YOU’RE THE VOICE
Singing engages the brain, helps us bond with others and makes us feel good. So perhaps it’s no surprise that it is also being prescribed as an innovative treatment for dementia sufferers.
Singing engages the brain and makes us feel good. This may be why it’s now being prescribed as a treatment for dementia.
Imagine you can no longer remember your favourite songs. Your memory has faded and you can’t recall the lyrics. You’re also having difficulty breathing, and you’re unable to get about your day like you used to. You are confused because of the drugs you’re taking for your mood imbalance, and you can’t find the right words to express yourself. For a person with dementia, this is their daily life.
Dementia is a group of cognitive, life-limiting symptoms that damage the brain progressively, leading to the gradual decline in a person’s memory, function and behaviour. People with dementia often experience a decline of brain and respiratory function, which leads to a loss in self- confidence and increased social exclusion.
In Australia, 10 per cent of people aged over 65, and up to 30 per cent of those over 85, are currently living
with dementia. Dementia is the single greatest cause of disability for Australians over 65. It’s estimated that more than 425,000 Australians are living with dementia, and this number is expected to rise. Since 2002, the cost of dementia to Australia has doubled, totalling $14.25 billion in 2016. Dementia is recognised as a global health priority. Yet people with dementia are doubly disadvantaged due to widespread ageism in society, combined with the stigma associated with mental health problems.
Over the past two decades, the arts have proven to be a remedy to the elderly and debilitated, which has led to increased research in the field. Group singing in particular has been scientifically proven to combat stress and anxiety in people with dementia, as well as performing a crucial role in enhancing their quality of life. Some parts of the world are even prescribing singing with a choir as a part of the treatment plan for dementia patients.
“Mental blocks of ‘I can’t sing’ are quickly overcome as confidence builds with people singing around them,” explains Alison Talmage – music therapist and co-founder of the CeleBRation Choir. Launched in 2009, the CeleBRation Choir is an initiative of the Centre for Brain Research at the University of Auckland. As part of the Centre’s research into singing helping to ‘rewire’ the brain after injury, the choir fosters community engagement and is a social outlet for people with neurological conditions like dementia, stroke and Parkinson’s disease.
“People often recall the music of their youth,” explains Talmage. “The ‘reminiscence bump’ – where memories [are] laid down from about 15 to 30 years old – activates a memory of a lifetime playlist of songs. With music streaming platforms, these playlists can be personalised. And in people with dementia, these individual playlists of familiar music encourage alertness, moments of surprising lucidity and happiness.”
Whether it’s ’60s soul, operatic arias or show tunes, music can soothe, stimulate and alter your physical and emotional landscape. When you sing in a group, this effect transcends the group to become a truly exhilarating and transformative medicine. It starts with something intimate, a sound that begins inside you, then is shared with a roomful of people, before coming back as something more thrilling: harmony. Connection through a choir can be good for both dementia sufferers and their carers. Those with dementia often experience feelings of isolation and loneliness. These are sentiments shared by their carers, especially when the patient’s communication skills are affected and they therefore have fewer opportunities to engage socially.
“Mum’s eyes light up when we sing to her, and her fingers start moving as if she’s playing the piano,” says carer Anna Taylor. “Dad used to sing to her every day until he passed away last year. Now I sing to her. It brings joy to both of us, and although it doesn’t take away from the dementia, it is a happy moment that stays with you.”
Through group singing, people (often couples where one person has dementia) come together in a shared experience. Those with dementia can regain their sense of self while their carers make new friends, and everyone becomes part of the group.
Thus it’s no surprise that group singing for people with dementia is on the rise. Across the globe there are many choirs sprouting up, from New Zealand’s CeleBRation Choir to the Singing for the Brain Choir in the UK.
“Listening to music and participating in making music is something we can all share,” says Trish Vella-Burrows, principal research fellow of the Sidney De Haan Research Centre at the UK’s Canterbury Christ Church University. “It’s a basic human need to want to feel part of a gang. Through performance, people in the choirs feel proud and the carers feel connected to a common cause.”
According to the UK’s 2015 Singing for Mental Health and Wellbeing Project, which was carried out by the Sidney De Haan Research Centre, findings from its East Kent study could be replicated in other networks with similarly positive results. This project established a network of seven singing groups in the East Kent area for people with mental health issues. Over 10 months, the choirs grew to involve over 100 mental health service users, together with their friends, family and health professionals. To mark the end of the project, the choirs held a public performance. The results showed that regular group singing reduced mental distress and increased wellbeing.
Singing is a form of natural therapy that allows the brain to ‘wake up’. Large areas of the brain light up during singing, activating language, emotion, motor, auditory, planning and memory networks – which then augment social bonding and empathy.
These emotional responses release dopamine, which lifts our mood and improves our overall mental health.
Physiologically, our pulse rate synchronises with the music. A 2017 study titled The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure, and Mood, published in the Scientific Reports journal, showed evidence that if people continue to sing over a longer period of time, the autonomic responses to music start to control our heart rate, blood pressure and breathing patterns.
“Singing is all about breathing control,” says associate professor Anne-Marie Forbes, a creative arts and health specialist at the Tasmanian Conservatorium of Music. “Breathing, posture and a strengthening of mouth and throat muscles are the cumulative effect of singing.”
“People with dementia are susceptible to respiratory difficulties, with some extreme cases resulting in influenza and pneumonia. Swallowing can also become difficult so nutrition becomes an issue.”
A 2017 study by the University of Tasmania, held in partnership with the Aged Care Deloraine residential facility, assessed the impact of group singing on breathing and wellbeing for people living with dementia. Novel measures such as the use of kazoos
– a musical instrument that adds a buzzing, timbral quality to a player’s voice when used – were employed to encourage controlled exhalation. The research found there was increased control over air and breathing. The use of the kazoo has been recommended for future singing-based interventions for people with dementia.
Forbes says that “quality of life … is the key measure”, and is what we should be hoping to improve for people with dementia. “Songs, music and sense of self are integral to selfexpression and enjoyment. Together they give meaning to a person’s life.”
Yet while ‘quality of life’ is often employed as the primary indicator of improvement for people living with dementia, measuring it has been quite challenging, as there is no one standardised measure. Wellbeing, on the other hand, is a commonly used term representing happiness and life satisfaction, thought to be derived from involvement in social activities that are meaningful and valued.
By participating in a choir, people with dementia learn a new skill, their self- esteem returns, and they make new friends. The pleasure that comes from singing in a group is their reward. A positive experience in a choir can also give people with dementia the confidence to engage in other social activities they’ve discontinued, reconnecting them to the community and to their past. In designing future dementia services, it is important to offer people a number of activities to help them maintain their confidence and manage their condition.
“Individual playlists of familiar music encourage alertness and lucidity.” ALISON TALMAGE
Traditionally, mood imbalance in people with dementia is treated with drugs and hospitalisation. However, those with dementia are extremely susceptible to adverse drug reactions, and even over-the-counter medications like paracetamol can cause negative reactions. So singing becomes the one thing in life where feeling better is almost guaranteed.
Using singing as a prescription makes good economic sense. “It’s a cost- effective way of boosting social inclusion, health and wellbeing,” says Forbes. “However, while singers need little convincing of the benefits of making music, an economic analysis of [the benefits] needs to be part of future studies in mounting a case to convince politicians, health services, funding agencies and some educators.”
More broadly, numerous studies have identified increases in emotional wellbeing and enhancement of mood associated with singing. A 2017 study in the Mental Health Practice journal found that singing programs have shown to be effective in boosting morale, and have also reduced the incidence of depression and anxiety in older people.
Similarly, research published in the British Journal of Psychiatry in 2018 found significant improvements in moderate-to-severe symptoms of postnatal depression among women involved in a group-singing program.
The World Health Organisation prescribes a ‘biopsychosocial-spiritual’ approach to disability services. The aim is for a more holistic approach to the care of people with dementia, and older people in general. Creative interventions, such as singing in choirs, are quickly becoming a way to reduce demand for more intensive services.
The measurable benefits of singing, such as improved breathing, increased oxytocin levels and improved social inclusion, are recognised by the UK, where singing with a choir can actually be prescribed by doctors as part of the treatment for depression or chronic pain.
Loretta Smith has secondary depression as a result of chronic pain experienced from a physical disability. “Making music calms and energises me at the same time. I always feel better after I sing,” she says.
Engaging with the arts is one of the ways we can all live life to the full. Cultural activities such as museum and art programs, physical activity such as dancing, as well as relaxation and mindfulness, can help engage people with dementia and their caregivers.
The creative arts can be used as a public health resource to help tackle the growing public health challenges associated with an increasingly elderly population. “Singing programs and community choirs should be easily accessible for everyone,” says Forbes. “Choir participants regularly report increases in feelings of inclusion, connectivity and general wellbeing, well past the initial experience.”
By having a person- centred, strengths-based approach to caring for people with dementia, a person’s sense of self can be re-awakened, with singing providing the opportunity for lifelong community connection.
Talmage agrees – and she adds this response from one of her choir members: “I am loving my experience with these singing groups. It is a joy meeting many wonderful people, learning new things and combining this new knowledge with my own life experience. What could be better than singing our way through the day?”