Episode 73 - Does Music Help Dementia With Alexis Baker

Welcome to Caregiver Relief. I'm Diane Carbo, a registered nurse and your host today. We have an incredibly important and uplifting topic to discuss, and it's does music help dementia?

Music is a universal language that speaks to all of us, and for those living with dementia, it can be especially powerful. I've seen the impact of music in my career over and over again. So I'm really excited to dive into this topic with our special guest today, Alexis Baker. Alexis is a board certified music therapist, a certified dementia practitioner, and the founder of Bridgetown Music Therapy. Her mission is to spark joy and improve the quality of life for older adults, particularly those living with dementia through meaningful music engagement.

Alexis is passionate about making a real difference in the lives of those she works with. And I just can't wait to hear what she has to share about her insights with us. Welcome Alexis. And thank you so much for being here. Oh, thank you, Diane. It's so good to be with you today. I'm excited. I think that it's really important that we start with telling our listeners, what is music therapy and how does it differ from simply listening to music?

Yes, absolutely. That is actually one of the questions I get the most as a music therapist. It's growing the awareness of music therapy, but it's still not fully in the general public's awareness and knowledge. So I still get that question a lot. Basically what music therapy involves, the formal music therapy, is a board certified music therapist, someone to facilitate the services.

And evidence based music interventions that are designed to accomplish very specific goals, which address the needs of a group or individual. So if it doesn't include both of those things, then it's not truly formal music therapy. And there is a myriad of different Music program services ways to use music and there can be a lot of overlap.

There can be things that look like music therapy, but aren't actually music therapy in the formal sense. So music can be used in a lot of different ways, but music therapy as a field profession an organized health care application is very specific. Can you share your journey, what led you to become a music therapist, and why did you choose to focus on dementia care of all things?

It goes back to two main things. So I grew up in a family where music was very highly valued and supported. And my parents wanted my siblings and I have a solid musical foundation. And so they had each of us begin piano lessons from a young age. I started at the age of eight. And then at the age of 10, I switched to guitar lessons, began playing guitar, fell in love with guitar, and I've been playing ever since then.

So I've always loved music. We had a family band at one point where my siblings played. I know so much fun. My siblings and I were writing and performing music together in coffee shops, and it was a blast. So I've just always been surrounded by music and in one way or another. And when I

began thinking about what I was going to pursue in life as a career and what I was going to go to college for I always knew I wanted to do something that involved helping people. So I thought about nursing, but I can't handle the sight of blood and bodily fluids and all of that. So that was quickly, you wouldn't have made a good nurse kid.

I'm glad I learned that early on and it was ruled out. I think I would have been an excellent nurse aside from that. And then I thought about counseling and psychology. But in the back of my mind , I couldn't help, but think I want to do something that involves music. And it was at 16 that I first heard about music therapy and that sounds like exactly what I want to pursue.

 I started looking into it and seeing what's involved and it's really just the perfect combination of music, using music and helping people. So then I started down the path of becoming a music therapist, completed all of the coursework and practicums and 1200 clinical hours of training, and then took the board certification exam and all of that.

So that's the music therapy side of it. And then my grandmother had Alzheimer's disease. She was diagnosed with it when I was a kid, didn't really understand it. But as I got older and she ended up passing when I was 16 and seeing her in the later stage of the disease, it made a really big impact on me and she was my first real exposure to dementia and it just made a huge impact on me and then I was able to see the interplay, the relationship of music and dementia and how they just go together and how music can be so supportive through the dementia journey.

You know what I can tell you. I've seen that through my whole career and people don't understand the power of music. And that's why I'm so excited. We're talking about this today. So that people may become more aware. Alexis, how can music benefit people living with dementia? And are there any specific improvements that you can observe and tell us about? I can say that researchers have been studying music and the brain for decades, and there are a lot of exciting advancements and discoveries that have been taking place.

Researchers are able to see how using MRI magnetic resonance imaging, they're able to see how music is one of the few things that activates all areas of the brain. So on the MRI screen, they see all the different areas of the brain lighting up when a person is engaged in a music based activity.

It could be singing. It could be listening to music or playing an instrument and music activates the feel good centers of the brain so it can help release and produce more endorphins in the body. And that leads to all kinds of wonderful benefits. It can even help create new neural pathways in the brain which is amazing in thinking about dementia and how dementia is a progressive condition that starts to break down the brain. But music is almost like a workaround to accessing language, speech receptive communication memories, all kinds of things. So it is a very exciting topic to talk about because there's a lot happening in the research world, and on just a more basic level, that's like the physiological level with the brain, music can release stress and anxiety. It can help improve mood, uplift the spirit, help get a person moving physically. It's a natural motivator. It can help people connect socially. It can support self expression or creativity. I could go on. There are many benefits to music. I want to share a story.

I was working in senior behavioral health and we had this older lady with dementia in the hospital, she was in like a catatonic state. She was there for several weeks. She never spoke, never grunted even, never made any noise. And I had a girlfriend, but she was very involved in her church.

And she was part of the choir. So I had a friend come in who played gospel music and stuff. And she came in and I brought this little lady with a lot of other clients to the activity that day. And literally we had asked the family, is there any special songs that she liked and stuff?

We were just curious. Now I want you to know I was clueless about music therapy. We were just trying to reach her somehow, some way, and this was decades ago, baby girl. That's a good place to start is asking. Yes. Specific songs, singers, what are their musical preferences? Huge. This lady's sitting literally in a reclining wheelchair, and she doesn't move, she doesn't talk She eats only if we stimulate her mouth to swallow.

And we're sitting there and I had my girlfriend come in who had beautiful music and very talented piano player. And she started playing gospel songs. And some of the ones that this lady knew for the first time in weeks. This little lady starts mouthing her words and singing like it was soft, like audibly.

Yes. Yes. And it was like. It literally brought tears to our eyes because, we've been trying, you try so hard to reach people, or think that they're still in there. It's just that you always see that blank stare. But one of the cruel things about dementia is that's why we call it the long goodbye is there are moments where a person will just have a fleeting moment of connecting with you in some way or some form.

And we had not had that experience with this little old lady. She was a sweet little girl. Cute little black lady. She was Southern Baptist, with the gospel songs and we got to her and it was my first experience with seeing the power of music and we had the family come in. We had church members come in and sing with her and it was just a beautiful experience.

And it just means so much to people when they feel like they can make that connection with their family member once again. I love this topic. Can you tell me what it is about music that makes it so effective in engaging with people with dementia? Sometimes it's difficult to put into words.

I like to say, sometimes it's It almost seems magical or miraculous, like sometimes there's just no explanation, even though there is a lot going on at the brain level. But a lot of it has to do with all the different elements involved in music. You have pitch, melody, timbre, harmony, lyrics, like each of those is engaging in its own way. And you never know what will trigger someone to make a connection or something like that. So there's a lot of creative arts therapies and they're all effective in different ways. But with music, it really does involve all the parts of the brain.

So yeah, it's pretty amazing. And it's an evidence based therapy. It's been studied how it's been effective. People that don't play music don't understand how it truly is a way to connect people. It's a universal language. And I mean that from the sense that a person from Africa or India or China or here in the U. S. can see a piece of music and play it and understand it. So whether, while we don't have languages that always we understand. Music is truly a universal language because everybody reads and understands when they play music, what people are expecting and what they're going to hear. I just think that's amazing.

My next question for you is, Alexis, can you explain how you tailor music therapy sessions to meet the needs of each client?

Yes. So with formal music therapy we, as music therapists are trained to complete assessments on our clients. And that involves really looking at all the different, we call them domains of functioning, all the different areas of being as a person. Their mental, physical, emotional, spiritual psychological, different areas of functioning and see where the greatest need is. See where there's an area we can use music to address and create specific goals and objectives to work on in the therapy. So it's definitely based on getting a picture of them as a whole person and then deciding what are their greatest needs and what can music based interventions address.

One of the things I do with my clients is I have them create a person centered profile. You really need to try to individualize care, especially for someone with dementia, because they can't tell you their history or what their likes or dislikes are. And one of the things I do is really encourage, not only be very specific about what their likes and dislikes are, but include their hobbies, activities, and music that they like, and families don't realize how important or when they hear music that is from the military or the Star Spangled Banner or patriotic music, It invokes something in them that they feel comfortable and good about it, can even be comforting for some of them, because I've taken care of some really challenging behaviors and music can be calming and comforting in so many ways, and we don't use it enough in our culture we, especially if you're in a memory care unit or something they don't make it a priority as much as they should, because I think that everybody should have some form of therapy like that every day and a family should be able to go in there and provide that, especially if they want to try to make that connection again.

Yeah, I feel like in Western cultures, we view music more as just entertainment. Something that it's more of a receptive experience versus actively engaging in it.

One of the things I like to say often is, music is like a vitamin and a little bit every day can do wonders to just nourish the heart, the mind, the soul. So I really encourage people to engage in music in some way every day. And it doesn't have to just be listening Yes. dance, there's singing, there's playing, there's using music for relaxation, like really leveraging as a music as a tool in your life to support your well being.

I like that the vitamin approach. I really do because we don't utilize music in healthcare as much as we should, and we're starting to do it a little more. But I know that physicians or surgeons in surgery use music sometimes because it's supposed to enhance healing and, improve their mood so that they've experienced less pain and those types of things.

And I think, people discount the power of music. Have you encountered cases where music therapy made a significant impact on your patient's behavior or mood? Oh, yes, absolutely. I have seen so many amazing things in my work over the years.

One of my favorite ways to witness the power of music is its ability to help a person find their voice again. And that could be in a physical way. I'll share a little story. There was a woman who had recently had a stroke. She was in a group setting. So I wasn't aware of the fact that she had just suffered a stroke and had lost her ability to speak, but I was just doing my thing, making my way around the group engaging all the residents of a memory care community.

And I got to her and knelt down to her level made eye contact and started singing a familiar song. You are my sunshine. It's very familiar to many. And she similar to your story, she began audibly singing. Yes. And there were a couple of staff members just behind her, and their jaws dropped. They were like, what?

Yep. Yep. She was not speaking, and now she's singing? It doesn't always make sense, but music can do amazing things. Yeah I worked with patients who similar to you that stuttered or were aphasic. They had an inability to express themselves verbally, but if they do it in a song, they all of a sudden it's easy for them.

So it's definitely a different part of the brain, but it helps people get over and families don't know that families need to know that, I have people that sing all day long, they're not the seniors so much, but there are happy people out there that just makes sing all day long because it makes them happy.

And I've had aides that do that and nurses, they'll go in and sing to the patient and just being silly. And it's fun because people that can't respond all the time, just think you can see a little twinkle in their eye or they'll smile or they'll just, and some of them will try to sing along.

And I just love that. I love it. It's just it's a second of connection that we never may have experienced and it may mean so much to that person in that moment. And it may be the only thing that good that happens to them the rest of the day, but they've had that experienced. Yeah, we've had staff and family members who say it brings them back to life.

Yes. It breeds life into them, and I've worked with many hundreds of individuals in advanced stages of Alzheimer's and other forms of dementia where they have gradually lost their ability to speak but sometimes they can still sing and sometimes it surprises you, they just start belting out a song and they know all the lyrics and it's beautiful and I'm just there to support them and let them do their thing because it, yeah, it may be an experience that is few and far between to just have that ability to be self expressive. Yeah. And you have to embrace those moments because that's coming from their long term memory, deep in their long term memory, and it still exists. So it is just a beautiful thing that they may not know who you are. But they'll remember that song and it makes them happy. You can see it calms them or makes them happy. I want to ask you, how do you involve family caregivers in the music therapy process? Yeah, that's a great question. I have had families where I've worked just directly with a loved one and and working with the family members more of a checking in with them or asking them questions about their loved one.

But then I've worked with individuals where their loved one is. right there in the session. And it's more of like there was a mother daughter duo who the daughter who was the mom's primary caregiver. She was part of the music therapy sessions. And so the focus really becomes providing them opportunities to connect with each other through music.

And that's such a beautiful thing that another way music can be used for that social and relational connection. So can you give me some suggestions that my family caregivers can use in using this type of approach at home when they still have their family member at home? Yes that actually has to do with I just contributed a chapter to a book called The Caregiver's Advocate, and the whole chapter is on this.

It's the chapter's called Sparking Joy and Connection, and it's seven ways to infuse music into dementia caregiving. So I love that. I love that topic. I love the title. Yeah. I literally go through seven different ways practical and like concrete ideas and tips of how to do that. So just really quickly there.

Singing, so singing together. It sounds simple, but a lot of people just forget to use music in the simple ways singing together, playing an instrument and don't think Oh, I have to go out and buy an expensive instrument and start taking lessons. Nope. Just find one that is user friendly.

You can just pick up and play it. A maraca, a hand drum, a harmonica. There's all kinds of instruments that you don't have to have a lot of knowledge to play. Dancing, dancing together, listening to music together, and really using it as a conversation starter, a catalyst for reminiscence. And it's really important to find music that is familiar to them that they prefer and that hopefully they have some memories tied to it so that you can use music in that way of really drawing upon those older memories. That's that was going to be my next question.

Are there certain types of music that tend to resonate with individuals with dementia, or is it very personal? I'd love your thoughts on that. Yeah, it's both music is very personal and everyone interacts with and experiences music differently. We're all drawn to different kinds of music and we may interpret or experience music differently than the person next to us, but then you can look at it in a collective way, like looking at a particular generation and there's a general rule of thumb that the music a person will resonate most with is music that was popular or like well known from their childhood, their teens, their 20s and 30s.

So that's, it's a 30, 20 to 30 year span you can look at and just as a starting point, pull music from those decades and yes it typically works. Working in nursing homes, one of the things I learned that I just loved was Lawrence Welk on TV. And I don't even know if you know who Lawrence Welk is, but I'm going to challenge you right now.

Lawrence Welk, he was a conductor and he had a show every weekend. I think it was Sunday nights. And I think it was right after or before it was before Ed Sullivan, which is another man you don't know, but anybody who has somebody. I'm 71, so these are things that I saw what I was a kid but, the big thing in the nursing homes, especially for like my grandparents and even my parents who are both deceased it was sitting around, they couldn't wait to sit around and get in front of the TV to watch Lawrence Welk and it's singing and dancing and in a nursing home, it was the highlight of their week.

It's just sitting and listening to Lawrence Welk. And you need to look them up because we've got some 80, 90 and 100 years old that would love to hear Lawrence Welk. Absolutely. I get requests all the time. Yes. Oh, I'm sure you do. Constantly learning music from those decades. Yes. How can caregivers use music at home to help soothe or stimulate a loved one with dementia?

Do you have any suggestions there? Yeah once again, that can be subjective. So it really depends on your person and what music they enjoy. But there is music in general that is considered calming and relaxing. I recommend starting with a playlist that spas use with massage therapy treatments and other treatments like that.

If you're looking to just have music on in the background nothing too stimulating sometimes instrumental music is good. is good because it doesn't have the lyrics. So you don't want to overstimulate or overwhelm someone with too much going on musically. It's just more to process for the brain.

So yeah, there's a couple ideas for just starting points. And then it really depends. Are you looking for Music at to accompany an activity like painting or coloring or car rides or yeah, it just depends. I know that's not the best response, but no, one of the things that trial and error.

And one of the things I think the family caregivers aren't aware of is the TV's on and it has lots of especially the news can be very unsettling for a senior or just a violent movie and people aren't in tune to, that's not what they need and it can cause them to be anxious and especially those that are sundowning and they start pacing and become anxious.

And one of the things that I encourage my family caregivers to do is lower the blinds, put dim lights on and put soft calming music. Right now I help people with dog sitting sometimes and we have a lot of dogs that have anxiety or separation anxiety or just, whatever.

And one of the things that I love, and I listen to it without any dogs around, and it's one of the things I used to do because I'm not doing hands on anymore, but it was always when I worked in the evenings was to put soft, calming music on. But Amazon has or YouTube has lots of Anxiety music for dogs, anxiety for dogs and stuff, and they're like 10, 12, 15 hours long sometimes, and I have to tell you, I put them on for the dogs, and there's times when they don't need it, but I like to sit and listen to it when I'm trying to do something because it's calming me.

So family members need to explore and be aware, Hey, with our aging population, we have more seniors than youth. We have to be smart about how we approach our seniors and care for them. And one of the things to do is we can use music as that tool to provide calmness.

And if you will, serenity to someone and instead of, the aids in the memory care, they're all trying to get people to bed or whatever and get them PM care, which means, getting them their pajamas on and washing their face and brushing their teeth as if that happens. But let's pretend.

And you always have the person that doesn't want to shower, doesn't want to do those things. And you're dealing with a lot of stress and anxiety. And I always mix the calming music with lavender, so you're taking all the senses and trying to calm somebody. So yeah I really think that's really important.

And if you want to wake somebody up, just put on a good, my generation, or not my generation, but my parents generation, they love swing, they love, there's music out there that, my generation's we're classical rock and roll. I don't know. I laugh. Because I don't know what the younger generations that are into head banging and stuff, I don't know what they're into either.

I don't know how that's going to work. I don't know how that's going to work.

I love the music of the older generations. That's one reason I'm drawn to working with older adults is because I love the music of those generations. And I'm glad you mentioned the TV because it can be very jarring. It's even sometimes for me, like a quote unquote, typically functioning person And so yeah, reducing distractions and stimulation and then also you mentioned getting ready for bed and the shower, challenging behaviors, all of that.

Music can be a great tool for transitions for like I had a caregiver who would sing like in a sing song way, she would sing like what they were doing or, Oh, you must be frustrated. Like acknowledge them through song and just help them feel better in that way. And singing in the shower, I had another caregiver who had a specific shower song.

How much is that doggy in the window was their shower song. And it just helped. Like it, yes. It made everything better in the shower. Yes. Yes. And people don't understand that about music. And when they're dealing with battling a person that even the sing songy way, that's what I was saying.

Some of the nurses and aides, they going out hi, and I can't sing at all, but, I'll make an effort and I go, I'll just approach them and hey, are you ready to go? Yeah. Just something silly, right? And it's corny and silly, but people don't understand that people with dementia may not understand what you're saying, but they pay attention to your tone and or the way you look.

So even if you're frustrated and angry and just want to scream, you have to put a smile on your face and talk sweet and sing and be encouraging. And it's really hard because for so many caregivers, family caregivers are just tired, but it could make their lives so much easier because the person with dementia is picking up on your cues.

They're picking up on your vibrations or whatever. So you have to change your perspective and change your attitude so that you can get them to do what you want. And it's not through anger and frustration, it's taking a deep breath and just, approaching it, thinking, like you said, put on some soft music.

Dim the lights if you have to, if they're stimulated, turn the phones off because a phone ringing, not many have landlines anymore but those landlines, if a person, gets a phone call it's disrupting. And, they don't know how to respond. They don't know how to talk, but even just the noise of the phone.

And that's one of the things that people have a hard time giving up the caregivers is that phone, and it's really important that, you don't want to know what's going on in the outside world when you're focusing on doing a task. Take the phone and put it on mute or vibrator, whatever.

Don't get distracted. Focus on what your task is with that person, your family member, whether it's just to get them to eat, and music when they eat is really important. If you'll sit down, a lot of people just, and I get it, I've been a caregiver professionally and personally and, one of the things you want people to eat and sit and talk to them or place of music and make it a calming and enjoyable experience.

You'll get them to eat better or drink or whatever versus just putting it down and walking away and expecting them to feed themselves So it's just there's little things like that can make a huge difference not just in the day of the person you're caring for but in your day and I know everybody's in a hurry to they have to cook the clean do laundry.

They have so many things to do but the bottom line is, you just want to have the best possible day and the dirt's going to wait unfortunately, and I encourage people to take a care team partner approach. I call it care team partners. And you need to be able to ask and say, Hey, I need help with cooking, I need help with cleaning. Caregivers feel like they're failing if they don't do that, but that's a really important part of their care too. Absolutely. And you mentioned your book. I'd like to hear more about it because it's really important that people, especially family caregivers, get the right information to them.

So tell me about the book, tell me I will put a link on the site to be able to find you and find it and purchase it. And I also want people to be able to find you. through the Bridgetown Music Therapy if they have questions or concerns they could reach out to you. So tell me about the book.

Yeah, I'd love to connect with anyone who has additional questions or whatever, just reach out. The book is called The Caregiver's Advocate and it was a collaborative project, a collaborative work. The lead author is Debbie Compton who was a family care caregiver herself for many years. So 21 authors total, we each contributed a chapter to the book on a different topic.

And let me tell you, each chapter is amazing. Like when I first read the book, I was just like, every single chapter is so valuable and really well written. So there's everything from elder law to how to talk to your aging parents about various issues. All kinds of topics, caregiver burnout.

This book is gold. And like I mentioned, I contributed a chapter. They ended up putting it first in the book. I had nothing to do with that. But chapter one is sparking joy and connection. Seven ways to infuse music into dementia caregiving. You know what? I'm excited. And very impressed that they even considered music therapy in that book, because so many overlooked that.

And I think that it's a vital part of dementia caregiving. And it should be incorporated into every day. I was very pleased that they put such a focus on it, having it 1st in the book and this launched in early July of this year, 2024 and it hit number one on Amazon within the same day in multiple categories.

So isn't that wonderful? I love it because we don't have enough support for family caregivers and there's so many out there struggling. Most of them don't even identify themselves as a caregiver. They just think they're completing their duty or obligation as a family member.

And it's just wonderful that you've put that book out there. So Alexis, what advice would you give to caregivers who want to integrate music into their daily routine, but don't know where to start? I always encourage caregivers to Don't shy back from trying something new or something that may be uncomfortable for them, like outside their comfort zone, because you never know what you may discover in doing that.

You might discover an amazing solution to something, a tool for helping you get through the day, helping your loved one get through the day better. You just never know with music and it's just this vast world of how it can be used in so many different ways and there's so much different music out there that even if it's trial and error in the beginning, like you'll eventually stumble on something that really clicks and works for you and your particular care setting.

So yeah, don't be afraid to just try and I love that. And I will tell you I can't sing. I just can't. I used to play the piano. But I can't sing. And I was always embarrassed to sing. And after my experience with my little lady, I'll sing even if it's off key, I don't care, I really don't care.

If it makes somebody laugh or giggle or just be connected in some way, that's what's more important to me. I don't care that they're never going to remember me as the nurse that was grumpy growly. They're going to remember me as, oh, that nurse, she couldn't sing, but she was fun to be with.

And I enjoyed her. Yeah, many of my clients, of my patients over the years would say, even if we don't see you, we hear you, they always heard my laugh. Which I did ortho rehab for many years and they're not really sick. They, the stroke victims and stuff. They're dealing with many things. So I did deal with a lot of sick people over a period of years. But even when you're there on their deathbed I had an experience where I had a musician and he was in the process of actively dying, and I had the family come in and play music for him.

And, so I said, if you'll do that, I would sing and the family would roll their eyes.

But I didn't care, I love that experience and it actually when you do those things and you make a full of yourself, people can relate to you and the families appreciated it. They really did. And that's the most important thing is you want to make a difference in people's lives, even if it's a tiny little difference, that they take with them.

It's that positive experience. Alexis, I am so excited we had this opportunity. I'm excited to introduce your book and more excited, not because the book isn't important, but to introduce music therapy because people really need to understand that music is so important to so many in ways that we didn't even realize.

Oh, it is a gift for sure. It absolutely is. And even for me, who's tone deaf and can't sing a tune. I even found before we end, I even found that singing children's songs that we heard as a kid. Yep. It's a big one. That can be very effective. Yes. Yeah. And it makes a connection. So the important point here is that music can make a difference and it's one way that somebody who's caring for somebody with dementia can connect to it in a way that they didn't think possible, even in the late stages of dementia. Yep. Thank you for being here today, and to my family caregivers, I want to say you are the most important part of the caregiving equation. Without you, it all falls apart. So please, practice self care every day, because you are worth it.

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