Growing research has shown that music can have a profound impact on individuals with memory loss. Right to Music is an organization dedicated to promoting use of personal music by families and professionals caring for people with dementia and other cognitive challenges. Founder Dan Cohen joins the podcast to discuss how music can affect memory loss and tips for starting music therapy. Guest: Dan Cohen, founder, Right to Music
- What inspired you to introduce music to people with memory loss? 1:10
- What brought you to music? 2:36
- What has research found around music therapy? 4:56
- What do you believe it is about music that is unique? 11:31
- Does genre of music matter? 14:16
- How can music help bring people together? 17:00
- How do you recommend a person start? 18:52
- Do you have any additional tips? 20:20
- Which songs help you on your playlist? 21:51
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Dan Cohen is CEO and founder of Right to Music, an organization dedicated to promoting use of personal music by families and professionals caring for people with dementia and other cognitive challenges.
The 2014 movie Alive Inside featured Dan and his work to demonstrate music’s ability to combat memory loss. Watch the trailer on the Alive Inside website.
In 2010, Dan Cohen founded Music and Memory, a non-profit dedicated to bringing personalized music playlists to people in nursing homes and other healthcare settings.
Dr. Nathaniel Chin: I'm Dr. Nathaniel Chin, and you're listening to Dementia Matters, a podcast about Alzheimer's Disease. Dementia Matters is a production of the Wisconsin Alzheimer's Disease Research Center. Our goal is to educate listeners on the latest news in Alzheimer's Disease research and caregiver strategies. Thanks for joining us.
On today's episode, we are going to talk about music and how it can improve quality of life for people with dementia and other cognitive and physical conditions. My guest is Mr. Dan Cohen who founded, in 2010, Music and Memory, a non-profit dedicated to bringing personalized music playlists to people in nursing homes and other healthcare settings. The 2014 movie Alive Inside featured Dan and his work to demonstrate music's ability to combat memory loss. Today, Dan leads Right to Music and promotes the use of music by families and professionals caring for loved ones at home. Dan, welcome to Dementia Matters.
Dan Cohen: Great. Well, thank you for having me Dr. Chin.
Chin: So what inspired you to introduce music into the caregiving setting for people with Alzheimer's disease and other cognitive conditions?
Cohen: Well it was sort of accidental. One day, this is back in 2006, on the radio I heard a journalist talking about how iPods were ubiquitous, they're everywhere. And I thought well that may be true for younger people but certainly if you're older and in a nursing home or other setting, you know, you didn't really have access to your own music. And I thought, Wow, let me see if I can volunteer to bring music on some iPods to people in a nursing home with their own music, their favorite music. I went in and it was an instant hit because people lit up when they were reconnected with their music, not music that other people were choosing for them. So that sort of opened my eyes to the fact that there's, you know, we all are our own experts on music. We've listened to music our entire lives. And for the thought that there's more to music, it can really help in a number of ways, in terms of one's health and one's mental health and one's happiness. You know, people sort of are on the edge of, Yeah, I get that, but they don't really understand to the extent to which it really is effective.
Chin: And it's actually quite complex and you've spent a lot of time over the past few years working on this. So could you share with our audience, how did this work unfold over the past years and bring you to this point of starting Right to Music?
Cohen: So, you know, I started off without any— yes I'm a social worker, but I had no special background in Alzheimer's or nursing homes and so I was really learning. Sort of that famous blank slate of well, how does this really work, what feedback am I gonna get. And over time, I'd get — yes, people were happier, they're in a better mood. I'd set people up but then one day I set up a person who was unintelligible. He sort of mumbled. And then after 30 minutes of listening to his own music, I was like, “Oh I'm understanding this guy,” and so I said to a speech therapist, “well, what was that?”. They said, “Yeah we know about that. If people hear their own music, they will tend to communicate more accurately. Or for people with advanced dementia, even if they can't communicate or articulate their needs very well and seem very sort of aloof and closed in, the music will help them sort of stay in touch with themselves and be more present and aware and alert and more willing to interact. So it does promote one's comfort in socialization. You know, and they say, “Gee, if you have two, three, four, friends or people you're interacting with as friends or connection with other people, you're going to be happier”. And so, what I've learned also tends to happen is when people have a diagnosis of Alzheimer's or some other form of dementia, their friends and relatives tend to stay away. There's a… yeah a nervousness or discomfort about visiting someone with dementia who is in a nursing home or assisted living or even at home. And of course that's the worst possible thing because they crave - their emotional systems are not compromised - they crave that connection. So the music helps with a bridge there and helps to keep people connected and facilitate one's sense of self and worth and meaning.
Chin: It's amazing that you got to see that firsthand in your interactions with your patients at that time, and then to be able to connect that to what other professionals have seen and what literature and research has shown. And on your website, righttomusic.com, you have a nice section that really kind of goes over some of the body of research supporting music for people with cognitive impairment. I'm wondering, can you share with us some of the highlights from this body of research showing those benefits.
Cohen: Sure! I'll start off with one that was recently published in JAMDA, which is the Journal of American Medical Directors Association, which was a large study — actually probably the world's largest study of nursing home residents, 4,000 of them in over 200 California nursing homes — who were all set up with their own music and over several years they found that the use of antipsychotic drugs declined by 13%, anti-anxiety medications by 17%, per quarter. So it's over, if over 2 years they had really solid results. Each quarter it declined. Also, the odds of the depressive symptoms declined 16% per quarter, so if 16% were over the entire length of the research, that'll be one thing. With this thing, every quarter it went down another 16%, you know. Even reports of pain, sort of - music and pain signals in the brain at one point follow the same pathway, and so when you're listening to your favorite music, it will reduce the perception of pain. And this has been written up, Journal of Advanced Nursing years ago - it's one of the first articles I read - talked about this but it's not really applied very much. Somehow it's easier and quicker to just give someone a pill for the pain instead of taking a non-pharmacological approach. So a lot of this is based in science as you opened it up, but somehow people are more medicalized. Just everything is with a pill, and we're sort of overlooking something that in some cases is actually better than pills. There's no side effects here. There's no contra-indications. There's nothing that's going to happen negatively. There's no downside, and if it doesn't work there's no downside, but it does work most of the time. Other research was one, actually the University of Wisconsin, your home turf, Eau Claire. The social work department, Dr. Lisa Quinn-Lee, studied people at home, caregivers who had their own music. Now caregivers, as you know and your listeners know, there's a lot of stress involved. It's hard, caring for someone at home with dementia. And so what they found - questions like “I feel frustrated caring for my loved one,” there was a 54% decrease in people feeling that frustration. “My relationship with my loved one depresses me,” a similar 53% decrease. Two other questions, “I feel helpless caring for them,” and that was a 76% decrease in feeling helpless. And “My relationship with my significant other no longer gives me pleasure,” and that was a 60% decrease in people saying that. So, in other words, when people have music at home, just as we found music in a nursing home, when there's music that's available and playing regularly, it changes the tone, the mood, the interaction. One of the reasons is that when there's music, especially with things as difficult as bathing, sometimes people are resistant, I don't want to be bathed. Well, if you play music beforehand and during — favorite music - the process very often goes much more smoothly. So life at home gets better. Activities of daily living get easier. Transitions get easier. It helps in a number of smaller ways. The New York City Health and Hospitals Corporation — it's a dozen hospitals in New York City - they all run personal music programs. They did research which was published in the International Journal of Neurorehabilitation and they found a significant reduction in falls. So we know falls a real issue, especially when people are so heavily medicated, but if you're able to take off these medications that are clouding people and replace it with music to get the same or better impact you will reduce falls. Also physical altercations — people tend to not hurt themselves or others when they're enjoying music. And music also has a residual effect so even when the music stops, people for an hour or two or three or four will have that same good feeling. StonyBrook University, Dr. Stephen Post — we did a study, actually was done by — we wrote it up. It was published, and in Wisconsin, one of the nursing homes found when they used music for people who had difficulty swallowing — they had choking issues — somehow with the music, it helped them remember how to swallow. So this was just hugely important according to Dr. Post, who's sort of a global person on end-of-life care and feeding tubes and whatever we can do to reduce that and not have people have to eat pureed foods which are tasteless. You know, at the end of life, two things that you're going to really enjoy with advanced dementia are food, good food, and music. You can still enjoy that. Anyway, those are some of the examples of the research, which is all recent. Music on personal research, for the most part, is just in the last sort of 12 years which I'm thrilled about. Before that there were hundreds of studies around music — the Mozart effect, maybe people remember hearing about that or classical music. But that's not what we all love, so you know, what's the real impact when we maximize our favorite music. The way all of us listen to the — we only listen to the music we want to. We choose the music we want, we listen when we want and for how long we want, and if any of us were to ourselves become more cognitively impaired, we're going to still love our music for the rest of our lives. And so that's what we want to give to all those around us and all those we care for at home or we care for in any kind of home-care, nursing home, assisted living setting.
Chin: And those are some pretty incredible findings. I'm glad you shared that with our audience. And a lot of those articles can be found on your website because they are more recent and they're also pretty profound. The fact that medications have side effects is a real issue and, of course, as a geriatrician that's something my colleagues and I focus on quite heavily. There is no side effect to music, other than not liking it perhaps, and therefore turning it off. But you can see the potential benefit. One of the things I found to be quite interesting about what you just reported is that music not only helps the person with impairment, it helps the person who's helping take care of that person, so the family member or the caregiver. It really just benefits anyone who is within earshot of listening to that. I think that's so incredible and shows the power of music. So I guess my question now for you is, what do you believe it is about music specifically that brings people joy and does something to the brain that other activities simply don't do?
Cohen: You know that remains, despite wonderful research by, you know, neuroscientists and such who are deeply involved in music research and how the brain works, it's still a mystery — the how and the exact cause I think. It just is. You know, if we try, if we listen to our, when we're listening to our own favorite music you're listening to a great song, you go, “Great, I love this.” You know, I like 60s if you give me, or old Beatles or Rolling Stones. What is it that I feel? Why am I loving this so much as I'm driving the car? Suddenly I'm just — I remember when I was listening to this when I was younger. It's a — it's a feel good, you know. It just connects with your emotional system in a way that is inexplicable. It's a feeling - that's why when we listen to music we like to move, we like to dance. You know when we go to a wedding or any party, we wait for the song that we want to dance to, right? So and it's just — why is that? Why do I feel like dancing? Well, I just do and then dance away. So, no, I don't know the answer to that question. It is just, you know, they say that music — our sort of enjoyment of music — predates speech and language, that it was just around first, kind of rhythm and the beat. And so these are all sort of historical kind of perspectives that have been developed over time, but I think for now still consider it magical. Let's leverage it. We can maximize happiness and enjoyment of life with music.
Chin: Well, fair enough. And some things, we still have to wait for answers and that's the point of science right? And you did hint to this already, but I just want to confirm. The music genre itself, does that matter when it comes to memory?
Cohen: That's a good question. I get that asked a lot. I would say, my answer, just based on seeing what people enjoy, is that the people enjoy what they know, what they've heard, what they're familiar with, what they love. And that can be any genre, any time — or not anytime but — whatever genre is close to them. But there is no genre that is in general, oh, country is more popular or polka is more pop — I mean, maybe in Wisconsin it's a little bit more popular right — but jazz. No, it all depends on someone's background, what they grew up with, what songs were sung, was the radio on growing up, was music played in the cars as you drove around, you know what are our parents, what did they play, family events, all that we listened to on the radio when we were young. What's interesting — there was a study someone once did. They took a data dump on Spotify and what people listen to who are older. And they found - and this was published in the New York Times probably five or six years ago but it was wonderful — and they found that people listened most to music from when they were between the ages of 10 to 14. That was really interesting. And they listened to music when they were 20, half as often as from the music when they were 10 to 14. So we know, if we want to find music for someone, just play — I mean we have our Alexa’s and Googles and Apple HomePods — just say, “Play top songs of whatever year.” And that's a wonderful way, especially since you can say, “Oh, I don't like that song. Skip to the next one.” And everything about having your own playlist for someone who is unable to, you know — you say, “Well I'll just play Pandora for my uncle, whatever.” I say, “Well, no, don't do that because they may play one song, you know, you put in a song that you like and they'll play that song but then they'll go off in other directions.” They may play stuff that sort of gets them agitated or that they don't like. So, as long as people can sort of hit that next button or with these voice devices say, “Skip that song. Go to the next one,” and you're playing a Top 20 list or Top 25 list from that year that is going to be when they were 10 to 14 or 15, 10 to 20 even and you can listen together, and maybe even extract from that the exact songs that they're responding to watch their reaction. And then make a playlist on an MP3 player or a playlist that will play on the smart speaker. This is what new technology can enable us to do, yeah.
Chin: You hinted to this earlier, as well, about the connectedness that comes from music not just with the person with impairment and their caregiver but all of us wanting to connect with others. This pandemic, of course, that we're in has really led to increased social isolation and loneliness for many people, particularly older adults especially if they're in facilities. So, how can music help right now, do you think?
Cohen: Music is probably — has been — one of the, the number one recreational activity. Karaoke, live singers coming in, group singing, that's all gone. So people are - my mother still is restricted to her room in assisted living. She's 93 and music is gone. So we have to make an effort to bring it to them, and to bring them their music, right, not just turn on a radio and say, “Here you go” because we don't like that. We don't want somebody else choosing our music. So I think we know music is already accepted as a way to just enliven environments. Now with the pandemic where people are really, sort of, suppressed and depressed and feel more isolated and angry and they're bored all day - what am I going to do? - for all of those reasons, we want to give them their music. So, I think it's very important for those - at home, same thing. Relatives are not visiting. Everybody's nervous. Nobody wants to to spread the virus, but we can get people their music working with an aide or family member at home. We can drop it off, we can set it up, we can support that, but we need to just be aware that if we did this it could really be a boon to that person's day.
Chin: For those interested in incorporating music into their lives or being more intentional with it, how do you recommend someone start?
Cohen: So I do know that on the Music and Memory website — musicandmemory.org — there is a free, downloadable “How do I set up a playlist for my loved one,” right. And on my website — righttomusic.com — I also sort of talk about, in the blog, just sort of how to approach it and what sort of the larger picture is. That we should be aware that, yes we have to choose. Do we have an MP3 player around? Should we do streaming? Should we — do we have a, you know, a HomePod Mini whatever or Alexa to play the music on and, you know, which one should we do? What are the pros and cons of each? These are some of the things that we don't have time to really dive into more deeply today, but people have a lot of choices. They just need to make a decision on what they're going to use, what they have accessible, what they're familiar with, and then set it up so that it's played every day. It's not played once or a visitor, a grandson comes over — “Oh, we're going to play the music on my phone. What do you like, grandma?” and then they leave and then they're not back for who knows how long. That's not - that doesn't work, right? That works for the moment. It doesn't work for ongoing health. We really need to have that daily diet of music — music for the soul, really food for the soul.
Chin: And for our listeners who are already listening to music and are interested in helping with some of their health, you know, are there certain things that you would recommend, in addition to, for instance, incorporating it into a daily routine — other sort of barriers that you have seen in your work with music?
Cohen: Well, the barriers are overcome by just really making decisions — you definitely want to do this. But many people say, “Oh, I don't know technology,” if it's someone with some form of dementia living at home, right? 15% of people with dementia are home alone, then a lot of them — a lot of folks are at home with a spouse and maybe both need assistance with the technology. So people should feel comfortable reaching out to their kids and their grandkids to get the help you need to make this happen. That would probably be the number one piece of advice. You know, it's not good enough to know that this works. It's only good - it only is - it's wonderful if you bring in the support to make it happen and keep it going over time - the aides, anybody. Once it's set up people can help. Who is there? Who's coming to visit? Who can check to make sure it's working? Who can answer any questions if it stops working? If somebody has an iPad, let's say, and the music was set up on the iPad. Well that's great, but you know is it set up in a way that's usable? They were shown and then, “Ohm they need to be reminded and explained again.” There needs to be a process in place for helping back them up, sort of tech support on doing that.
Chin: So those are great and helpful tips because those are the kind of questions people are going to wonder in establishing this routine and trying to avoid any pitfalls so that they can actually enjoy this music, this kind of therapy on a daily basis. My last question for you is what songs are on your playlist? What helps you?
Cohen: I find I love — I mean I alluded to earlier — really 60s. I look at — I now go a little bit further back, so I do listen, I do. What were the top songs when I was 10 years old, you know, in the 60s. And in terms of The Beatles invasion or whatever, and James Taylor and like some classical and I like — and I like stuff from, you know, my whole life. That's been sort of Number One Hits and sometimes to find them it's not so easy. There's sort of many one-hit wonders out there that are sort of gems. So you need to listen. You're always sort of — the other piece of advice is, whoever you're helping set up the list or setting it up for yourself, is to be on the lookout. Think of where you can find music. I just did training for actually the Alzheimer's organization in Poland. There are people from all over the country, caregivers, and they found - a couple of people found that their parents had left spiral notebooks with, one had the lyrics of music in it. Another one had a list of their favorite songs built into their diary, and it helped them understand what music they loved. So we want to, sort of, we need to be a little bit - act like a music detective and continue that process over time. So just because we come up with a list of 100 songs today, there are some songs in six months we'll get tired of listening to and we want to find others. That's part of — especially for folks who can now articulate their preferences, we want to ask them, what's their favorite music and what memory is it - are those songs associated with? So that as we maybe forget about those memories, we can be reminded of them later from those we love who'll say, “Oh, this song! You know, oh yeah, you love this song! This reminds you of the time you met your spouse!” and you know, whatever. The dialogue can come about this and this is where it can really help to keep people engaged with their — themselves, the sense of self, and those around them, sort of add pleasure to their time.
Chin: Dan, I appreciate your passion and interest in this and thank you for being on Dementia Matters. I think you're doing great work and we're hoping to continue to spread your message here on the show.
Cohen: Well, thank you so much. I really appreciate it!
Chin: Please subscribe to Dementia Matters on Apple Podcasts, Spotify, Podbean, or wherever you get your podcasts. And rate us on your favorite podcast app — it helps other people find our show, and let's us know how we are doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health and the Geriatric Research Education and Clinical Center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and edited by Bashir Aden. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments email us at email@example.com. Thanks for listening.