Many of the individual areas that we are thinking of highlighting as potential areas of difficulty often come down to a combination of difficulties in communication and around emotional regulation. When people may no longer be able to do this independently and need support, often musical in nature to assist with this- e.g., to provide feelings of comfort, familiarity, reduce arousal level, increase arousal level etc.
Offer supportive touch when you are using music with someone who is living with dementia. This should be reassuring, and you can usually gauge whether it is welcomed or not. Use your hands to play their instrument if they are holding it but not playing. This can support them to feel the vibration in their hands, to hear the rhythm, or feel the change of texture when the instrument moves. This is different to holding their hand and playing the instrument for them. This can be done sensitively but avoid coercing someone to play – read the resistance in their hands and body movement and stop if you find they are unwilling.
Singing with someone is a wonderful way to feel connected and strengthen relationships. When you’re singing with someone, make sure that they’re able to see your face. Clearly mouth the words of the song so that they have visual and auditory clues to the lyrics. Be near them, alongside or perhaps in front of them, and at eye level. Standing behind someone and singing may add to the sense that they are being sung with but is much less relational. Singing is a way of relating to somebody when conversational skills may be lessening.
If someone is unable or unwilling to use or hold an instrument, or if instruments are not available or appropriate, try gently tapping out the rhythm of the song as you hold a person’s hand. You might tap their arm or their leg if you are sitting together. This creates a multi-sensory experience when listening to music together. Be sure not to startle someone from behind with unexpected or non-consensual touch and gauging by overt or subtle cues in their responses/vocalisations/body language do not maintain contact if it is clearly not desired.
One of the best ways to encourage someone to join in with music making, is to be joining in yourself. Modelling ways of being can support someone to better understand the context of where they are and how they might behave in that context. Playing an instrument yourself can support a sense of togetherness with the person you are trying to encourage. It does not matter if you play well, or rhythmically. If everyone is a bit “rubbish” this can sometimes be quite funny and fun. Repeatedly telling a person to join in, or yelling jovially over the music, may sometimes have the opposite effect – as you might know yourself in certain situations.
Learning as much as you can about a person’s musical background can support you to use music that is most meaningful to them, and most likely to trigger memories, conversation and connection. The “reminiscence bump” refers to the music that we store best, usually the music from when we were between the ages of 10 and 30 years old. These are the years when we are forming our identity and so our musical preferences are closely tied with this. Using newer music, or music that you personally enjoy, might have an effect but it is better to begin with the familiar to support feelings of comfort, and identity.
Turn-taking is a way of having a musical conversation and connecting without words. You can do this by sharing an instrument to begin with, and then perhaps moving to separate instruments. Or you might use body percussion to clap or tap your knees. Leave a gap to play after you play something. Start with simple rhythms, one or two taps on the drum or a well-known door knocking pattern. You might not get an immediate response, so leave time and space for them to respond. Take another turn if the gap is very long or tap their instrument to model the effect. You might support their hand to the instrument as we’ve learned in the Hand and Rhythm sections above.
Sometimes certain songs will illicit an emotional response. This can also happen when using non-recorded music helps a person to feel connected for the first time in what might feel like a very long time. When and if this happens, validate the experience. It’s important that people are able to feel these emotions. Mention what you notice, if there is a tear or a smile, name the emotions and validate them. It is important that people feel listened to at these times, and you can direct back to the music, perhaps a new song choice when you feel that they are ready to move on.
Moving to music is almost a reflex. If someone is clapping or swaying, waving their hands or dancing, join in! Mirror their movements and maybe extend them into new movements. Make sure everyone is moving safely. Using more upbeat music can help to activate or stimulate movement. As with the turn-taking, allow time for a person to respond to the music. It may take 2 or 3 songs before someone’s fully orientated to the music and ready to dance or sway.
When choosing music to listen, sing or play along to, do consider the mood of the person you are supporting and try to begin with music that matches this mood. Over the course of 3 or 4 songs, you may be able to try different music if and as their mood changes. If someone is feeling sleepy or in a low mood, start quieter and move into more dynamic music. If someone becomes distressed or upset, perhaps shift gears again into quieter music, or allow some silence.
It is important that you are your authentic self when you are interacting with a person. If you are shy and awkward about using music, be shy and awkward about it and use it anyway – this could be a shared experience. You will have specific knowledge of the person you are supporting, an existing relationship that is important and valuable. Introducing music into this relationship based on your knowledge and experience of the person will make it more personal to you both. It really does not matter if you have a beautiful singing voice or not, or whether you can hold a beat or not, what matters is that you are creating opportunities to connect with someone in a way that doesn’t require words, when words might be failing them.
