Using Music to Develop a Multisensory Communicative Environment for People With Late-Stage Dementia

Amy Clare, DClinPsych; Paul M. Camic, PhD; Sebastian J. Crutch, PhD; Julian West, BA; Emma Harding, Bsc; Emilie Brotherhood, Msc


Gerontologist. 2020;60(6):1115-1125. 

In This Article

Abstract and Introduction


Background and Objectives: Research has indicated the benefit of music interventions on biological, psychological, and cognitive aspects of dementias, yet there is limited research focusing on music's role in communication. This study developed a conceptual understanding of how people with late-stage dementia may express themselves nonverbally and interact with others during a live music group over time.

Research Design and Methods: Eight people with advanced dementias in residential care (aged 82–97 years), four care staff, and three musicians participated in 8-hr-long weekly live Music for Life sessions and listened to 1-hr-long recorded music session. Visual grounded theory was used to analyze video data collected nonintrusively via the Fly 360-degree camera.

Results: The live music group facilitated a multisensory communicative environment allowing for verbal and nonverbal communicative actions, social interactional components and agency to develop over time. These aspects were influenced by three factors: time, one-to-one interaction within a group setting and the characteristics of the music.

Discussion and Implications: Nonverbal communication in later-stage dementia may be overlooked or underestimated by busy care staff and families. Using music as an interactive way to communicate can help develop mirroring and turn-taking which has been shown to improve quality of life for people with communication impairment, increase their nonverbal communication and allow for a connection to be built between people. Although further research is recommended, individuals responsible for residential care should feel confident that the development of ongoing music groups for this population is warranted as part of ongoing care.


The field of dementia care has been greatly influenced by Kitwood's (1997) theory of "personhood," which proposed that the needs of people with dementia include comfort, attachment, inclusion, occupation, and identity. Although Kitwood's ideas have been hugely influential over time there has been a move towards more relational theories of dementia. Nolan, Davies, Brown, Keady, and Nolan (2004) claim that person-centered care does not adequately capture the reciprocity and interdependency that underlies caring relationships and that it needs to be expanded to a relationship-centered care approach underpinned by a psychosocial theory of relating they identified as the "senses framework." Within this framework, Nolan and colleagues (2004) suggest that all parties involved in caring need to experience relationships that promote a sense of security, belonging, continuity, purpose, achievement, and significance. According to Henwood and Ellis (2015), dementia treatment and care has historically tended to focus on physical rather than social aspects. de Oliveira and colleagues (2015) found that nonpharmacological interventions (e.g., music interventions) have significant impact on biological, psychological, and cognitive symptoms of dementia and shifting focus to more relational aspects, therefore they should be considered as a primary intervention.