Music is a form of human behavior that can be used as a healing modality for elderly persons in nursing homes. One goal of nurses in this type of health care setting is to assist elderly persons in achieving optimum health potentials. To accomplish this goal, the nurse needs to understand the rhythms of elderly persons, of music, and of the environment and their interaction so the life process of elderly persons can be more fully comprehended.
This is necessary because in our society elderly persons in nursing homes have been relegated to roles and status that alter their interactions with the environment. This relegation along with the aging process often leads to a decrease in self-esteem and a change in the body image. Frequently there is an increase in feelings of dependency and a decrease in feelings of autonomy. In addition, the range for socialization is drastically reduced.
The nurse can use music and its rhythms as the "organizer and energizer"1 to help repattern these altered behavioral manifestations of elderly persons in nursing homes. Nurses' use of music will help them to perceive elderly persons as a whole and not just their parts.
Music and Interpersonal Relationships
The interaction continuum of elderly persons in nursing homes goes from active engagement to disengagement where they withdraw and isolate themselves. The use of music all along this continuum fosters interpersonal relationships because music is the most social of all the arts.2 Interpersonal relationships are important for elderly persons in nursing homes because it is from social and personal involvements that they can maintain and develop patterns of shared expectations, emotional relationships, and social adjustments that are aspects of their wholeness.3 A music group is one means of facilitating interpersonal relationships so these patterns can be maintained and/or developed.
Through the use of a music group, the experiences of elderly persons can be made more enriching and growth expanding ones. The music makes it easier for them to communicate with other elderly persons and to experience a feeling of belonging to a significant group. Most likely, the music will be familiar since the other elderly persons are in the same cohort group. The familiar music will evoke pleasant memories that will give them a sense of security and will make their interpersonal relationships with new and strange persons less threatening ones.
Elderly persons may have feelings of hostility, anger, and rejection toward their families that hinder interpersonal relationships. As elderly persons experience the expressions of other members of the music group and the acceptance they show toward each other, their sense of belonging to a meaningful group will be enhanced. As the cohesiveness between members of the music group is perceived, they will express more freely the feelings and emotions they have toward their families and others.
It is important that the nurse gives elderly persons the freedom to make their own choice to join a music group. Many times the freedom of choice has been taken away from them, especially if they did not choose to be admitted to the nursing homes. By giving them the freedom to make their own choice, the nurse fosters the self-esteem that is so important to them now. For elderly persons who choose not to join, they can sit on the periphery of the group. Many times the familiar music is enough to get them to join the music group because rhythms furnish a nonverbal persuasion not only to act but to act together.1
In addition, if these elderly persons are not visually handicapped, they can see the friendly expressions and the touching of the group members as they dance. Rhythmic activity to music such as dancing will make it easier for them to enter the group since no words are needed. Dancing leads to verbal conversation that enhances the expansion of interpersonal relationships. If the elderly persons now choose to join the group, the nurse has allowed for the expansion of previous freedom to choose and has given the opportunity to be more self-directed, all of which further increase selfesteem.
Elderly persons' experiences with a music group will expand as they continue to participate in the group. Whether it be with musical instruments, dancing, or singing, the interpersonal relations of the members of the music group will provide opportunities for cooperation and competition. This competition may be with other members or with themselves as they strive to perform better.
Music and Self-Actualization
Elderly persons do not stop growing after a certain age is reached; they always have the potential for growth and development and need opportunities to achieve self-actualization as they move through their life cycle. Nursing homes do not always give elderly persons opportunities to develop these potentials and to remain an active participant in significant groups in society. Their vague role in society makes it difficult for them to channel their energies in the appropriate direction for growth and development. Nonverbally society has told them they have no future and they begin to incorporate this negative attitude and develop feelings of worthlessness, hopelessness, not being wanted, not being loved, etc. These feelings hamper self-actualization of their potentials.
A music group in nursing homes permits and encourages elderly persons to participate dynamically in their growth and development.1 One of the pervading qualities of music is its ability to stimulate free association of ideas and the revelation of inner, hidden attitudes.4 Music helps to recall past experiences, events, emotions, and feelings that occurred along the life cycle. This reminiscing does not change past experiences but it helps elderly persons to integrate them into their present situation. To achieve a sense of integrity versus despair, elderly persons need to look over their progress so they can see the relationship between the rhythms of their past, present, and future in reference to their situation in the nursing home and their creative potentials. In so doing, they will be able to repattern their altered self-esteem, capitalize upon the positive aspects of their personal losses, and repattern their sense of identity to support the integrity of their wholeness. The interpersonal process mentioned earlier enhances self-actualization by giving elderly persons opportunities to express themselves, share their expectations, and feel valued for their contributions to the group. All of these opportunities enhance their sense of security and enable the process of the actualization of their creative potentials to emerge.
Elderly persons have experienced many losses as they progressed through their life cycle. The greatest loss for them will be their own death. Reminiscing stimulated by a music group will help members to review their life and to share this review. In the process of sharing with others, they will be able to sense the emotional ties that exist in the group and with others in society. This sharing among the group members provides mutual support as the members seek to verify the significance and value of their life and their uniqueness as a person as they resolve their future death.
Gilbert suggests that a family music session can be used as a vehicle to assist verbalizations of emotions and ideas that might be threatening for family members to express.5 A family music group can be used to let family members share the positive and negative aspects of their lives. Can a family music group be used in nursing homes as a normal component of nursing care where family members can get to know each other better and to accept the eventual death of elderly persons? The family music group might provide elderly persons with evidence that their life is of importance and value and that their contributions are significant. Reminiscing enables elderly persons to maintain their sense of the integrity of their wholeness by generating feelings of being needed and loved by others and by being able to give of self in an important matter such as their death. Hopefully in the process the younger members will be able to cope better with the death of elderly persons and be able to use the experience as anticipatory grief for their own eventual death.
Music and Repatterning of Behavior
The human body is organized into rhythmic patterns. As elderly persons age, alterations in these patterns bring about changes in behavior. The rhythms of music can be used to repattern these altered rhythmic patterns to enhance optimal integration of elderly persons since the human body is a resonant as well as a rhythmic instrument sensitive to music.2
One significant aging process in elderly persons is a decrease in the ability to move through space. Movement through space is enhanced through the use of the rhythms of music as evidenced by hand clapping and foot tapping of elderly persons confined to wheelchairs and the dancing movements of elderly persons using walkers. The nurse can use these behaviors to maintain flexibility of fingers and other joints to prevent contractures and muscle disuse. Dancing to music can be used to give grace and poise and a sense of security in walking. At the same time, these movements of the body improve patterns of circulation and muscle tone that give a sense of wellbeing. Needless to say the patterns of self-esteem, sense of independence, and dignity have moved toward greater complexity during these therapeutic movements.
Frequently elderly persons must be involved in extensive exercises to maintain and/or re-establish optimal movement. These exercises can be boring and painful and many elderly persons skip or refuse them because of their fear of pain. Music can be used to distract the attention of elderly persons and to raise their threshold to pain to make the exercises less painful and to make repetitive movements more meaningful and acceptable. If learning is involved in the exercises, music can assist memory by relaxing tension. This is especially useful for elderly persons who are trying to learn how to walk again.2
The repatterning of mental behaviors through music is appropriate for elderly persons. Frequently memory patterns of elderly persons deteriorate after they are admitted to nursing homes. Music through its reminiscing capabilities can stimulate memory because of past associations with it. As each member of the music group verbalizes his memories, stimulation is provided to the other members. To further aid in memory stimulation, the elderly persons might be asked to think of favorite pieces of music during the day and to keep a diary of the associations with them. These can be shared during music sessions and can serve as stimulants to thinking. In addition, the keeping of a diary provides meaningful mental activity.
Thus, music can be used to establish or re-establish interpersonal relationships, bring about self-esteem and self-actualizations, and utilize the unique potential of rhythms to energize and bring order to altered patterns of elderly persons in nursing homes.3
- 1. Gatson ET: Man and music, in Gaston ET (ed): Music in Therapy. New York. Macmillan Co. 1968, pp 17, 26.
- 2. Alvin J: Music Therapy. New York, Basic Books, Inc. 1975, pp 88, 95, 118.
- 3. Gaston ET (ed): Music in Therapy. New York, Macmillan Co, 1968, pp v-vi.
- 4. Bright R: Music in Geriatric Care. New York, St Martin's Press, 1972. pp 28, 33-35, 43.
- 5. Gilbert JP: Music therapy perspectives on death and dying. J Music Ther 14:170, Winter 1977.
- Alvin J: Music Therapy. New York, Basic Books, Inc. 1975.
- Bright R: Music in Geriatric Care. New York, St Martin's Press, 1972.
- Burnside IM (ed): Nursing and the Aged. New York, McGraw-Hill, 1976.
- Burnside IM (ed): Working With the Elderly: Group Process and Techniques. Massachusetts, Duxbury Press, 1978.
- Gaston ET (ed): Music in Therapy. New York, Macmillan Co, 1968.
- Gilbert JP: Music therapy perspectives on death and dying. J Music Ther 14:165-171, Winter 1977.
- McMahon AW, Rhudick PJ: Reminiscing: Adaptational significance in the aged. Arch Gen Psychiatry 10:292-298, 1964.
- Palmer MD: Music therapy in a comprehensive program of treatment and rehabilitation for the geriatric resident. J Music Ther 14:190-197, 1977.
- Shapiro A: Apiloi program in music therapy with residents of a home for the aged. Gerontol 9:128-133, 1969.