used to connect with clients with memory impairments such as dementia. 

Musical experiences help with long-term memory even for those who have trouble having conversations. Plus, it helps people connect with the individual - and helps the individual connect with themselves.

Topics discussed:
- Dementia
- Music therapy for seniors
- Managing memory impairments
- Tomatis® method
- Stimulating memory with music
- Insurance and music therapy

Takeaways from this episode:
- Even if a senior with dementia is having trouble speaking, they may still be able to sing. Song lyrics are stored differently in the brain than conversational speech.
- Long-term memory lingers longer than short-term memory and just needs different triggers to stimulate it - like music.
- The Tomatis method can be used in people with dementia to keep their brain healthier as it builds up the brain by switching between 2 different ways of transmitting sounds.
- People tend to respond better to music that is familiar and live. They connect better and feel the vibrations and emotions.
- If the person with dementia is agitated, playing softer and gentler music can bring joy.
- People with dementia regress faster if they don’t work through some unresolved, pent-up emotions. Music can help release them.
- Music therapy is not just playing music. It’s a trained profession that involves sensitivity to the individual’s unique needs.

Resources mentioned in this episode:
Nicki Cohen, PhD, MT-BC
https://musictherapyandimagery.com/https://twu.edu/music/faculty-and-staff/nicki-cohen-phd-mt-bc/
Video of Gladys Wilson and Naomi Feil:
https://www.youtube.com/watch?v=CrZXz10FcVM

To suggest a topic, be a guest or to support the podcast please email: Lori@Loriwilliams-seniorservices.com
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Welcome to aging in stall with me, Laurie Williams. I'm an optimist by nature and I believe you can followyour dreams at any age. My grandmother's journey with dementia ignited a passion inme to work with seniors. I've spent the past thirteen years learning about seniorsand aging. In my mid S, I followed my own dream and foundedmy company, where I use my expertise to help seniors locate housing and resources. On this podcast we cover all aspects of aging. Joanna's each week tomeet senior living experts and inspirational seniors who are following their dreams. The factis, we're all aging, so why not do it in style? Hey, guys, welcome back to another episode of aging in style with Laurie Williams, and today we are talking about music therapy and how that works with dementiaand with seniors in general, with aging, and we brought on an expert today. Her name is Dr Nicki Cohen and I'm just going to have hertell us all a little bit about herself and her background. So welcome Nicki. Hi, Lori, thank you for inviting me. It's really an honorto be asked to do this. I have been music therapyst since one thousandnine hundred and seventy eight, so a long time right one there weren't toomany of us around, and I just retired from teaching music therapy at TexasWoman's university a year ago and now all I have a private practice in musictherapy. I work out of a separate office, and then I also ama certified Tomadas Practitioner, and so I have begun seeing to modest clients aswell. I'm still working just as far and I'm just working doing clinical workinstead of teaching. Well, wonderful tell us for people who don't really knowmuch about music therapy, and a lot of people aren't very familiar with it. So tell us what. What exactly is music therapy? Well, musictherapy is a profession that has been formal since one thousand nine hundred and fifty. That's when it was first formed, and it is a an approach,a music centered approach, where one uses music to connect with clients. Andthere are many different types of clients that you would find, but will focuson people with memory impairments, people with dementia. So music therapist would bringin the types of musical experiences that would help facilitate memory, long memory.Oftentimes people are able to remember the words of a song because it's there storedsomewhat differently than just conversational speech, and so even if people are having troublewith speaking conversational speech, such as a Phasia, which is common, anddementia, they are able to keep the fluency going with the singing, andit's not until a person with dementia is farther along in the dementia process thatthey cannot sing anymore, quite far along music therapy. So it's used tostimulate memory. So because lots of times people will be able to remember theirchildhood or their adult years from the singing of certain songs that are familiar tothem, as opposed to being asked questions. is also used, for in thetomatas method. It's used with people with dementia to help keep the brainhealthier, because the tomadis method focuses on building up the brain and that's abilityto pay attention and focus by using two different kinds of ways to transmit soundthrough the bones in the face and also...

...through the air, and it's quitecomplicated, I found out, and studying it. But basically people listen tomusic and the music shifts between light and low pitches and louder and softer.Basically you're teaching your brain to expect the switches or to get ready for whenthe switches occur, and so the brain learns to respond in a way thatit hasn't responded before. At first there's a treatment that's used primarily through recordedmusic and hiphones. That modest is done and it seems not only with peoplewith dementia but also children on the autism spectrum really respond well to this approach. So that that's something else that I do. Getting back to music therapy, which is what you asked, I've noticed that people with dementia really enjoymovement type experiences and the movement can be quite free and it's styling it.I'm not talking about dancing, I'm talking about moving different ways to music,and they seem to really like the stimulating music, especially music of their youngadult years. MMM, and they will laugh, they'll get up and startdance, saying they'll they'll be eye contact and a change and emotion from usingmore stimulating music and allowing movement to occur. So that's you. So the wayit's like the memory of music is stored so like for me, ifI hear a song from, you know, one thousand nine hundred and seventy four, it takes me back to my childhood and it just brings back amemory. Like, you know, I can remember the house we lived in, you know, just certain things about my childhood. So that is evenwith dementia, the same thing happens, that they hear a song from whenthey were eight years old. It brings all those memories back exactly, becauselong term memory, as you know, and dementia, is stored more thanthe short term memory. We lose the short memory almost entirely, but thelong term memory is still there. It just needs different triggers to stimulate it. And Music is a wonderful trigger to stimulate memory and reminiscence. It allowspeople to reminisce about more pleasant times in their life and if they're living inthe more pleasant times, if which often happens with dementia, then you canbring in music that fits where they are, whether they're back as a mother oras a teacher or whatever. You can find a music that that willhelp them feel have a better quality of life. So when you have anew client, say someone comes to you and they want you to help theirmother and father with dementia, do you find out, like what were theirfavorite types of music? That's one of the first things. There are twofacts about music therapy that music therapists are taught and memorized, and that isthat people tend to prefer music that is preferred, that is familiar, andthey will respond better to preferred music then they will to music that's not knownto them. So, rather than trying to teach a new song to someonewith dementia, I would use the song that they know. So I wouldfind out what their musical preferences are, list of songs that they the childknows that they like, maybe a music that they listen to when they werechildren and the parents were, you know, hang it at home or making musicwith them. The second fact is that people respond better when you uselive music as opposed to recorded music.

Really, yes, much better,much better. So I would definitely create all the music live, whether it'son a keyboard or guitar or Acapella. However, it is because people cansee you making the music, they can hear you making the music. Theycan feel the vibration of the music and and there's so much more connection thatwe establish musically with people when we do it live. That's so interesting.Yes, yes, so alive and preferred music, the music therapist. That'sa motto that we use perfect so you would. So when you start comingto meet with someone, do you do like the the therapies? It likea weekly therapy or what? How does that usually look? Usually a weeklytherapy and in the case of dementia it's not the goals. Are Not goalsthat would reverse the DEMENSIA. That would be ridiculous and frustrating for everyone.It would be to meet the person where they are right now and to bringin music that would be meaningful to them right now, that they would enjoy, and not asking them to do tasks that they're not able to do.That would be frustrating. Yeah, so using songs and asking, you know, giving them the option to sting along or just to listen, or theymight be able to play an instrument along with the depending point where they arein the course of dementia, and giving them a lot of musical choices sothey're not expected to do one thing. In that way, it's very differentthan music education, where you're trying to teach music and musical skills. You'reusing music and and all of the energy and meaning that it has to connectwith the individual and help the individual connect with themselves. So it's really tojust bring some joy and happiness to their lives. And I'm wondering, doesit sometimes calm people who may be a little agitated with demented yes, itworks very well. Is it just actor? Music is a distractor and it's alsohelps relax people. So if I work and have what with people whowith dementia, who could have gotten agitated, for example, which is quite common, I would change the music and make it more suiting, probably putit in a triple meter and sing music that they know but that's softer andmore gentle to help just naturally relax them. Yeah, and then would you bringin the you mention the Tom Tomato's method. Is that how you pronouncethat the tomatoes? You do did great to Madis. I would use thatfor people, I think, especially in the earlier stages of dementia, alsopeople who have brain injury of one sort or another, to help them usethe full capacity of the brain. That they do have, by helping themtrain the muscles and, of course, the brain itself, which doesn't haveany muscles, to expect what is going to happen, to anticipate what isgoing to happen and to respond to it. And that's why tomatoes is so wonderful, because you don't know when the music is going to change, andso you build. As we know, tasks tend to be learned better ifthey're taught not on a regular basis, but you don't know when you're goingto be asked to do the ask. It tends to be grounded in betterthan the other way around. So I crossed paths recently with a gentleman whoshares my passion for seniors. His name is Jimmy Zolo and he shared withme that after both of his grandparents had moved into a senior care community,his family's world was just turned upside down...

...as they became caregivers overnight. Asyou know, being a caregiver to someone close to you is often overwhelming andthere's just so much for you to manage, even with the support of living ina senior care community, like making sure your loved one is all theproducts they need and keeping them stocked when stuff runs out. Well, Jimmyhad that problem too, and he was scrolling through all of these product reviewsacross the Internet and, like most of us in the sandwich generation, wedon't have enough hours in the day, so it can end up being waytoo time consuming and frustrating. He wish there's a simpler way to shop forhis grandparents. And then, of course, the pandemic head which prevented visitation tothe communities, making this process even more difficult. So Jimmy decide tolaunch his own business to solve this problem. He found it Joe and Bella,to make shopping for older adults simple. They carry everything from comfy clothes tocreative gifts. They even have toilet trees that can be automatically reordered intech that makes caregiving easier. And what I love, and I know y'allwould love this too, is that each and every product on Joe and Bellahas been carefully selected by caregiving experts. Jimmy is giving us an exclusive offeredfor the listeners of this podcast. You can use Promo Code style to receiveten percent off your first purchase at Joe and Bellacom that's code style style forten percent off at Joe and Bellacom. So if someone wanted to to havemusic therapists come to their loved one, is it something that's covered by Medicareor insurance or is it a private pay sort of thing? At this point, some insurance companies will cover music therapy, especially if the music therapy is partof what the facility offers and can can fit under some of the servicesthat the facility already offers. Lots of times music therapists won't be covered byinsurance and Medicare we've not had a lot of luck with. Yeah, partbe hospitalization, a little bit, a little bit, but I under themental health area as opposed to GEROPSYIC or memory care. Yeah, so musictherapists do best if they just try these private insurance companies and see how theyrespond. Some of them will surprise you. They will pay for it and someof them won't. But parents or different of people with memory loss oftenwill pay to have someone come in and work with their parent because it bringssome such which joy and meaning, and it's one of the other areas thatwe haven't discussed yet, is our emotions, that it allows someone to express themselveswhen they might not be able to do so in text. But theycan express themselves either through playing of an instrument or through singing, and itmight be expression that's sad and might be in expression that is lonely or feelingabandoned, but very important to get out. So music therapists will allow that andwill support if someone is improvising musically, they will support that and kind ofback them up so that they can they have somebody, they are withthem. Awful. So how does that actually work? Bringing out their emotions? So you said if they they could improvise. So if they're singing orplaying an instrument, is that what you mean? Sometimes? I mean weall need to express our emotions. We all have a need to get themout and oftentimes in dementia those emotions are stored up from a lifetime, especiallythose areas that have not been resolved for the individual. And so if theindividual is not allowed or given the opportunity...

...to work through some of those emotions, not the rational part of it, because I can understand it, butthe actual expression of the emotions, that's going to cause them to regress faster. And I'm quoting now Naomi file and all of her wonderful work and validationtherapy. But she talks about you got to give them the opportunity to resolvethe issues they hadn't resolved before, or they're going to continue to regrets.And so in music therapy, if I see someone, for example, startto cry due to the music, I will continue, not in a cruelway but in a very soft, gentle way, to allow them to feelwhat it is that they're that they're feeling, and and then I might ask somequestions that are easy for them to answer, questions where I provide acertain number of answers and they can pick from the answers I've given them,such as members of their family or relationship when they were younger or something likethat, and then allow them to get that emotion right and to talk aboutit in a way where they're not really capable of rationalizing about it, butthey can identify the people and they can't feel. As a matter of fact, as an I oni file says, they think through feeling. So likeif the one started crying when you're playing the song, you might, youknow, say to them, would you say like, is this this makeyou think of your mother or is like something like that? Is that thekind of question you would ask? First of all, I would make surethat it's okay with them that I keep singing okay song, you know.So I'm not cruel, yeah, and punishing them in any way. Butlots of times people just need to cry and it's interesting that others will startto cry as well when one person is sort of allowed that expression. Andif it's okay, I'm very gentle with it. You know, I rememberonce a student put on unforgettable, the NEAT king call and Adeline thinkle right. Well, everyone in the room got up and walked out. These wereall people with memory loss and they all got up and started to cry andwalked out. Okay, so that was way too strong, but yeah,and I'm in settle. Yeah, you know, when we do it liveyou can establish the eye contact, you can sing it very stoutly, youcan slow it down, you can put the person's name in there, youcan do all kinds of things to make it more intimate for them. HMM, yeah, I definitely see that. What you mean that you can doingit. I've would make a lot more sense, would connect more with them. Absolutely right. You can modify it so much more. You could justplay it and not saying it. You could just, you know, playas a melody and there's all kinds of things you do to minimize the impactof it but still allows them to feel a little bit hmm. So youjust gage how they're reacting to how you continue on with the music exactly.It's so it's by the moment. It's by the moment. It's what theyneed and therapist intuition in regards to how to provide that music that will helpthem with what they need at that moment. That's wonderful. That's so interesting.I love what you do. That's so great and music therapy is great. It's a wonderful profession. Absolutely our music therapist work in memory care.Do they have any that are work in a memory care like for the memorycare or they just come in as as a service or an add on typeof thing for therapy? Some music therapists...

...are hired as activity directors and theydo is a therapy is part of the total services that are offered. Somecome in just to work on certain aspects of memory care. It depends onthe facility and what they want, but obviously the people with memory care areoff in memory care facilities are usually the most miserable. MMM, and andand. So you want to give them something that's going to help their qualityof life and any you can, music therapy does, and there's a lotof research that's been done on music with people with dementia and how well itworks for them when other approaches may not get to them. Hmm, cansee that and I think it's so interesting. I'll see. You know, sometimes, I think we've all seen things on facebook or whatever where they'll showsomeone just start playing the piano. They maybe you know they have dementia andthey are playing the piano like I mean they played when they were twenty five. So that memory is just stored, like you said, it's stored differentlyso that they can retrieve it and still play the piano or whatever instrument rightin the Cerebellum, yeah, and right it are in the motor Cortex,and so their muscles remember how to make that song and and a lot ofpeople can remember their their muscles know where to go. They can sit downat the piano and play even if they're having trouble keeping a conversation. Buteventually that skill does go. Yeah, with regression that ability does go,but as long as it's there, whether it's a violin or Ukulele or aBanjo or a guitar or whatever it is, the music therapist should incorp created intothe setting, you know, because it gives them an identity. Yeah, that and a way to express HMM. Absolutely. So you can do music, music therapy all the way through with Demento. Once they're towards thevery like in stage of dementia into their journey, are you still able todo some music therapy just maybe to give them some comfort or how does thatusually look? Yes, well, music therapist work in hospice care and alot of times people in the later stages of dementia will receive music therapy servicesin hospice care, and one is just to connect with them in any wayyou can, getting up close, maybe touching the arm, the person's arm, or putting your face so they can see your face, give them acost to want to open their eyes, especially if you've got music going.They may open their eyes much more with the music playing them if they're justthere on the vegetative state. And there was a beautiful, beautiful video onYoutube of Naomi file with a woman who's in what's called the repetitive motion stageof dementia, where's people will make one motion over and over and over againand it's the repetition of that motion which allows them to express themselves. Sometimesthey scream or yeall, which is quite distracting for other people. Sometimes theyrock, whatever it is. And she was with a woman named Mrs Wilsonand she showed all of these beautiful skills as far as putting her face rightnear Missus Wilson's face, beautiful eye contact, touch everything. I won't give itaway. Everyone should take a look at that, as on Youtube mayonly file Feil and at the end you are going to cry and guarantee it, you're going to cry because of what she gets out of Miss Wilson andhow meaningful it is from Mrs Willson. Okay, that's in the later stayof dementia. Also, I had a...

...student, a student who works hospiceand she keeps me up on the latest things. Her thesis project was touse sensory stimulation and music to see if she could get responses from people inmore vegetative states, and she did, with a hundred percent, a hundredpercent of the people in vegetative states, when she added all factory stimulation,robbing, you know, doing something with the scan. She would have atheme, like date night. That was one of earth themes. I rememberbecause she made these little wonderful little panoramas for each one of them. Andshe would have coffee, the coffee beans. So but the US, and youknow, you might go out for to the Coffee House, to coffeeshop and in the person could smell freshly roasted coffee. She would make surethat they didn't spill it, that it wasn't in that kind of the situation. They had a top on it and blah, Blah Blah, but theysmelled it. And then she would talk about a kind of fabric they wouldwear. The women, you know, they went out on a date andshe would past the fabric around so they would feel it and look at it, which often times brought about a lot of response, laughing, smiling,you know, for about some memory thing, lots of memories. She would doa number of song titles or famous sayings, our Song Lyrics that haveto do with dating, like when you wore a tulip, a sweet yellowTulip, and I wore a big red rose. Now it's primarily the lyricsfrom a song in the s that people are responding to, because that's whenthey were young and in their twenties and late teens. And so she wouldmaybe leave one word out and I wore a big red and oftentimes some peoplewill be able to fill it in because it's automatically stored. Those song lyricsare stored in a different part of the brain than conversational speech. And thenshe will sing or you know, do music involves those, those kind oflyrics. So she had a number of different scenes. That was one ofthem. Date night. I'll never forget how wonderful that was and the responsehe it, response as she got were just amazing. So that's very clever. I think that's that's amazing. Well, I love the story you told alsoabout these the DAYOMI file. Was that it? And Mrs Wilson,Yes, yes, I'm going to look it up and I'll post it onmy facebook because I want everyone I'm going to go watch it. Yeah,and I'm sure cry make sure you have some clean act. I will forsure. I can't wait to see it. Well, I so appreciate you.There was one more thing I wanted to say. Okay, everybody,you have to be trained to do music therapy. Anyone can do music andwe all love music and we don't own music. Nobody owns music, butto do music therapy you have to be trained, and people who put headphoneson the ears of persons with dementia are not doing music therapy. They maydo something that makes the people happy because they may be listening to songs thatthey recognize, but it's not music therapy. It's not like how I've been describingyeah, it's not live, it's nice and interactive like that right.So just wanted to clarify that. Good. I'm glad you did, because Iknow a lot of people, and myself included, probably we thought thatinitially. You know that it's just headphones and wasn't, you know, livemusic, like you said. So that's why I'm so glad you were ontoday. Excellent, and I wanted to say one more thing to your listeners. Sure, my father had also hoomerus and so I know what it's like. You know, I went through it,...

...the whole thing all those years,and I never saw anything better than music for him, because he wasable. He was scat singing the whole time. He just always loved todo that and it just became more and more as he couldn't talk anymore anyway. So I do know what it's like. You've had the personal experience, soyou understand. I sure have. Yes, well, thank you somuch for being on and will have your contact information as well after the podcastso that people can reach out to you if they want to learn more aboutmusical therapy or the tamatas method. And so thank you so much for comingon the show and, as always, I thank everyone for listening in andinformation is on my website, which is Lari Williams senior Servicescom and if youhave questions want to know more about music therapy, will definitely connect you withDr Cohen. So thank you so much. But by.

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