Music and Dementia

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Training for musicians in The Netherlands

Music contributes to the quality of life of people living with dementia and can make the person behind the dementia visible. The research group Lifelong Learning in Music developed an innovative practice in The Netherlands and established a training programme for musicians who want to work in this field. The research group did this in collaboration with partners from the health care sector and the music profession. This new practice will increase the opportunities for the professional practice of (future) musicians. The number of people living with dementia in The Netherlands will increase in the coming years and an innovative practice such as this, which contributes to the wellbeing of people living with dementia and the communication with their carers, therefore is important. The project was made possible by grants from the RCOAK Foundation, the Sluyterman van Loo Foundation, the Banning-de Jong Endowment of the Prince Bernhard Culture Foundation.

Music for Life Wigmore Hall and Dementia UK in London


In the UK the programme Music for Life, a joint project of Wigmore Hall and Dementia UK, in association with the organization Jewish Care, has developed a lot of expertise in the field of creative music workshops for people with dementia and their carers.

From 2009-2012 the research group conducted research into this practice. At the dissemination symposium on the 20th of September 2014 at Wigmore Hall in London insights into this practice were shared. Researchers professor dr. Rineke Smilde, Kate Page, MMus and former project manager of Music for Life, and professor dr. dr. Peter Alheit (Georg-August University, Göttingen) presented the findings of this research here. The publication 'While the Music Lasts - On Music and Dementia' discusses these findings and was published in 2014. Music and Dementia II, the continuation of the first project, is aimed at developing a training for musicians in The Netherlands, based on this research, together with partners in The Netherlands and the UK. For this purpose a development group was established.

Project phases and locations


The preparation of the project took place from September to December 2012. During this time the activities for the whole two-year development period were prepared. Moreover a number of Music for Life workshops in London were observed, analysed and described by members of the development group.
At a meeting with the members of the development group in January 2013 a start was made with the development of the training for musicians who want to work with people living with dementia and their carers in creative music workshops. Furthermore the criticital friends, who serve as a sounding board for the project, also met. This group has an advisory role. The training was tried out in pilots in care homes in Groningen in the Autumn of 2013. Master students from the Prince Claus Conservatoire and the Royal Conservatoire The Hague took part in the training. Subsequently no more than six students were selected who participated in the pilots together with members of the development group.
The pilots took place in the beginning of 2014 in a day-care centre in Groningen region and a nursing home in The Hague. The project was concluded by a symposium in June 2014.

Training Musicians for the specialisation Music and Dementia 


The training programme is now part of the study route Audiences and Innovative Practices, a master programme of the Prince Claus Conservatoire Groningen and the Royal Conservatoire The Hague and can, in time, also be offered to professional musicians who want to specialize in this practice.

Development group Music and Dementia

Professor Dr. Rineke Smilde: leader
Karolien Dons: project coordination
Renee Jonker, teacher and coordinator of the Joint Master programme 'New Audiences and Innovative Practice' of the Royal Conservatoire The Hague
Philip Curtis, teacher at the Prince Claus Conservatoire, a.o. 'Performance and Communication' and 'Musicians as Actors' of the Joint Master programme 'New Audiences and Innovative Practice'
Lucy Payne, free-lance cellist and Music for Life practitioner
Patrizia Meier, free-lance harpist and Music for Life practitioner 


Advisers:
Padraic Garrett, staff development practitioner from the organisation Jewish Care;
Linda Rose, consultant Music for Life Wigmore Hall and Dementia UK, and founder of the programme Music for Life.

Partners
Royal Conservatoire The Hague
Concertgebouw Amsterdam, department of Education and Participation
Wigmore Hall Learning in London
Alzheimer Netherland (Dutch Alzheimer Society)
ZINN Groningen(organisation for (home)care, living and wellbeing of the elderly in Groningen, Haren and Hoogezand)

Critical friends
Paula van de Heuvel, ZINN
Yolande Kraaijpoel-Brandt
Anja van Keulen, Concertgebouw Amsterdam
Linda Rose
Padraic Garrett

Music and dementia I

The aim of the research into Music and Dementia is to investigate the practice of music workshops for elderly people with dementia and their carers. In order to do this the Research Group is looking into the work of Music for Life Wigmore Hall and Dementia UK, in association with Jewish Care. This consists of a series of interactive music workshops in care homes and day care centres for people with dementia. The research project is aimed at the development of the practice for musicians. After a preparatory phase during which a literature study was done and interviews were held, the research project started officially in London in 2010.

Research on location

 

In the period between October and December 2010 a Music for Life project was researched that consisted of eight consecutive workshops in a care home in the UK, led by the organisation Jewish Care. Three musicians and the staff development practitioner were involved. The research was set up in a triangulated way so the practice could be researched from different perspectives. It consisted of:

  • Observation of each workshop
  • Narrative thematic interviews with the musicians as group
  • Narrative expert interviews with the workshop leader and the staff development practitioner
  • Reflective journals, kept by the musicians and the staff development practitioner
  • Linda Rose

A symposium was held about the research results on 20 September 2012 at Wigmore Hall, London.

Kate Page, former project manager of Music for Life and researcher for the Research Group, observed the workshops and held the majority of the interviews. Rineke Smilde was present during the first, the fourth and the last workshop where she did the observations and the interviews together with Kate. The data have been processed and analysed. The outcomes will appear in a book under the title 'While the Music Lasts - on Music and Dementia', written by the researchers involved.
Researchers: dr. Rineke Smilde, Kate Page (MMus, freelance researcher) and prof. dr. dr. Peter Alheit (University of Goettingen, Germany).

Interview with Linda Rose and Kate Page

Backgrounds and objectives

The focus of the research project Music and Dementia lies especially on the work, seen from the perspective of the musicians. The outcomes will serve as a basis for the training and development of musicians who would like to specialise in this practice. A deep understanding of the context of dementia care is indispensable for the musicians in this. The follow-up trajectory in the Netherlands will consist of setting up educational programmes based on this research, which will then be put into practice. This will also happen in close collaboration with Wigmore Hall Learining.

Music for Life

Music for Life was developed by Linda Rose during a period of almost twenty years, as an organisation which sets up interactive music workshops in care homes and day care centres for people with dementia. In a project of eight weeks three professional musicians work with a group of eight residents and five carers. They use musical improvisation as a catalyst to bring about communication in its widest sense. Musicians and carers work together as a team and make use of a wide range of verbal and non-verbal approaches which support the participants and the group as a whole. Individual involvement and group involvement of both residents and carers is stimulated. Enjoying the process and reflection on the process by the carers are seen as important elements of the work.

The long-term influences of the work for residents as well as for carers are also determined by the motivation, observation and insights of the carers. Research shows that musical communication as it takes place in the workshops of Music for Life has a positive effect on people with dementia. The Music for Life projects also show that musical communication can make an important contribution to the interaction between residents of the care home and their carers, which is often intensified on an implicit, non-verbal level. The development of the carers in relation to the project happens parallel to the project, among others in collaboration with Jewish Care and Dementia UK (both national charities) that work together with Wigmore Hall Learning.

Transfer to the Netherlands

Work like that of Music for Life did not exist in the Netherlands yet, while the number of people with dementia is increasing. Working with elderly people, and also with those with dementia, can be an important new area of professional practice for (future) musicians.

www.wigmore-hall.org.uk
www.dementiauk.org
www.jewishcare.org

Why Music and Dementia?

In the Netherlands over a quarter of a million people live with dementia and it is expected that in 2050 this number will have doubled (source: Alzheimer Nederland). Music can have a positive influence on the wellbeing of people living with dementia. During the past years the research group Lifelong Learning in Music has conducted research in the UK into giving music workshops to people with dementia. The follow-up of this research is the development of a training, adapted to the Dutch context where the care for people with dementia has often been organised in a different way than in the UK.

Music workshops in health care centres in the Netherlands

Health care institutions were very interested in offering music workshops in health care centres and centres for day-care. Two health care institutions in Groningen and The Hague (ZINN and Rudolf Steiner Care) were involved in the further development of the training, which quickly brought the realisation of this new practice in health care centres in the Netherlands closer. More and more musicians these days are working in new contexts and have portfolio careers in which they combine several musical activities. This new innovative practice offers (future) professional musicians opportunities to expand their professional practices. The training programme is part of the study route New Audiences and Innovative Practices, a master programme of the Prince Claus Conservatoire Groningen and the Royal Conservatoire The Hague, and in future could be offered to professional musicians who wish to train themselves in this practice.

About the research

In the UK the Music for Life programme, a joint project of Wigmore Hall and Dementia UK, in collaboration with Jewish Care, a great deal of expertise has been developed about creative workshops for people with dementia and their carers. The research group conducted research into this practice for two year. The publication 'While the Music lasts - On Music and Dementia' describes the results of this research and is expected to appear in 2013.


 

Phases training development

The duration of the Music and Dementia II project is two years, starting September 2012 to August 2014 and it has been divided into the following phases:

Preparation: launch symposium and observations (September to December 2012)

In the autumn of 2012 a symposium took place in Wigmore Hall in London, which provided insight into the research conducted by the research group Lifelong Learning in Music into 'music and dementia' and the practice of 'Music for Life Wigmore Hall and Dementia UK' between 2009 and 2011. During the symposium there was attention for the publication While the Music lasts – On Music and Dementia, written by Rineke Smilde, Kate Page and Peter Alheit (Page en Alheit of respectively Wigmore Hall and the University of Goettingen, Germany). In this preparatory phase a number of Music for Life workshops in London were observed, analysed and described by members of the development group of the conservatoires in the Netherlands.


First phase: training development (January to August 2013)

During intensive meetings, the development group worked on a research based documented training for musicians to realise creative workshops for older people with dementia and their carers. The development group was advised by Linda Rose, founder of Music for Life, and by Padraic Garret, staff development practitioner of the organisation Jewish Care. During this phase the sounding board group of critical friends met in order to monitor and give advice to the development group


Second phase: testing of the training (September to December 2013)

The second phase of the project began with taster days for students introducing the training. After this weekly training sessions took place in Groningen and The Hague. The training was carried out by the Dutch teachers of the development group. At the end of the training 6 students were selected who took part in the intensive training in Groningen. During this training participants carried out a number of sessions in locations in Groningen. The group of critical friends also met up once during this phase.

Third phase: pilot projects (January to August 2014)

In the third phase pilots of eight weeks each were carried out in Groningen and The Hague. Teachers from the development group took part in these pilots, as well as participants from the training. The development group and the sounding board group of critical friends met in order to evaluate.

Final symposium (June 2014)

The outcomes of the project were presented at a symposium in June 2014.

 

Objectives Music and Dementia

The objective of Music and Dementia II was to develop a training programme for musicians in the field of Music and Dementia, based on research conducted by the research group Lifelong Learning in Music. This training programme was carried out and evaluated in pilots in the regions of Groningen and The Hague. It is offered as part of the study route New Audiences and Innovative Practices of the master programme of the Prince Claus Conservatoire Groningen and the Royal Conservatoire The Hague, and in due course as further training to professional musicians who wish to expand their professional practice after graduation. In this way musicians are being trained to work with this practice in Dutch nursing homes and day-care centres.


This artistic practice is not only of vital importance to people with dementia and their carers. Working in this setting is very important for the musicians as well, and has a great influence on their personal and professional development. This practice could lead to the development of new musical skills and to personal and artistic growth.
This is illustrated in the interview with a part-time alt-player in the Royal Philharmonic Orchestra who took part in Music and Dementia I:

"Doing this work has been a way for me to connect my musicianship with a deepening sense of who I am in this world, brought about by extraordinary interactions with extraordinary people. This work continues to teach me who I am, and is a benchmark against which I judge everything else I do. It's extraordinary how working with people whose version of reality is so vague can in fact be the ultimate reality check!"

Phases training development                   

The duration of the Music and Dementia II project is two years, starting September 2012 to August 2014 and it has been divided into the following phases:

Preparation: launch symposium and observations (September to December 2012)
In the autumn of 2012 a symposium took place in Wigmore Hall in London, which provided insight into the research conducted by the research group Lifelong Learning in Music into 'music and dementia' and the practice of 'Music for Life Wigmore Hall and Dementia UK' between 2009 and 2011. During the symposium there was attention for the publication While the Music lasts – On Music and Dementia, written by Rineke Smilde, Kate Page and Peter Alheit (Page en Alheit of respectively Wigmore Hall and the University of Goettingen, Germany). In this preparatory phase a number of Music for Life workshops in London were observed, analysed and described by members of the development group of the conservatoires in the Netherlands.

First phase: training development (January to August 2013)
During intensive meetings, the development group worked on a research based documented training for musicians to realise creative workshops for older people with dementia and their carers. The development group was advised by Linda Rose, founder of Music for Life, and by Padraic Garret, staff development practitioner of the organisation Jewish Care. During this phase the sounding board group of critical friends met in order to monitor and give advice to the development group

Second phase: testing of the training (September to December 2013)
The second phase of the project began with taster days for students introducing the training. After this weekly training sessions took place in Groningen and The Hague. The training was carried out by the Dutch teachers of the development group. At the end of the training 6 students were selected who took part in the intensive training in Groningen. During this training participants carred out a number of sessions in locations in Groningen. The group of critical friends also met up once during this phase.

Third phase: pilot projects (January to August 2014)
In the third phase pilots of eight weeks each were carried out in Groningen and The Hague. Teachers from the development group took part in these pilots, as well as participants from the training. The development group and the sounding board group of critical friends also met in order to evaluate.

Final symposium (June 2014)
The outcomes of the project were presented at a symposium in June 2014.

Music and Dementia II interview Lucy Payne and Patrizia Meier

Musicians Lucy and Patrizia on their experiences in Music for Life

Music contributes to the quality of life for people living with dementia; through music the person behind the dementia can become visible again. This can be a great help to show carers the emotional, social and physical potential of the people in their care. Quite often it changes the communication between residents and carers for the better.

The research group Lifelong Learning in Music is working on the development of an innovative practice in The Netherlands, based on the practice of Music for Life in the UK. In the UK workshops with people with dementia have been taking place for many years. In a project of eight weeks three professional musicians work with a group of eight residents and five carers. They use musical improvisation as a catalyst to bring about communication in its widest sense. Musicians and carers work together as a team and make use of a wide range of verbal and non-verbal approaches which support the participants and the group as a whole.

Part of the development of this new practice in the Netherlands is a training programme for musicians who want to work in this field. In the UK a number of musicians has been working with this group of people for quite a number of years already. So, who are these musicians, and what does it mean to be a musician and work with people with dementia in a care home? We would like to introduce two of them: cellist Lucy Payne and harpist Patrizia Meier.

Patrizia Meier

Music making with a sixth sense
Lucy Payne has been working with Music For Life since 2007 and Patrizia started working with Music for Life about fourteen years ago. At the time Patrizia was playing with Sinfonia21, a chamber orchestra with very innovative programming. While she was working there, she was offered to train with Music for Life over an extended period. The project was quite new and innovative. Patrizia: 'It was very forward thinking for its time. Dementia was not in the public domain the way it is now, and this kind of training gave us players time to see if we liked this work and how suited we were for it. We could develop personally and musically in a safe way in an environment we often perceived as different and challenging.'

Both Lucy and Patrizia are freelance musicians working in London. They combine their work for Music for Life with their other work as a musician. Lucy: 'I work mainly with chamber orchestras such as Britten Sinfonia and Northern Sinfonia. I have also always loved improvising and I have played with various singer-songwriters, folk musicians and even some theatre companies. Alongside the performing work I do, I teach the cello and work as an Artist in Residence with Jessie's Fund- a charity that takes musicians into schools for children with disabilities.' Patrizia mostly performs as an orchestral freelance harpist with larger orchestras. She finds that the work for Music for Life is quite different from her other work. 'It is music making in a chamber sized group. Nowhere else in my work do I improvise as I do here. It requires a lot of sensitivity and sometimes a "sixth sense" to detect what is going on around (and maybe behind!) you. I need some very good people skills too.'

Lucy: 'When you're a freelancer, sometimes you can go into an orchestra which is sadly full of disillusioned musicians. I am so grateful for the work I do with Music for Life as I am given the opportunity to be constantly reminded of what an amazing and powerful thing music can be.'

 
A musician working for Music for Life needs to learn quite a few special skills. In the workshops you do not perform as a musician would on stage. The barrier disappears and instead you are playing for and with someone who is sitting right next to you. There is no hiding yourself here. So working for Music for Life is not only very gratifying, but can also present huge challenges. Both Lucy and Patrizia say that their professional role disappears in many ways. Lucy: 'You are not just 'a musician' but asked to be wholly yourself, one person seeking to connect to another with music as the tool, or language. All of the music is improvised with the aim of finding the 'music of the person' you are playing with and for. It is therefore hugely challenging artistically as you try to play to the best of your ability, using every part of your musical vocabulary, whilst picking up on the tiniest signals in order to create music that connects.'

Patrizia: 'The depth of feeling I have experienced with this work
has very rarely been matched in my other work.

'I am often amazed by the music that is deeply hidden in people'

There is something quite amazing about seeing the connections that music can make, the musicians say. Even if the setting of a nursing home is not the most glamorous in the world, it is often the background to the most amazing and profound musical feelings. Lucy: 'Seeing the impact that music can have first hand, particularly with people who have often lost their ability to communicate in other ways, is such a humbling and moving experience. It has definitely reaffirmed my love of music and my belief in its power to communicate beyond words. It has also reinforced my belief that music is simply an essential part of being human. We work with the same eight residents for eight weeks so you really do go on a journey with people. Often it is the smallest signal that reveals that for a moment we have, through music, made a connection. This could be the utterance of a single word by someone who usually doesn't speak, a smile from a very anxious person, a story that someone tells after the music that reveals something about them for the first time to the staff in the home. We often use a conductor's baton in the workshops. The resident is given the baton and encouraged to move it and as they do we as musicians seek to interpret their movements. There is often this moment when the resident suddenly senses that they are in control, that it is 'their' music that they are hearing. I am often amazed by the music that is deeply hidden in people! Their strength of gesture and feeling has on occasions matched that of a renowned conductor.'

This week we worked with a lady who was very anxious for the first thirty minutes of the session. She had very little verbal communication and anything she did say tended to be confused and negative. We had been told that she had had trouble sleeping since being in the residential home in which we were working, and that she only slept when her husband came to visit in the afternoon. Towards the end of the session my colleague Kate (a violinist) and myself were improvising a gentle lullaby-like piece and as I watched her, her eyes began to close as if she was going to sleep. When we finished playing she turned to me and said "that was so lovely, I have the most lovely feeling". After that she was totally different in the session; she began saying 'hello' to other members of the group and led the final piece by singing the melody of our closing tune. The transformation was really remarkable. Often it is much more subtle than that, but it was amazing to see how music provided a moment of wellbeing, a moment of safety and peace for her and that this triggered a response in her to reach out to other members of the group. Music really did connect with her and enable her to connect with others.

Lucy Payne

 

Lucy Payne

Special friendships

Another aspect which appears to come as something special with this way of working together, is that the musicians feel a very close bond with each other. Patrizia: 'A lot of my fellow musicians have become very dear friends of mine over the years. I can't say that has happened to the same extent with any of my other work. Lucy adds: 'It's to do with this amazing sense of team that develops. We work as teams of three musicians on Music for Life projects and, obviously due to the challenging and emotional nature of the work, you tend to bond quite quickly. I have always loved chamber music for the intuitive and instinctive way in which you have to interact and react as an ensemble, and in many ways the work with Music for Life is an extension of these skills and that "feeling" of reacting to each other. Except that with Music for Life all the music is improvised.'

'This work gets under your skin'

Lucy and Patrizia both feel that their work for Music for Life has changed them as a person. One of the reasons for this is that the work forces you to examine yourself and to look at who you are.

Patrizia: 'Only by knowing my own strengths and weaknesses have I felt able to do justice to Music for Life's core values. The process is ongoing and together as a team we are continuously growing and changing. I feel privileged to be part of Music for Life. It has greatly influenced me as a person and consequently also me as a musician. I feel passionately about it and would not want to imagine my professional life without it!

Lucy: This work has definitely changed me and continues to change me, both musically and personally. Each person you meet and work with leaves an impact and it is therefore a very life-affirming, enriching and humbling experience. And it's also had a further impact on me. I had never worked with elderly people before working with Music for Life, but I absolutely love it. It is such a privilege to spend time with people who have lived 'huge' lives and the wisdom and experience that they bring, even if they are unable to tell you about it. This work has definitely made me notice the older people in my community more, and my husband and I are currently helping to set up some visiting schedule to isolated older people in our area. This work definitely gets under your skin and shapes your view of the world!

Interview: Annejoke Smids, February 2013

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