Playing from memory: Music and dementia care

Over the past decade, research and advocacy have increasingly highlighted the transformative role music and the arts can play in the lives of the 950,000 people in the UK living with dementia. The ‘Power of Music’ report, published by UK Music in 2022, revealed that music therapy was effective in reducing the need for anti-psychotic medication in 67 per cent of dementia patients. This growing body of evidence has begun to shift the landscape of dementia care. In 2017, when the Utley Foundation led a commission on music provision in care settings, the findings highlighted the fragmentation of services. Since then, efforts have been underway to consolidate resources, funding, and policy, creating a more cohesive framework for integrating music into dementia care.

Notably, Greater Manchester has recently been designated the UK’s first Centre of Excellence for Music and Dementia, and the Power of Music Consortium – along with its associated Fund and Network – is thinking practically about projects, working with musicians and healthcare professionals, and gathering evidence to advocate for policy changes. A second Centre of Excellence is in the pipeline and the long-term goal is to ensure that music becomes a standard part of NHS care for dementia patients; an essential aspect of their treatment and well-being.

A key advocate for embedding music into personalised care plans is Grace Meadows, a leader in dementia policy, campaigning, and music therapy. Her work with the Utley Foundation involved forming a task force of over 100 practitioners from health, social care and music sectors, who worked together to explore how music can be used across different stages of dementia. ‘It involved everything from lived experience to clinical expertise, and it translated complex music therapy and scientific principles into accessible, actionable information,’ she explains. One of the most consistent messages that emerges from both reports and first-hand accounts is the importance of the quality of engagement. Working to use music in care for people living with dementia is not one- size-fits-all; it is about finding the right music at the right time for the right person – and finding how music can best communicate with each individual. This can range from curating a personalised playlist to organising group music therapy sessions, it can be working on a one-to- one basis or involving a person’s family.

A nuanced approach: Musicians need to understand dementia care to ensure interventions are beneficial (© Image courtesy of Arts For Dementia)

The Music for Dementia care guide for social workers offers practical tools, including surveys and questions, to help carers understand how to integrate music into care routines. ‘We wanted to help people see their role in the ecosystem,’ says Meadows, emphasising that specialist music therapists are not always required. Sometimes, simple interventions like playing a familiar song during a patient’s morning routine can have a calming effect, making daily activities feel more manageable.

In Greater Manchester, the Manchester Camerata orchestra is at the forefront of dementia music therapy with its Music in Mind programme. This initiative, in partnership with the Alzheimer’s Society’s Singing for the Brain, trains both care workers and musicians to lead dementia-friendly music projects in Music Cafés – community hubs across the city’s 10 boroughs. With a potential reach of three million people, the programme emphasises sustainability: training local ‘Music Champions’ ensures that the work can continue long after professional musicians leave the scene. Sarah Metcalfe, CEO of Music for Dementia commends the ethos of what Manchester Camerata has been doing. ‘There is a drive to take it beyond the orchestra and out into the community,’ she explains, ‘it is our philosophy that people can take it away; we give it away – the Manchester Camerata has a real ability to share with others and to show that you don’t have to be musical to benefit.’

Giles Wilmore, director of community and learning at Manchester Camerata, points out that these Music Champions not only receive support around using downloadable music and hand-held percussion instruments, but also engage in ongoing training through online courses and in-person inspiration days. The Music in Mind team has already been out to work in Hong Kong and Taiwan, demonstrating the global potential of this approach – building a network of available resources and support is a key ambition both nationally and (eventually) internationally.

While trained music therapists play a vital role in dementia care, advising and helping with many of the existing projects, another key element of the Power of Music initiative is upskilling non-specialists to work effectively with people living with dementia. Musicians need to understand the nuances of dementia care to ensure their interventions are beneficial. ‘It’s easy to infantilise people with dementia, but they’re not children,’ says Penny Fosten, chief executive of Arts for Dementia.

The training looks at what adaptations are necessary and at the challenges beyond the more obviously known memory loss: problems with the visual cortex which, for example might mean that someone would mistake a doormat for a hole in the ground; with task sequencing or around making a choice. Feeling comfortable is a precursor to being able and willing to participate in activities, and breathing exercises and warmups that involve hand gestures can be useful for a facilitator to plan to help participants, and to gather fast feedback about their capacity. Organisations like Arts for Dementia and the Tibbs Dementia Foundation offer training programmes that equip musicians with these skills.

© Image courtesy of Arts For Dementia

The impact of music on people living with dementia is profound, as seen through the experiences of musicians working directly in this field. ‘It’s staggering what people remember musically,’ says Philharmonia Orchestra cellist Karen Stephenson who is involved in the Philharmonia Orchestra’s Hear and Now projects, which include dementia care as a central part of the wider community reach. ‘One man has been coming to everything with his family, he is non-verbal and it’s been sad to watch that decline,’ she says, ‘but he is still able to hit a percussion instrument in time.’

This idea of musical agency – allowing patients to lead what happens with music in their own way – forms the foundation of much of the work. ‘It’s not about performing to them, it’s about being with them,’ explains Janet Fulton, principal percussionist with Manchester Camerata. ‘We are there to support them musically, which might be copying them or holding a pulse, or picking up on a march rhythm someone is playing. Dementia can be a lonely experience due to communication challenges, but music creates a shared space. It flows between people – not just within the circle but to the Music Champions as well.’ This shared experience is especially powerful when the patients coming together do not necessarily speak the same languages.

Importantly, not every musical moment is about happiness or active participation. As Fulton points out, silence can be just as meaningful – a space where participants reflect and prepare to contribute to the group. Reflective, therapeutic practice for the musicians involved with the projects is integral to each session, examining what has worked well and what has not, really being aware of the connection to each participant in bringing out pitch, timbre, or just reacting to a gesture. Fulton explains that this reflection enriches the preparation her and her colleagues undertake for their own orchestral concerts, as it encourages them to think about what a composer is trying to communicate.

Technology plays a significant role in expanding access to music for people living with dementia and one example is Casio’s Light Up My Life project: a collaboration between Casio, Grace Meadows and Dr Ming Hung Hsu, senior research fellow into dementia at Anglia Ruskin University’s Cambridge Institute for Music Therapy. Casio’s light-up keyboard, preloaded with around 100 songs, helps patients play music by lighting up the corresponding keys, putting the melody to a backing track and with optional extras, melodies and backing tracks can be adapted to auto-correct – something that could be useful if a patient is getting frustrated. The project initially equipped 50 MHA care homes with these keyboards, along with training for care staff and music therapists. As a result, 80 per cent of participants experienced improved memory recall. The increased confidence and enjoyment of a patient is tracked beautifully through a short case study example on the project’s website. The keyboards are an accessible option for less mobile patients and do not require musical expertise – anyone can buy the keyboard and training package for £250.

Similarly, the Philharmonia Orchestra has incorporated the use of the Clarion, an iPad that functions as a musical instrument, into Hear and Now. Technology can be a barrier for some older patients, but the nature of the projects means that young members of the community are involved and often help the older generation. Likewise, technology is proving a useful way that younger family members can help with an elderly relative suffering with dementia. As Karen Stephenson says, ‘Dementia will touch every family at some point,’ and it seems increasingly important to raise awareness and compassion among the younger generations.

The next years seem exciting for the holistic work around dementia. The evidence gathered from the existing projects will be used to try and push further for policy change and it is hoped that this will unlock more funding, some of which has been diverted away from dementia care because of so many other post-pandemic needs. The hope is that with training days and education, integrating music into dementia care need not be either incredibly specialist or prohibitively expensive. One thing that everyone notes is that it is hugely meaningful work.