Thursday, October 3, 2013

Intimate live music performances and quality of life for dementia patients

Van der Vleuten, M., Visser, A., and Meeuwesen, L. (2012) The contribution of intimate live music performances to the quality of life for persons with dementia. Patient Education and Counseling, 89:484-488.

This study investigates the effects of live, vocal music performances on the quality of life of patients with varying severities of dementia. Multiple studies investigating the effects of music on dementia have previously shown that it decreases apathy, depression, and anxiety, and improves self-esteem, general expression, independence, memory, social interaction, and participation in meaningful activities. This publication is one of the first to describe the benefits of live music in particular on total quality of life. Previous investigations on the benefits of live music have been limited to the effects on levels of engagement and well-being  In this publication, live music is suggested as a form of complementary care that could be used in nursing homes.

 There are four types of music that have shown to have different effects on patients with dementia: music therapy, singing caregivers, background music, and live music.

 Music therapy is the targeted, intentional use of music as a therapeutic strategy, administered by a therapist, and designed for a specific patient. This has shown to alleviate pain, decrease stress, fear, and depression, and improve expression of emotions, memory, health, and communication.

 The singing caregiver seems to improve mood and expression of positive emotions. This also helps improve caregiver-patient relations, and can promote vitality in patients with advanced stages of dementia.

 Background music improves expression of positive emotions and promotes playfulness.

 Live music appears to have a greater effect on patients with dementia than any other type of music. It has shown to increase levels of engagement and well-being to a greater degree than recorded music, regardless of the degree of cognitive impairment. The authors state that this is due to the participation and social interaction involved in live music.

 In this study, live music was performed by professional vocalists wearing fairy-tale like outfits. These performers also had been trained to maximize audience participation by encouraging dancing, maintaining eye contact, and interacting directly with the patients. These performances also included visual props and spoken poetry.

 To assess total quality of life, this study used the following four parameters: participation, mental well-being, physical well-being, and residential conditions. Results were measured via 43 different characteristics, including body language, reaction when approaching, etc., which were allotted into one of the following subcategories: human contact, care relationship, communication, positive emotions, or negative emotions. These parameters were evaluated, following the performance, by the caretakers or family members of 45 dementia patients as either 1) decreased 2) did not change, or 3)increased.

The study found that live music had a positive impact on mental well-being, and participation, but did not affect physical well-being or residential conditions. The authors suggest incorporating live musical performances as part of complementary care for dementia patients. These findings also suggest that live music performances decrease patient anxiety, aggression, and depression, which in turn decreases the work load of caregivers.


I think the conclusions drawn from this experiment are valid, and merit closer inspection. There is clearly a correlation between increased cognitive presence, expression of positive emotions, and live performances.

The initial concern I had regarding experimental design was that the responses were being evaluated by either family members or caretakers. This introduces an additional variable that was not addressed in the paper. I think it is extremely difficult for a family member to maintain complete objectivity when observing whether or not the performance is making their loved one happier, because that individual, on a deeply personal level, wants the patient to improve. It is likely impossible for the family member to remove an emotional bias. In order to work around this, the evaluations could be done by either care takers exclusively, or by a group of graduate students or volunteers both before and after the performance, in consultation with the care givers or family members. This way, one could insure that the observations were noticeable by a more objective party.

The second critique was that the authors state explicitly that in previous studies, live music increased levels of engagement and well-being due to participation and social interaction. In the review that was cited for this statement, the authors are very careful to explain that this is most likely due to participation and social interaction. This seems like a subtle difference, but what if the increase in well-being and engagement is due to the visual component that does not accompany recorded music? Could one play a music video and see similar responses in these parameters? Are these benefits due to a stimulation of both the auditory and visual systems, as opposed to the former in isolation? Could similar results be obtained by employing the use of Ipads instead? In all likelihood it is the social aspect of live music that seems to increase the overall quality of life to a greater extent than recorded music, but if these answers haven't been directly addressed, it can lead to false assumptions to make statements of this kind with absolute certainty.

 It is also important to create a control group, since in this case one cannot decisively say if the benefits were due to live music performance alone, or in conjunction with costumes, props, poetry, and direct interaction with the audience. The authors did comment that this would need to be improved upon in future studies.

 In summary, I feel this study makes a compelling case as to why live music should be incorporated into care strategies for dementia patients in old age homes. Despite some weaknesses in the preliminary study design, there is undeniably a correlation between improvement in quality of life and live music performance. It has certainly inspired me to organize more live musical performances for nursing homes in my community!


Rebecca Claborn said...

Hi Danielle,

Thanks for this information - I'm interested in the various ways we can offer music performance as complementary care, even outside the realm of music therapy. I was wondering if the article detailed the style of music that was performed? (I can't seem to access it without paying!) From the description of the performance, I'm guessing that it wasn't music within the Western classical repertoire - but maybe classical music isn't as effective in this setting? From my own limited experience in this area (I've sung in a few hospices in the GTA) I've found that singing "classically" seems less appropriate due to the size of the rooms and the volume of the sound, and have tended to stay with repertoire like jazz standards or folk songs; what did these singers choose?

Cheryl Jones said...
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Cheryl Jones said...

I appreciated the fact that this study explored four types of music experiences and that it also included four measures to assess quality of life. The value of music for dementia patients was noted in all four music experience types, with live music being the most effective. However, I was unsure why the vocalists were dressed in costumes. I agree with you, this visual component could be a stimulus for response rather than, or more than, the music. I’m wondering if the authors explained the decision to include costumes. It seems this point nullified the conclusion that live music had impact. However, the responses to the other three musical activities suggest the value of music for dementia patients.

Although having family members or caretakers evaluate the responses may seem to potentially interfere with the results, perhaps a family member would be more attuned to the responses. Comparing family with student or staff observations could be an interesting study in itself.