Music Therapy and Spiritual Care for Persons with Dementia: A Mixed-Methods Study/Musicothérapie et Soins Spirituels Auprès De Personnes Atteintes De Démence: éTude À Méthodologie Mixte

Imagine people with dementia finding and experiencing wholeness, connection, self-expression, and relationship with themselves and others. In the context of existing approaches to dementia care this sounds implausible, and yet these were the goals the first two authors of this study (a music therapist and a chaplain] were striving for with a combined spiritual care and music therapy (SCMT] group at an extended care facility where they worked. Residents with moderate to advanced dementia met weekly under their leadership, and the goal of the program was not to stimulate memory but to facilitate an experience of compassion, meaning, individual caring, connectedness, self-worth, and community. The facilitators used seasonal, personal, and spiritual themes presented and experienced through popular music, hymns, pictures, sounds, smells, storytelling, poetry, scripture from various traditions, and ritual.Over the decade that this group had been running, it had consistently elicited responses not found in other programming at the facility. Group members demonstrated caring behaviours with each other, sometimes holding hands spontaneously, smiling warmly at the hearing of a lovely poem or sacred song, or weeping when receiving an individual blessing. Residents who were usually perceived as uncommunicative and isolated were observed engaging with others and expressing themselves through words and action. To further develop the practice of combining spiritual care and music therapy for the benefit of people with dementia, we investigated the meaning and significance of these responses and explored which approaches were most effective in eliciting them.Music and spirituality have long been associated with one another through secular and religious traditions, but their importance to overall health and well-being has only recently been identified in the health care literature. Upe (2002] conducted a review of the literature on music, spirituality, and health, stating, "The connections between music and both medicine and religious experience are well-established, but little is known about how the musical and spiritual aspects of human experience work together to influence well-being" (p. 209]. Ryan, Schindel-Martin, and Beaman (2005] echoed this opinion, stating that "interpersonal connections are especially important to older adults with dementia for maintaining their spirituality" (p. 105] and suggesting that dementia can compromise personhood and communication; they noted that the spiritual well-being of people with dementia can be fostered through a personhood-centered approach, which includes strategies for creating meaningful social interactions, emphasizing individuality, encouraging life narrative, and exploring past roles, relationships, and experiences (p. 109]. They also highlighted the value of goals and interventions that had long been incorporated in the SCMT group: feeling competent, experiencing beauty and wonder, participating in ritual, affirming worth, offering love, fostering a sense of belonging, acknowledging life stories, providing opportunities to express and share grief, and much more (p. 110). These personhood-affirming strategies include careful attention to environment and to non-verbal, verbal, and interpersonal experiences.Research is required to further understand this relationship and to articulate the practices that best support positive health outcomes for people with dementia, and thus the purpose of this study was to examine the effectiveness of a combined SCMT group on extended care residents with moderate to advanced dementia.Definition of TermsDementiaSkoog and Nilsson (1993) define dementia as a clinical syndrome characterized by deterioration in cognitive functions. It is associated with more than 60 conditions, the most prevalent of which are Alzheimer's disease and vascular dementia.Music TherapyThe Canadian Association for Music Therapy (CAMT) defines music therapy as "the skillful use of music and musical elements by an accredited music therapist to promote, maintain, and restore mental, physical, emotional, and spiritual health. …