Tuning into the Soundtrack of a Life

"I don’t think I have ever worked with a person with dementia that hasn’t connected with music," says Dr Sandra Garrido, Senior Research Fellow in Brain Sciences at the MARCS Institute for Brain, Behaviour, and Development at Western Sydney University. "Sometimes the family will say, 'Oh, Dad has never really liked music that much', and then we play some music and Dad’s the one dancing down the hallway."

Garrido has a background in music and psychology, and her research brings the two fields together to study the use of music for mood regulation, improved mental health and wellbeing. Her research includes young people with depression and older people with dementia. 

"With younger people we find the lyrics are the most important factor in whether a song will make them feel better or not, because it’s about the message they’re taking from the music," she says. In people living with dementia, as that cognitive response is lost, the innate physical response to music comes to the fore. "We know that our physiological systems, our heartbeat and our breathing rate, will synchronize to an external beat," Garrido says. "Our key finding with people with dementia was that lyrics don’t matter so much, but tempo is very important."

There is a strategy used in music therapy that first matches the music to the person’s current mental state before gradually shifting them to a calmer state, says Garrido. On the other hand, in different situations she has observed that music can help people to reach an optimal state of emotional arousal or calm. "If they are anxious and agitated, you can calm them by playing the music that helps reduce their heart rate and slow their breathing," she says. Alternately, if a person with dementia is withdrawn and not engaging with the world, more up-tempo tunes can be used to bring them out. 

"When people get to a certain stage in dementia, and their inhibition is gone, you see just the natural response to music," she says. "It is quite beautiful to watch."

The response to music by people with dementia changes over time, Garrido has shown. "In the early stages of dementia people seem to be able to enjoy all sorts of music, including music they’ve never heard before," she says. As the condition progresses, the range of effective music narrows to a handful of songs. "For each person, there are maybe three or four songs connected with really strong emotional memories during their life — perhaps a song that they loved in their teens, or their wedding song, or something they sang to their children."

Connection to music can be deeply embedded. "Working with one lady, I played some opera and her face just came alive, and suddenly she remembered all these stories about how singing had been a big part of her life," Garrido says. "She had such a connection to opera, and she didn’t remember that about herself until she heard it." Given the powerful emotional connections — positive and negative — we make with music during our lives, it is also essential to identify and avoid music that could trigger traumatic memories, Garrido adds. 

Based on her findings, Garrido has worked with collaborators at The Dementia Centre, HammondCare, in Sydney, to develop training to assist aged care workers incorporate music into dementia-patient care.  

"The guidelines take caregivers through a six-step process for setting up a personalised music listening programme for a person with dementia," she says. A key point of the training is that the music is not just being used as entertainment, but as a targeted intervention to help with their specific needs, Garrido explains.  

"If they’re having sleep problems, there’ll be a playlist for that. Or if they have agitation around certain situations during the day, such as mealtimes in the noisy dining room, there’ll be a playlist and a strategy around when and how to use it," she says.  

As aged care staff are often time poor, the team recently distilled the training into a freely accessible one-hour online course. "We have also developed a 15-hour credentialled course," Garrido says. "There are modules designed for either aged care staff, or volunteers, or family members who are caring for someone with dementia."

"Sandra’s work has been significant in the effective translation of knowledge into practice," says Holly Markwell, National Programme Manager at The Dementia Centre, whose Dementia Support Australia service is led by the not-for-profit organisation HammondCare. "I have been working with Sandra since 2019 on the topic of personalised playlists, and it is a great example of how industry expertise and research-based evidence combines to create real world impacts, supporting quality of life for people living with dementia."

Garrido is now exploring the role of technology in enabling a wider rollout of individual music programmes in dementia care. "I don’t think the ideal technology exists yet for aged care staff to implement personalised playlists programmes en masse," she says. "The potential exists to explore how artificial intelligence could be used to streamline processes to help staff implement and monitor music programmes they’ve put in place for multiple people."