Music and Memory: A Caregiver’s Tool for their Toolbox

Virginia Federation of Chapters of National Active and Retired Federal Employees Convention

Cathy Tompkins and Emily Ihara April 14, 2015

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Teaching Young Adults about Older Adults

When I am 80 exercise: What will I look like?

Where will I live?

What will I be doing?

What will I be known for?

Experiential learning Research experiences

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Research Interests

Dementia Care

Non-pharmacological Interventions Future needs

Caregiving

Reduction of stress Respite care

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The Older Population

In 2010, 40 million people age 65 and over accounted for 13 percent of the total population in the United States. In 2030, the number of older Americans is expected to grow significantly—to 72 million, representing nearly 20 percent of the population (NIA, 2012).

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The Older Population

The 85+ population is projected to increase from 5.9 million in 2012 to 14.1 million in 2040 [

AoA, 2013

] The great majority of those over age 65 today are healthy, happy and fully independent. Normal aging changes may lead to adjustments in some physical and mental health functions but often are able to be maintained with proper health care.

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The Older Population – Chronic Conditions

Just under half of Americans age 50-64 have a chronic condition, nine out of ten Americans ages 75 and older have at least one chronic illness, and more than 20% of those 75 and older suffer from five or more chronic illnesses [AARP, 2010]

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Alzheimer's Disease is not Normal Aging!

Alzheimer's disease is a type of dementia, a general term for a condition in which someone develops cognitive problems as a result of changes in the brain. Alzheimer's is thought to be caused by the buildup of toxic proteins in the brain and is said to be the most common type of dementia [

Alzheimer’s Association, 2012]

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The Older Population (continued)

By 2025, 190,000 Virginians are projected to suffer from Alzheimer’s disease (Alzheimer’s Association, 2014) compared to approximately 130,000 in 2014.

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Caregiving - defined

A caregiver is anyone who provides help to another person in need.

The Family Caregiver Alliance defines a caregiver as an unpaid individual (a spouse, partner, family member, friend, or neighbor) involved in assisting others with activities of daily living and/or medical tasks. Formal caregivers are paid care providers providing care in one’s home or in a care setting (daycare, residential, care facility, etc.)

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Who are the Informal Caregivers?

65.7 million caregivers make up

29%

of the U.S. adult population providing care to someone who is ill, disabled, or aged 43.5 million of adult family caregivers care for someone 50+ years of age and 14.9 million care for someone who has Alzheimer's disease or other dementia.

[Alzheimer's Association, 2012]

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Who are the Informal Caregivers?

An estimated 66% of caregivers are female. One-third (34%) take care of two or more people, and the average age of a female caregiver is 48 years old. Among spousal caregivers 75+, both sexes provide equal amounts of care [

Family Caregiver Alliance, 2012

]

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Who are the Informal Caregivers?

72% of caregivers care for a parent, step parent, mother-in-law, or father-in-law, and 67% of caregivers provide for someone age 75 or older [

Gallup Healthways Wellbeing Survey, 2011

]

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Caregiving – Who Becomes a Primary Caregiver? Why?

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Interventions for Individuals with Alzheimer’s Disease

Adults with Alzheimer’s disease have shown improved cognitive functioning and emotional well-being after participating in art and music activities.

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Music

Stuckey and Nobel’s (2010) literature review of creative arts interventions found music engagement: Decreased anxiety, tension, and pain Increased immune system functioning in clinical populations

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Music

Musical training can produce life-long benefits, preserving auditory neural precision that decreases the risk for subcortical auditory processing decline and, thus, stabilizing speech production despite natural aging (Parbery-Clark, Anderson, Hittner, & Kraus, 2012a).

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Music

A participatory music intervention for older adults with dementia helped increase resident behavioral engagement over time, as compared to a reading control group (Harrison, Cooke, Moyle, Shum, & Murfield, 2010). Thaut and colleagues (2009) employed a music therapy intervention for patients with brain injuries, with results showing improved cognitive functioning and decreased depression and anxiety.

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Alive Inside

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Study Site for our iPod Intervention

• • • Insight Memory Care Center (IMCC) is the only dementia specific adult day center in the Washington D.C. area that cares for participants in all stages of Alzheimer’s disease.

During the Fall of 2014, there were 18 people in the Early Stage programs, 38 people in the Mid-Stage program, and 9 people in the Late-Stage program.

IMCC is a Music & Memory Certified Care Facility (musicandmemory.org) and has been using iPods to reawaken memories linked to emotions through the use of personalized play lists for certain individuals.

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iPod Pilot Study

• • • Staff identified the late afternoon as a high-stress transition time as participants begin to be picked up by family, a non-family caregiver or leave by arranged transportation (van/bus service).

Our study was designed to examine the effects of personalized music during this high-stress transition time (3:00-5:00 pm).

Control group participants and intervention group participants not listening to their iPods are involved in the scheduled center activities.

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Sampling

• • • • Introductory recruitment letter was sent out to caregivers of center participants in the mid- and late stage programs.

Out of the 44 recruitment letters sent, 31 consents were received.

The 31 participants were randomized into treatment and control groups.

Obtained assent from the participants when possible.

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Description of the Sample

Intervention Group Control Group

Average age: 76 years 50% female; 50% male 50% have a college degree or higher 19% are in the late-stage program at IMCC Average age: 77 years 43% female; 57% male 71% have a college degree or higher 14% are in the late-stage program at IMCC

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Methods

• • • • Every day that IMCC was opened, 2-3 members of our research team observed and noted behaviors of both intervention and control group participants during a 2-hour window.

Baseline data for the day is collected for the first 30 minutes when participants are typically involved in a scheduled activity.

After snack, intervention group participants are offered their personalized iPods, and other participants at the center engage in balloon volleyball or other individualized activities.

Data about iPod use and emotional/behavioral responses are recorded on the Music and Memory program’s patient response form.

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Preliminary Findings

Common Themes (Intervention Group)

Engaging

: participating in an activity alone or with others

Socializing:

a behavior of participating, interacting and engaging that stimulates joy for some and agitation and aggression in others

Vocalizing/talking

: a human behavior that enables individuals to express wants, needs and emotions; sometimes understandable; indication of being “alive inside.”

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Engaging

• An 81-year-old woman in the Late-Stage program listens to her iPod for an average of 33 minutes. She is non-verbal, but when she listens to the music, she sometimes answers staff’s questions clearly and loudly. She moves her body forward and back as she listens to the music, and at times moves her hand up and down in rhythm. Her husband told one of the researchers that she used to sing all the time, but doesn’t anymore. However, it is clear that the music triggers some positive reactions.

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Socializing

• A 76-year old male in the mid-stage program at IMCC becomes very engaged when he listens to his iPod. Sometimes he talks about his past work experiences, where he lived and went to school, hums to the music, or pretends to play the guitar. He is much more verbal when he has his iPod on than when he is in the large group. His music also seems to stimulate him and help him recall memories. He listens to his iPod an average for about 48 minutes.

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Vocalizing/Talking

A 75-year-old male in the mid-stage program enjoys listening to his iPod. He verbalizes with rapid speech, and taps his feet and claps his hands to the rhythm. Although it is difficult to understand what he is saying, he “chats” quite a bit while he is listening to his iPod. He listens to his music for an average of about 39 minutes.

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Next Steps

Future Research

o Strengthen the intervention study to test the effectiveness of a personalized music intervention of older adults at the mid to late stages of AD.

o Explore the effectiveness on a personalized music intervention on stress, anxiety, and depression among caregivers.

o Build the evidence base around the use of personalized music reducing behaviors associated with dementia.

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Questions???

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