MUSIC AND QUALITY OF LIFE AMONG NURSING HOME RESIDENTS WITH DEMENTIA )PART 1)

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

MARTIN GIZZI, MD, PHDCHAIRMAN, NJ NEUROSCIENCE INSTITUTE AT JFK MEDICAL CENTERPROFESSOR AND CHAIRMAN, DEPARTMENT OF NEUROSCIENCE, SETON HALL UNIVERSITYPRESIDENT, MUSIC FOR ALL SEASONS MEDICAL ADVISORY BOARD

Dementia is an enormous public health issue, affecting 13-15 million Americans and at least halfof residents in long-term care facilities have dementia. Quality of life issues for this populationare varied but uniformly include the non-cognitive issues of apathy, depression, agitation, sleepdifficulties, loss of autonomy and social isolation. It has been said that “patients withAlzheimer’s disease do not die of the disease, they die with it from some other cause” (Boller andDuyckaerts, 1997).

Across the spectrum of dementing illnesses from vascular dementia to Parkinson’s and Alzheimer’s diseases, depression is both a manifestation of the dementingprocess (Cummings, 1992) and the consequence of social isolation. In the view of someinvestigators, depression itself may be responsible for the precipitous declines in clinical course(Absher and Cummings, 1993). The consequences of agitation and sleep difficulties may also be dramatic. The need for sedatingmedications during the daytime leads to poorer social interaction and exacerbates a reversal ofthe sleep-wake cycle. Demented patients, already inclined to increasing disorientation after nightfall, will be more alert and agitated following a day during which sedatives have been used.This, in turn, leads to a greater use of hypnotics at bedtime, contributing to the steady declineinto the vegetative stage of many dementias.The medical benefits of musicThe use of music in dementia has extended into multiple areas involving both the cognitive andnon-cognitive aspects of the condition.

Go tell et al (2002) have identified increased verbalcomprehension among demented patients exposed to singing. Gregory (2002) induced highermeasures of attentional ability in adults with cognitive impairments following weekly musicsessions. Clark et al (1998) saw reductions in 12 or 15 identified aggressive behaviors in a long-term care population with dementia during and following exposure to music. Music has alsobeen documented to reduce agitation among elderly (Remington, 2002) and demented(Ragneskog et al, 2001) residents of long-term care facilities.

Music For All Seasons (MFAS) is a not-for-profit organization that brings, live, interactivemusic performances to audiences in long-term care facilities, medical centers and other facilities.The organization operates on the principle that music serves a healing purpose as well asimproving cultural awareness and social connectedness.Brian Dallow is the co-founder and Executive Director of Music For All Seasons, which he andhis wife, Artistic Director Rena Fruchter, created in 1991.

Mr. Dallow studied at the Royal College of Music, the Royal Academy of Music, the London School of Economics, BrandeisUniversity, and Rutgers University. He holds degrees in performance, composition and theory,and musicology. In addition to Music For All Seasons,

Mr. Dallow is a composer and pianistand is the co-founder of two orchestras, the New York Virtuosi Chamber Orchestra and thePhilharmonic Orchestra of New Jersey.The New Jersey Neuroscience Institute at JFK Medical Center is a comprehensive facilitydesigned exclusively for the diagnosis, treatment, and research of complex neurological andneurosurgical disorders in adults and children. Services offered at the Institute include programs in.......read all about MUSIC AND QUALITY OF LIFE AMONG NURSING HOME RESIDENTS WITH DEMENTIA and come back here for more great information

Music Therapy for Parkinson's and Dementia

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Caregiver.on.ca

Music therapy holds so many promises for so many types of diseases, not only for memory loss but also for working with people who have movement disorders, especially Parkinson's.


Research at Beth Abraham Hospital shows that "Parkinson's Disease patients regain some ability to organize and perform movements that were lost due to the disease. Not just any melody will do. The music must evoke a response in each patient, which is used by Tomaino to help the patient enact a specific physiological movement, such as walking. For the patient to move physically, the rhythm must be stimulating and the music familiar enough to allow for carry-over outside the music therapy session."


Michael Thaut, AoA Grant Project Director of Colorado State University, in the bulletin on the White House Mini-Conference on Aging and Music Therapy, 1994, states: "The results of this study impact neurological rehabilitation because they demonstrate that particular elements of music have a specific effect on motor systems. After three weeks, the patients with Parkinson's disease demonstrated longer stride length and improved gait velocity by an average of 25 per cent. These data validate the effectiveness of auditory rhythm to improve gait through the rhythmic coupling of auditory and motor systems."


In working with persons who have dementia, certain cautions need to be taken, as certain types of music may cause agitation. Two example come to mind:

one psychologist told me that in his Alzheimer special care unit, their least successful "musical session" involved live bagpipe music: this session was not meant to be retreive memories (the audience had no special association with the music and therefore could not access long-term memories) but meant as more of a quality of life occasion, but the results were increased agitation and outbursts. Their most successful sessions (audience was relaxed and peaceful) were with classical music and hymns.
Be prepared that people may retrieve both positive and negative memories. Connie Tomaino of Beth Abraham told the story of the time she played a waltz to a women who broke out in sobs, only to find out later that the woman had been in a concentration camp (unknown to Connie at the time) and hearing waltz music was a traumatic event for her.

For those interested in learning more about the effects of music therapy on memory and gait, I would suggest contacting the National Association for Music Therapy at 301.598.3300. You can contact them for additional information on specific music research. Their brochure also lists specific federally funded studies and one of the responsibilities of the recipients is the dissemination of their study's results: many will have write-ups in brochures, booklets, books, magazines, etc.


Here is a partial list of recipients from the National Association for Music Therapy:

TITLE: Music Therapy for Alzheimer's and Dementia Individuals:
Recipient: University of Iowa, Kate Gfeller, School of Music 319.335.2611

TITLE: Music Therapy in Alzheimer's Disease
Recipient: University of Miami, Ted Tims 305.284.3943

TITLE: A Rhythmic Sensorimotor Music Therapy Program to Improve Gait Ability in Parkinsonian Patients and Healthy Elderly
Recipient: Colorado State University, Michael Thaut 303.491.7384

You may also want to contact the Institute for Music and Neurologic Function at 718.519.4164 and ask for their booklet "Music has Power" -- it is good write-up of the overall picture on the therapeutic benefits of music. They are also conducting research in five catorgories: music and hearing, music and language, music and memory, music and learning, and music and recovery from nerve injury.


Other comments about the use of music:
Rosemary Bakker Gerontologist/Interior Designer smartage@msn.com

The best type music? I have seen the best results with using the music
that was popular in the patient's "prime" time of life. That is if you have the luxury of knowing what the individual enjoyed. Our recreational therapist was familiar with our above mentioned gentleman and realized what he needed. Some good old fashioned swing music was wonderful. For a 50-year-old patient, R&B might do the trick. Soft, or "elevator music" is never inappropriate. Most older patients, especially here in the Bible Belt, respond well to instrumental hymns and spirituals.


Poor choices would obviously be rock, jazz, polkas, lively spirited songs and oddly enough patriotic music (especially with veterans). You want to avoid "getting the juices flowing,"' so to speak.

More music activities that are good for a dementia person.

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Dementia Today

Here are more reasons why music brings about many positive interactions.

Almost non-verbal persons with dementia will sing many of the words to a favorite song.

Singing is good for the lungs of a person with dementia.

Singing songs will probably bring back happy memories and open the door for many meaningful discussions

Musical Excitement

You can have a sing along with audio or video tapes if you feel you need them. You can actually play the music while you are doing something else. But make sure to check on the dementia person periodically to renew his/her interest if necessary

More next time

Remember to leave your comments and questions

Music activities are good for a dementia person.

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

Dementia Today

Music is a powerful tool when it comes to interacting with a person who has Alzheimer’s disease or a related dementia.

There are so many reasons why music brings about many positive interactions.

Memories of songs are automatic meaning you really do not
have to think about them. The words and melodies just pop into
your brain and the brain of dementia persons, automatically.

You can take advantage of this by just starting to sing a song you know is a favorite of theirs or is at least familiar to them.

You will see that if they enjoy music, even a little bit, they will start singing, humming or tapping their toes to the music.

Of course, as I stated in an earlier post, you must be animated and excited about the interaction.

Go to this post for a list of some familiar songs for those with dementia.

Alternately, go to sing along songs for those with dementia
More next time

A History of Celebrating Residents’ Rights Week

Activities directors, caregivers, and healthcare professionals,here is some great information about Residents' Rights Week

Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

NCCNHR

NCCNHR, The National Consumer Voice for Quality Long-Term Care
invites you to honor residents of long-term care settings by celebrating Residents’ Rights Week, the first full week of October (October 4-10, 2009).

This is an opportunity to show tribute to residents as well as support ombudsmen, citizen advocates, facility staff and family members who work to promote and support residents’ rights. Setting aside a week to focus on rights is an effective way to make sure that this important topic is never forgotten in your community, facility or state.

Residents’ Rights Week is designated by NCCNHR each year to highlight residents living in all long-term care
settings.

It is a time to reflect on the importance of the Nursing Home Reform Law of 1987 that promises quality of life and care and rights for each resident. During this week NCCNHR also gives special recognition to the work of thousands of individuals who collaborate daily to help assure that dignity, privacy and other basic human rights - often taken for granted in the community - are maintained as an integral part of the lives of residents living in long-term care settings.

Residents’ Rights Week originated in 1981 at a NCCNHR annual meeting. Several nursing home residents in attendance from across the United States decided that it would be special for all residents if time were set aside to celebrate residents and their rights, separate from annual National Nursing Home Week events always held in May. NCCNHR organized a successful petition drive to persuade Congress to designate a "Residents’ Rights Day."

Senator Claude Pepper (D-FL) and Senator David Pryor (D-AR) responded by introducing a Congressional Resolution for that purpose.

Since 1980, NCCNHR has preserved this tradition of celebrating Residents’ Rights, although we have extended the designation to a full week so that facility staff, family members, community advocates and ombudsmen will have flexible opportunities to conduct educational programs and festive events.

Every year, numerous states and communities designate Residents’ Rights Week! Celebrations and activities take place all over the country and include rallies, parties, training events, and more!

Thank you for working to make Residents’ Rights Week special and meaningful for all involved. Please remember to share information about how you will be celebrating Residents’ Rights Week. NCCNHR would like to highlight these celebrations on our website.

If you have questions, please call us at (202) 332-2275 ext. 222.

How can enrollment in a hospice program help in late stage Alzheimer's?

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

American Hospice Foundation

Unfortunately, patients with end-stage Alzheimer’s disease often receive burdensome medical interventions of questionable benefit and suffer from inadequately controlled symptoms. One study showed that, although end-stage Alzheimer’s patients have four to five times the mortality rate after pneumonia or hip fracture of those without dementia, they receive the same amount of painful procedures, including daily needle sticks for blood work, placement of intravenous catheters, and painful injections of medicines. In this same study, Alzheimer’s patients were more likely to undergo placement of catheters into the bladder and placement of feeding tubes through the nose or surgically through the abdomen than patients who were not demented. In spite of the fact that tube feeding has not been shown to prevent aspiration (contents of mouth or stomach go into the lung), prolong survival, reduce infections, improve functioning, or increase patient comfort, persons with advanced Alzheimer’s disease undergo placement of feeding tubes at alarming rates. Tube-fed patients with Alzheimer’s disease and other dementing illnesses typically die within a year, have increased lung infections, and show increased agitation requiring more use of physical restraints and sedation, which in turn results in more instances of painful skin breakdown.

Hospice and palliative care can help address these issues for patients and their families.

Hospice care typically addresses directly what studies have shown patients with serious illnesses want (Singer et al, JAMA 1999; 281(2), 163-168):

Pain and symptom control
Avoid inappropriate prolongation of the dying process
Achieve a sense of control
Relieve burdens on family
Strengthen relationships with loved ones
Hospice care also addresses what family members and caregivers want (Tolle et al, Oregon Report Card 1999; www.ohsu.edu/ethics):

Loved one’s wishes honored
Inclusion in decision processes
Support/assistance at home
Practical help (transportation, medicines, equipment)
Personal care needs (bathing, feeding, toileting)
Honest information
24/7 access
To be listened to
Privacy
To be remembered and contacted after the death
Hospices stress excellent management of pain and other distressing symptoms; use an interdisciplinary care team comprised of a physician, nurse, social worker, nurse’s aide, chaplain, and volunteer, to comprehensively address all sources of suffering; and develop an individualized care plan focused on the needs of the patient and family rather than on the disease.

When should I call hospice for my loved one with Alzheimer’s disease?

When your loved one can no longer care for him or herself and has lost the ability to walk independently, especially if you are feeling stressed from caregiving, ask hospice to evaluate your loved one for admission. Particularly when your loved one has begun having choking episodes, is losing weight, or has had fever and infections, it is likely time to ask hospice for help.

Validation Therapy Used in Dementia Care

Activities directors, caregivers, and healthcare professionals,here is some great information
Here is a great dementia resource for caregivers and healthcare professinals,

Here is information on being the best caregiver you can be

Here are more interesting dementia brain boosting activities

eHow

Caring for a person with dementia is difficult. Knowing about dementia makes the job easier. Validation therapy helps a caregiver to take care of a dementia patient because it relies on the patient's feelings. Emotions are one of the last things to be lost in a person with dementia. Although not all aspects of validation therapy work for every person with dementia, understanding the concept of it is useful to the dementia caregiver.

Dementia

Dementia, a brain condition, is characterized by a group of symptoms that cause changes in the functioning of the brain. The changes have to do with thinking, perception and learning. These changes affect decision making, judgment, memory, spatial orientation, thinking, reasoning and communication. This condition interferes with daily life because of the seriousness of the changes in the brain. Behavior and personality problems most often occur. As we age, the likelihood of developing dementia increases. Validation therapy helps control problem behavior.

The Dementia Sufferer's Reality

Time, for a person with dementia, can be the present at one moment, the past at another and the future at another. Time has absolutely no continuity.
People with dementia know what they know at any given moment. Accepting the dementia world is difficult for caregivers. You cannot force those with dementia to accept the real world. Caregivers need to accept the dementia world. This makes their job much easier.
Dementia patients pick up on the feelings being expressed. For a caregiver it is how you say things, not what you say.

Validation Therapy

Naomi Feil, a social worker, designed validation therapy to help dementia sufferers. It relies on the patient's emotions. Feil reported in her book "The Validation Breakthrough" that after six months of using validation therapy once a week, persons with dementia showed improvement in eye contact, walking and behavior. Her theories explain why people with dementia behave the way they do.
History of Validation Therapy
Feil developed validation therapy between 1963 and 1980 for older people with cognitive impairments. Initially, this therapy did not include those with dementia. Applying validation therapy in dementia care occurred in the early 1980s. Validation therapy attracted a good deal of criticism from researchers. Many studies have been conducted over the years with no proof that it is effective in dementia care. Feil strongly believes that validation therapy works. Validation therapy in dementia care may work in your particular situation.
Principles of Validation Therapy
Validation therapy classifies individuals with cognitive impairment, or pre-dementia, in one of four stages. These stages are mal-orientation, time confusion, repetitive motion and vegetation.
The therapy is based on the general principle of validation and treating people who have dementia with genuine respect and legitimatizing the expression of their feelings.Treat each person with dementia as an individual. Even the most disoriented person has value. Improper behavior happens for a reason.
When more recent memory fails, people with dementia try to restore balance in their lives by retrieving earlier memories. Painful feelings that are expressed, acknowledged and validated by a trusted listener diminish. Painful feelings that are suppressed gain strength.
Empathy builds trust, reduces anxiety and restores dignity.
Caregiving With Validation
Some parts of validation therapy work for most people with dementia. You, as a caregiver, must discover what portions are effective for the person you are taking care of.

Here are some hints.

Never argue with a person who has dementia, because he believes what he is seeing and feeling is real. Logic does not work. Instead, agree with the individual with dementia. Then steer him to something else. In other words, refocus and redirect his feelings and actions.

This works best when you know the present interests of a person with dementia. Knowing what triggers bad behavior is also helpful. You must be a detective and a stretcher of the truth.

Here is an example: A person with dementia is asking to go home because he thinks that he left the front door open. You as a caregiver know this information is not true. Tell the dementia sufferer that you will call his niece to shut the front door. Then pretend to call the niece. If the dementia patient still insists on going home, tell him that we will right after we set the table and eat supper or another thing you know he will want to do. The trick is to nip agitated behavior in the bud before the dementia patient gets too upset and needs medication to calm him down.