By Rose Hoban
A bright winter’s afternoon at Charles House in Carrboro finds a group of several dozen seniors and young people sitting in a circle singing Christmas carols.
Musician Erich Leith played “Silent Night,” “The First Noel” and several other songs, while the group – young and old – all sang along, some from memory, some reading from the song sheets passed out before each tune.
But when Leith started playing “Jingle Bell Rock” on the piano, the room really began to move. At least a half-dozen intergenerational couples took to the floor to cut the rug.
What makes the scene striking is that some of the older folks singing are people who usually don’t speak at all. Some have forgotten important details of their lives, such as the names of their children or spouses or the information that made them experts in their fields during their working lives. They all come to Charles House, a day program that specializes in the care of people with memory disorders, because of that memory loss.
But long ago, the staff at Charles House figured something out: that music is a way into the lost memories of their clients.
“It’s awesome; people dancing.… It really wakes them up,” said Leith, who has been coming to Charles House to play music several days each week for the past 10 years. “Some people sleep through the music, but they all enjoy it and the community. It’s great stimulation, and stimulates parts of the brain that don’t get stimulated otherwise.”
According to Charles House’s director, Paul Klever, since the first day of operation, in 1990, the program’s recreational therapist has integrated music into the daily routine. But because the music is programmed into the middle of the day, families often don’t see the effects on their seniors.
Leith told of a recent conversation with the daughter of a Charles House member:
“I happened to be finishing up when someone came early to get her dad,” he said. “She said later that as she and her father got out of the car, he said, ‘I had the best time.'”
Research catches up with experience
Now the research on music and memory loss is catching up with what the staff at Charles House have known for years: that music is a mainline into restoring the memories and personalities of people who’ve lost much to Alzheimer’s and other forms of dementia.
People who care for those with memory loss know the frustration and fear that dementia can bring, said Cassandra Germain, a research scientist in behavioral medicine at Duke.
“The things that are the most problematic for caregivers are anxiety, agitation,” said Germain, who herself is caring for an aging mother with dementia. “Oftentimes, people with dementia have feelings of fear because of the disorientation and the anxiety. Combined with agitation, that sometimes leads people to act aggressively.”
Germain said that caregivers have reported anecdotally for years that music has a calming effect on people with Alzheimer’s and other forms of dementia, but only recently have neurologists and psychiatrists like her started studying the phenomenon systematically.
“There really is an explosion of interest,” she said. “But still, unfortunately, we don’t have the evidence to pinpoint what part of the brain is being affected by music. There seem to be areas of the brain connected to sensory memory and procedural memory, such as how to do things – routines like brushing teeth.”
Recent advances in neurological imaging such as function magnetic resonance imaging – where an MRI machine can track what parts of the brain are “lighting up” as a subject does a task or is exposed to emotional triggers – have provided some clues.
“The preliminary work suggests there are quite a bit of integrated areas of the brain that music seems to help tap into,” Germain said. “But how these areas connect together – we’re still working to figure that out.”
She said research points to areas such as the prefrontal cortex of the brain, where “executive functions” such as decision-making, judgment and determining the future consequences of current actions take place.
But the evidence does point to one very important phenomenon: When people with memory problems hear music – in particular, if it’s music that meant something to them when they were younger – it can have a therapeutic effect. Studies have shown that music can reduce the need for sedation or other medication to calm agitated people with dementia.
Some of the medications used can have undesired side effects, Germain said, like over-sedation, which can increase fall risk or bedsores.
“There’s a real desire to find a non-pharmaceutical method to reduce some of those behaviors and improve the quality of care for patients and caregivers,” she said.
Theory into practice
So what if someone with dementia – someone who was, say, a big-band aficionado in his youth – were given an iPod filled with Tommy Dorsey and Benny Goodman tunes?
That’s the idea behind the Music and Memory project that’s being rolled out in a number of senior facilities in the Triangle.
Dan Cohen, a social worker in New York, stumbled on the idea of using music to reach his clients with dementia who live in nursing homes, and discovered how powerful it could be. He started Music and Memory as a not-for-profit to spread the idea around the country.
The theory behind the Music and Memory method is simple: Families identify and gather music that meant something to their elders when they were young and load it onto an iPod. They then place headphones on their loved ones, and watch their faces light up.
Carmelita Karhoff, nursing home ombudsman for the Triangle J Council of Governments, has been tirelessly pushing the Music and Memory initiative for the past year, ever since she met Cohen at a conference.
“It’s a terrific way of reaching out to individuals who’ve lost memories,” she said. “It brings them back to those moments – memories of past relationships and love and experiences. It’s a simple yet elegant way of bringing them back to those happy moments.”
“It was so simple that we didn’t know why we didn’t think of it before,” Karhoff said.
Her first step was to raise awareness. Last summer, she hosted a screening of a documentary about Cohen’s work. Since then, she’s helped get iPods filled with music into more than a dozen senior facilities in Durham, Orange, Chatham and Wake counties.
Staff at homes that are interested go through Music and Memory’s training and certification process. They then work with families to identify the music that means something to their relatives and get it onto an iPod.
One limitation is the cost of the iPods and ever-changing updates to the software and hardware.
“The old iPods and the new iTunes are not compatible. so we need new iPods,” said Denise Mitchell, director of the Adult Day Health program at the Durham Center for Senior Life.
Mitchell was donated a handful of old iPods and spent an afternoon at an Apple Store trying to get them up to speed, before giving up. Now she’s up to about 10 donated devices, but said she needs another 40 to provide all of her 53 clients with a headset.
“Our participants are quite far along in their journey of Alzheimer’s and dementia,” Mitchell said. “We want to help our participants remember as much as they can and be as engaged as possible. We thought it’d be an excellent opportunity to bring them more music, when they’re upset, to calm them down, or feeling depressed, to improve their mood.”
Angela Farrell knows how music improves the mood of folks at the Adult Day Health program. Her 68-year-old mom, Mildred Cannady, has been participating in the program for three years. Each week, a gospel performer comes to the Center for Senior Life to lead songs with the members, most of whom are African-American. Other days feature a piano player or guitarist.
“[My mother] remembers every word when it comes down to hearing lyrics and music, but her memory is gone as far as getting herself to the bathroom, or she needs help putting her clothes on,” Farrell said. “We could be having a conversation, and after we end the conversation I can ask her the pieces of the conversation, but she doesn’t remember.
“But there’s something about music. That, she remembers.”
Farrell wants to get her mom one of the iPods and fill it with gospel music: “Old hymns, contemporary gospel, because that’s what she loves to sing,” she said, as well as some old-school R&B such as Gladys Knight and the Temptations.
“She gets a smile on her face; she’ll join in,” Farrell said. “She can remember. It’s amazing.”