Folding back the years: 1. Music, dance and movement

Benson S (2024) Folding back the years: 1. Music, dance and movement. Journal of Dementia Care 32(6)26-28.

Sue Benson looks back over 31 years of JDC articles, focusing here on music, dance and movement in dementia care.

The arts in dementia care have always been a strong theme in JDC. Right from the start we have featured, promoted and aimed to explain in practical detail how arts-based approaches can help us connect with people living with dementia. From our very first issue, 31 years ago now, our authors have tried to help everyone involved to ‘Discover the person, not the disease’, in the words of the late Tom Kitwood. Tom’s article in the very first issue of JDC (Kitwood 1993) pointed the way forward to the positive approach we have always championed, with articles that not only inspire but help in a practical way to truly see and respond to the person within.

The arts have played a large part in this, and the best work has always led to a deeper connection and communication. John Killick has been a key figure. In an early edition of JDC (Benson 1994) we described his early work as a poet in residence in care homes; this led John not only to more wonderful projects and published poetry, but also deeper projects on communication, especially with those in later stages of dementia, in collaboration with Kate Allan, Claire Craig and others.

Sally Knocker and I have taken a dive into the JDC archive from 1993 to 2024. Our review of JDC articles on the arts will be broad and, inevitably, selective – focusing on those articles we have personally found most memorable over the years. We would love you to tell us about articles you remember and those that influenced you most – please do get in touch and we’ll follow this up in forthcoming issues of JDC. My focus here is on music, dance and movement, and Sally’s is on poetry, drama, photography and filmmaking, and the visual arts.

The arts and activities

Activity coordinators/lifestyle leads have always played a vital role in encouraging the arts. Their contribution to quality of life for people with dementia in care homes and elsewhere is enormous and vital. Recently NAPA shone a spotlight on some brilliant work in their year of the arts (Teader 2023). Music, dance and movement have always played an important part in group activities, and several articles from JDC’s early years include accounts of how they enabled “lightbulb” moments of communication, where skilled practitioners and care staff recognise and build on these.

Music in a group situation

Early issues of JDC described successful activities such as tea dances (Howarth & Ketteringham 1995) and singing sessions. Olive Walker, a retired violinist, described how sensitive playing of songs on simple instruments brought a variety of positive responses from individuals and groups of people living with dementia in a care home (Walker 1996). Reminiscence played a part as many songs prompted memories and pleasurable chat in the group.

There is also recognition that music is not always positive. In 1997 music therapist Jeanette Morrison wrote of the disabling effects of background music in lounges, over which residents often had no choice, and sometimes it seemed to be there for the staff’s benefit: “Often there is music playing on cassette player, radio or television… loudly and continuously over a long period of time, sometimes in addition to other sounds, such as the vacuum cleaner, shouting,…”. This lack of control over their environment, as well as “acoustic garbage” must have had hugely disabling and disturbing effects – well recognised over the years since.

In the same issue Vernon Pickles (1997) urges staff and carers to use music in a person-centred way, with personal preference, but he acknowledges how difficult this is in a group situation, even when a small group can be formed. The technology for providing personal music via headphones did exist then, but was not widespread. Personalising music choices has become much easier with today’s technology, as other articles in this issue show.

“It’s a pity not to sing”

This wonderful comment came not from JDC but from a resident in a care home after I’d led a singing session in the lounge. The benefits of simply singing together are widely known and some excellent initiatives have grown in recent years – notably Singing for the Brain, dementia choirs in the community and in care homes too.

Describing the wide benefits of a care home choir in bringing together residents, staff and families, music therapist Stuart Wood (2007) explained how the act of singing affects us all: “When music catches someone and draws them into singing it changes them. During the time they are singing, they are more highly organised, their emotions flow and they become more connected to those around them…” Singing has special value for people with dementia, who “can find that their abilities return when they sing…and people who become isolated by the effects of dementia can be drawn back into meaningful community through singing together” (Wood 2007).

Music-therapeutic caregiving – where caregivers sing to a person during care – is an interesting practice that deserves exploration. In a 2001 article, Brown, Gotell & Ekman described a positive evaluation of this: “Singing to a person is a highly emotive activity, one that conveys a great sense of personal involvement, caring and gentleness… Individualised singing can be enormously soothing and can create a great feeling of security and bonding,” the authors say.

Movement and communication

In 1997 dance therapist Sarah Crichton of Jabadao described their work with people with dementia, where the spotlight is on movement conversation: “When I go into institutional settings, I see people eager for contact… Fred cannot speak but is actively seeking contact. Verbal dialogue may not be possible. Moving talk is… I am starting from where they are, not from how I would like them to be” (Crichton 1997).

Tessa Perrin observed the session and concluded that above all, it is the personal qualities of the therapist/activity leader that makes the difference: “Jabadao is a wonderful experience, dynamic and elemental, colourful and tactile; it is about letting go… being yourself just as you are, and being valued, just as you are … Jabadao is all these things, but I  have wondered if its secret is more in person than technique, in the activity leader more than the activity. For above all things I have been impressed with the exquisite courtesy of the approach, the equality of attention to all participants no matter how damaged or overtly objectionable, the self-confident use of body and voice, the skilled reading of atmosphere and ambience, the agility and flexibility of response” (Perrin 1998).

This quality of attention is the key, but it can be very difficult for family or care staff to achieve. Arts practitioners have the privilege of being able to come and go from an emotionally demanding situation, and they probably couldn’t give this exquisite attention if that were not the case. Arts approaches can teach us much, but we need to understand the difference and the pressures, and not be too critical of ourselves as carers, paid or unpaid.

Exploring feelings

Jeannie Donald and Sue Hall (1999) describe how a dance therapy group for people just diagnosed, in early stages of dementia, helped them explore difficult feelings: “At the end of this session, Margaret opened the topic of her fear of ‘Alzheimer’s’. It was as if the chord of emotional energy released through the vivacious dancing had reduced tension and allowed the group the feeling of safety necessary to broach this terrifying subject.” But the short (10-week) programme did not give enough time and space for real progress, the therapists felt.

In the same issue Dorothy Jerrome (1999) wrote about the benefits of circle dancing, how it can provide emotional security, encourage expression of feelings, and observed that “the capacity of carers to communicate acceptance and love through touch helps to preserve a sense of self”.

“The arts is all that’s left – give them us!”

1999 saw the start of a landmark series by John Killick and Kate Allan on the arts in dementia care. The importance of the arts is encapsulated in an urgent comment made to John as he showed paintings to a group: “The arts is all that’s left – give them us!” (Killick & Allan 1999b). People with dementia may be near the end of their lives – in extremis – and the authors see this striking remark as expressing an urgency to give shape to inner experience before the opportunity is lost.

In their first article (1999a) Killick & Allan focus on music, reviewing an abundance of scholarly work and research, considering the difference between music therapy and music as an activity, ranging from case studies of individual benefits to studies (from the perspective of a medicalised understanding of ‘problem behaviours’) of how music can have a calming effect. They quote the research observation that “singing is really slow and sustained speech, enabling you more time to process, comprehend and participate successfully” and others describe how music and singing can bring back pleasurable, self-affirming memories. This last is a well-known benefit that lies behind many interventions – all the better for being informed by individual preferences and access to culturally specific music.

Fruitful partnerships

Notable musical institutions have shared their talent and facilities in community projects such as Mindsong, innovative music therapy linked to the Three Choirs Festival in Gloucestershire (Holland & Crampton 2009; Crampton et al 2012). Glyndebourne Opera House, set in beautiful countryside on the South Downs, ran a series of sessions for people living with dementia and their family carers (Wynn-Jones et al 2010). Feedback highlighted the significance of this classy setting, as well as high quality music: “We are provided with other help and opportunities to get together but so often the events are in dusty and rather down-at-heel village halls. Being at Glyndebourne makes us feel respected and valued again. It’s such a lovely place and we get to share in its qualities.” Another carer commented: “It awoke something that was dormant in my husband, gave him a whole month of pleasure.”

The partnership between Manchester Camerata’s Music in Mind programme for people living with dementia and the University of Manchester grew over ten years to encompass live improvised music-making sessions and interdisciplinary research as well as training for staff in care homes. The collaborative relationship “has allowed for the development of creative research methods which centre the voices and lived experiences of people living with dementia”, exploring the role and meaning of music in their lives and developing new methods for capturing these experiences (Dowlen 2024).

Planning, training and staff support

We first described the work of Music for Life – professional musicians in care homes, day centres and hospitals – in 2001. They worked in small groups of two or three musicians and a few residents (selected and supported by staff) improvising with varied instruments – with some moving stories of individuals. The article highlights the importance of mutual planning for such projects to have any chance of success:

When arts projects with their open-endedness move into care settings, they meet a highly structured world… Arts projects bring with them the unfamiliar – the artists themselves, the strange tools of their trade, the demand for space and time and cooperation…. Where these differences are taken account of in training and project planning, the work has a chance of benefiting the community…We have learned that the more we address the structural needs of the project – organisational, managerial, session content – the greater the chance for sensitive and meaningful interactions. (Rose & Schlingen-Siepen 2001).

Music for Life’s activities have grown and widened, supported by the Wigmore Hall in London. Their work for Jewish Care over many years was described in a further article (Rose et al 2008).

An emphasis on planning and supporting staff, in articles on the Links project and Music for Life

“A dynamic, interactive circle of play, movement and song” is how movement psychotherapist Marion Violets Gibson described her work in care homes and day care. It is a lovely example of practice and another article that stresses the importance of training and support for all staff involved. The Links project she describes “developed out of the need to train staff working in dementia care to use very specific evidence-based techniques which would enable them to run social activity groups, even when people were severely ill” (Violets Gibson 2002).

Jackie Kindell and dance therapist Diane Amans describe how planning and working closely with staff in a continuing care ward and day hospital led to striking results and special moments, such as when “Cherry, who never usually sat for more than a few moments, engaged for nearly an hour… Sadie’s constant swearing and irritable comments gradually transformed into positive praise and warm comment.”

Benefits of individual work

For many years Maria Mullan ran lively music sessions culminating in a boisterous “performance” with instruments and voices. A comment from one woman in particular about the group experience “…what you’re producing is not your own – it’s some dry stuff, not very feeling” was the stimulus that led her, with support, to explore individual work, and she describes the rich rewards it brought for both parties:

Gradually I had come to understand that music should not be used as a quick ‘fix’ for distress, frustration or agitation. It slowly dawned on me that music could become a means for a person experiencing dementia to express the emotions that underlie distress and frustration. As my ideas changed, so did my practice…. I offer the person time, space and freedom to communicate, to follow their own path, their own music.’ (Mullan 2005)

Creative expression – vital for all

Skilled work can point the way, but creativity is not just for artists. It is vitally important for us all, and enabling creative expression is a skill that can be learned, as dance therapist and researcher Richard Coaten has urged:

The arts can be an ideal medium through which to support, train and develop care workers in a person-centred approach to care. This does not mean staff need to learn all the skills of professional arts workers; the valuable skill they learn is how to use their own skills and life experiences more effectively.

I believe care workers can be taught these skills, as they primarily involve an increase in perception and awareness, an alertness for recognising these creative opportunities and the ability to celebrate them in the preferred art form

Creative expression is not the responsibility of a few gifted individuals we label “artists”. It is a vitally important activity for us all. (Coaten 2001)

References

(JDC = Journal of Dementia Care throughout.)

Benson S (1994) There’s so much to hear, when you stop and listen to individual voices. JDC 2(5) 16-17.
Brown S, Gotell E, Ekman S-L (2001) JDC 9(4) 33-37.
Crichton S (1997) Moving is the language I use – communication is my goal. JDC 5(6)16-17.
Coaten R (2001) Exploring reminiscence through dance and movement. JDC 9(5)19-22.
Crampton et al (2012) Together in song. JDC20(6) 12-13.
Donald J, Hall S (1999) Dance: the Getting There group. JDC 7(3)24-27.
Dowlen R et al (2023) Music in Mind: celebrating ten years of growth. JDC 31(6) 27-31.
Holland A, Crampton J (2009) Mindsong: festival outreach to people with dementia. JDC 17 (1) 18-19.
Howarth R, Ketteringham R (1995) Let’s face the music – and dance. JDC3(5)22-23.
Jerome D (1999) Circles of the mind. JDC 7(3)20-24.
Killick J, Allan K (1999a) The arts in dementia care: tapping a rich resource. JDC 7(4) 33-38.
Killick J, Allan K (1999b) The arts in dementia care: touching the human spirit JDC 7(5) 33-37.
Kindell J, Amans D (2003) Doing things differently: dance in dementia care. JDC11(2) 18-20.
Kitwood T (1993) Discover the person, not the disease. JDC(1)1 16-17
Morrison J (1997) Is it music to their ears? JDC5(3)18-19.
Mullan M (2005) Finding harmony together through musical expression. JDC13(2)22-24.
Nairn H (2011) ‘Thank you very much for that!’ JDC 19(4) 14-15.
Newman-Bluestein D, Hill H (2010). Movement is the medium for connection, empathy, playfulness. JDC 18(5) 24-27.
Perrin T (1998) Lifted into a world of rhythm and melody. JDC 6(1) 22-24.
Pickles V (1997) Music’s power, purpose and potential. JDC5(3)20-21.
Powell H, O’Keefe A (2010) Weaving the threads together: music therapy in care homes. JDC18(4) 24-28.
Rose L Schlingen-Siepen S (2001) Meeting in the dark – a musical journey of discovery JDC 9(2) 20-23.
Rose L et al (2008) Music for Life: a model for reflective practice. JDC 16(3) 20-23.
Teader A (2023) The National Day of Arts in Care Homes 2022 – Shining a spotlight on arts in care provision. JDC 31(1) 14-15.
Violets Gibson (2002) Reawakening the language of the body. JDC 10(5) 20-22.
Walker O 1996) Music vibrates in the memory. JDC 4(1)16-17.
Wood S (2007) Chalfont Lodge choir: heart of a home and community. JDC 15(1) 22-25.
Wynn-Jones F, Fordham K, Hill V (2010) ‘A whole month of pleasure’ – making music on the South Downs. JDC 18(4) 28-30.
Whyte S (2010) Life-enhancing dance for elders with dementia. JDC 18(2) 37-39.

All articles are available to JDC subscribers on our website.