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


This study sought to develop a conceptual understanding of communication within a group intervention, Music for Life, for people with advanced dementias in residential care. In doing so, it attempted to understand the ways people with dementias communicate longitudinally over an 8-week music-based activity. Furthermore, it sought to draw out relationships that may exist between the way people communicated and the actions and processes of the music, musicians, and carers.

The communicative actions observed included both verbal and nonverbal. Verbal communication can be compromised for people with dementia therefore reducing the opportunities for making connections with other people, building relationships, sharing experiences, and belonging to a group. This is particularly the case if the environment they live in places highest value in verbal communication. According to Ridder (2003), it is essential that both verbal and nonverbal communication are attended and responded to for people with dementia allowing for social interactions and therefore relationships to develop. This study supports this view and indicated that with careful noticing and responding to both verbal and nonverbal communicative actions a social interaction can occur through the use of mirroring and turn taking.

Caldwell (2008) suggests that mirroring is "a way of capturing attention, a door to enter the inner world of our partners" (p. 72). Previous research has shown that nonverbal communication techniques have been developed that use mirroring as their core foundation; intensive interaction (Nind & Hewett, 2012) and the subsequent version for people with dementia, adaptive interaction (Ellis & Astell, 2017). Both have been shown to improve quality of life, increase nonverbal communication repertoire and allow for connections to be built between people with communication impairment (Ellis & Astell, 2017). The musicians' use of mirroring and turn taking during the group may offer the same benefits and support Wigram's (2012) research that music can help to develop a nonverbal conversation between two people.

The communicative actions and the subsequent social interactional components align with previous research indicating the importance of relationship-centered care. In doing so, interactions can be developed in order to reduce social isolation (Nolan et al., 2004). The theory aligns closely with Nolan et al.'s (2004) "senses framework" that suggests that all those involved in caring, as well as people with dementia, need to experience relationships that promote a sense of security, belonging, continuity, purpose, achievement, and significance.

The multisensory nature of the intervention supports previous research that indicated multisensory environments can improve communication between staff and residents (van Weert, van Dulmen, Spreeuwenberg, Ribbe, & Bensing, 2005). Furthermore, several of the residents showed that they had remembered certain routine parts of the group indicating that a musical multisensory environment may be able to enhance new learning in advanced dementia.

This study also offers insight into the changes in expressions of agency. According to Boyle (2014), people with dementia have been historically assumed to have little or no agency as a result of agency theory being heavily influenced by verbal abilities. Boyle (2014) argues however that agency can be demonstrated through the expression of emotion and nonverbal behavior. This study supports this argument in that residents were given several opportunities to make choices: a choice to participate from the onset, of how to participate, whether (and how) to influence the musicians' actions, and about the music being created (Camic et al., 2018).