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***WHITEPAPER***
PersonalizedMusicforPersonswithDementiaandtheirLifeQuality:
ReportonaPilotStudyofIn-HomeUse
SusanH.McFadden,Ph.D.([email protected])
SharayahPreman,M.S.
ShelbyKelso,M.S.
AlexandriaEbert,B.S.
DanicaKulibert,B.S.
JenniferMeer,B.S.
UniversityofWisconsinOshkosh
Wisconsin’sMusic&MemoryProgramhasenabledpersonslivingwith
Alzheimer’sdiseaseandotherformsofdementiainover250long-termcare
residencestoenjoytheirfavoritemusicbylisteningtoiPodshuffleseitherthrough
headphonesorspeakers.Staffmembersattheseresidenceshavereceived
certificationfromDanCohen’sNationalMUSICANDMEMORYSMprogramby
participatingintrainingwebinarsmeanttohelpthemunderstandthepurposeof
theprogramandhowtointroduceitintotheirfacilities.Theycontinuetohone
theirskillsandtradeinsightsontheuseofMusic&Memorythroughmonthly
webinarsorganizedbytheWisconsinDepartmentofHealthServices.
InWisconsin,researchersareexamininghowpersonalizedmusicforlongtermcareresidentswithdementiamayhelptoreduceagitationandanxietyaswell
astheuseofpsychotropicdrugstocontrolbehavioralandpsychologicalchallenges
oftenassociatedwithdementia.Otherstateresearchprogramsareinvestigatingthe
effectsoftheMusic&Memoryprogramsinresidentialcarefacilitiesonstaffjob
satisfactionandretention.TheWisconsinDepartmentofHealthServicesaskedus
toinvestigatethedeliveryofpersonalizedmusicviaiPodshufflestopersonsliving
withvariousformsofdementiaintheirownhomes.
Inthisreport,webeginbyreviewingtheliteratureonpersonalizedmusicfor
peoplewithdementia,mostofwhichdescribesstudiesconductedinlong-termcare
residences.Next,wedescribehowwerecruitedparticipantsandconductedour
studyusingtwopointsofdatacollectionaboutthreemonthsapart.Wereportthe
resultsofoursurveysandinterviews,evaluatethelimitationsofourstudy,andoffer
insightsintochallengesandopportunitiesforprogramslikeMusic&Memorythat
providepersonalizedmusicinpeople’shomes.
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WhyisMusicImportanttoPeoplewithDementia?
Onecouldanswerthequestionofwhymusicisimportanttopeoplewith
dementiabysimplystatingthatmakingandenjoyingmusicisasignificant,
meaningfulaspectofbeinghuman.TherenownedneurologistOliverSacksoften
describedhowmusicaffectedhispatientswithvariousneurologicaldisorders.
SacksisbestknownforhisobservationsaboutmusicinhisbookMusicophilia
(2007),butinanearlierbookchapter,hewrotethatmusic“canaffectusasnothing
elsecan,andateverylevelofthebodyandmind”(1998,p.1).
Sackswroteabouthowhispatientswithdementiacouldexperience
“organizationandorientationandcalm”(1998,p.11)whenlisteningtomusic.He
alsonotedthatwhilememorylossmayappeartodegradepersonalidentity,identity
is“sodeeplyingrainedinthenervoussystemthatitisneverwhollylost”(p.11).
Theidentityformationprocessisintimatelyentwinedwithfamiliar,preferred
musicfromchildhoodthroughearlyadulthood,asresearchontheso-called
“reminiscencebump”(Holmes&Conway,1999)hasdemonstrated.Sacksobserved
thatinpersonswithquiteadvanceddementia,thereisa“continuingpossibilityof
beingaffectedbymusic”(p.11).
AccordingtoSacks,familiarmusic—whattheMusic&Memoryprogramcalls
“personalizedmusic”—actsasakindofmnemonic,ormemoryaid,togivepeople
accesstoemotionsandmemoriesoncethoughtlost.Anyonewhohaswatchedthe
filmAliveInsideabouttheNationalMUSICANDMEMORYSMprogramcanseethisin
Henry’sresponsetoputtingonheadphonesandlisteningtowell-loved,well-learned
music.Henry,whorarelyspoke,begantotalkaboutthemusic.Hecommunicated
hispleasurenotjustwithwords,butalsowithrhythmicgestures.
Researchersarejustbeginningtounderstandthewaythebrainisorganized
suchthatpeoplewhoappeartohavelostsomuchabilitytoremembercanstill
recognizetheirfavoritemusicfromthepast.PetrJanata,oftheCenterforMindand
BrainattheUniversityofCaliforniaDavis,hasbeentryingtounderstandthe
connectionbetweenmusicandmemorythroughaseriesofresearchstudies.Inone
study,Janataexaminedthecontentofundergraduates’“music-evoked
autobiographicalmemories”(MEAMs)andfoundthattheirmemorieswere
predominantlyofpersonalexperiences,positiveemotions,andnostalgiaforthepast
(Janata,Tomic,&Rakowski,2007).Inanotherstudyusingfunctionalmagnetic
resonanceimagining(fMRI),Janatafoundthatautobiographicalmemory,familiar
music,andpositiveemotionsareallassociatedwithactivationofthedorsalregion
ofthemedialprefrontalcortex(MPFC;Janata,2009).Whilespeculativeatthis
point,JanatabelievesthattheMPFCremainsintactlongerasAlzheimer’sdisease
progresses.
Familymembersandprofessionalswhoworkwithindividualswithdementia
knowthateventhosewithseverecognitivedeficitscanoftensingmultipleverses
andchorusesoffavoritesongs.LikeHenryinAliveInside,theyalsodemonstrate
MEAMsafterlisteningtowell-learnedmusic.Neuroscientistsstudyingmusicare
beginningtounderstandtheimportanceoftheMPFCinprocessingmusicand
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associatingitwithemotionandmemory.Theyarealsoidentifyingmanyotherparts
ofthebraininvolvedwithrecognizingandmovingtotherhythmsofmusic.Intheir
extensivereviewofthisresearchanditsrelationtodementia,Särkämöetal.(2012)
statedthat“thislarge-scaleactivationandmodificationofthebrain,especiallythe
emotionalandmemorycircuits,inresponsetomusicalexperiencemaypartly
explainthepowerofmusictostimulateemotionalandcognitivefunctionsin
dementia”(p.155).
Ifmusiccanevokepositivemoodstates,itmayalsoreducenegativestates
associatedwithanxietyandagitation(Gerdner,1997;Sung,Chang,&Lee,2009).
Thishasbeenthefocusofconsiderableresearch,primarilyintheareaofmusic
therapypractice(e.g.,Raglioetal.,2013;McDermott,Crellin,Ridder,&Orrell,2012;
Sakamoto,Ando,&Tsutou,2013).Musictherapyinvolvesdirect,personalcontact
withaprofessionallytrainedtherapist.Usingavariationonmusictherapy,Janata
(2012)conductedresearchonwhathecalled“musicmedicine.”Musicmedicine
meansthatpeople(particularlythoseinhospitalsorlong-termcareresidences)
havetheopportunitytohearmusicthroughtheday.Inthisstudy,Janataasked
musictherapiststoidentifythemusicpreferencesofnursinghomeresidentswith
dementiaandwhentheymightenjoylisteningtomusic.Hethenarrangedforthe
musictobeplayedintheirroomsforthreehoursaday,sevendaysaweekfor12
weeks.Janatafoundthestrongesteffectforreducingagitatedbehaviorsinthe
mornings.Interestingly,healsofoundthatresidentsinthecontrolgroup(whohad
nomusictheirrooms)oftenwanderedintotheresidents’roomswheremusicwas
playing.Thisobservationsupportsanearlierresearchfindingthatpeoplewith
dementiawhoparticipatedinmusicactivitieswithamusictherapistshowedan
increaseintheirsocialbehavior(Pollack&Namazi,1992).
Ameta-analysisofnineteenstudiesconcludedthatmusicinterventionscan
increasequalityoflifeforpeoplewithdementiabyproducingshort-term
improvementsincognitiveabilitiessuchasattentionandautobiographicalmemory
andinphysiologicalmeasures(e.g.,heartrate,breathingrate,bloodpressure)
(Vasionytè&Madison,2013).However,thereweremixedfindingsaboutmusic’s
roleinreducinganxietyandagitation,perhapsduetohowthemusicwaspresented,
thetypeofmusic,andtheindividualityofthepersonswithdementia(e.g.,some
becomeover-stimulatedbycertainsounds).
Asmanyofthepapersreviewedinthemeta-analysisnoted,oneofthe
challengeswiththisresearchisthatitfailstomeetthescientificstandardsapplied
toothertypesof“interventions”forpersonswithdementia.Theresearchtendsto
lackrandomizedassignmenttotreatmentandcontrolgroups,hassmallnumbersof
personsenrolledinthestudies,andvariesinthepresentationsofthemusicandthe
outcomemeasureswhichmakescomparingstudiesdifficult.Itisparticularly
challengingtodrawconclusionsaboutanylong-termbenefitsofengagementwith
musicgiventhefactthatdementiaisaprogressivecondition.
Thesecritiqueshavebeenappliednotonlytovarioustypesofmusic
programs,butalsotootherwaysofengagingpeoplewithdementiawiththearts.In
abrilliantlytitledpapercalled“ShallIcomparethreetoadoseofdonepezil?”,de
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MedeirosandBasting(2013)acknowledgedthesecritiquesbutarguedthatthe
samestandardsshouldnotbeappliedtoculturalartsprogramsastotrialsofnew
medications.Musicandotherartformscanhelpdevelopindividualandsocial
meaningsystems,somethingpharmacologydoesnotdo.Moreover,peoplevaryin
whatismeaningfultothemasisdemonstratedbythestudiesthatfindvariousways
ofpresentingmusicaffectpeopledifferently.Animportantpointmadebythese
authorsisthatculturalartsinvolveasocialnetworkofstaff,otherresidents,and
familymembers.Thissocialaspectishighlysignificantduetothefactthatdementia
canbea“diseaseofexclusion”(Corner&Bond,2004,p.153).
Feelingsofexclusioncanbeparticularlyacuteforpersonslivingwith
dementiaintheirhomeswhoarecaredforbyaspouseoradultchild.Friendsmay
driftawaybecausetheynolongerknowhowtointeractwithapersonwithmemory
lossandothercognitive,behavioral,andemotionalchallengesofdementia.These
challengesaremostdirectlyfeltbycarepartners.Thisisonereasonwhywe
wantedtoinvestigatetheuseofpersonalizedmusicinpeople’shomessincethere
hasbeensomeindicationfromstudiesinlong-termcareresidencesthatitcanbe
effectiveinaddressingproblemslikedepression,anxiety,anxiety,anddepression.
Theseareoftenlabeledas“behavioralandpsychologicalsymptomsofdementia”
(BPSDs),althoughwepreferthedesignationsuggestedbytheDementiaAction
Alliance:“bio-psycho-socialdistress”(alsoBPSD).Thistermreferstothemultiple,
interactingsourcesofdistressratherthanimplyingthatthedistressisanoutcome
ofdementiaalone(e.g.,asymptom)(DementiaActionAlliance,2016).
PersonalizedMusicinPrivateHomes
Mostresearchonpersonalizedmusicforpeoplewithdementiahasbeen
conductedinlong-termcaresettings.Weknowofonlyonepublishedpaperabout
researchconductedinpeople’shomes.Itdescribedresearchthatdidnotusethe
approachofthenationalMUSICANDMEMORYSMprogramwithplaylistsoffavorite
musicloadedontoiPodshuffles.Rather,theresearcherslearnedabout15
participants’favoritemusicandgavetheircarepartnersCDstoplayfor30minutes
priortothetimetheyhadidentifiedaspeakagitationperiods.Thisoccurredtwicea
weekfortwoweeks,followedbytwoweekswhencarepartnersdidnotplaythe
CDs.Theresultsshowedthatagitationafterlisteningtothemusicwaslowerthan
beforelistening,butthereductionofagitationdidnotgeneralizetothetwoweek
periodwhentherewasnomusiclistening.Inotherwords,itwasashort-term
effect,muchlikewhathasbeenobservedinthenationalMUSICANDMEMORYSM
programresearchinlong-termcare.
AnunpublishedstudybytheAlzheimerSocietyofTorontoiPodProject
examinedfamilycaregiverdistress,caregiverconfidenceaboutprovidingcare,and
depressioninthepersonwithdementia(Wlliams,Peckham,Rudoler,Tam,&
Watkins,2014).Somecaredforrelativesathome,whileothersvisitedlovedonesin
residentiallong-termcaresettings.Thisstudyusedthetechniqueofthenational
MUSICANDMEMORYSMprograminbothsettingsandcomparedfindingsaboutcare
partnersandcared-forpersonsatthebeginningofthestudyandthreemonthslater.
Theresearchersreportedanumberofbenefitsofparticipation,includinggreater
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enjoymentofinteractionswithotherpeople,mostlikelyduetogreatercalm.
Althoughmeasuredcaregiverdistressdeclined,thedifferencebetweenTime1and
Time2wasnotsignificant.However,thedeclineinnegativefeelingsaboutthe
impactonpersonallifeandhealthwassignificant.Thecaregiversalsofelt
significantlygreaterabilitytoengagesociallywithothers.
Thestudyconcludedthatthepersonalizedmusicmayhavehadagreater
impactonindividualslivinginresidentialcareandtheircaregiversbecause
residentsexperiencedmoreagitation,anxiety,anddepression.Nevertheless,
Williamsetal.(2014)arguedforcontinueduseofpersonalizedmusicloadedon
iPodsregardlessofwheretheindividualwithdementialives.Itshouldbenoted
thatinadditiontoprovidingtheiPods,theAlzheimer’sSocietyofTorontoalso
offeredotherservicestoparticipantslikesupportgroups,creativetherapygroups,
one-on-onecounseling,andeducationalworkshops.Beingsurroundedbyallofthis
supportcouldhavepotentiatedthepositiveresultsofregularuseoftheiPods
loadedwithfavoritemusic.
APilotStudyofMusic&MemoryinPrivateHomes
Participants
AgrantfromBaderPhilanthropiesofMilwaukee,WI,enableduspurchase
equipmentfor24personswithdementiaandtheircarepartners.Participants
included10womenand14menwithdementia;allhadspousalcarepartnersexcept
foronemanandonewomanwhosedaughtersweretheircarepartners.
Participantsandcarepartnerswererecruitedthroughannouncementsat
localMemoryCafésandontherecommendationofthecommunitycarecoordinator
atalocalmemoryassessmentcenter.Lettersweresenttoindividuals’homesand
werefollowedupwithtelephonecalls.
MaterialsandProcedure
Initialinterviewswithparticipantpairsintheirhomesdeterminedmusic
preferences.TheresearchersadaptedtheMusicAssessmentQuestionnaireandthe
MusicGenre/ArtistPreferenceMatrix(bothsuppliedbythenationalMUSICAND
MEMORYSMprogram)togatherinformationaboutthekindofmusicparticipants
wantedontheiPods.Insomecases,carepartnerssuppliedfavoriteCDs.We
purchasedmusicfromiTunesandalsohadalargeCDlibraryloanedbystaffata
locallong-termcareresidence.
AssoonasthemusicwasorganizedintothreeplaylistsloadedoniPod
shufflesforeachindividual,theresearchersmadeappointmentstoreturnto
participants’homestoshowthemhowtousetheequipment.Eachpairof
participantsandcarepartnersreceivedtheiPodshuffle,headphones,smallspeaker,
charger,plasticboxtoholdtheequipment,printedinstructionsaboutiPoduseand
charging,andsuggestionsforsociallyinteractiveactivitieswhenthespeakerswere
used.Inadditiontodemonstratingtheequipmentduringthesecondvisit,we
answeredquestionsabouttheMusic&Memoryprogram,administeredtheBath
AssessmentofQualityofLifeinDementia(BASQID;Trigg,Skevington,&Jones,
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2007)totheparticipantsandleftscalesfortheparticipantsandcarepartnersto
completeandreturntouswithinaweekofourvisit.
Approximatelythreemonthslater,wemadeappointmentstoreturn.During
thesevisits,were-administeredtheBASQID,interviewedtheparticipantsandcare
partnersabouttheirexperienceswiththeMusic&Memoryprogram,andleftscales
forthemtocompleteandreturntous.
TheBASQIDconsistsof17questionsorganizedintothreegroupsmeasured
on5-pointLikertscales:ratingsofqualityoflife,health,andmemory(1=verypoor;
5=verygood);satisfactionwithhealth,abilitytolookafterself,levelofenergy,
enthusiasmfordoingthings,usualwayofspendingtheday,levelofindependence,
personalrelationships,andabilitytotalktootherpeople(1=notatallsatisfied;5=
extremelysatisfied);ratingsofextenttowhichtheindividualcanmovearoundthe
localcommunity,doalltheactivitieshe/shewantstodo,dothingshe/sheenjoys,
haschoiceaboutthingshe/shewantstodo,feelsuseful,andfeelshappy(1=notat
all;5=agreatdeal).Theinterviewershowedthequestionprintedinlargefontand
heldupthecorrespondingscaletowhichtheparticipantscouldpointorreply
verbally.TheadministrationoftheBASQIDwasrecordedonadigitalrecorderand
latertranscribed.Occasionallythecarepartnerassistedtheparticipantin
answeringthequestionsandtheseresponseswerealsorecorded.
ParticipantscompletedtheOshkoshMusicListeningExperienceScale
(OMLES)approximatelyoneweekafterreceivingtheiPodsandagainattheendof
thestudy.Thescalewasdevelopedforthisstudyandconsistsofnineitemswhich
participantsanswerona5-pointLikertscale(0=notatall;4=completely).Examples
ofitemsare“Ihadtotalconcentration,”“Ifoundtheexperiencerewarding,”and“I
wanttolistentomoremusic.”
Carepartnerscompletedthreescalesatthebeginningandendofthestudy.
FortheRevisedMemoryandBehaviorProblemsChecklist(Teri,Truax,Logsdon,
Umomoto,Zarit,&Bitaliano,1992),carepartnersratedthefrequencyof24
behaviorsinthepreviousweeksuchas“askingthesamequestionoverandover”
and“appearssadordepressed”ona5pointLikertscale(0=notatall;4=dailyor
moreoften).Theyalsoratedhowmuchthe24behaviorsbotheredthem(0=notat
all;4=extremely).
TheGaininAlzheimerCareInstrument(GAIN;Yap,Luo,Ng,Chionh,Lim,&
Goh,2009)askscarepartnerstousea5-pointLikertscale(1=disagreealot;
5=agreealot)toindicateagreementwith10itemsaboutwhetherprovidingcare
has,forexample,“helpedtoincreasemypatienceandbeamoreunderstanding
person,”and“helpedtobondmyfamilycloser.”
Thefinalscalecompletedbycarepartnersatthebeginningandendofthe
studywastheCaregivingDistressScaleasadaptedbytheTorontoAlzheimer’s
Society(CDS:Williamsetal.,2014).Forthisscale,carepartnersratetheir
caregivingexperiencesona5-pointLikertscale(1=stronglydisagree;5=strongly
agree).Sampleitemsare“Itakepartinorganizedactivitiesless”and“Caringfor___
hasmademenervous.”
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Asemi-structuredinterviewwasconductedduringtheTime2visittoinquire
aboutexperienceswiththeMusic&Memoryprogram.Participantsandcare
partnersansweredquestionsaboutfrequencyofuse,duration,timeofday,
responsestothepersonalizedmusic,effectsontheparticipantandcarepartner’s
relationship,andtechnicalissuesrelatedtotheuseoftheiPod.
Results
Lettersandphonecallsresultedin12pairsofparticipantsandcarepartners
agreeingtoanotherin-homevisitaboutthreemonthsafterbeginningtheMusic&
Memoryprogram.Unfortunately,only10pairsreturnedthesecondroundofscales.
ReasonsfornotparticipatingatTime2includedvariouslifestressorssuchasan
injurysustainedbyoneparticipant.Transcriptsoftheinterviewsrevealedthat
severalcarepartnershadnoteddeclinesincognitiveabilitiesbetweenTime1and
Time2.WesurmisethattheindividualswhochosenottoparticipateintheTime2
datacollectionmayhavealsoexperiencedsimilarchallenges.Inaddition,although
weexplicitlystatedinourlettersandphonecallsthatitdidnotmatteriftheyhad
decidednottousetheiPodshuffle,wethinksomepeoplemayhavebeen
embarrassedtoletusknowthat.
Becauseofthelowreturnrateforthescales,wecoulddonostatistical
analysesofthedata.However,wedidobservetrendsinthemeanscoresthat
showedanincreaseinparticipants’positiveresponsestothemusic(OMLES),buta
decreaseintheirlifequality(BASQID).Similarly,weobservedadropinmean
scoresontheGAINscale,butanincreaseincarepartnerdistressasmeasuredby
theRevisedMemoryandBehaviorProblemsChecklistandtheCDS.Theinterviews
gaveussomeinsightsintowhythismayhaveoccurred.
Themesfrominterviews.Aftertranscribingtheinterviewsconductedat
Time2abouttheMusic&Memoryprogramandthecommentsmadeduringthe
administrationoftheBASQIDatTime2,weappliedthemethodofinterpretive
phenomenologicalanalysis(IPA;Quinn&Clare,2008)todescribeandinterpretthe
findings.Wereadeachtranscriptseveraltimes,mademarginnotesaboutwhat
participantsandcarepartnerssaid,andgroupedthenotesintothemes.These
themeslinedupwiththetwocomponentsoftheTime2discussions.Somethemes
relateddirectlytothediscussionabouttheMusic&Memoryprogram,andothers
becameapparentwhenwereadthediscussionsthatoccurredduring
administrationoftheBASQIDtoascertainparticipants’qualityoflife.
ThemesaboutMusic&Memory.Weidentifiedfourthemesrelatedtothe
responsesofpersonswithdementiatothepersonalizedmusic.Participantsand
carepartnerstalkedaboutmusic’scalmingeffect,positivefeelingsassociatedwith
listeningtofavoritemusic,physicalengagementwiththemusic,andthewaymusic
canfocusattentiononotheractivities.
“It’sgoodforrelaxation.”Thecalmingeffectoflisteningtofamiliarmusicwas
acommontheme.Bothparticipantsandcarepartnersnotedthis.Oneparticipant
hastinnitusandhiscarepartnercommented,“whenhesayshisheadbothershim,
thisbecomessomethingsoothingthatfillsthatspace.”Thistypeofresponseisone
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ofthereasonstheNationalMUSICANDMEMORYSMprogramhasbecomesopopular
inlong-termcareresidences.Understandinghowagitatedbehaviorsamong
personswithdementiamightbemitigatedthroughlisteningtofavoritemusichas
beenamajorresearchfocusformanyyears.
“Ienjoyit.”Inadditiontothereductionofarousal,thepositiveemotions
associatedwithlisteningtopreferredmusichavealsobeenamajorfocusof
research.Bothparticipantsandcarepartnersdescribedtheenjoymentelicitedby
music,enjoymentthatcouldinsomecasesdivertattentionfromnegativeemotions.
Forexample,onecarepartnerstated,“WhenIfeelhisfrustrationatnotbeingable
totalk,weusethisandcanjustseehimrelax.”
“Thebeatiswhatshegotinto.”Inapaperonmusicandthebrain,neurologist
OliverSacksdescribedthepropulsivepowersofmusic“toelicit,todrive,andto
regulatemovement”(1998,p.4).Onecarepartnerobservedhowherhusband
tappedhisfootintimetothemusic.Otherformsofengagementincludedhumming
alongwiththemusicasthevocalsystemengagedwiththerhythmandmelodyof
songs.
“Shegetsoneofherprojectsgoingandputsthemusiconandshe’llstaywith
it.”Someparticipantsandtheircarepartnersindicatedthatlisteningtothemusic
helpedmaintainattentionwhenengagedinotheractivities.Althoughwedidnot
specificallyinquireaboutthis,itispossiblethatbeforetheonsetofdementia
symptoms,someparticipantsalwayslikedmusicplayinginthebackgroundof
activitieslikestudyingforanexam,doingwoodworking,cooking,etc.Inour
interviews,weheardaboutpeopledoingpuzzles,sewing,andgoingforwalkswith
theiPodplayingfavoritemusic.Thelatterwasespeciallynotedforoneindividual
withParkinson’sdisease,anobservationcorroboratedbySacks(1998).
Twothemesemergedfromcarepartners’commentsabouttheirperceptions
ofparticipants’responsestolisteningtotheiPods.Inadditiontonotingthethemes
justdescribed,theyalsodescribedhowusingthepersonalizedmusichelpedthem
tocopewiththeircareduties.Asecondthemeconcernedtheirdecision-making
aboutusingtheiPodsintermsofhowMusic&Memoryfitwithintheirdailylives.
“Itkeepsheroccupied.”Byhavingtheparticipantsbeoccupiedwiththe
personalizedmusic,carepartnerscouldaccomplishvarioustasksinthehome.
Sometimeskeepingtheindividualoccupiedhelpedthecarepartner“notgo
bonkers.”Whenthedaughterofamanevidencingvariousformsof“bio-psychosocialdistress”feltclosetothestateshedescribedas“bonkers,”sheputthe
headphonesonherfatherandhadhimlistentomusic.Sometimes,beingoccupied
wasanalternativetolackoffocusandattention.OnewifeofferedtheiPodasan
alternativeactivitywhen“he’smaybejustnotengagedinsomethingelse.”Finally,
onedaughterstatedthatbeyondkeepinghermotheroccupied,“Iamtryingtodo
anythingIcantohelpmymotherliveabetterlife.”Allofthesestatementscanbe
seenasexpressionsofthewayscarepartnerscopedthroughusingtheMusic&
Memoryprogram.
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“Wekindofgotoutofit.”Thisquotecamefromaspousewhoruefully
admittedthattheywerenotusingtheiPodshuffleforlisteningtofavoritemusic.
Shesaid,“Thingshavebeenbusyhere.”Anothercarepartnerstated,“TheiPodis
oneofthefirstthingstogooffcourse.”Inotherwords,theyrealizedthattherewas
onlysomuchtheycoulddointhecourseofaday,anditwasnotalwayspossibleto
pauseandproducetheiPodandheadphonesorspeaker.Similarly,acarepartner
toldus,“We’vegotthingsgoingonallthetime.”Finally,anothersimplysaid,“NowI
havetodoeverything”andtendingtothedemandsofeverydaylifeinterferedwith
herabilitytomaintaintheiPod,whichneededregularcharging.Thissituation
resultsnotonlyfromthemultiplecomplexdemandsofdailylife,butalsofromthe
lossofexecutivefunctionpersonswithdementiaoftenexperience.Inotherwords,
theycannolongerformulategoalsandtakeinitiativetomeetthem(e.g.,expressthe
desiretolistentofavoritemusicoraskfortheiPod).
ThelastsetofMusic&Memorythemesdepictsissuescarepartnersand
participantshadwhenusingtheiPodequipmentandthenegativeresponsesof
someparticipantstothemusicselection.Thelatterproblemmaybeduetothe
limitednumberofmusicalgenres,artists,andgroupsonthelistwepresented
participantsandthedifficultymanypeoplehavenamingperformersorsongs,even
well-lovedones.
“Afewtimesit’sdisappeared.”TheiPodshufflesareverysmallsoitisnot
surprisingthattheywereeasilymisplaced.Arelatedproblemwiththesizewasthat
withtheexceptionofthefewadultchildrenservingascarepartners,alltheother
carepartnersandparticipantswereolder.Somehadvisualchallenges;others
complainedthattheir“bigfingers”couldnotmanagethetinybuttons.Althoughwe
providedplasticboxesfortheequipment,sometimesthevariouspiecesgotlost.
Searchingfortheequipment,orrememberingtochargeit,seemedlikeaburden.
“Wedon’thaveabigenoughplaylist.”Eventhoughwetriedtomatchmusic
preferencesidentifiedintheinitialinterviewwiththemusicweloadedontothe
threeplaylistsoftheiPodshuffle,wedidnotalwayssucceedinpleasing
participants.WereturnedtopickuptheiPodsandloaddifferentmusicforseveral
participantswhowereunhappywiththemusicselections.Forexample,oneperson
decidedhewantedsomebluegrassandanothercommentedthatsomeofthemusic
was“tooold.”Anothertoldus,“Thereareacoupleofsectionsthatarereallyblahto
me.”Themostalarmingreportcamefromthedaughterofaparticipantwho
describedhowupsethermotherbecamewhenlisteningtosomeJohnnyCashsongs
becausetheymentionedguns.Shebecameconvincedthereweregunsinherhouse.
Wecouldnothavepredictedthissinceintheinitialinterview,shenotedthatshe
likedJohnnyCash’smusic.Theseobservationsleadustoconcludehowimportantit
istorealizethatmusicpreferencesarejustthat:preferencesthatcanbequite
strong.Peoplecanlikeonesongbyanartist,butstronglydislikeanothersongby
thesameartist.Caremustbetakeninselectingthemusicandflexibilitymustbe
maintainedinwillingnesstorevisetheplaylists.
Themesaboutdementialifequality.Webelieveitisimportanttoplaceour
findingsabouttheMusic&Memoryin-homepilotstudywithinthelargercontextof
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thelivesofourparticipantsandcarepartners.Thetranscriptsfromthe
administrationoftheBASQIDgaveusaglimpseintosomeofthechallengesthey
werelivingwith.Thisappreciationofthecomplexityoftheirliveshelpsus
understandthemixedresultsweobtainedfromthescalesandalsothereluctanceof
somepersonstocontinueinthestudybyparticipatingatTime2.
FourthemesemergedfromtheIPAprocess:(1)participantsareawareof
theirmemorydifficultiesandgrievethelossesthataccompanythem,(2)
participantsaregratefulfortheircarepartnersandareawarethattheirneedfor
careresultsfromthedifficultiesdementiahasintroducedintotheirlives,(3)
participantsareawareoftheconstrictionsimposedontheirlivesduetolost
functionslikedrivinganddeterioratingcommunicationabilities,and(4)despiteall
this,manyparticipantsstatetheycanstillenjoylife.ResearchbyLindaClareand
hercolleaguesconfirmsourfindings.Onestudyfoundthatpeoplewithdementia
livingincarehomesretainawarenessabouttheirsituationinthreedomains:self,
relationship,andtheenvironmentalcontext(Clare,Rowlands,Bruce,Surr,&Downs,
2008).Theydefinedawarenessas“anaccurateappraisalofagivenaspectofone’s
situation,functioning,orperformance,oroftheresultingimplications”(p.2367).In
anotherstudyofawarenessamongpersonsstilllivingintheirhomes,Clareandher
colleaguesnotedtheinteractionofawarenessofthechangestakingplaceintheir
livesduetodementiaandtheircopingstyles.Similartoourfindings,someoftheir
participantscopedbyadjustinginvariouswaystothechangeswroughtby
dementia,whileotherscopedwithaself-maintainingstylethatexplainedchanges
asduenottomemorylossbuttootherissueslikeageorahistoryoftrouble
rememberingthings(Clare,Roth,&Pratt,2005).
“Becauseofalackofmemory,itjust…itjustdrainshappiness.”Oneofthefirst
itemsintheadministrationoftheBASQIDaskedparticipantstoratetheirmemory.
Theyweregivenastripofpaperwiththepossibleresponsesrangingfrom“very
poor”to“verygood.”Mostpointedtosomewherebetween“poor”and“verypoor”
thoughtheyelaboratedininterestingwaysbynotingaffectiveresponsestomemory
lossasinthequoteaboveandindescribingvariationsinmemoryabilityrelatedto
thetypeofmemoryorthecircumstances.
Forexample,onemansaid,“Igotselectivememory”andwentontosaythat
ifyoutoldhimhehada“bottleofboozedownthestairs”hewouldrememberthat,
althoughhealsosaidhequitdrinkingbooze.Anotherwomandifferentiated
between“memories”and“memory”bysaying“they’reprettygoodmemoriesbutI
couldplunkout,too.”Oneparticipantdifferentiatedlong-termmemoryfrom
recentlyencodedmemoriesbysaying,“Ican’tremembercurrentthingsbutIcan
rememberthingsfromyearsago.Sothere’sagapinthere.”Anothernotedhowhis
abilitytoremembervaries:“Mymemorykindofgoesupanddown.”
Thethemeofmemoryreturnedaswemovedthroughtheitemsonthe
BASQID.Forexample,awomanlaughedwhenweposedthememoryitemforher
andsaid,“Oh,Idon’thavememory.Ican’trememberanything.It’salmostterrible.”
Abitlaterwhenweaskedifsheissatisfiedwithhowthingsareinherlife,shesaid,
“IwouldsayalittlesatisfiedbecauseIgotarealgoodmotherandIcantalktomy
11
mother…oh,no.She’sdeadnow.”Herdaughterinterjected,“That’sexactlyright.
There’samemory”towhichthewomanreplied,“Mypoormotherisdead,toobad.”
Thisexchangeisalsoanexampleofhowpersonswithdementiarelyoncare
partnerstoassistwithremembering.Manyhaveevolvedaformofcollaborative
cognition,whichpointstothesecondthemewenotedaboutrelationality.
“She’smyGPS.”InresponsetoseveraloftheitemsontheBASQID,
participantsmentionedtheircarepartners.Themanwhotalkedabouthiswifeas
hisGPSwasrespondingtotheitemthataskedabouthisabilitytodothingshe
enjoys.Foranotheritemthatinquiredabouthissatisfactionwithhislevelof
independence,hestated,“Myindependence.IfIwasaloneitwouldbeaminus,not
atall.Withherhelp,Iwouldsayalittlesatisfied.”
Anothermanrespondedtothefirstitemthataskedhimtoratehisqualityof
lifebystating,“Prettygood;mywifetakesgoodcareofme.”Stillanother
participantrespondedtothatitembysaying,“Igotagoodhubby.”Replyingtoan
itemabouthissatisfactionwithhowheusuallyspendshisday,onemansaid,
“Satisfied.Iliketostayhomeandshe’sgotalottodowiththat.”
Mostofthecommentsaboutrelationshipsandlifequalityreferredtothe
spouseoradultchildascarepartner.Onemanwasunusualinthathementioned
friendsseveraltimes.Hiswifehasenlistedseveralfriendswhotakehimto
communityactivitiesforpersonswithdementialikeMemoryCafésandasinging
program.Inresponsetoanitemabouthisabilitytochoosethingstodoonadaily
basis,hesaid,“IthinkthatifIwanttodosomething,IjusttellherI’mgoinghere,or
I’mdoingthat.I’vegotfriends,severalthatIgoplaceswiththemandthatsortof
thing.”Earlierintheinterviewwhenweaskedifheissatisfiedwiththewayhe
spendshisday,hesaid,“There’stwootherguys.It’sgood.SometimesIthinkthatto
getgoing,tokeepmegoing.”Thismanrespondedtootheritemswithstatements
thatmatchedourthirdtheme:awarenessofotherlimitations.
“Iwouldliketogetoutalittlebitfurthersometimes.”Severalparticipants,
includingthewomanquotedhere,hadtostopdrivingbetweenTime1andTime2.
HeranswerwasinresponsetotheBASQIDitemthataskedabouttheextentto
whichshecouldmovearoundinhercommunity.AmanwithParkinson’sdementia
talkedabouthowhelikedtodrivebutacknowledged,“Iknownooneisgoingtolet
mehaveitbacksoIdowhatIcan.”Later,whentalkingabouthisabilitytodothings
heenjoys,heexpressedresignationabouthissituationbysaying,“Iwanttodriveall
thetimeandIcan’tdoanydriving.SoItakebicycleseverywhere.Sothat’sjustthe
wayitiswithme.Notgoingtoworryaboutit.I’mnotgoingtofightit.”Amanwith
adualdiagnosisofAlzheimer’sdiseaseandLewyBodyDementiarespondedtoan
itemabouthissatisfactionwithhislevelofindependencebyreferringtohavingto
stopdriving.Hesaid,“Nokeys,nogoal.”
Inadditiontodemonstratingawarenessoflimitationsimposedbynolonger
beingabletodrive,participantsalsocommentedonlimitationsderivedfrom
communicationdifficulties.Forexample,onemanrespondedtotheitemabout
whetherheissatisfiedwithpersonalrelationshipsbysaying,“Ihaveahardtime
12
withcommunication,soprobablynotatall.”Anotherstatedhisfrustrationwithhis
inabilitytoexpresshisappreciationtopeoplewhohelphim.Thiscameinresponse
totheitemthataskedtheextenttowhichhefeelshappy:“Therearealotofpeople
lookingaftermeandworkingformeandIcan’ttellthemhowmuchIappreciate.”
Somepeoplesituatedtheircommunicationlimitationswithinthecontextof
therelationshipwiththeotherperson.Inresponsetotheitemthataskedabout
satisfactionwiththeabilitytotalktopeople,amansaid,“dependsonthepeopleand
soforthandwhatthey’redoingandstuff.”Inaway,thisreflectsarobustfindingin
gerontologyregardingthewayolderpeopleareselectiveaboutrelationshipsinthe
serviceofemotionregulation(seee.g.,Carstensen,Fung,&Charles,2003).
Socioemotionalselectivityappearedinawoman’sresponsetothesameitem:
“There’salotofthemIdon’tlikethatIdon’twanttobetalking.Don’twanttobe
botheredwith.”
“Ireallylovetodothings.”Despitealltheirfrustrationswithmemoryandthe
needtorelyonothers,aswellasthelimitationsontheirlives,manyofour
participantsstatedthattheycanstillenjoylifeeventhoughasonewomanputit,
“Gettingolderyoudon’thavetheoompayouhad.”Shewentontorespondtoour
lastitemaboutwhethersheishappybysaying,“IfeelifI’mnothappy,Ibetter
changeafewthings.”Anothermanwhostatedwithalaugh,“Idon’trememberbutI
missalotofstuff”endedtheinterviewbyreplyingtothehappinessitembysaying,
“MostofthetimeI’mfine.”Similarly,awomancommented,“AsI’vegottenolder
andolder,Ican’tdoanymore,”butthenshesaidabouthappiness,“Ireallythink
thatIenjoymylife.”Weheardmanyrepliesliketheseindicatingawarenessofthe
dramatic,irreversiblechangesintheirlivesasaresultoftheirdementia,butatthe
sametime,mostpeopleexpressedresilience.Wecouldofferothersimilarquotes
fromourparticipants,butwillendwithaone-wordstatementfromawomanin
responsetothehappinessitem.UsingtheBASQID,weasked,“Towhatextentdo
youfeelhappy?”Sheanswered,“Blessed.”
SummaryandConclusions
Ourstudyofthein-homeMusicandMemoryprogramproducedvaried
results.Ontheonehand,weweredisappointedbyourinabilitytopersuadehalfof
ourparticipantstoallowustoreturntotalkwiththemthreemonthsafterthey
enrolledintheMusic&Memoryprogram.Moreover,fromthelimitedquantitative
dataweobtained,weobserveddeclinesinourmeasureofparticipantlifequality
andincreasesincarepartnerdistress.However,ourinterviewsrevealedafarmore
nuancedportraitoftheseindividuals’lives.Someappreciatedandfrequentlyused
iPodshufflesloadedwiththeirfavoritemusicandthatwasreflectedinanoverall
increaseinscoresontheOshkoshMusicListeningExperienceScale.Welearned
howparticipantsandcarepartnersusedtheiPodsandsomereasonswhytheydid
notusethem.AnumberofcarepartnersfeltmaintainingtheiPodsandbeing
responsibleforhavingparticipantsusethemwasaburden,whileotherssaw
benefitsinhelpingthemcopewiththemanytaskstheyneededtoaccomplishevery
day.
13
Oureffortstomeasureparticipants’lifequalitycouldnotbestatistically
analyzedduetothelownumberofresponses.However,thetranscriptionsof
discussionsconductedduringadministrationofthelifequalityinstrumentwere
informative,showinghighlevelsofawarenessoflimitationsofmemory,relianceon
carepartners,andfrustrationfromgivingupsignifiersofindependence.However,
manyindividualsalsocommunicatedasenseofresilienceandcontinued
appreciationandenjoymentoflife.
Ourconclusionsarelimitednotonlybythesmallnumberofrespondentsat
Time2,butalsobythefactthatwedonotknowhowmuchmusictheylistenedto
priortoenrollmentintheMusic&Memoryprogram.Wealsodidnotrequest
informationaboutmedicationusewhichmighthaveaffecteddailyrhythms,
includingagitationandanxiety,aswellaspleasure.Wehadnomatchedcontrol
groupthatdidnotreceivepersonalizedmusic.Finally,wedidnotconductdrop-out
researchtolearnwhyhalfofouroriginalparticipantsandcarepartnersdeclined
theTime2interview.Inotherwords,theremaybeaselectionbiasoperatinginthe
personswhodidagreetotheTime2interview.
Music&Memoryisapopularprogramandwordaboutitisspreadingamong
carepartnersofindividualswithdementia.Despitethelimitationsofourstudy,our
experienceleadsustomakeseveralrecommendationsforfurtherimplementation
andstudyofin-homeMusic&Memoryprograms:
Theplaylistsshouldbecarefullyconstructed,usinganexpandedlistof
possiblesuggestions.
• Participantsandcarepartnersshouldreceiveaprintoutoftheplaylistbefore
thesongsareloadedinordertoavoidtheproblemwehadwithsome
individualsrejectingthesongselections.
• SomeindividualsmayhaveBluetoothcapabilitiesintheirhomesandcould
subscribetofreePandorastationsforlisteningeitherwithheadphonesor
speakers.
• AlternativestothetinyiPodshufflesshouldbeconsidered,especiallyfor
olderpeoplewhoarenotusedtothistypeoftechnology.
• Wedidnotwanttoaddfurtherburdentocarepartnersbyaskingthemto
recordwhentheiPodswereused(bothintermsoftime,andintermsofthe
situationandtheparticipant’smood)butthiswouldbeusefulinformationto
researchers.
Thefactthatdementiaisaprogressiveconditionaffectsresearchers’ability
tostudytheeffectofartsprogramslikeMusic&Memoryovertime.Nevertheless,
webelieveitisimportanttocontinuetostudytheroleofmusicinthelivesofpeople
withdementiaandtoexpandthefocusbeyondlisteningtopersonalizedmusiconan
iPod.OnealternativecomesfromFinlandwhereresearchersusedaPicture
Gramaphonetodelivermusicthatparticipantscouldselectbytouchingascreen.It
showedtheartist,gavethenameofthesong,andthenshowedlyricsasthesong
played(muchlikeakaraokemachine).Staffinfacilitiesusingthismachinereported
anincreaseinsocialinteractionamongresidentsandanincreaseinpositivemood
•
14
(Topoetal.,2004).Similarprogramslikelycouldbeloadedontotabletcomputers
foruseinpeople’shomes.
Wegaveourparticipantsandcarepartnerssmallspeakersbecausewe
wantedtooffertheoptionofsharedmusiclistening.Someresearchhasexamined
thepresentationofmusicwithastrongersocialelementthantheMusic&Memory
programdeliveredviaiPodsandheadphones.Forexample,Sherratt,Thornton,and
Hatton(2004)foundthegreatesteffectonwell-beinginpersonswithdementia
fromlisteningtolivemusic.Itproducedmoremeaningfulengagementthanwhen
recordedmusicwasplayed.Livemusicisinherentlysocialbecauseatleastone
otherpersonispresenttosingand/orplayaninstrument.
ASwedishresearchstudy’smethodscouldbeappliedtocaregivingwithin
privatehomes.Dailycaretaskswereconductedinanursinghomewithoutmusic,
withbackgroundmusicplaying,orwiththecaregiversingingtoorwiththe
resident.Thesingingproduceda“jointsenseofvitality”(Götell,Brown,&Ekman,
2009,p.422),morepositiveemotions,andareductioninaggressivebehaviors.
AnotherFinnishstudycoachedcarepartnersintheirhomestosingwithandtothe
personstheywerecaringfor;theyalsoregularlylistenedtomusictogether.The
researchersstated,“Regularmusicalactivitiescanhaveanimportantrolein
maintainingcognitiveability,enhancingmoodandQOL[qualityoflife],and
promotingthewell-beingoffamilymembersinmild/moderatedementia”(Särkämö
etal.,2013,p.648).
Toconclude,wereturntothewisdomandexpertiseofOliverSackswho,
throughouthiscareerasaneurologisttreatingpeoplewithvarioustypesof
debilitatingneurologicaldisorders,repeatedlyreferredtothetransformativepower
ofmusic.MusicalmemoryispreservedinAlzheimer’sdiseaseandotherformsof
dementia.Musicindementia“canstillbeperceived,enjoyed,andrespondedto.
Wherethereishumanconsciousness,therecanbearesponsetomusic”(Sacks,
1998,p.13).Thefutureholdsmuchpromiseforcollaborationamongresearchers
whostudytheeffectsofartsprogramslikeMusic&Memoryonqualityoflifein
personslivingwithdementia,practitionerswhoenactandsupporttheseprograms,
andpolicymakerswhoallocatemoneytounderwritetheseprograms.
References
Carstensen,L.L.,Fung,H.H.,&Charles,S.T.(2003).Socioemotionalselectivity
theoryandtheregulationofemotioninthesecondhalfoflife.Motivation
andEmotion,27,103-123).
Clare,L.,Roth,I.,&Pratt,R.,(2005).Perceptionsofchangeovertimeinearly-stage
Alzheimer’sdisease:Implicationsforunderstandingawarenessandcoping
style.Dementia,4,487-520.
Clare,L.,Rowlands,J.,Bruce,E.,Surr,C.,&Downs,M.(2008).“Idon’tdolikeIused
todo”:agroundedtheoryapproachtoconceptualizingawarenessinpeople
15
withmoderatetoseveredementialivinginlong-termcare.SocialScience&
Medicine,66,2366-2377.
Corner,L.,&Bond,J.(2004).Beingatriskofdementia:Fearsandanxietiesofolder
adults.JournalofAgingStudies,18,143-155.
DeMedeiros,K.,&Basting,A.(2013).“ShallIcomparetheetoadoseofdonepezil?”:
Culturalartsinterventionsindementiacareresearch.TheGerontologist,54,
344-353.
DementiaActionAlliance(2016).Livingwithdementia:Changingthestatusquo.
Retrievedfromhttp://daanow.org/wpcontent/uploads/2016/04/Living_Fully_With_Dementia_WhitePaper_040316.pdf.
Gerdner,L.A.(1997).Anindividualizedmusicinterventionforagitation.Journalof
theAmericanPsychiatricNursesAssociation,3,177-184.
Götell,E.,Brown,S.,&Ekman,S-L.(2009).Theinfluenceofcaregiversingingand
backgroundmusiconvocallyexpressedemotionsandmoodsindementia
care:Aqualitativeanalysis.InternationalJournalofNursingStudies,46,422430.
Holmes,A.,&Conway,M.A.(1999).Generationidentityandthereminiscence
bump:Memoryforpublicandprivateevents.JournalofAdultDevelopment,
6,21-34.
Janata,P.(2009).Theneuralarchitectureofmusic-evokedautobiographical
memories.CerebralCortex,19,2579-2594.
Janata,P.(2012).Effectsofwidespreadandfrequentpersonalizedmusic
programmingonagitationanddepressioninassistedlivingfacilityresidents
withAlzheimer-typedementia.MusicandMedicine,4,8-15.
Janata,P.,Tomic,S.T.,&Rakowski,S.K.(2007).Characterisationofmusic-evoked
autobiographicalmemories.Memory,15,845-860.
McDermott,O.,Crellin,N.,Ridder,H.M.,&Orrell,M.(2012).Musictherapyin
dementia:Anarrativesynthesissystematicreview.InternationalJournalof
GeriatricPsychiatry,28,781-794.
Pollack,N.J.,&Namazi,K.H.(1992).Theeffectofmusicparticipationonthesocial
behaviorofAlzheimer’sdiseasepatients.JournalofMusicTherapy,29,54-67.
Quinn,C.,&Clare,L.(2008).Interpretivephenomenologicalanalysis.InR.Watson,
H.McKenna,S.Cowman,&J.Keady(Eds.),Nursingresearch:Designsand
methods(pp.375-384).London:ChurchillLivingstone.
Raglio,A.,Bellandi,D.,Baiardi,P.,Gianotti,M.,&Granieri,E.(2013).Listeningto
musicandactivemusictherapyinbehavioraldisturbancesindementia:A
crossoverstudy.JournaloftheAmericanGeriatricsSociety,61,645-647.
Sacks,O.(1998).Musicandthebrain.InC.M.Tomaino(Ed.),Clinicalapplicationsof
musicandneurologicrehabilitation(pp.1-18).St.Louis,MO:MMBMusic.
16
Sacks,O.(2007).Musicophilia:Talesofmusicandthebrain.NewYork,NY:A.A.
Knopf.
Sakamoto,M.,Ando,H.,&Tsutou,A.(2013).Comparingtheeffectsofdifferent
individualizedmusicinterventionsforelderlyindividualswithsevere
dementia.InternationalPsychogeriatrics,25,775-784.
Särkämö,T.,Laitinen,S.,Tervaniemi,M.,Numminen,A.,Kurki,M.,&Rantanen,P.
(2012).Music,emotion,anddementia:Insightfromneuroscientificand
clinicalresearch.MusicandMedicine,4,153-162.
Särkämö,T.,Tervaniemi,M.,Laitinen,S.,Numminen,A.,Kurki,M.,Johnson,J.K.,&
Rantanen,P.(2013).Cognitive,emotional,andsocialbenefitsofregular
musicalactivitiesinearlydementia:Randomizedcontrolledstudy.The
Gerontologist,54,634-650.
Sherratt,K.,Thornton,A.,&Hatton,C.(2004).Emotionalandbehavioralresponses
tomusicinpeoplewithdementia:Anobservationalstudy.Aging&Mental
Health,8,233-241.
Sung,H-C.,Chang,A.M.,&Lee,W-L.(2009).Apreferredmusiclistening
interventiontoreduceanxietyinolderadultswithdementiainnursing
homes.JournalofClinicalNursing,19,1056-1064.
Teri,L.,Truax,P.,Logsdon,R.,Uomoto,J.,Zarit,S.,&Vitaliano,P.P.(1998).
Assessmentofbehavioralproblemsindementia:TheRevisedMemoryand
BehaviorProblemsChecklist.PsychologyandAging,7,622-631.
Topo,P.,Mäki,O.,Saarikalle,K.,Clarke,N.,Begley,E.,Cahill,S….Gilliard,J.(2004).
Assessmentofamusic-basedmultimediaprogramforpeoplewithdementia.
Dementia,3,331-350.
Trigg,R.,Skevington,S.M.,&Jones,R.W.(2007).Howcanwebestassessthe
qualityoflifeofpeoplewithdementia?TheBathAssessmentofSubjective
QualityofLifeinDementia(BASQID).TheGerontologist,47,789-797.
Vasionytè,I.,&Madison,G.(2013).Musicalinterventionforpatientswithdementia:
Ameta-analysis.JournalofClinicalNursing,22,1203-1216.
Yap,P.,Luo,N.,Ng,W.Y.,Chionh,H.L.,Lim,J.,&Goh,J.(2009).GaininAlzheimer
CareInstrument—Anewscaletomeasurecaregivinggainsindementia.
AmericanJournalofGeriatricPsychiatry,18,68-76.
Williams,A.P.,Peckham,A.,Rudoler,D.,Tam,T.,&Watkins,J.(2014).Evaluationof
theAlzheimerSocietyofTorontoiPodproject.Retrievedfrom
http://alz.to/wp-content/uploads/2014/12/IPod-Project-Evaluation-FinalReport-April-2-2014-FINAL-REV.pdf.