March 2020

The Nation Reviewed

We’ll meet again

By Kate Cole-Adams
Helping carers use music to unlock the minds of people with dementia

Tap–tap–tap. Felicity Baker knocks her fingers on the table; an insistent percussive beat. It could get annoying. We are in an otherwise tranquil room at the Southbank home of the Melbourne Conservatorium of Music, where Professor Baker (small, intent, energetic) is head of music therapy. It is a field whose previous lack of recognition was once a source of frustration to her. But that is not why she’s tapping.

Baker is recalling an encounter with a patient in an aged-care home where she was working. The woman had dementia and, like many others with the disease, she was often agitated. When she was agitated, she would tap – and soon everyone else would be agitated too. 

“It’s not just distressing for staff, it becomes distressing for other residents, and then they get agitated and then the whole environment becomes chaotic.”

So Baker did what she had been trained to do. Leaning across, she began to tap on the woman’s leg. And as she tapped, she sang. At first, she matched the woman’s rhythm, beat for beat, until after a while, she says, she felt something shift, as if a tiny switch had been flicked. Gradually Baker slowed her tapping and singing, and as she did, the woman’s own tapping slowed too, and eventually stopped. Not forever; maybe not even for long, says Baker. But something had changed. “There was a calmness there.”

And an idea began to form: “I started thinking, Well, why couldn’t I show other people how to do that?

That was more than a decade ago. Now the encounter has spawned a multinational study that could reshape the care of people living with dementia.

The Homeside study, developed and led by Baker, will assess the strategic use of music to improve the lives both of people with dementia (including sufferers of Alzheimer’s disease) and those caring for them at home. Coordinated through a European Union program set up to tackle degenerative brain disease, and funded locally by the federal government’s National Health and Medical Research Council, the study will train 500 carers across Australia, Germany, Poland, Norway and the United Kingdom to use music as a tool to reduce depression and agitation in their charges. If successful, the 12-week program could help dementia sufferers to live in familiar surroundings for longer, potentially saving millions of dollars along the way.

At its heart is the idea that rather than leaving it up to family or friends to manage a frequently daunting and dispiriting array of symptoms (with or without pharmaceutical help), we need to support the central relationship between a person with dementia and their primary carers.

In Australia, dementia is the second leading cause of death after heart disease. Nearly 460,000 people have the condition, a figure Dementia Australia expects to top 1 million by 2058 – by which time annual costs are projected to be near $40 billion. Globally, more than 50 million people are now thought to live with dementia, a figure set to treble by 2050, according to Alzheimer’s Disease International. A decade from now, global costs are expected to hit a staggering $3 trillion.

There is no known cure.

The costs in terms of human suffering are incalculable. This is true not only for the person with dementia but also for the family members who care for them despite the toll on their own physical and mental health. One study found that 65 per cent of carers showed signs of depression. Baker says it is not just the demanding and often thankless work that has an impact, but also the sense of hopelessness carers feel as they watch parents and partners recede.

Which brings us back to that moment in the aged-care home all those years ago, and that tiny switch that Baker sensed as she tapped and sang with the woman. Music therapists describe it as a process of “attunement” or connecting. “You know when you’ve connected with a person with dementia,” says Baker. “They visibly change. Their posture lifts, their facial expression becomes animated. They might smile, or hold out their hand to take yours. They might tap to the music. They might sing. They just come to life.”

She says the process continues after the music has stopped – sometimes in surprising ways.

The links between music and the brain are deep and persistent. As well as activating areas of the brain that have evolved to distinguish and respond to rhythm, harmony, tone and tempo, music activates pathways involved in memory, emotion and reward, as well as language. In doing so, it lays down a sort of neural soundtrack for some of our most meaningful experiences. Music we hear at important moments in our life is encoded along with those memories and can awaken them decades later.

And because we process musical memories in so many different parts of the brain, they can be remarkably resilient, even against the onslaught of advancing dementia. Baker says the right song can transform the most withdrawn patient. “When the music stops, they might suddenly say, ‘I remember when my husband used to take me to the dance,’ or ‘I sang this song to my child when she was a baby.’ ”

Studies show that clinical music therapy in formal residential-care settings can reduce the distressing behavioural and psychological symptoms of dementia. But Homeside is the first large-scale randomised study attempting to translate these findings to the family home, where spouses and adult children shoulder the bulk of the nation’s dementia care.

Baker (who also oversees international research partnerships for the University of Melbourne’s National Music Therapy Research Unit) notes drily that her work involves more than just “come in, play a few songs and leave”. The wrong music, or the right music delivered the wrong way, can make a situation worse. During the study, which is now recruiting, trained music therapists will visit carers at home and teach them skills including how to read the body language of the person with dementia to help identify the right music and right moment. 

She stresses that carers aren’t expected to be experts. She envisages the process as a sort of virtuous cycle: the carer learns to deploy music strategically, triggering memories and lifting the mood of the person with dementia; in turn the carer feels more connected and confident, and is motivated to do it again. Nor do carers need to be good singers. “It’s the same principle as when a mother sings to a newborn baby – the baby doesn’t care if you’re not singing in key.”

The next step is to develop an app to vastly broaden the program’s reach, as well as letting Baker and her team translate and adjust its content for different ethnic, linguistic and cultural groups. They are set to hire a project manager, she says, with the help of a substantial philanthropic grant.

Meanwhile, Baker is making a playlist. “Songs that I would like people to know are meaningful for me. So that, God forbid something does happen to me at some point, people will know what music is going to touch me.” Lately, she’s been listening to the Bill Withers classic “Just the Two of Us”. It reminds her of a friend who died. When she gets time, she says, she’ll expand her notes to explain why each song is special to her. That way, her family might one day be able to use the music to build a bridge and reconnect her, at least for a time, to herself and the people she loves.

Kate Cole-Adams

Kate Cole-Adams is the author of Anaesthesia: The Gift of Oblivion and the Mystery of Consciousness.

The Monthly March 2020 cover

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