Handout for Geriatric Skills Day Workshop on Music for Behavioural & Psychological Symptoms of Dementia

1. Terminology
Music Therapy
Music Therapy is a discipline in which credentialed
professionals (MTA*) use music purposefully within
therapeutic relationships to support development,
health, and well-being. Music therapists use music
safely and ethically to address human needs within
cognitive, communicative, emotional, musical,
physical, social, and spiritual domains.
- Canadian Association for Music Therapy
*Music Therapist Accredited, designation from the
Canadian Association of Music Therapy indicating an
individual who has completed:
 Bachelor or Graduate Certificate
 1000 hour supervised clinical internship
 Certification Board of Music Therapy exam
 Continuing education
Music Therapists who have graduated from a Graduate
program are also eligible for registration with the
College of Registered Psychotherapists of Ontario.
Music Interventions
There are numerous active and receptive intervention
techniques that use music or musical elements to
address physical, emotional, cognitive, social and
spiritual needs. Many of these are commonly used by
the general public, however they may be utilized by
Music Therapists and other Health Care Professionals
to address therapeutic goals. Some common music
interventions are:
 Singing
 Playing Instruments
 Rhythm Based
Activities
Improvising
Composing/Songwriting
Imagery
Active Listening
Evidence
Clinical Guidelines
Music/Music Therapy was recommended for BPSD in the
following Clinical Guidelines:
 National Collaborating Centre for Mental Health (2007)
 Canadian Coalition for Seniors’ Mental Health (2014)
 Toward Optimized Practice (TOP), (2017)
Systematic Review/Meta-Analysis
“The results of this meta-analysis…showed that music
therapy influenced BPSD in patients with dementia. The
effects of music therapy on anxiety symptoms were
moderate, while the effects on depression and behavior
were small.” (Ueda, Suzukamo, Sato & Izumi, 2013, p. 637)
Qualitative Research
“The study findings demonstrated that the effects of music
go beyond the reduction of behavioural and psychological
symptoms. Not withholding the limitations, the study
highlights how music is closely linked to personal identity
and life history of an individual, how people at all stages
of dementia can access music and how music can help
improve social psychology of care home environments.”
(McDermott, Orrell & Ridder, 2013, p. 7015)
Key Considerations
The use of music is not formulaic or prescriptive, but
dynamic and relational. Some elements of music that
impact how an individual may respond include:
 Rhythm
 Melody
 Harmony
 Tempo (speed)
Volume
Familiarity of Music
Live vs. Recorded Music
Instrumental vs. Vocal
Evidence indicates that the music from an individual’s
teenage years (12-22) is the most impactful due to the
increased neurological development during that
developmental stage.
Music for Behavioural & Psychological
Symptoms of Dementia (BPSD)
Karen Blumenstock, MTA, NMT
MSc(OT) Candidate, McMaster University
karenblumenstock@gmail.com

2. Dementia-Specific Considerations:
Hearing Loss. Gradual deterioration of hearing
(Presbycusis) may impact an individual’s ability to hear
higher frequencies, or result in discomfort when hearing
loud higher-pitch frequencies (Loudness Recruitment)
Processing Speed. A slower musical speed (tempo)
may be beneficial for clients whose aural processing is
impacted by the disease progression.
Interdisciplinary Significance
Regardless of the professional role, some key uses for
music interventions include:
 Using music to build rapport
 Incorporating client-preferred music during interaction
(care, assessment, examination, etc.)
 Providing education to caregivers/family
 Referring to music therapy services if available
Sources
Canadian Coalition for Seniors’ Mental Health [CCSMH]
(2014). CCSMH Guideline Update - The assessment and
treatment of mental health issues in long term care homes:
(Focus on mood and behavior symptoms). Toronto.
McDermott, O., Orrell, M. & Ridder, H.M. (2013). The
importance of music for people with dementia: the perspect-
ives of people with dementia, family carers, staff and music
therapists. Aging & Mental Health, 18(6). 706-716.
National Collaborating Centre for Mental Health (2007). The
NICE-SCIE Guidelines on supporting people with dementia
and their carers in health and social care. NICE Clinical
Practice Guideline (42). British Psychological Society &
The Royal College of Psychiatrists.
Toward Optimized Practice (TOP) cognitive Impairment CPG
Committee 2017 Feb. Cognitive impairment: diagnosis to
treatment clinical practice guideline. Edmonton, AB:
Toward Optimized Practice.
Ueda, T., Suzukamo, Y., Sato, M., Izumi, S.I. (2013). Effects of
music therapy on behavioral and psychological symptoms
of dementia: A systematic review and meta-analysis.
Ageing Research Reviews 12/ 628-641.
Unmet Need/Trigger Therapeutic Goals Musical Intervention
Physical
 Lack of Sleep
 Physical Pain/
Discomfort
To promote
relaxation/sleep
To provide distraction
from discomfort
Entrainment1
of heartbeat with relaxing music (50-60 beats/min.)
Musical engagement (singing, instrument playing, imagery,
reminiscence) as distraction from discomfort
Intellectual
 Previous Function
 Communication
 8 A’s of Dementia
 To increase cognitive
stimulation
 To facilitate non-
verbal communication
Strength-based learning of new or familiar instrument
Facilitated reminiscence through familiar music
Improvisation to communicate feelings and emotions
Musical Speech Stimulation (MUSTIM)2
to trigger automatic
speech and stimulate spontaneous speech
Emotional
 Mental Health
 Current Mood,
Anxiety, Fear
 To encourage self-
expression
 To reduce agitation or
confusion
Strength-based musical participation; validation of participation
Provision of client-preferred music to evoke emotion/memories
Music in Psychosocial Training and Counseling (MPC)2
to
address psychosocial function
Capabilities
 Vision, Hearing,
Mobility
 ADLs/IADLs
 To increase alert
responses
 To increase sense of
dignity during care
Entrainment1
of heartbeat with upbeat music (60-125 beats/min.)
Musical Sensory Orientation Training (MSOT)2
to increase
attention, arousal and sensory response
Music provided during care (live or recorded)
Rhythmic Auditory Stimulation (RAS)2
during exercise
Environmental
 Physical
Environment
 Social
 To decrease sensory
over-stimulation
 To promote positive
ambiance
White noise/relaxing music to block out upsetting or
overwhelming auditory stimuli
Stimulating music chosen based on group preferences and to
reflect appropriate mood/level of arousal for current activities
Social
 Family
 Friends
 Professionals
 To increase social
interaction
 To facilitate emotional
connection
Group music participation
Choral singing
Dancing
Shared musical experiences with family/caregivers
1
Refers to the synchronization of organisms to an external perceived rhythm
2
Indicates Neurologic Music Therapy (NMT) technique (https://nmtacademy.co/)
Using Music to Address BPSD
Below potential triggers for responsive behaviours (PIECES™ framework) are presented alongside potential therapeutic
goals and interventions. This is NOT a comprehensive list, but may provide ideas for the uses of Music for BPSD.