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

Episode · 1 year ago

043. Explaining Music Therapy for Seniors With Dementia


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
Video of Gladys Wilson and Naomi Feil:

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Welcome to aging in stall with me, Laurie Williams. I'm an optimist by nature and I believe you can follow your dreams at any age. My grandmother's journey with dementia ignited a passion in me to work with seniors. I've spent the past thirteen years learning about seniors and aging. In my mid S, I followed my own dream and founded my 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 to meet senior living experts and inspirational seniors who are following their dreams. The fact is, 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 dementia and 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 her tell us all a little bit about herself and her background. So welcome Nicki. Hi, Lori, thank you for inviting me. It's really an honor to be asked to do this. I have been music therapyst since one thousand nine hundred and seventy eight, so a long time right one there weren't too many of us around, and I just retired from teaching music therapy at Texas Woman's university a year ago and now all I have a private practice in music therapy. I work out of a separate office, and then I also am a certified Tomadas Practitioner, and so I have begun seeing to modest clients as well. I'm still working just as far and I'm just working doing clinical work instead of teaching. Well, wonderful tell us for people who don't really know much about music therapy, and a lot of people aren't very familiar with it. So tell us what. What exactly is music therapy? Well, music therapy 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. And there are many different types of clients that you would find, but will focus on people with memory impairments, people with dementia. So music therapist would bring in 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 stored somewhat differently than just conversational speech, and so even if people are having trouble with speaking conversational speech, such as a Phasia, which is common, and dementia, they are able to keep the fluency going with the singing, and it's not until a person with dementia is farther along in the dementia process that they cannot sing anymore, quite far along music therapy. So it's used to stimulate memory. So because lots of times people will be able to remember their childhood or their adult years from the singing of certain songs that are familiar to them, as opposed to being asked questions. is also used, for in the tomatas method. It's used with people with dementia to help keep the brain healthier, because the tomadis method focuses on building up the brain and that's ability to pay attention and focus by using two different kinds of ways to transmit sound through the bones in the face and also...

...through the air, and it's quite complicated, I found out, and studying it. But basically people listen to music 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 when the switches occur, and so the brain learns to respond in a way that it hasn't responded before. At first there's a treatment that's used primarily through recorded music and hiphones. That modest is done and it seems not only with people with 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 enjoy movement 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 young adult years. MMM, and they will laugh, they'll get up and start dance, saying they'll they'll be eye contact and a change and emotion from using more stimulating music and allowing movement to occur. So that's you. So the way it's like the memory of music is stored so like for me, if I 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 a memory. Like, you know, I can remember the house we lived in, you know, just certain things about my childhood. So that is even with dementia, the same thing happens, that they hear a song from when they were eight years old. It brings all those memories back exactly, because long term memory, as you know, and dementia, is stored more than the short term memory. We lose the short memory almost entirely, but the long 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 allows people to reminisce about more pleasant times in their life and if they're living in the more pleasant times, if which often happens with dementia, then you can bring in music that fits where they are, whether they're back as a mother or as a teacher or whatever. You can find a music that that will help them feel have a better quality of life. So when you have a new client, say someone comes to you and they want you to help their mother and father with dementia, do you find out, like what were their favorite types of music? That's one of the first things. There are two facts about music therapy that music therapists are taught and memorized, and that is that people tend to prefer music that is preferred, that is familiar, and they will respond better to preferred music then they will to music that's not known to them. So, rather than trying to teach a new song to someone with dementia, I would use the song that they know. So I would find out what their musical preferences are, list of songs that they the child knows that they like, maybe a music that they listen to when they were children and the parents were, you know, hang it at home or making music with them. The second fact is that people respond better when you use live music as opposed to recorded music.

Really, yes, much better, much better. So I would definitely create all the music live, whether it's on a keyboard or guitar or Acapella. However, it is because people can see you making the music, they can hear you making the music. They can feel the vibration of the music and and there's so much more connection that we establish musically with people when we do it live. That's so interesting. Yes, yes, so alive and preferred music, the music therapist. That's a motto that we use perfect so you would. So when you start coming to meet with someone, do you do like the the therapies? It like a weekly therapy or what? How does that usually look? Usually a weekly therapy and in the case of dementia it's not the goals. Are Not goals that 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 bring in 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 they might be able to play an instrument along with the depending point where they are in the course of dementia, and giving them a lot of musical choices so they're not expected to do one thing. In that way, it's very different than music education, where you're trying to teach music and musical skills. You're using music and and all of the energy and meaning that it has to connect with the individual and help the individual connect with themselves. So it's really to just bring some joy and happiness to their lives. And I'm wondering, does it sometimes calm people who may be a little agitated with demented yes, it works very well. Is it just actor? Music is a distractor and it's also helps relax people. So if I work and have what with people who with dementia, who could have gotten agitated, for example, which is quite common, I would change the music and make it more suiting, probably put it in a triple meter and sing music that they know but that's softer and more gentle to help just naturally relax them. Yeah, and then would you bring in the you mention the Tom Tomato's method. Is that how you pronounce that the tomatoes? You do did great to Madis. I would use that for people, I think, especially in the earlier stages of dementia, also people who have brain injury of one sort or another, to help them use the full capacity of the brain. That they do have, by helping them train the muscles and, of course, the brain itself, which doesn't have any muscles, to expect what is going to happen, to anticipate what is going 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, and so you build. As we know, tasks tend to be learned better if they're taught not on a regular basis, but you don't know when you're going to be asked to do the ask. It tends to be grounded in better than the other way around. So I crossed paths recently with a gentleman who shares my passion for seniors. His name is Jimmy Zolo and he shared with me that after both of his grandparents had moved into a senior care community, his family's world was just turned upside down... they became caregivers overnight. As you know, being a caregiver to someone close to you is often overwhelming and there's just so much for you to manage, even with the support of living in a senior care community, like making sure your loved one is all the products they need and keeping them stocked when stuff runs out. Well, Jimmy had that problem too, and he was scrolling through all of these product reviews across the Internet and, like most of us in the sandwich generation, we don't have enough hours in the day, so it can end up being way too time consuming and frustrating. He wish there's a simpler way to shop for his grandparents. And then, of course, the pandemic head which prevented visitation to the communities, making this process even more difficult. So Jimmy decide to launch 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 to creative gifts. They even have toilet trees that can be automatically reordered in tech that makes caregiving easier. And what I love, and I know y'all would love this too, is that each and every product on Joe and Bella has been carefully selected by caregiving experts. Jimmy is giving us an exclusive offered for the listeners of this podcast. You can use Promo Code style to receive ten percent off your first purchase at Joe and Bellacom that's code style style for ten percent off at Joe and Bellacom. So if someone wanted to to have music therapists come to their loved one, is it something that's covered by Medicare or 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 part of what the facility offers and can can fit under some of the services that the facility already offers. Lots of times music therapists won't be covered by insurance and Medicare we've not had a lot of luck with. Yeah, part be hospitalization, a little bit, a little bit, but I under the mental health area as opposed to GEROPSYIC or memory care. Yeah, so music therapists do best if they just try these private insurance companies and see how they respond. Some of them will surprise you. They will pay for it and some of them won't. But parents or different of people with memory loss often will pay to have someone come in and work with their parent because it brings some such which joy and meaning, and it's one of the other areas that we haven't discussed yet, is our emotions, that it allows someone to express themselves when they might not be able to do so in text. But they can express themselves either through playing of an instrument or through singing, and it might be expression that's sad and might be in expression that is lonely or feeling abandoned, but very important to get out. So music therapists will allow that and will support if someone is improvising musically, they will support that and kind of back them up so that they can they have somebody, they are with them. Awful. So how does that actually work? Bringing out their emotions? So you said if they they could improvise. So if they're singing or playing an instrument, is that what you mean? Sometimes? I mean we all need to express our emotions. We all have a need to get them out and oftentimes in dementia those emotions are stored up from a lifetime, especially those areas that have not been resolved for the individual. And so if the individual is not allowed or given the opportunity... work through some of those emotions, not the rational part of it, because I can understand it, but the 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 validation therapy. But she talks about you got to give them the opportunity to resolve the 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, start to cry due to the music, I will continue, not in a cruel way but in a very soft, gentle way, to allow them to feel what it is that they're that they're feeling, and and then I might ask some questions that are easy for them to answer, questions where I provide a certain 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 like that, and then allow them to get that emotion right and to talk about it in a way where they're not really capable of rationalizing about it, but they 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 like if the one started crying when you're playing the song, you might, you know, say to them, would you say like, is this this make you think of your mother or is like something like that? Is that the kind of question you would ask? First of all, I would make sure that 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. But lots of times people just need to cry and it's interesting that others will start to cry as well when one person is sort of allowed that expression. And if it's okay, I'm very gentle with it. You know, I remember once a student put on unforgettable, the NEAT king call and Adeline thinkle right. Well, everyone in the room got up and walked out. These were all people with memory loss and they all got up and started to cry and walked out. Okay, so that was way too strong, but yeah, and I'm in settle. Yeah, you know, when we do it live you can establish the eye contact, you can sing it very stoutly, you can slow it down, you can put the person's name in there, you can do all kinds of things to make it more intimate for them. HMM, yeah, I definitely see that. What you mean that you can doing it. I've would make a lot more sense, would connect more with them. Absolutely right. You can modify it so much more. You could just play it and not saying it. You could just, you know, play as a melody and there's all kinds of things you do to minimize the impact of it but still allows them to feel a little bit hmm. So you just 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 they need and therapist intuition in regards to how to provide that music that will help them 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 memory care or they just come in as as a service or an add on type of thing for therapy? Some music therapists...

...are hired as activity directors and they do is a therapy is part of the total services that are offered. Some come in just to work on certain aspects of memory care. It depends on the facility and what they want, but obviously the people with memory care are off in memory care facilities are usually the most miserable. MMM, and and and. So you want to give them something that's going to help their quality of life and any you can, music therapy does, and there's a lot of research that's been done on music with people with dementia and how well it works for them when other approaches may not get to them. Hmm, can see 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 show someone just start playing the piano. They maybe you know they have dementia and they 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 differently so that they can retrieve it and still play the piano or whatever instrument right in 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 of people can remember their their muscles know where to go. They can sit down at the piano and play even if they're having trouble keeping a conversation. But eventually 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 a Banjo or a guitar or whatever it is, the music therapist should incorp created into the 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 the very like in stage of dementia into their journey, are you still able to do some music therapy just maybe to give them some comfort or how does that usually look? Yes, well, music therapist work in hospice care and a lot of times people in the later stages of dementia will receive music therapy services in hospice care, and one is just to connect with them in any way you can, getting up close, maybe touching the arm, the person's arm, or putting your face so they can see your face, give them a cost 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 just there on the vegetative state. And there was a beautiful, beautiful video on Youtube of Naomi file with a woman who's in what's called the repetitive motion stage of dementia, where's people will make one motion over and over and over again and it's the repetition of that motion which allows them to express themselves. Sometimes they scream or yeall, which is quite distracting for other people. Sometimes they rock, whatever it is. And she was with a woman named Mrs Wilson and she showed all of these beautiful skills as far as putting her face right near Missus Wilson's face, beautiful eye contact, touch everything. I won't give it away. Everyone should take a look at that, as on Youtube may only 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 and how meaningful it is from Mrs Willson. Okay, that's in the later stay of dementia. Also, I had a...

...student, a student who works hospice and she keeps me up on the latest things. Her thesis project was to use sensory stimulation and music to see if she could get responses from people in more vegetative states, and she did, with a hundred percent, a hundred percent of the people in vegetative states, when she added all factory stimulation, robbing, you know, doing something with the scan. She would have a theme, like date night. That was one of earth themes. I remember because she made these little wonderful little panoramas for each one of them. And she would have coffee, the coffee beans. So but the US, and you know, you might go out for to the Coffee House, to coffee shop and in the person could smell freshly roasted coffee. She would make sure that 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 they smelled it. And then she would talk about a kind of fabric they would wear. The women, you know, they went out on a date and she 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 do a number of song titles or famous sayings, our Song Lyrics that have to do with dating, like when you wore a tulip, a sweet yellow Tulip, and I wore a big red rose. Now it's primarily the lyrics from a song in the s that people are responding to, because that's when they were young and in their twenties and late teens. And so she would maybe leave one word out and I wore a big red and oftentimes some people will be able to fill it in because it's automatically stored. Those song lyrics are stored in a different part of the brain than conversational speech. And then she will sing or you know, do music involves those, those kind of lyrics. So she had a number of different scenes. That was one of them. Date night. I'll never forget how wonderful that was and the response he 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 also about these the DAYOMI file. Was that it? And Mrs Wilson, Yes, yes, I'm going to look it up and I'll post it on my 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 for sure. 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 and we all love music and we don't own music. Nobody owns music, but to do music therapy you have to be trained, and people who put headphones on the ears of persons with dementia are not doing music therapy. They may do something that makes the people happy because they may be listening to songs that they recognize, but it's not music therapy. It's not like how I've been describing yeah, 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 I know a lot of people, and myself included, probably we thought that initially. You know that it's just headphones and wasn't, you know, live music, like you said. So that's why I'm so glad you were on today. 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 was able. He was scat singing the whole time. He just always loved to do 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, so you understand. I sure have. Yes, well, thank you so much for being on and will have your contact information as well after the podcast so that people can reach out to you if they want to learn more about musical therapy or the tamatas method. And so thank you so much for coming on the show and, as always, I thank everyone for listening in and information is on my website, which is Lari Williams senior Servicescom and if you have questions want to know more about music therapy, will definitely connect you with Dr Cohen. So thank you so much. But by.

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