Care Organisation TOOLKIT
Examples
Anna (the name is changed) has Alzheimer’s disease. She is always very clear in the morning, but as the day progresses, she becomes increasingly agitated. She constantly thinks she needs to go home, that she needs to see her mother, and that the bus is coming to pick her up. This caused a lot of efforts for the staff members to find the ways how they can calm Anna down.
Anna is very religious and always attends the church hour on Sundays, where she enthusiastically sings along with the music. The staff discussed that Anna’s care problem of becoming increasingly agitated as the day progresses could be alleviated by playing music that Anna recognizes, especially calming music. When familiar music is played, in this case, Christian music, Anna should experience a sense of recognition. They’ve created a playlist from the songs Anna sings during the church hour so that it can be used when necessary.
Anna was in the living room with her coat on, talking about how she was going to be picked up by the bus. Another resident told her this wasn’t true, which made her very agitated, and she started yelling. The staff took her to the visitor’s room, which was empty at the time. She was still very upset. The staff played the playlist. At first, she was in shock because she recognized the song. She then said that she always listens to it during the church hour and also that it reminds her how she was attending the church when she was a young woman and how it has helped her to feel relaxed and calm. She gradually became calmer. When she was calm, the staff took her to her room, and she went to sleep.
Mermory recall: Music has a unique ability to bring back memories and emotions from the past.
Elisabeth (the name is changed) is 86 years old, diagnosed with Dementia. She has a strong urge to move and cannot sit still if she is alone. She feels lonely and abandoned. When people are with her, for instance, during meals or in the living room in the afternoon, she stays seated. She has a husband who doesn't visit often and rarely receives other visitors. She loves having a chat but can quickly become angry if asked to do something she doesn’t want to do. She used to dance and sing a lot. She loves music and can sing almost all the songs she knows from memory, even though she struggles to find her words during a ‘normal’ conversation, often repeating herself or talking in circles.
The staff discussed that they can try to use music in order to keep Elisabeth seated, so she doesn’t walk around aimlessly. They chose the music according to Elisabeth’s taste and that is familiar to her – songs from her past and rhythms from the dance styles of her younger days. During the table sitting Elisabeth usually sits at the table, waiting for other residents to arrive for the meal. While the staff was setting the table Elisabeth came to the room and heard the music. She sat at the table and started to sing. She loved the music - “lovely, so beautiful. Wouldn’t you like to dance for a moment?”, - she said. The staff found it heartwarming to see how happy and joyful someone can become from music they haven’t heard in a long time. During lunch, Elisabeth and the staff had a long conversation about how beautiful it was.
Emotional and behavioral regulation: Music deeply impacts emotions, helping individuals manage anxiety, agitation, and other behaviors
Emotional and behavioral regulation: Music deeply impacts emotions, helping individuals manage anxiety, agitation, and other behaviors
Diana (name changed) lives in a nursing home. She has Alzheimer’s disease and is in the fourth stage. Due to her condition, Diana can no longer clearly express her feelings or explain what’s bothering her. She is still physically active but mumbles a lot and often sings to herself, which can be disruptive for the rest of the group. Her constant mumbling can irritate others, and she becomes restless during daily activities like dressing or washing. When she resists these activities, she can become aggressive, hitting, pinching, or even spitting.
The staff decided to try using music during the Activities of Daily Living (ADL), thinking that it might help calm Diana and make these tasks easier. They spoke with Diana’s family to find out what kind of music she enjoys. The very next day, the staff put their plan into action. When helping her get out of bed, they played some of Diana’s favorite music, listening to it together before starting the dressing routine. As Diana focused more on the music, she became calmer and more cooperative, making the whole process smoother for both her and the staff.Social interaction and communication: Music provides a way for individuals to connect socially, even those who struggle with verbal communication
Rimas (the name is changed) is a 58-year-old man, who cannot express his needs because of Demantia. He has been monitored for Down syndrome since birth. Recently, his condition has been deteriorating, he cannot stay at home, his orientation and perception are deteriorating, his daily living skills are regressing, outpatient care is ineffective. Nursing care and supportive treatment are provided. Lives under the care of a carer. Rimas is conscious, disoriented in time and environment, uncritical, slow thinking, unproductive. His mood is flat, emotions are superficial, speech is slurred, answers only a few questions in a low voice, eye contact is brief, attention is markedly impaired, often feels anxious.
Rimas participates in a group music therapy sessions 2 time a week, the duration of the session is 45-60 minutes. 4–8 patients participate in the session, depending on their health condition. The main diagnosis of the patients is dementia. The patients walk, move with the help of a wheelchair, grasp a stick, but are not self-sufficient, need constant care, have impaired orientation, memory, perception, wandering, behavioural changes, mood swings, anger outbursts, aggression, and are therefore treated separately in the fenced area of the nursing home ward.
The music therapy sessions took place in the ward foyer between the wards, where patients can watch TV, eat together, in an everyday environment that is familiar and does not scare them. Musical instruments were arranged on a large table, with patients sitting at the table so that they could pick up an instrument comfortably, and others sitting next to them on the bed, with the music therapist handing them the instruments. In good weather conditions, during the summer, music therapy took place outdoors in an enclosed courtyard area. There was no special preparation of the environment, as there was no possibility to do so, as many activities take place in the same space. Different music therapy interventions were used according to the group goals, such as emotional soundtrack, musical instrumental improvisation, fine and gross motor training, singing songs with a music therapist, listening to music to stimulate imagery, rhythmic stimulation (body percussion: clapping, tapping, dance elements). Group members were provided to various musical instruments – ocean drum, rain stick, diatonic bells, thunder drum, metallophone, castanets, musical bracelets, various small percussion instruments, acoustic guitar.
During the first three sessions of music therapy, Rimas was reluctant to join the group, watched from a distance, and kept approaching the therapist separately to ask for his name. Later, observing the others, he sat closer and closer, listened more acitvely, started to greet and look forward to the sessions, picked up the instrument (drum) and beat the rhythm with it while listening to the songs, and started to smile more. The staff members also felt happy that the music therapy sessions were taking place and that Rimas felt better, he was calmer and less anxious. Rimas' relatives also participated in several of the music therapy sessions, and as they observed that music helps to relax, calm down, promotes a better mood, develops attentiveness and a willingness to be in a group, and reduces physical and emotional discomfort.
Cognitive stimulation: Engaging with music can stimulate the brain, promoting mental engagement and alertness
Mykolas (the name is changed) is 73 years old man, hospitalized for nursing and supportive treatment. He was diagnosed with ischaemic heart and brain disease, chronic atrial fibrillation, arterial hypertension, diabetes mellitus and incipient dementia. He has moderate special needs, cannot walk, cannot take care of himself and has constant hip pain. A treatment plan was drawn up, which included consultation by a physiotherapist, the consultation of a spiritual assistant and music therapy.
Mykolas started individual music therapy once a week for 45- 60 minutes.Sessions were held in the hospital chapel, where the piano and organ instruments were. Already during the first meeting, Mykolas played the chapel organ, talked about the religious chants he had created, and tried to remember and play a few of them. During first meeting Mykolas mentioned that there was nothing else in his life but music. In his youth, he taught himself to play the piano and clarinet, and learned the secrets of musical notation and harmony with great desire and perseverance. He worked in a foundry, as a controller, and in his spare time played for many years in the Orchestra of the Blind. Now, in his old age, Mykolas does regret not having had the opportunity to study music professionally. It is like an unfinished dream. What's more, after two strokes, he can no longer play the piano as he used to because he has difficulty controlling the third and fourth fingers of his left hand. He is also unable to play the clarinet because he no longer has teeth.
The main goals of the music therapy were to help the client accept the situation and to focus on music making as a multifaceted resource for enhancing cognitive functions, independence and self-confidence, and meaning in life. Music therapy session always started with a musical greeting and little chat about last week happenings and feelings. After followed activities based on what client would preffer that day. Musical review of life was used as a main individual music therapy method. Also performing selected songs together with a music therapist and creating songs or song lyrics. Mykolas always prepared responsibly for the next meeting. He had with him a notebook of music specially enlarged by the therapist, a pencil, an eraser, and while waiting for the next meeting, he spent his time composing new songs and various melodies. During music therapy session he would love to perform it and to improvise together with therapist.
Music therapy has stimulated Mykolas need for intellectual activity, helped him to develop independence and self-confidence, and enabled him to make choices and decisions when writing or performing music. It helped him to accept his current situation and to focus on opportunities rather than limitations. Music therapy re-energised musical communication, reduced feelings of loneliness and isolation and responded to spiritual needs. In client‘s words, music activated his life force and allowed him to breathe and be happy again“.Enhanced quality of life: Music can uplift mood, evoke positive emotions, and generally improve well-being.
David (name changed) is an 85-year-old man in the advanced stages of Alzheimer’s disease. In addition to dementia, he has various physical ailments. Due to his age and the progression of Alzheimer’s, his physical condition has deteriorated, and he can no longer walk long distances, even with the help of a walker. David gets tired more easily now, and after breakfast, he usually likes to go back to bed. However, when it’s time for lunch, he often becomes grumpy and uncooperative when staff try to wake him up. Although David generally wants to eat, he resists getting out of bed. Once he is downstairs in the living room, his mood typically improves, but it’s a challenge to get him there. Because of his physical fatigue and Alzheimer’s, David’s mood is often irritable when the staff attempt to get him out of bed.
The team wanted to help David start his day on a more positive note, so they decided to use music as a way to cheer him up in the mornings. The idea was to create a warm, welcoming atmosphere to lift David’s spirits and get him moving. Since David loves music and often reacts positively by singing along, the staff planned to sing to him while helping him out of bed. The goal was to make the process smoother and improve his mood right from the start of the day.
One morning, David wasn’t feeling well and had stayed in bed all morning. The nurse assistant woke him up just before lunch, but despite being well-rested, he still preferred to stay in bed. The nurse assistant suggested that eating might make him feel better, and David agreed to get up. As they entered the elevator, however, David remained grumpy and tired, even though he had just slept. To brighten his mood, the nurse assistant started singing a song she knew David would recognize from previous experiences. As soon as she began singing, David recognized the song and started singing along immediately. His mood lifted quickly, and his voice was filled with joy. He smiled and seemed genuinely happy. The nurse assistant was pleased with the result and found that using music in this way was a simple yet effective tool for improving David’s mood and making the morning routine more pleasant for him.
John (the name is changed) has dementia and is living at nursing home. Also, he has suffered a stroke and as a consequence had difficulties in moving his left arm. He had problems attending physiotherapy but was willing to do simple exercises to strengthen his arm.
John participates in a group and individual music therapy sessions one goal of which is to address his physical difficulties caused by dementia and a stroke knowing that music and singing are wonderful ways to stimulate movement and thus to support physical exercises when needed.
As a part of group music therapy sessions, music therapist uses selected songs to support simple exercises while the residents sit in their chairs/wheelchairs. The movement in the song is used to support each exercise, for example marching tune for walking movement, songs in waltz tempo to support swinging of arms and moving the upper body to the sides and forwards/backwards. These simple exercises often wake the residents who tend to fall asleep all the time. They smile and look more cheerful. Clapping and rhythm instruments are introduced in order to stimulate their attention. On a good day, people make dance movements in their chairs or stand up to take a few dance steps.Improved physical functioning : Music can improve coordination and movement, which is why it's often used in physical therapy.