Talking Music: 'The Thing that Stays' (Part 1)

Colm Cunningham: 0:12

Hello to you and welcome to The Dementia Podcast. I'm Colm Cunningham and with the dementia center's podcast team, I'm really delighted to welcome you today, you're listening to a podcast that will focus on the power of music engagement. And to do that, I'm joined from Edinburgh, by Diana Kerr, Diana Kerr has done much research in dementia, including in intellectual disability. But most recently, her publications and focus has been on the importance of music and music groups for older people and people with dementia. Now I have to declare that you will sense a familiarity between the two of us because we've known each other for 30 years. After nursing, I actually studied social work with Diana. And in fact, she had to fight for three days of content focusing on dementia. Now 30 years ago, that was actually rather radical. But it is ridiculous to think that our citizens with dementia, even today, do not have people coming out from their training with adequate understanding of their needs. So even though that was 30 years ago, I still hear it as an issue that we have to fight for that content to be core and focused on. But I guess where I want to start the conversation on music is the fact that it's for everybody, it's very easy to start talking about music for people with dementia. Instead of talking about people and their love of music. Of course, Diana is one of those people, as you'll hear her story and passion for music comes from a love of it herself. When I went to her house as a student of social work, I saw a piano and many other musical instruments, which told me the story of somebody with a lifelong love of music. Hello, Diana, it's great to have you with us. So that passion for music, it's clearly been lifelong,

Diana Kerr: 2:02

I suppose. I've always had music in my life since I was about four. And I was sent to piano lessons. If my grandmother said that there were three things you had to think about in life when you had children. First of all, you put your children first. Secondly, you fed them well. And thirdly, you gave them all music. And if you did all those things, you would have a wonderful world to live in. So yes, music has been central to my life

Colm Cunningham: 2:30

So Diana to my first point, which is we're obviously gonna talk about music, because I know it's firstly a passion. But secondly, you've written books, and researched the importance of music for everybody. So is it a little bit ridiculous to be talking about music in the context of dementia?

Diana Kerr: 2:48

Well, no, it's not ridiculous. It's very, very important that we do that. I think what is important, though, is that we don't see providing music for people living with dementia as something different or some something over psychotherapy, it is therapeutic, but it's therapeutic for all of us to listen to music. Music is just what we do. There's very, very few people in the world who don't enjoy music, even people who say they're not very musical. Enjoy music listening to it. So yeah, so the idea that there's a bit of a sort of thing, you know, suddenly people discovered music is good for people with dementia. Well, anybody who's known somebody with dementia knows that anyway, because we've all seen people with dementia light up, as soon as the music comes on, just as the rest of us do. So it's not just something that comes about with demand that we have music in us from the very beginning. You know, when we're born, one of the things the baby has, is a response to rhythm. You know, the heartbeat is the one thing it's heard, which is why when mothers pick up their baby, we tap their back, and we hum to them, and we hope the baby will calm down and go to sleep. And it's the last thing to go. And one of the last things to go when somebody has dementia. So yeah, so it is important to talk about music, emulation, music, music with people dementia, but I think it's very important not to see it as something different from the rest of us, you know, we're all what we are doing is playing to people's strengths. So in a way, it is important because we need to emphasize, maybe a lot of other things to be trying to get people with dementia to do aren't the best thing. Or maybe they work for a while. But the music lasts all the time. Right to the very end. So yeah, it's very important to talk about it and promote it

Colm Cunningham: 4:39

and promote it. Absolutely. And I think one of the things we'll also be doing is promoting some of your work and links in the podcast at the end. But I guess one of the things we'll be interested in, is there any science behind the benefit of music for people with dementia?

Diana Kerr: 4:54

Yeah, gosh, how long have we got I'll make this very short because otherwise it would be boring. There's lots of research. And I think one of the things that I get slightly irritated by, but that maybe it's a reflection of my age is that suddenly it's become the thing, you know, in 2020, or 2019, or whatever the last few years was actually, there's research going back to the 1980s, early 1990s, which show very clearly how music affects people with dementia. There's research which shows for example, that if you play the right music at mealtimes, people with dementia will eat more. And given the people who may have such difficulty eating, why don't we do it? There's, you know, there's research which shows that it reduces people's agitation. Well, you know, why give someone a pill, if you could play them some Mozart or, or you could sing with them, there's research which shows it increases people's reality orientation, if whatever, you know, their, their ability to remember where they are and what they're doing. There's masses of research, which shows the benefits, it shows how people will start to communicate, they start to use language that they haven't been using, that they will start to engage with other people, you know, it's all there. And I think it's a bit irritating, sometimes it's taken so long for people to go, Oh, my God, the informations there, however, thank God. And in a way, things like YouTube have managed to do that they've, they've put it out there, I think one of the problems and you'll know, this is a bit of a bugbear of mine, that very often, what you call the science, the research can get stuck in the field of academia. And I think one of the problems has been that there's been all this research, but it hasn't been getting out to people who are actually living, working, supporting people with dementia. And at last that's happening.

Colm Cunningham: 6:50

And I was listening to Charge of the Light Brigade the other day, because somebody else had it on and it was winding me up, I was fine.

Diana Kerr: 7:00

That is so important is it that one things we know we can do with music, and it's something that I'm talking about for years is we can use music to do that to calm people down or to liven and people up. So given that people with dementia are very often very agitated and distressed. And a lot of the behaviors that we call challenging, or experiences challenging are actually from feeling threatened or distressed. If music can do something about that, why don't we so why don't we for example, if somebody is agitated or distressed, why don't we or noisy? Why don't we use music, there's research which shows that if you for example, play the right music, you can reduce people's agitation. However, what is really important in that is that you don't, if some just feeling really agitated, noisy, play some agitated noisy music, you know, be where they are with the music and then change the music, bring it down and down and down. I mean, you can imagine if you were really wound up if somebody started to play some very lyrical music, it probably annoy you. And the other way round, you know, if somebody is down and depressed, and that plays the music where they are, and then gradually increase the tempo and the noise and the rhythm or whatever, and people's mood will be lifted. It's not very difficult.

Colm Cunningham: 8:20

It's not very difficult. But I suppose I can even think to a time when I was a student doing the MSC and I gave you an example of a tip I'd always played with people who knew whom I was helping manage called songs that won the war. Until the day this particular new resident who was a Londoner was under the table. And we were going What the heck but I'd never realized it was a siren at the start or before we went into we'll meet again or whatever came next. So again, as you say, you probably need to know the individual most important Have you any experiences of tailoring the music and making sure it's actually right for the person.

Diana Kerr: 9:01

Absolutely. And in fact, that example you've given is not what I was because it's not uncommon it's it is becoming more and more uncommon now because of time, but certainly in the past, I have had people who have been distressed by music either as you say it may be reminds them of something like the Blitz or just music that is about some sad time. I mean, we can all be reduced to tears with music that triggers sad memories or whatever. And I think one of the issues is when we're using music with people with dementia, is we need to know something about them and where they are. You know,

Colm Cunningham: 9:35

it's interesting because you've just triggered a memory for me when when you and I were doing night shift research, and I remember, either you or I can't remember which one of us could see this woman's hand tapping to the beat of the music, and I could just see it from behind where I was observing what was happening as people were taken to bed as we experienced in our observation of the research and just suddenly the staff member changed the music to something she wanted to listen to. And I remember the distress of her hand just dropping on the chair. And it's just it's just so sad because, again, that's the other thing probably here is, who's the music for? it's not for the staff, it is for the people we're there to support.

Diana Kerr: 10:23

Um, certainly, I think one of the issues is about how you choose the music and who chooses the music. And one of the problems, of course, is that the people who are doing the caring, in homes and, and even at home, often, if they're caring for a parent, have got a different set of music in their head. And it's about finding out what what music the person with dementia wants to listen to, and not just having music that you want to listen to, and we mustn't make assumptions. Like they're old. So they're like war music, you know, whatever. Although, of course, people will like music of that era. Yeah, so we have to think about who the music's for

Colm Cunningham: 11:01

Yes and we also have to think about clearing the airwaves, because the other thing you go in is that the radio might be on in there, the TV might be playing music somewhere else in somebody's room. So multiple sources, or it can also be very challenging. So thinking about being intentional.

Diana Kerr: 11:18

Very, very important that the music is for that person. And that is the music that they hear whether they using it as a on an iPod, or an mp3 player, or whether it's a singing group, or whether they're just singing on their own with somebody else, that actually there aren't these other noises because of course, the problem is for people with dementia is that they can't differentiate, you know, if you and I will often we can be in a room and the telly can be on. And we could be talking but we can't hear the telly because we we have our brain is blotting it out. And of course, for someone with dementia, they can't do that. So we've got to be very careful when we're playing music or using music to think it. What music is this person actually hearing? Can they hear the vacuum cleaner next door? Or the staff calling to each other? Or somebody singing in the kitchen? Do you know? What is it that they What did they get to concentrate on? Yeah.

Colm Cunningham: 12:12

And it has a role in reminiscence? Can you give us a sense of some of the towel? You've seen it used? Well?

Diana Kerr: 12:20

Yeah, I mean, the thing about music is, of course, well, come on everybody listening to this reminisces with music, everybody goes, Oh, do you remember that, and it can pull up all sorts of feelings and whatever. If I just had to recently, one of my dearest and best friends has just died. And one of the pieces of music I can remember us playing. Actually, a whole group of sick when we used to go to France was Indiana, wants me, and it's not a piece of music I would normally listen to, but it was on the radio the other day and reduced me to tears. The music pulls you back, I was back in France, whatever. And that will happen as well. Of course, with people with dementia as particularly since they are going back anyway, they're going back into that period of their life. And that's what they were they're probably feeling quite comfortable. And it is much much harder for them, I suppose. Do you want me to tell you a story?

Colm Cunningham: 13:15

You can tell me as many as you want

Diana Kerr: 13:17

Right? Well, I'm going to tell you a story which is exactly about that it was it was in this care home. And there were these three women that Margaret, Janet and Pauline. And they would sit in the sitting room every day. However, they said very little to each other, or indeed anybody else. Janet was particularly withdrawn. And Margaret was constantly saying she wanted to go home, which we'll all be familiar with. They also actually showed an element of a noise or even jealousy. If somebody went to talk to one of them do you know they'd be there. But But and they obviously wanted to be together, but they didn't want any one of them to have more attention than the other. And one day, I can't believe how it happened. We started playing some Glenn Miller. The first piece we played was in the mood. We then played moonlight serenade followed by tuxedo junction. And by the time we got to Chattanooga Choo choo, all three women was singing along smiling. Margaret then started to tell the story about going to dances in the war. She then reminisced about her time as an ambulance driver. I mean, this was powerful stuff we'd never heard before. And because she started speaking Pauline started and she started to reminisce about her experiences of dances as well and the Blitz in London, and it was like the floodgates opened. Dances, boyfriends, clothes, all sorts of stuff came out. And actually it was a history lesson, and they were in their element. And these memories were so so vivid, and some of them are sad. But these women came alive and we saw them in a very different way. There was they were laughing, they were talking to each other. Now they had sat there for months, not communicating and the music, finding the right music had just triggered this amazing communication between them. And joy that the most important thing is they were so happy. Yeah,

Colm Cunningham: 15:12

I guess I'm interested in when people start thinking, right, I've listened to you is, what are we going to do is it expensive? You know, do we have to get lots of equipment and buy iPods and all these sorts of things. I don't think you buy an iPod anymore. But

Diana Kerr: 15:29

we were talking about doesn't if I mean by the people in a care home, I think what the most difficult thing is actually for carers, people who are at home, caring for their husband or their wife, very often older people won't. I mean, there's a myth that everybody's got a computer, you know, there's all sorts of assumptions people make, that people got a computer, or they might have the computer, but unless their grandkids can come around and sort it out. I have to say, I, my 10 year old grandkids sort everything out for me. Yeah, I think it depends what sort of music we're talking about. If we're talking about using music, or just playing records, and obviously, or discs, people will often still have records by the way, or discs or whatever, then people will already have the equipment. One of the ways that many people will have heard of bringing music to people with dementia is by using it, you know, playlist for life using I play iPods or mp3 players or whatever. And the idea behind that is that what you do is you identify the music that's important to that person, and you put it together like a compilation. And then they've always got that music to listen to. Now there's issues in there, which we could probably come back to in a bit, if you want to ask me later on. But one of the issues there is, of course, that many people, many partners or whatever, either don't have the time, or they don't know how to load things on to an Iplayer or mp3 player, whatever. And there is just in passing a wonderful organization called "Purple Angel". And I think watch it, you'll be able to make a link to this. But Norman McNamara who runs it as it's amazing thing where he if you contact him, and if you have the link from the site people can do that, although it's in Britain, people can do it from anywhere. And he will, if you tell him what music the person likes, he will load it onto an mp3 player. And he will send it to you get the player and you get the mix. The issues in that are of course that and I think it is good. It's very good. It does work very well. But it's not necessarily the playlist you want for life. So you know, if you think about it, if I was to ask you today to tell me the pieces of music, you would like give me 20 pieces of music you like you could give me them. But if in about a month's time, you know, and the sun's out now, while the sun's out there where you are in Australia, I'm in Edinburgh, if the sun if the sun was out, I have a different feeling. And I might choose different music. So I think it's quite important that we don't just make up these playlists for life and think that's it. Do you know, we need to keep adjusting them. And we also need to make sure that we don't just which I have seen and I've heard reported simply, if you like plug people in and then leave them to listen to their music. Now, a lot of people will want to sit and listen to their music quietly. Yes, not all the time and particularly got dementia, they probably would rather have a bit of company.

Colm Cunningham: 18:28

Now, I believe you've got some advice on maybe what's a sensible period of time to listen to music? Yeah, yeah.

Diana Kerr: 18:37

Well, what the research shows is that really about 20 minutes. And actually, you see the trouble with the thing is people with dementia are just like you and me. And you and I will disagree on lots of things. We are different. And so one day, you might want to listen to music, you might listen to music for an hour, another day, you might only want 10 minutes, they want to do something else. But what the research does show is that generally, after about 20 minutes, think about turning the music off. Otherwise it just becomes background music. I think I've told you the story before, but I can remember I did some training with some managers of a care homes. And I was going to train the managers and then train the staff. And during the training, I had talked about the importance of using music, and that they really you know, the usual thing you know, you must use music use as much as you can. Anyway, about a month or so later I was training the staff and one group of them came up to me they said look, before you start, we just have to ask you, did you say that you put music on and you leave it on all the time? And I went? No, I didn't say that. But what I'd forgotten to say, actually, you turn it off after about 20 minutes, and the staff said we're crawling up the wall it goes on and it becomes just this awful loop of music. So yes, you've got to think You've got to think of how long is it reasonable? Watch the person. When do they look like they're becoming a bit agitated, or bored. So yes, about 20 minutes, although some research suggests longer than that. And that's what you've got to measure. I think you mustn't have these hard and fast rules you know. But just an indication, after 20 minutes, think about whether the person wants to.

Colm Cunningham: 20:24

And I think it is important to say that that is solid research. And as you've said, it also shows that people are most much less likely to pace but more walk, or less folk, repeated vocalization. So there's really solid evidence that these things are important. You've talked about playlists, can you tell me a little bit more about the pros and cons or learnings about you also got to be careful at these playlists. And we absolutely will put Norman's Purple Angels link,'cause I know, he is thinking about how he helps other countries, as it has been the UK but so we don't want them to become set pieces that nobody reviews again, any other issues about playlists?

Diana Kerr: 21:08

Well, I think just that the, the recognition that people's tastes change, and also, of course, because of the nature of dementia, people are going back in their life. So it may be that music that they you know, they really enjoy music of the 60s. And then after a while, because that they go back beyond the 60s, they'll want to listen to music of the 50s or whatever. And that's, that's one way of cut. Of course, most music goes across decades all across our lives. But music that's important to us has probably been across our lives. But it's important to think about that that music might that one point might be important might not be later on, while later. And also as I said earlier, we mustn't just plug people in and leave them. I know a friend of mine, her mother had had a playlist It was of lovely music. And she used to take it, she used to take the earphones off. If she saw her daughter move, she thought her daughter was going to leave her. And she wanted her daughter beside her all the time. And I think it's really important that we don't think necessarily that we can just leave people I did hear of a home where they had a plug in playlist hour which, well anyway, I hope it's the only home. You know, everybody was plugged in and left to the music staring at each other.

Colm Cunningham: 22:27

So personalizing rather than the group activity.

Diana Kerr: 22:30

Yeah. Oh, yes, absolutely. And obviously, everybody's moods good. One of the difficulties, of course, with making up the playlist is finding out what it is that people really want to listen to. And if you think about it, who is it? Who's making the decisions about that? I mean, if it's someone, a mother, and it's a daughter, does she know which music her mother really likes? Does she know the music that was important to her mother when her mother was young? I mean, one of the things we know about music is the music that often resonates strongly, strongly with us and that we hang on to longest is the music from our teens, for obvious reasons. I suppose it's when we're highly emotional or whatever. So music for our late teens, early 20s. So yes, it's about looking up and seeing what that music is and what music the person would have liked. And certainly a friend of mine, Patty, I say a friend of mine, she's now friend, is somebody I met at a party and was asking me what I did for a living. And I was telling her about the music because I tell everybody because I want them to do it. And she told me this amazing story about her mother, and how the playlist completely changed her mother from being somebody who sat who was agitated, who wouldn't go to meet other people in the home. And she realized that she could use make up a play that she'd heard about Sally Magnusson's work. And she made up a playlist for her mother. And she did that by going through her mother's records and CDs. And trying to remember she tried to remember songs that she'd heard her mother sing the first few lines of thought she obviously didn't know the rest, but she could remember her singing those and she made up this complete playlist for but what she also did, which I think was brilliant, was she used a split earpiece. So she sat with her mother, and they listened to the music together, which I think was lovely. You know, and, yeah, so yeah, I think you need to think about it. It's not just a matter of banging stuff on something and then sitting somebody down to listen to it.

Colm Cunningham: 24:29

Absolutely, Diana. It's so important to be invested and plan, but this is a perfect point to pause. Danna, thank you so much for joining us in part one. And thank you to everybody for listening to the first episode of music engagement. Diana will join us again shortly to talk about singing groups and choirs for those with dementia. In our show notes, we've provided the links to the fantastic resources mentioned in this episode. If you wish to engage and find out more about them. We love that you join us on the dementia podcast. Whether you're a person living with dementia, a carer, or professional worker, we'd love to hear your feedback and your ideas on future series that we should cover. To give us feedback. please email us on hello@dementiacentre.com. Finally, thank you to HammondCare Publishing, for supporting this podcast and of course, to the dementia center podcast team for all the hard work and research. Thank you so much for listening. And we'll look forward to you joining us in part two of music engagement. Bye for now.