Singing, background music and music-events in the communication between persons with dementia and their caregivers

Detta är en avhandling från Stockholm : Karolinska Institutet, Department of Clinical Neuroscience

Sammanfattning: The overall aim of this thesis is to illuminate the impact of singing and music on persons with dementia and their caregivers, and to describe a concept based on caregiver singing. The aim of Study I was to illuminate the importance of music events and the reactions and social interactions of patients with dementia or suspected dementia and their caregivers before, during and after such events, including the reminder of the day. The ethnographic method was used. Patients displayed the ability to sing, play instruments, perform bodily movements and make jokes during the music events. While singing familiar songs, some patients recalled distant memories, which they seemed to find pleasurable. During and after the music events, the personnel experienced a bonding with the patients, who seemed easier to care for. In Study II, the aim was to examine the employment of active music?making by caregivers during the course of their actual caregiving activities, focusing on verbal communication. The phenomenological-hermeneutic method was used. In the absence of music, patients communicated with cognitive and behavioral symptoms associated with dementia. During caregiving activities, the caregivers devoted their verbal communication to narrating and explaining the activities to the patients. However, the patients and the caregivers had difficulties understanding one another. When background music was playing, caregivers reduced their verbal instructions and narrating, while the patients communicated with an enhanced understanding of the situation, both verbally and behaviorally. When caregivers sang to the patients, a paradoxical influence was observed. Despite an evident reduction in the amount of verbal narration and description by the caregivers, the patients tacitly understood what was going on. In Study III, the aim was to illuminate the movement and sensory awareness characteristics of persons with dementia and their caregivers during usual morning care sessions, morning care sessions with background music playing, and morning care sessions in which caregivers sang to and/or with patients. Qualitative content analysis was used. It revealed that during the usual morning care session, patients exhibited slumped posture, sluggish and asymmetric motion, listlessness, minimal awareness of both their egocentric and physical environment, and a poor ability to perform activities necessary for personal care to completion. Both background music playing and caregiver singing had a strong influence on body and sensory awareness. Particularly during caregiver singing, patients displayed straight posture, strong and symmetric movements, and greatly increased sensory awareness of themselves and their environment. In Study IV, the aim was to illuminate vocally expressed emotions and moods between caregivers and persons with severe dementia when caring for patients during usual morning care sessions, morning care sessions with background music playing, and morning care sessions in which caregivers sang to or with the patients. Qualitative content analysis was conducted. Emotions/moods and vitality were interwoven. It sounded as if the patients regained vitality when listening to music and caregiver singing. In one group, positive emotions were dominant from the start and were enhanced when listening to background music and singing. Between one caregiver and patient, negative emotions and moods were dominant from the start and intensified during music listening and caregiver singing. Study V is a description of an active way of singing by caregivers, and patients are invited to sing along, but they can also respond in a receptive way and just listen to the singing. Conclusions: Listening to background music and particularly caregiver singing had a positive influence on the patients and caregivers.

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