Dr. Jeannette Sorrell is Music Director, Apollo’s Fire Baroque Orchestra, Cleveland Heights, Ohio, and Dr. Jeanne Sorrell is Professor, School of Nursing, College of Health and Human Services, George Mason University, Fairfax, Virginia.
Address correspondence to Jeanne M. Sorrell, PhD, RN, FAAN, Professor, School of Nursing, College of Health and Human Services, George Mason University, 4400 University Drive, Fairfax, VA 22030; e-mail: email@example.com.
Recently, there has been increased research in ways to enhance physical and mental health in older adults, including measures to minimize cognitive decline and depression (Committee, 2006; Cook, 2007; Williams & Tappen, 2007). Evidence is increasing that regular mental and physical workouts can maximize overall health and functional abilities in older adults (Cook, 2007). What might these activities look like for older adults who are wheelchair bound and unable to participate in traditional walking or other aerobic activities?
David Dworkin, a 73-year-old, retired Metropolitan Opera clarinetist and former conductor of the New Jersey and Vermont symphonies, thinking about the aerobic workout he gets from leading an orchestra, created Conductorcise, an exercise program that encourages participants to wave batons as they sweat to Beethoven and Mozart “oldies” (Parker-Pope, 2007). Although no scientific research exists on the health benefits of Conductorcise, studies do show that physical activity that boosts heart rate is good for adults at any age. Older adults who participate in Conductorcise workshops increase their heart rate through exercising the upper body, which is often neglected by walkers and runners. And because it is low impact, even older adults who are wheelchair bound can participate.
However, when considering the health benefits of an activity such as Conductorcise, it is important to recognize the broader health benefits of the music itself. Although conducting to a recording may simply seem like a kind of physical exercise, a communal form of music making, such as singing in a choir or playing in a handbell choir, can be emotionally energizing and fun. This is the philosophy behind many music therapy programs.
Music therapy is a well established health care profession that uses music to help meet the physical, emotional, cognitive, and social needs of individuals of all ages. The American Music Therapy Association (2004) has a mission to “advance public awareness of the benefits of music therapy and increase access to quality music therapy services in a rapidly changing world” (¶1).
Music in Dementia Care
Music therapists have recently extended their work with older adults to focus specifically on music as a means of improving memory, health, and identity in those with dementia, particularly Alzheimer’s disease. Memory may fail in many ways, but often, a melody will be retained as a means to weave memories into a “fabric of reality” (Aldridge, 2000, p. 9). Individuals with brain damage from Alzheimer’s disease appear to respond to music that touches uninjured parts of the brain, and music can help them communicate with others and lead a more social life (Cromie, 2002). Music can be used as therapy to decrease agitation and wandering in those with dementia and to help them reconnect with memories from the past, such as through war-time ballads. Singing together can be a way of connecting, inviting the individual with dementia to participate without confronting their losses, serving as an alternative means of communication and social interaction (Ridder, n.d.).
Many studies have shown that people who actively exercise and challenge their memories are less susceptible to the onset of dementia. The much-publicized Nun Study—David Snowdon’s groundbreaking research involving 700 American nuns—demonstrated that nuns who were intellectually and mentally active were less likely to develop symptoms of Alzheimer’s disease (Parris, 2002).
Learning music by rote is an excellent memory-building exercise. In recent decades, the highly successful Suzuki method of music teaching has demonstrated how dramatically an individual’s memory capacity can expand through music-memory exercises. Individuals hear a short, simple melody and are asked to sing it or play it by ear. Then the melody is extended, a few notes at a time. Those trained in this method eventually learn to memorize lengthy and complex musical pieces with ease. Although the results are the most dramatic with children, adults can also build memory capacity in this way, thus helping keep their mental abilities fit and active.
Music in Depression
As many as 20% of Americans older than age 65 may have depression; yet this problem is often undiagnosed and untreated (Segal, Jaffe, Davies, & Smith, 2007). Studies have indicated that nearly half of all nursing home residents have depression (Starr, 2007). Older adults are the highest risk group for suicide, and health experts warn of the effects of ill mental health on physical well-being (BBC News, 1999). Part of the reason for underdetection and undertreatment is ageism: People, including physicians, nurses, and older adults themselves, may expect elderly individuals to feel “down” and may not consider this as a treatable illness.
Research suggests that people being treated for depression and anxiety may receive long-lasting benefits from music to help them relax their minds and bodies (Cromie, 2002). The music seems to affect the autonomic nervous system and does not appear to be a simple placebo effect limited to one part of the brain. Combined with cultural influences, private emotions, and personal memories, the effect of music therapy can be complex.
A variety of musical activities have been used to help relieve depression in older adults, including choral singing and group instrumental activities. One excellent example of how to integrate the benefits of music therapy into a nursing home setting is provided by residents at Villa St. Joseph, a long-term care facility run by the Sisters of St. Joseph in Baden, Pennsylvania (Starr, 2007). With budget cutbacks, most nursing homes cannot afford to hire music therapists, but with a $75,000, 2-year grant from the Staunton Farm Foundation, Villa St. Joseph implemented a music therapy research program to alleviate depression in elderly nursing home residents. One activity engages residents in playing Suzuki tone bars (bell-like musical bars that are easy to manipulate). Other aspects of the musical programs at Villa St. Joseph involve residents in choral singing, bell choirs, and playing percussion instruments. The nursing home administrators believe the music activities help bring beauty back into residents’ lives and enhance residents’ communication with others.
Implications for Using Music with Older Adults
The potential uses of music as a healing art for older adults are exciting, as more is learned about the therapeutic benefits of specific musical activities for dementia and depression, as well as other disorders (Music therapy, n.d.). Music therapy has been used effectively to decrease agitation in Parkinson’s disease and fatigue and pain in cancer and a variety of other illnesses (Cromie, 2002; “Music therapy for Parkinson’s,” 2000). Oliver Sacks, a well-known author and neurologist, noted that patients with nervous system disorders who cannot talk or move are often able to sing, and even dance, to music, suggesting that music has a unique capacity to organize and reorganize brain function that has been damaged (Cromie, 2002).
One important point to recognize is that all older adults will not be equally affected by the same kind of music. Just as younger individuals are drawn to certain genres of music, so are older adults. Country music may not motivate individuals who have devoted hours of listening to classical music; jazz lovers may be bored with a Bach invention (a particular kind of keyboard piece by Bach). Thus, the opportunity to participate in a genre of music that “speaks” to the individual is important.
In some cases, the cost of professional music therapy can be covered, at least partially, by medical insurance (Cromie, 2002). However, most older adults living in the community or in nursing homes do not have access to the expertise of trained musical therapists. How can these individuals gain access to the potential benefits of music? Health care professionals usually do not have the training to integrate music into therapeutic interventions for their clients, but they can build connections with music organizations in the community to foster musical opportunities. Students in music therapy programs can provide valuable guidance as interns. Nursing homes can invite music performance majors from nearby universities and music schools to perform. Such collaborative relationships provide needed performance experience for the music students, as well as meaningful and artistic entertainment for the older adults.
In addition, a music appreciation class taught by a professor from a local college, during which participants listen to recordings of famous pieces and learn about the composers and musical form, would be fun for many people. The Conductorcise activity might come at the end of such a course. After participants have studied a certain Beethoven symphony in the class, they could then practice “conducting” it. With further work, they could learn strategies conductors use to facilitate the effect they want in producing the music. In addition, many conducting exercises are good for strengthening independence of the left and right brains. To experience this, one could practice showing a smooth gradual crescendo and diminuendo with the left hand, while beating time with the right hand. This is tricky!
Whether using Conductorcise, choral singing, or instrumental groups, or singing a simple song around the piano or at the bedside, music has the potential to bring beauty, meaning, and healing to older adults. It is clear that music, like all of the arts, affects people in both intellectual and emotional ways. Although benefits of music have been demonstrated in mental, and especially memory, capacity, the harder-to-measure emotional benefits may be even more significant. As Nielsen (2007) suggested, “Conductors tend to have great longevity not only because of the aerobic exercise, but because they receive applause.” Let’s applaud all of those who are able to experience the joy in music to improve their health.
- Aldridge, D2000. Music therapy in dementia care London, United Kingdom:Jessica Kingsley.
- American Music Therapy Association. 2004. Music therapy makes a difference. Retrieved January 2, 2008, from http://www.musictherapy.org/
- BBC News. 1999, October13. Elderly depression “ignored.” Retrieved December 30, 2007, from http://news.bbc.co.uk/2/hi/health/401901.stm
- Committee, CM2006. Exercise as a treatment for depression in older adults. Retrieved January 7, 2008, from the West Virginia University Web site: https://eidr.wvu.edu/files/5073/Exercise%20as%20a%20treatment%20for%20depression%20in%20older%20adults.pdf
- Cook, LJ2007. Exercises for mental wellness: Couldn’t we all benefit?Journal of Psychosocial Nursing and Mental Health Services, 455, 8–9.
- Cromie, WJ2002. Treating ills with music From anxiety to Alzheimer’s, from pain to Parkinson’sHarvard University Gazette. Retrieved January 8, 2008, from http://www.hno.harvard.edu/gazette/2000/11.09/01-music.html
- Kaza, MJ2007, November12. Re: A little more sweat, maestro [Msg 4]. Message posted to New York Times electronic mailing list, archived at http://well.blogs.nytimes.com/2007/11/09/a-little-more-sweat-maestro/#comment-6360
- Music therapy. (n.d.). Retrieved January 8, 2008, from the Holistic Online Web site: http://holisticonline.com/stress/stress_music-therapy.htm
- Music therapy for Parkinson’s. 2000. Family Practice News. Retrieved January 8, 2008, from the Healing Music Organization Web site: http://www.healingmusic.org/Library/Newsroom/MusicTherapyForParkinsons.asp
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- Parker-Pope, T2007, November9. A little more sweat, maestro. New York Times. Retrieved December 30, 2007, from http://126.96.36.199/search?q=cache:iJaytm-vKM4J:well.blogs.nytimes.com/2007/11/09/a-little-more-sweat-maestro/+sweat+maestro&hl=en&ct=clnk&cd=1&gl=us
- Parris, BS2002. Nuns’ gift to Alzheimer’s research: The nun study reveals clues about Alzheimer’s. Retrieved January 7, 2008, from the Suite101.com Web site: http://www.suite101.com/article.cfm/alzheimers_disease/90363
- Ridder, HM (n.d.). Singing in individual music therapy with elderly persons suffering from dementia. Retrieved January 2, 2008, from the Music Therapy World Web site: http://www.musictherapyworld.de/modules/archive/stuff/papers/HanneMe.pdf
- Segal, J, Jaffe, J, Davies, P & Smith, M2007, October4. Depression in older adults and the elderly: Recognizing the signs and getting help. Retrieved February 1, 2008, from the Helpguide.org Web site: http://www.helpguide.org/mental/depression_elderly.htm
- Starr, P2007, December6. Program uses music to lift spirits in Baden nursing home. Pittsburgh Tribune-Review. Retrieved January 8, 2008, from http://www.pittsburghlive.com/x/pittsburghtrib/s_541317.html
- Williams, CL & Tappen, RM2007. Effect of exercise on mood in nursing home residents with Alzheimer’s disease. American Journal of Alzheimer’s Disease and Other Dementias, 22, 389–397. doi:10.1177/1533317507305588 [CrossRef]