Communication for people living with dementia becomes increasingly difficult as language abilities are compromised. When the need to communicate is unmet, it can contribute to anxiety, agitation, depression and more.

A recently published study shows that music, especially familiar music (and especially from childhood and youth), is linked to long-term memories and can open a person to communicate.

Formally titled, Caregivers’ Experiences of how Music facilitates Communication for People with Dementia, the study out of the University of Calgary focuses on how caregivers – both formal and informal – experience the effects of music on communication for people living with dementia.

About the study

Nine formal caregivers (including six music therapists and three health-care aids), and four informal caregivers (including three spouses and one daughter), were recruited for the study.

A grounded theory methodology was used, which involves the researcher seeking to identify a “theory” that is discovered or “grounded” in the data. As qualitative, the study allowed acknowledgement of the subjectivity of caregivers, as well as the researcher's own in the construction and interpretation of the data. A total of 16 interviews (13 via Zoom, three via telephone) were conducted, including three follow-up interviews. Additionally, one Zoom focus group was held with a mixture of three formal and two informal caregivers.

For the study, caregivers described examples of music-aided communication by people living with dementia. These examples included verbal and nonverbal communication:

Verbal:

• Singing
• Humming
• Speaking
• Utterances

Nonverbal:

• Facial expressions
• Eye expressions
• Body language
• Rhythmical actions (e.g., tapping, moving to the beat and dancing)

Results

Three enriching categories emerged from the discussions with caregivers: (a) Relating with Others, (b) Memories through Music, and (c) Being in the Moment. As actions, these can be seen simply as relating, remembering and being.

The interplay of the three categories resulted in an emergent theory, an all-encompassing main category, which is described as Communication through Emotional Connectedness. This is reflected in the diagram to the right, which shows the three categories linked together to make the main category. The musical note is to emphasize that music enabled these findings.

Furthermore, each of these categories are made of sub-themes. Here is a breakdown of each:

Category A: Relating with Others

Key sub-themes of this category are The Voice, Body Language, and A Conduit, which are visible in the diagram to the left.

• The Voice: This represents when the person with dementia used or responded to the voice in any manner to connect with the caregiver. The familiar voice also added emotional connectivity, especially through song/humming, which is a more intimate way of using the voice.

• Body Language: This represents visual signs shown by the person living with dementia such as smiling, making eye contact or turning towards the caregiver, and rhythmical indicators such as tapping to the beat and dancing.
• A Conduit: This represents the sharing of experiences by both parties (for example, a meaningful moment triggered by music, which could be reflected in body language and facial expression).

Category B: Memories Through Music

Key sub-themes of this category are Identity, Reminiscing, and Familiar Music, which are visible in the diagram to the right.

• Identity: This represents a sense of awareness (including culture), which could enable a re-attaching to oneself, leading to connection with the caregiver. Triggering identity through music can enhance and strengthen emotions, especially those of positive connection, such as love and building a relationship.

• Reminiscing: This represents triggering memory through familiar music. This can be verbal recollection or engaging with a familiar song through humming, singing or body language (e.g., closing eyes, having a faraway look) indicating reminiscing.

• Familiar Music: This represents music, ideally from early life, that is engrained in long-term memory. Familiar music can help connect to past meaningful events by triggering the recall of words and melodies. Familiarity can enhance emotional connection, as memories are linked to emotions.

Category C: Being in the Moment

Key sub-themes of this category are Anchoring, Togetherness, and Being in a Safe Place, which are visible in the diagram to the left.

• Anchoring: This represents a sense of awareness in the moment — of engaging with the caregiver and connecting. Intimacy is also reflected in anchoring, which was seen by holding the caregiver’s hand or having a softer tone of voice.

• Togetherness: This represents a sense of being together and connecting in the context of the moment. Togetherness is an “I’m with you” or “I’m listening to you” moment. Togetherness can lead to natural and spontaneous self-expression such as singing and recalling words.

• Being in a Safe Place: This represents how safety emerges as a sense of “the bubble”, or a feeling of safety and autonomy. Being in a safe place can become a communication enhancer for people living with dementia when they become aware of unconditional acceptance by the caregiver.

Discussion

The results show communication emerges as a dynamic interplay of the main categories (relating, remembering and being), leading to emotional connectedness. Caregivers experience music as facilitating far deeper interactions than merely appropriate responses to daily living for people with dementia. This is reflected in signs of the interplay of relating (smiling or dancing), remembering (joining in a familiar song or recalling a memory) and a state of being (a feeling of awareness and openness to the caregiver).

Photo courtesy of Canva.

Emotion emerges as a universal mediating factor reflecting that music is primarily emotive as it facilitates relating, remembering and being. Examples of emotional communication include smiling, eye contact, hugging, touching, kissing and holding hands. As emotional connectedness, communication is the process of making a connection to the caregiver caused by emotional responses to music, which results in sharing experiences, feelings of togetherness (physical, emotional and cognitive) and open and engaging body language.

Making an impact 

Based on the insights of a diversity of caregivers in real-life situations, this study results in a new and deeper understanding of how music can aid communication through emotional connectedness. Caregiving emerges as relational and emotive through music, which enhances the potential for mutually beneficial communication, as caregivers also became emotionally connected.

These results show improving communication for persons with dementia has the potential to better their quality of life as it enhances relationships with caregivers. This can be significant for spouses and families, as communication can maintain the sharing of lifelong memories.

The findings of this study provide a solid basis to build future research in a diversity of settings and health professions.