Music Programmes and Alzheimer's Sufferers

Nora Dowse
University of Otago

Deep South v.2 n.3. (Spring 1996)

Copyright (c) 1996 by Nora Dowse

How effective are music programmes for Alzheimer sufferers? The results presented in this paper, based on the author's MA thesis, demonstrate that they can be very effective.

The field work for the investigation took place in a rest-home. Six residents of Ross Home, Dunedin, who were diagnosed with Alzheimer's dementia, were each given six individual music sessions. During these sessions, the participants spontaneously reacted to the music and engaged in a number of music-related activities. This was in marked contrast to their generally apathetic state in their dayroom.

An analysis of behaviours was made by using video-recordings of each participant's music sessions and unstructured dayroom periods. The researcher's observations as participant-observer were also noted. The paper discusses this blended method approach of both quantitative and qualitative data.


My interest in researching the effectiveness of music programmes with Alzheimer's sufferers arose from my work at Ross Home, a Dunedin resthome. I was implementing music programmes with some people with dementia who were no longer able to obtain any benefit from activities which required a reasonable level of cognitive awareness.

The effect of the music was immediately apparent to me and to observers (i.e. staff and visitors). It was like switching on a light. As soon as the individual or group music sessions commenced, many of the residents "came alive", singing or whistling, shaking small hand-held percussion instruments, and moving hands and feet rhythmically.

The startling contrast to their previously dormant state, suggested that music programmes were enhancing the quality of life of dementia sufferers by spontaneously engaging them in a present-oriented activity.

Bright (1986) examined, by means of individually administered questionnaires, the stress level of staff working with people suffering from advanced dementia in three institutions. She demonstrates from some of her earlier studies the effectiveness of using music therapy to effect positive changes in the behaviour of disruptive dementia sufferers.

In an investigation of the use of music to retrieve long-term memories, Smith (1986) gave six thirty minute sessions to twelve residents of two nursing homes in Philadelphia, diagnosed as having Alzheimer's disease. Two of the sessions used musically cued reminiscence; two sessions were spent in verbal reminiscence without music; two sessions consisted of familiar songs. The results for the musical activity were statistically significant.

In a case study of a woman diagnosed as having Alzheimer's disease, over three years from the age of 69 years, and resident at an Alzheimer's disease research centre, music therapy was used in the form of songs which she had sung when younger (Lipe, 1991). These helped to sustain appropriate verbalizations during the music session and singing both in the music sessions and at other times (the latter reported by nursing staff).

Prickett and Moore (1991), examined verbal recall, with and without music, of people diagnosed as having Alzheimer's dementia. Ten patients were each given three sessions of music therapy consisting of a new song and old songs which were familiar to them. Spoken communication (without music) was also included in the session. Video recordings were used to monitor the participants reactions, the words being counted as they sang or recited with the therapists. The percentage of correct words was then compared for each individual between their sung and spoken session. The results showed that the music encouraged responsive participation (singing, humming, tapping) and that words in a musical context facilitated recall more than words without music.

Christie (1992) researched the effects of music therapy with an individual and a small group of people all diagnosed as having Alzheimer's dementia. The aim of the therapy for the first resident was his participation by singing and clapping. Singing, hand-held percussion instrumental playing, smiling, nodding head and eye contact with the therapist were the goals sought with the small group. The results showed that during the sessions, the individual resident participated throughout by singing for 65% to 100%. Participation for the group ranged between 40% to 100%.

The use of drums was investigated with individuals in the advanced stages of dementia (Clair, Bernstein, Johnston, 1995). Group drum playing helped to access their inherent sense of rhythm. The rhythms were varied over time; however their repetitive and predictability nature provided a stable base for a positive participatory activity.


In many attempts to evaluate the relative effectiveness of behaviour intervention or therapeutic programmes, measurements are made by researchers coming into the researched setting as "outsiders", carrying out their study and then departing from the setting. This can intangibly affect the methodologies and outcomes. For example, a researcher may feel it necessary to incorporate rapport building sessions into the programme, a device that would be unnecessary if the researcher was meeting the participants on a regular and more informal basis as part of their normal environment.

Indeed, the usefulness of keeping a distant detachment has been disputed: "without close, empathic, interpersonal interchange and relationships... researchers will find it impossible to gain meaningful insights into human interaction..." (Maguire, 1987, p.20).

It has been argued that social science researchers are participants in their own analyses. Any subjective statement will contain their perspective as well as that of the subject. The choice of a research topic also often arises out of situations in which researchers find themselves (Burgess, 1984).

This was obviously the case in my own investigation: my topic and methodology arose out of my work situation.

Researcher categories of observer, participant observer and complete participant have been differentiated (Burgess, 1984). As a staff member I was fully participant in the setting I chose to research. This gave me the advantage of being able to easily implement my fieldwork. It was not viewed as intrusive or "strange" but merely a continuation of the kind of programme I had already undertaken. It also facilitated my gaining permission to include the participants in the study from the resthome management, relatives and advocates. Thus, as an "insider" in the research setting, my roles were participant, participant-observer and music facilitator.

I adopted a blended method strategy to evaluate the responses of six participants in six music sessions each including both quantitative measurements and qualitative interpretations.

Quantitative measurements

The quantitative measurements took the form of behaviour observation. As many people with dementia cannot appropriately articulate their feelings, an important criterion to me that the therapy was having an effect, was a change in their overt behaviour in the music sessions, compared with another setting.

The life expectancy of people with dementia is short; from onset the average time remaining is five years. As preservation of the quality of their remaining life is facilitated by maintaining familiar routines and environment, I chose to work in a naturalistic setting, comparing the behaviour of the six participants in two settings. These were six music sessions, and a free activity setting in their dayroom.

Dayroom observations were chosen by me as a comparison because I was reminded, whenever I visited the participants' dayroom, of the repressive effects of Alzheimer's dementia. The residents were either sitting in a state of total apathy apparently staring into space, were asleep or in the case of one or two, muttering to themselves.

In order to preserve normal conditions it was important for my research methods to be minimally obtrusive. I therefore used a camcorder on a tripod to collate observations in both settings. In this way I was able to eliminate the necessity to introduce strangers in the form of reliability observers into the participant's environment.

An additional advantage was to enable my roles of researcher and participant-observer to be effectively separated in time. The video-tape subsequently provided the material which I analyzed as researcher. The recorded material was then also available for independent observation and analysis verification.

Qualitative data

Behavioral data provides precise, quantified information on human performance which is useful for evaluating against subjective judgements and against behaviours recorded in more than one setting. However, it can tell only part of the story. Some aspects of human behaviour "cannot be reduced to a physical act or translated into a space-time framework" (Blumer, 1969, p.178), such as when someone is acting aggressively, respectfully, jealously or kindly.

It has been maintained that in order to fully explore and understand, it is important to exist in an experience, rather than standing outside of it (Adler, 1993, p.160, citing Pinar, 1975). Because I was an "insider", part of the happening, I was affected by various nuances and signals which subtly or overtly influenced the direction of the music session.

As I collected and returned each participant to their unit, I was in the role of participant-observer, interacting with the participant-client, with staff, relatives, and other visitors. Before and after the music sessions I noted where relevant, comments made or incidents which had occurred and (following each session) my impressions of the musical interaction.

I also had unstructured interviews with some family members and staff regarding the participants, and how they perceived the relative effectiveness of the music programmes.

The music and dayroom sessions

The music used in the individual sessions included old popular songs, many from the early years of this century when the participants were young; well-known classical piano works, and some early twentieth century piano pieces.

Additionally I improvised on the piano, keyboard, autoharp, and glockenspiel. The improvisations were initially based on the songs or pieces already performed in the session. They developed according to the participant's musical responses, usually when the participant was tapping the glockenspiel. At times the improvisations developed into a musical conversation.

The aim of the music sessions for five of the participants was to engage them in musical activity such as humming, whistling, singing, instrumental playing and moving their arms or feet rhythmically, so these were the targeted behaviours. It was intended that the music have a calming, relaxing effect on the sixth participant, and that she would cease agitatedly talking to herself, so silence was her targeted behaviour.

The dayroom recordings were made at times that the participants were normally seated in their lounge. The camera focused upon one to three participants at the same time for ten minutes.

The videotapes were transcribed, then reviewed and the music intervention and the participant's targeted behaviours timed with a stopwatch. The descriptions and measurements of the targeted behaviours formed the behaviour observations. The tapes were viewed a third time and analyzed from a qualitative perspective, noting such aspects as the participant's facial expression and the general demeanour of both the participant and myself.

Results: Quantitative data

The behaviour observational data highlighted the marked contrast between the participants' behaviour in the music session and the dayroom. One participant was active for an average of 46% during her four music sessions (she died before completing six sessions). Four participants were active for an average of 74.6%, 76.2%, 92.6% and 97.5% during their six music sessions. This activity contrasts with the five participants' completely inactive behaviour in the dayroom.

Silence was obtained for the sixth participant, where the aim had been to quieten her agitated chatter for 82% of her six music sessions compared with 3% silence in her dayroom sessions.

An example of one participant's activity in the dayroom and music sessions is given below:

Percentage of Cliff's Activity during each Dayroom Observation

Session             Active
1                    0.0%
2                    0.4%
3                    0.0%
4                    0.0%

Cliff's Activity and Continued Activity During Each Music Session as a Percentage of Total Researcher's Activity

Session Activity Continued Activity 1 100.0% 10.3% 2 100.0% 3.5% 3 96.9% 0.0% 4 100.0% 12.0% 5 78.8% 9.4% 6 81.5% 28.0%

(The "continued activity" refers to the participant's continuation of a music activity after the researcher's music activity had ceased. This figure was not added to the total participation time however).

The following table shows the effectiveness of the music sessions in quietening the sixth participant.

Fran's Silence During Each Music Session as a Percentage of Total Music

Session Time

Session             Silent
1                      66.8%
2                      79.5%
3                      98.7%
4                      81.5%
5                      73.0%
6                      81.8%

Fran's silence during each music session as a percentage of total percentage of time Fran was silent during the Dayroom Observation.

Session             Not Talking
1                       0.00%
2                       0.00%
3                       2.66%
4                       0.83%

Qualitative data

The qualitative data, a description and interpretation of each individual session and the evolving circumstances of each participant, provided the insights and meaning behind the quantitative results.

"Multiple methods work to enhance using one type of data to validate or refine another" (Reinharz, 1992 p 201). This is especially highlighted by the account I was able to give of a participant who, one day, when I collected her from her unit, seemed unusually listless, and her hands hot when I transferred her to a wheelchair. Her temperature and blood-pressure were checked, but both seemed regular. During the music session, she showed little interest in any activity, and gasped slightly, so I terminated the session after a short time, and returned her to her unit. She was subsequently admitted to hospital and died within a few days. The quantitative results alone could not enlighten the reader regarding the reason for the sharp drop in activity for this session, but the descriptive, interpretative commentary gave substance and meaning to the table and graph.


Adler, S. (1993). "Teacher education: research as reflective practice". Teacher & Teacher Education, Vol. 9, No. 2, pp 159-167.

Bright, R. (1986). "The use of music therapy and activities with demented patients who are deemed 'difficult to manage'". Clinical Gerontologist, Vol. 6, Part 2, pp 131-144.

Blumer, H. (1969). Symbolic interactionism; perspective and method. New Jersey: Prentice-Hall.

Burgess, R. (1984). In the field:- an introduction to field research. London: Allen & Unwin.

Christie, M. (1992). "Music therapy applications in a skilled and intermediate care nursing home facility: A clinical study". Activities, Adaptation and Aging, 1992, Vol 16, (4), pp 69-87.

Clair, A. Bernstein, B. & Johnson, G. (1995). "Rhythm playing characteristics in persons with severe dementia including those with probable Alzheimer's type" Journal of Music Therapy, XXX11, 2, 1995, pp 113-131

Glynn, N. (1992). "The music therapy assessment tool in Alzheimer's patients". Journal of Gerontological Nursing, Vol 18 no.1, 3-9.

Lipe, A. (1991). "Using music therapy to enhance the quality of life in a client with Alzheimer's dementia: A case study". Maryland: Music Therapy Perspectives, 1991, Vol 9, pp 102-105.

Maguire, P. (1987). "Doing participatory research". Centre for International Education, University of Massachusetts.

Prickett, C. & Moore, R. (1991). "The use of music to aid memory of Alzheimer's patients". Journal of Music Therapy, XXVIII, (2), pp 101-110.

Reinharz, S. (1992). Feminist Methods in Social Research. Oxford University Press

Smith, G.H. (1986). "A comparison of the effects of three treatment interventions on cognitive functioning of Alzheimer patients" Music Therapy, Vol. 6A, No. 1, pp 41-56.

Write a letter to The Editor.