Musician and dementia

Musician and Dementia

An overview literature study on Music and Dementia from a musician’s

point-of-view

Krista Pyykönen

NAIP European Master of Music The Royal College of Music in Stockholm

The Literature

Zeisel, J. (2009). I’m still here: Creating a better life for

a loved one living with Alzheimer’s. London: Piatkus.

Kitwood, T. (1997). Dementia reconsidered: The person

comes first. Berkshire: Open University Press.

Garrett, P. (2009). Can Music for Life enhance the well-being of

people with dementia and develop the person-centered care skills of care workers?. MSc Dissertation: University of Bradford.

Aim and Focus

• Collect data on a musician’s role in dementia-related music-workshops

• Find out how to apply the information to Music&Dementia-module

• My pre-understanding: flexible instrumental skills, inter-personal skills

• Values and ethics (VIPS):

 The absolute value of a human lives regardless of age or cognitive ability

 Individualized approach, recognising uniqueness

 Understanding the world from the perspective of the service user  Providing a social environment that supports psychological needs

Central Themes

following Garrett’s division

• Musical/Artistic Engagement

• Well-being

• Ill-being

• Person-centered care

Applied themes:

• Dementia as an experience and phenomenon

• Communication & Interaction

What are we talking about?

• Putting it into numbers:

In Europe, 5 million people are living with Alzheimer’s.

Worldwide number of Alzheimer’s is 50 million. (Zeisel, 2010) • A unique experience

• Psychological coping skills

• Steps: grief – denial – anger – depression – acceptance

• Sense memories, emotional memories, body memories, art memories, song memories and skill memories last the longest • Positive effects: increased creativity and emotionality

Person-centered care

• Understanding and caring for people’s unique

personhood

• Understanding that dementia doesn’t destroy

personhood

• Building communication, relationships, identity and

meeting psycho-sosio-cognitive needs

• Aiming to reduce agitation, anxiety, apathy or aggression

• Increasing the quality of life, joy

• Helping people to maintain their dignity, independence

and self-respect

Musical/Artistic Engagement

• Music helps identifying emotions, telling stories, linking it to people’s own lives

• Music links together separate brain locations and activates the emotional memory

• The instinctual abilities of understanding music are not lost

• New relationships, quality of life, joy, increased self-esteem are found

• Music interventions ease depression, aggression, communication, irritability and interaction

• Zeisel: people with Alzheimer’s are freer, more honest and more expressive than most others  openess for musical engagement

Well-being

• Respecting the uniqueness of a personal history: culture, gender, temperament, lifestyle, outlook, beliefs, values, interests

• Appreciating the capabilities and abilities of the person and seeing the person through the illness

• Employing as many non-pharmacological treatments as pharmaceutical ones

• Maintaining personhood and individuality • Living in the present moment - Being present • Supporting the existential feeling of the present

LOVE

Psychological Need for Love

• Gray-Davidson (Kitwood): “To give generous, forgiving,

unconditional acceptance, a whole-hearted emotional giving without expectations”

• Comfort: tenderness, closeness, calming and soothing, security, warmth

• Attachment: responding to the instinct-like need of forming bonds • Inclusion: understanding the need to be part of a group,

understanding “attention-seeking behavior”, clinging, protests etc. • Occupation: helping to be involved in a process in a way that is

personally significant

Positive ways of interaction

• Hear and respond to the other person’s reality

• Be present • Be honest • Be calm

• Introduce yourself clearly

• Always address the person directly • Use friendly body-language: smile,

eye-contact

• Do as little as possible for a person • _{Use all senses: also touch}

• Find a person’s unique way of self-expression • Involve all participants

• Negotiate: ask and listen

• Collaborate: involve the person’s abilities • Play: encourage to self-expression

• Facilitate: enable to take part and try

• Validate: acknowledge the reality of a person’s feelings

• Positivity: create a positive experience • Ease anxiety

• Ask one question at a time • Speak slowly and give time

• Watch for non-verbal expressions

• Let the person decide the topic of conversation • Avoid slang, but use words that relate

• Don’t test the person

• _{Don’t say ”don’t”, butredirect instead} • Don’t react, but respond

• Don’t approach the person in a child-like way • Don’t jugde

Ill-being

Interaction promoting ill-being:

• Failing to recognize the attempts of interaction, being over-cognitive instead of sensitive, withdrawing too early from interaction, rushing the interaction

• Judging by symptoms Dementia-related ill-being:

• Feelings (situation-related): fear, sense of weirdness, panic, grief, anger, sadness, anxiety, sense of being excluded or imprisoned. • Global States (general): terror, misery, rage, chaos

• “Burnt-out” States (permanent): despair, depression, vegetation, exhaustion, apathy

The Musician - Who?

• Motivation

• Attitudes

• Interaction skills

• Interpretation skills in non-verbal communication

• Empathy

• Psychological stability: no projections towards the person

• Garrett: Effects on the Musician (Music for Life)

Support

Following Kitwood’s figure

 Debriefing

 Counseling/Mentoring  Two-way communication  Stress management

The musician’s well-being

applied from Kitwood’s organization manual

• Induction

• Teambuilding, the importance of team

• Supervision

• Training, psychological preparation

• Individual development