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November 25, 1997

Sound Medicine:

Music Enhances Life For The Elderly

by MaryAnn Logsdon

The profound technological achievements in medicine today have resulted in a dramatic increase in average life expectancy. Although we are savoring our victories over suffering and infirmity through medical progress, we are at the same time creating new problems in our society by extending longevity without developing adequate provisions for the care of our aging citizens.

Growing old is often regarded with much trepidation. As we observe the physical deterioration of our bodies, we fear the impending mental decline and the eventual loss of ability for self-maintenance that is sure to come. Our former social and occupational roles that defined us as individuals no longer exist, and feelings of esteem and self-worth quickly erode as self-sufficiency is replaced by dependency on others.

In the past, the elderly were looked upon with respect and recognized as individuals who had achieved great wisdom with the passage of time. They held a place of high honor in the homes of the younger generation who personally cared for them until death. Changes in social structure and modern medical advances have greatly affected present day practices in caring for the elderly.

As medical technology continues to cultivate opportunities for survival, health-care professionals are challenged to explore different techniques for perpetuating the substance of life. Mere custodial care is not sufficient. Leisure awareness and education are important aspects in providing health-care services to the elderly. E. Thayer Gaston, author of Music in Therapy, writes, "The opinion that old age is a period of inactivity until death is considered now to be invalid." He points out that although the deterioration of life functions was once thought to be primarily physiological in nature, it has been proven that environmental influences affect the production of symptoms in geriatric patients.

The current trend of employing music, often referred to as the universal language, to promote healing actually dates back to primitive times. The earliest music therapists were ancient tribal musicians who also served in the capacity of healers. These primal physicians were looked upon with great respect for their innate ability to communicate with the spirits by imitating their sounds. The songs used by the shaman in healing ceremonies were thought to come from the spirits in dreams or visions, along with directions for curing a particular disease. Early American Indians assumed that harmony existed between man and nature as a natural condition. Illness was considered to be a state of disharmony. Healing ceremonies involving group singing were frequently held to add strength to the healer's power.

Early Greek philosophies held that music and exercise were two essential elements of a balanced person. They were concerned with the functioning of human beings as whole individuals. Many healing temples were constructed in pastoral settings where patients were treated with soothing music, along with purifying baths and massages. Much of our modern holistic approach to medicine has evolved from Greek notions.

The application of music to achieve therapeutic goals declined in the Age of Enlightenment during the late 18th century in favor of more scientific approaches. The use of music was revived and gained professional recognition as a healing source during the 20th century. Initially, music was used predominantly in psychiatric settings as a diversional activity for entertainment. As the program developed, music therapy was given specialized applications such as background music during surgical procedures, during childbirth, and for electroshock treatment. A professional organization, The National Association for Music Therapy, was founded in 1950 to support the therapeutic use of music in hospital, rehabilitation, educational, and community settings. Today, music therapy is an established allied health profession using musical activities to address physical, psychological, cognitive, and social needs of individuals with disabilities.

The universal appeal and the expressive capabilities of music makes it an ideal vehicle for enhancing life experiences for everyone, particularly for the elderly. Music has often played a significant role in the earlier lives of people, is readily accessible, and has the capacity for touching the very essence of the soul. As physical and mental faculties decline with advancing age, music is a medium that is still comprehended by the brain. A renowned neurologist and author, Oliver Sacks, views music as a lifeline for individuals who are suffering from the impairments of aging. In his work with Parkinson patients, Sacks noted that the basal ganglia are damaged, which prevents patients from mastering consecutive movement. He stated that "music can substitute for this basal ganglier function by becoming (while the music lasts) a template for organizing a series of movements for doing." Sacks says that "music is not a luxury but a necessity for such patients, and can (for a while) provide them with what their brains no longer provide." He also found that music served as a means for triggering memories and past associations that have been long forgotten in memory-impaired individuals who are suffering from Alzheimer's disease.

Music has proven to be an effective tool in the verbal retraining of patients suffering from aphasia, a language disturbance resulting from damage in the left hemisphere of the brain. The perception of musical chords and singing skills are found to come predominantly from the right hemisphere of the brain. These factors all serve to demonstrate how music possesses the capacity for stimulating the brain into functioning even when serious damage is present.

As people grow older, even in the absence of disease, mental and physical proficiencies diminish. Exercise, good nutrition, a supportive environment, and a healthy attitude all tend to promote life satisfaction at any age, but most especially in the aging adult. Circumstances such as the development of a disabling condition, death of a spouse or long-time friend, retirement, insufficient financial resources, loss of transportation, and loss of independent living arrangements, all serve to diminish mastery over life events for the elderly. Emotional depression is commonly experienced by many elderly individuals in response to these losses, and can accelerate the need for institutionalized living arrangements.

A primary treatment goal should be to promote independence and thus minimize the need for assistance with daily living activities, but the majority of nursing homes today are inadequate due to funding and staff shortages. Irene Burnside, author of Working With the Elderly, says that many institutionalized clients show signs of diminishing mental functions as a result of feeling deserted and forced to enter institutions. She further states that although the medical world has viewed this trend of diminished functioning as irreversible, it has recently been shown that with consistent and daily stimulation, patients can be helped back toward reality. In her work with the elderly, Burnside discovered that institutionalized adults often become very silent, but that by adding sound to movement, patients were able to become much more lively and verbal. A variety of effects may be achieved with patients through the use of music therapy. Singing and dancing are known to raise energy levels and have the capacity to alter respiration and heart rates. Music serves as an emotional catharsis by encouraging an awareness of feelings. It is capable of altering moods, calming, relaxing, cheering, inspiring, and stimulating reminiscence. Group cohesiveness and social interaction are enhanced through the use of musical activities. In hospices, there has been a recent renewal of ancient monastic practices with the use of music as a facilitator of the dying process. It has proved to be an excellent vehicle for promoting an emotional and spiritual transition for terminally ill individuals into the next life.

My first experience with the use of music as a treatment modality happened quite by accident. Aunt Mary lived in a local nursing home due to the deteriorating effects of Alzheimer disease. I had known her all of my life as a dynamic and vital woman who always had an entertaining story to tell. When I entered her room, I found her curled in a fetal position at the top of her bed. I tried to talk with her, but she did not respond. I had a Walkman in my purse that day, and I placed the headphones in her ears and played for her a few classical music selections. After about 15 minutes of listening to the music, she began to talk about the good old days just like she used to do. Soon she was up and out of bed dancing around the room. She reminisced about the days when her mother played songs like that on the piano. I was so moved by the behavioral change that I witnessed, from apathy to animation, that I later pondered about the stimulating effects of music in relation to health. I began reading of other instances where music was used to promote health, and became aware of the application of music in the health care field where I was employed.

For my senior project in the Personalized Study Program for Adults at the University of South Alabama, I researched the field of music therapy through extensive reading and by visiting many local health-care agencies that provide services to the elderly. At one residential assisted living facility, for six months I observed that the singing session were a priority to many of the residents. Some sang to old-time favorite folk tunes while others clapped or played small, hand-held rhythm instruments. A piano was available and was played occasionally by one of the residents, but often by a visiting nun, who had not realized that she herself was a member of the elderly class although she professed to be 85 years of age. The residents seemed to enjoy the music and social interaction as evidenced by their smiles, laughter, and toe tapping. On one occasion, I invited the members of my adult piano student organization to perform a small concert for the residents. We were warmly received, and many stated that they particularly enjoyed the opportunity to hear classical works performed. I witnessed a vibrancy in the residents despite their advancing age. I attributed this resilience to the sensory and other stimulations the residents received.

At the Restorative Care Program at USA Knollwood Park Hospital, I observed a musical activity program with the elderly population. The majority of patients admitted for restorative services have suffered from strokes, organic brain syndrome, or broken bones acquired from falls. I observed a group of patients who were recuperating from orthopedic injuries. The patients were seated in wheelchairs and were arranged in a circular format in small groups of six to ten patients. The music therapist, Marie, teamed up with the occupational therapist, Connie, to facilitate the activity. Connie played recordings of slow melodic but rhythmic music, and patients were given a two-foot-long piece of wooden doweling with measured weight attached to hold in their hands. The participants were asked to raise their arms off the wheelchair and make circular or up-and-down motions with their sticks to the beat of the music. The purpose was to increase strength in the upper arms and torso so as to improve the patient's ability to perform activities of daily living. Marie selected more brisk recordings where patients were given rhythm sticks and instructed to play the rhythm while at the same time marching with their feet in front of their wheelchair. Marie helped some of the patients by moving their feet for them if they were having difficulty and needed assistance. These activities were designed to increase range of motion, improving endurance and mobility, teach coordination while at the same time providing a stimulating and enjoyable experience. A patient named Helen commented that "it's a lot of work relearning to move and walk again since my fall, but at least the music group is a fun way to get the work done."

I accompanied a group of recreational therapy students to Autumn Breeze nursing home to facilitate a musical activity with the residents. The activity consisted of playing pre-recorded familiar tunes that were to be accompanied by specific movements designed to address both upper and lower body functions. Approximately thirty residents ranging in age from 60 to 103 participated at varying levels, from simple observance to one lady who stood in front of her wheelchair and clapped wildly throughout the activity. Another lady, Grace, whom we were informed was 103 years old, sat during the first few songs very still with her arms folded across her chest but her toes tapping. I noticed her eventually get into the swing of the music, waving her arms in the air. One resident named Wilbur sat in the corner of his wheelchair, slumped over and asleep during the first half of the program. After a while, his toes were moving in time to the music along with his hands that were folded in his lap. One 85-year old gentleman told me that he was unable to move his legs due to a former back injury, but I witnessed him participating through movement of his upper arms and torso. The participants appeared to enjoyed the music as evidenced by their smiles and interaction with the song leaders. Some participants held hands with the students and performed a wheel-chair dance, while others actually stood in front of their chairs and danced. These observations confirmed the literature I had read and validated my belief that no matter how low functioning individuals have become, they still possess the capacity to respond to musical stimulation.

During many years of working in the health-care profession, I have had the opportunity to observe instances where music seem to be a treatment of choice or an adjunct to other treatment measures. Chinese Music Therapist Dr. Mong Chin- Shan views music as a non-invasive treatment that is often superior to drugs, which he feels should be used as a last resort. Considering the side effects I have often witnessed in patients being treated with drugs, I tend to agree. In my current position as a Registered Nurse in a psychiatric setting, I often encounter patients who are suffering from insomnia and are not responding to medication to listen to music as they lie in bed at night to promote relaxation. Patients have told me this proved successful. I recently persuaded a patient who was experiencing a panic attack to lull herself to sleep by humming a favorite gospel tune.

In Sept. of 1994, my mother was diagnosed with terminal cancer. As I cared for her during the course of her brief illness, we shared a lifetime of memories through our mutual love of music. I frequently resorted to music to assist my family, my mother, and myself to process her dying. Sometimes I played the piano for her. When possible, I placed her in front of the piano in a wheelchair where she was often able to strike familiar chords. One unforgettable highlight for her and our family was when my piano teacher, Dr. Jerry Allen Bush, performed a private concert for her in our living room. She responded with, "such beautiful music. We should open the doors and charge admission." Listening to recordings of many of her favorite works often relaxed her, eased her pain, grounded her in reality during periods of confusion, and enabled her to relive old memories. She usually responded to familiar melodies, which helped us to connect when verbal communication was not possible. As a result, I experienced one of the most meaningful events in my life and Mom experienced what she always referred to as "a good death". In the words of Don Campbell, author of the recently published The Mozart Effect, "It's important to point out that healing is not always synonymous with curing. Although relieving a disease or eliminating pain may be the ultimate goal, the immediate one is learning to integrate our conscious and unconscious life -- an ongoing process and an end in itself."

The Harbinger, Mobile, AL