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

Disclosures

Gerontologist. 2020;60(6):1115-1125. 

In This Article

Implications

Methodology

According to Griffiths and Smith (2016), the analysis of microdata from detailed descriptors of verbal and nonverbal interactions using video recorded data allows for the theorizing of behavior that may usually be unremarkable, small, or unseen. The use of video analysis in this study allowed careful observation of subtle communicative actions and the 360-degree camera provided in the moment observation of multiple, simultaneous interactions, permitting comparisons between participants. These nuanced interactions and behaviors would likely have been missed if a camera with a more limited field of view had been used or only field observations had been made. The ability to slow the recording, pause, go back, and review specific moments allowed for a detailed analysis of behavioral and interactional aspects.

Music-based Interventions

The majority of the interactions occurred between the musicians or carers and the residents with dementia. It may be that the residents could be encouraged to direct their instrument playing towards each other to increase the group's interaction as a whole. It is interesting that the character of the music seemed important to the communicative actions observed. Specifically, the tempo, nature, and type of instrument used can have an impact on the way that people communicate. In this study, lively music of a faster tempo led to changes in communicative actions particularly when the djembe drum was used. The fact that all of the music being played was improvised, with musicians responding moment by moment was of significance; playing set pieces of music would not have allowed the residents to influence the music making to the same degree.

Dementia Care

Staff and relatives could be encouraged to notice and respond to nonverbal communication that may be very subtle or unremarkable in day-to-day life. By doing so they may be able to develop social interactions and therefore strengthen relationships with people with dementia. Live music that responds to individual communicative action within a multisensory environment can be a way of responding to and building social interactions for people who may find verbal expression difficult. Taken with other studies involving music and singing in the early to middle stages of dementia, using live music in residential care may be able to reduce isolation, increase enjoyment for staff and residents, and encourage types of communication that could increase positive interactions in residential care environments. This study also indicated that one-to-one interactions within a group environment led to positive changes in communicative actions and social interactions between both staff and residents and residents and musicians.

Limitations

The nature of the methodology and the detail of observation performed was essential for observing the nuanced behaviors and the subtle interactions surrounding them. Although time consuming, according to Griffiths and Smith (2016), this is not necessarily a limitation but instead a caution about the methodology. The timing of the negative case (the recorded music session), being prior to the live music sessions, may have influenced the differences in observations that were noted for that session. During that first session, the participants would have been less familiar with the musicians and the format.

A larger-scale study may be able to gather data from similar groups in different residential care settings involving people from different socioeconomic or ethnic backgrounds. Although grounded theory assumes that the theoretical understanding applies to the context it is derived from, the current sample meant that it was not possible to feel certain that this intervention would result in a similar analysis in a different setting with other participants. There was also a possibility of the influence of the effect of the researchers' preconceptions and assumptions, although these were discussed and reflected on in team meetings and through a research diary.

Future Research

Further research should consider including the carer staff and musicians' experiences of being in the group and how the group might further support the senses framework suggested by Nolan and colleagues (2004). This framework suggests that all parties involved in caring need to experience relationships that promote a sense of security, belonging, continuity, purpose, achievement, and significance. It seems likely that the intervention described in this study could encourage the development of relationships between residents and care staff and therefore help to promote relationship-centered care outside of the group.

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