1. Musician and Dementia An overview literature study on Music and Dementia from a musician’s point-of-view
Krista Pyykönen
NAIP European Master of Music
The Royal College of Music in Stockholm

2. The Literature Zeisel, J. (2009)
The Literature Zeisel, J. (2009). I’m still here: Creating a better life for a loved one living with Alzheimer’s. London: Piatkus. Kitwood, T. (1997). Dementia reconsidered: The person comes first. Berkshire: Open University Press. Garrett, P. (2009). Can Music for Life enhance the well-being of people with dementia and develop the person-centered care skills of care workers?. MSc Dissertation: University of Bradford.

3. Aim and Focus
Collect data on a musician’s role in dementia-related music-workshops
Find out how to apply the information to Music&Dementia-module
My pre-understanding: flexible instrumental skills, inter-personal skills
Values and ethics (VIPS):
The absolute value of a human lives regardless of age or cognitive ability
Individualized approach, recognising uniqueness
Understanding the world from the perspective of the service user
Providing a social environment that supports psychological needs

4. Central Themes following Garrett’s division
Musical/Artistic Engagement
Well-being
Ill-being
Person-centered care
Applied themes:
Dementia as an experience and phenomenon
Communication & Interaction

5. What are we talking about?
Putting it into numbers:
In Europe, 5 million people are living with Alzheimer’s. Worldwide number of Alzheimer’s is 50 million. (Zeisel, 2010)
A unique experience
Psychological coping skills
Steps: grief – denial – anger – depression – acceptance
Sense memories, emotional memories, body memories, art memories, song memories and skill memories last the longest
Positive effects: increased creativity and emotionality

6. Person-centered care
Understanding and caring for people’s unique personhood
Understanding that dementia doesn’t destroy personhood
Building communication, relationships, identity and meeting psycho-sosio-cognitive needs
Aiming to reduce agitation, anxiety, apathy or aggression
Increasing the quality of life, joy
Helping people to maintain their dignity, independence and self-respect

7. Musical/Artistic Engagement
Music helps identifying emotions, telling stories, linking it to people’s own lives
Music links together separate brain locations and activates the emotional memory
The instinctual abilities of understanding music are not lost
New relationships, quality of life, joy, increased self-esteem are found
Music interventions ease depression, aggression, communication, irritability and interaction
Zeisel: people with Alzheimer’s are freer, more honest and more expressive than most others  openess for musical engagement

8. Well-being
Respecting the uniqueness of a personal history: culture, gender, temperament, lifestyle, outlook, beliefs, values, interests
Appreciating the capabilities and abilities of the person and seeing the person through the illness
Employing as many non-pharmacological treatments as pharmaceutical ones
Maintaining personhood and individuality
Living in the present moment - Being present
Supporting the existential feeling of the present

9. LOVE Comfort Occupation Identity Attachment Inclusion
Following Kitwood: Figure 5.2

10. Psychological Need for Love
Gray-Davidson (Kitwood): “To give generous, forgiving, unconditional acceptance, a whole-hearted emotional giving without expectations”
Comfort: tenderness, closeness, calming and soothing, security, warmth
Attachment: responding to the instinct-like need of forming bonds
Inclusion: understanding the need to be part of a group, understanding “attention-seeking behavior”, clinging, protests etc.
Occupation: helping to be involved in a process in a way that is personally significant
Identity: supporting the cognition and feeling of know who one is

11. Positive ways of interaction
Hear and respond to the other person’s reality
Be present
Be honest
Be calm
Introduce yourself clearly
Always address the person directly
Use friendly body-language: smile, eye-contact
Do as little as possible for a person
Use all senses: also touch
Find a person’s unique way of self-expression
Involve all participants
Negotiate: ask and listen
Collaborate: involve the person’s abilities
Play: encourage to self-expression
Facilitate: enable to take part and try
Validate: acknowledge the reality of a person’s feelings
Positivity: create a positive experience
Ease anxiety
Ask one question at a time
Speak slowly and give time
Watch for non-verbal expressions
Let the person decide the topic of conversation
Avoid slang, but use words that relate
Don’t test the person
Don’t say ”don’t”, butredirect instead
Don’t react, but respond
Don’t approach the person in a child-like way
Don’t jugde
Don’t project your own feelings or insecurities

12. Ill-being Interaction promoting ill-being:
Failing to recognize the attempts of interaction, being over-cognitive instead of sensitive, withdrawing too early from interaction, rushing the interaction
Judging by symptoms
Dementia-related ill-being:
Feelings (situation-related): fear, sense of weirdness, panic, grief, anger, sadness, anxiety, sense of being excluded or imprisoned.
Global States (general): terror, misery, rage, chaos
“Burnt-out” States (permanent): despair, depression, vegetation, exhaustion, apathy
The four A’s of Alzheimer’s: Apathy, Aggression, Agitation, Anxiety.

13. The Musician - Who? Motivation Attitudes Interaction skills
Interpretation skills in non-verbal communication
Empathy
Psychological stability: no projections towards the person
Garrett: Effects on the Musician (Music for Life)

14. Support Demands Musician’s Personal Resources Organizational Support
Debriefing
Counseling/Mentoring
Two-way communication
Stress management
Psychological preparation
Output
Following Kitwood’s figure

15. The musician’s well-being applied from Kitwood’s organization manual
Induction
Teambuilding, the importance of team
Supervision
Training, psychological preparation
Individual development
Reward