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AMDA Keynoter: More Music Means Fewer Meds

      The love of a favorite song and happy memories invoked by music from one's youth — these never die, even as people age and cognition slips away. Just ask Kelly Curry, CTRS, director of activities at Sea View Hospital and Rehabilitation Center and Home in Staten Island, NY.
      “We had a patient on the dementia unit. He was on an antipsychotic reduction plan. He was very angry and agitated. His wife mentioned that he loved opera music, so we got him an iPod and put a few select songs on it,” Ms. Curry recalled. Afterward, every time she saw him, he'd be animated and laughing. “He would 'conduct' the orchestra with a pen or pencil. He'd have a big smile on his face.”
      Dan Cohen, MSW, closing keynote speaker at AMDA's 2016 annual conference, is founding executive director of Music & Memory. His nonprofit organization trains nursing home staff and other elder care professionals, as well as family caregivers, on how to create personalized playlists using iPods and related digital audio systems that enable those struggling with Alzheimer's, dementia, and other cognitive and physical challenges to reconnect with the world through music-triggered memories.
      “We know music can reach people up until the end of their lives,” Mr. Cohen told Caring for the Ages. “Even though someone can't recognize a relative or communicate verbally, they can respond to music from their youth that has personal meaning because the emotional element is still intact.”
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      Volunteers can help make a music program successful by donating iPods and iTunes gift cards, as well as compiling favorite music playlists for residents.
      Photo courtesy of Michael Rossato-Bennett

      Orchestrating Successful Programs

      The use of arts and personalized music programs has gained increased attention in recent years as nursing homes and other LTC facilities have sought to reduce antipsychotic use, motivated in part by increased focus by the Centers for Medicare & Medicaid Services on the prescription of these medications. The National Partnership to Improve Dementia Care, a private coalition that includes CMS, as well as consumers, advocacy organizations, providers, and professional associations such as AMDA, established a goal of reducing antipsychotic use by 15% by 2013. The success of this effort led to a new national goal to decrease antipsychotic use by 25% by the end of 2015 and by 30% this year.
      A growing number of organizations and facilities are implementing personalized music programs as part of their efforts to reduce antipsychotic use. For instance, University of Wisconsin researchers are completing a study about the precise impact of personalized music as a viable alternative to antipsychotic medications in facilities throughout the state. While the study is still in progress, the state Department of Health Services is encouraged by anecdotal results to date, which suggest that personalized music can reduce or eliminate the need for antipsychotics for at least some patients.
      “They found some things they didn't expect,” Mr. Cohen said. “For instance, people didn't need chair or bed alarms as much. Staff morale was up, and turnover went down.” He noted the state recently received funding to encourage all 300-plus nursing homes in the state to adopt personalized music programs. Other states, including California, Utah, Vermont, Ohio, New Mexico, and Texas, are following suit.
      In the meantime, facilities in a variety of states are reporting positive results. California-based Lemon Grove Care & Rehabilitation Center reported a 50% reduction in antipsychotic use after instituting a personalized music program. At New York's Coler-Carter Specialty Hospital & Nursing Facility, staff have seen antipsychotic use drop from 38% to 13% after implementing nonpharmacologic interventions, including a personalized music regimen.

      Beginning the Overture

      “You can't just play any music and expect results,” said Mr. Cohen. The key is to find music from the past that is significant to the patient. This isn't always easy, he admitted. However, a bit of research, some careful questioning, and a little trial and error can produce positive results. When possible, family members and even the residents themselves can help identify songs for their playlist. “You can have volunteers — high school and college students — do this. They can ask about concerts the person went to, records they listened to, instruments they played, and so on,” Mr. Cohen said. “We'll develop a list and send it around to family and friends.” Otherwise, the facility can devise a playlist — based on the person's age, religion, and other factors — and watch for a reaction. If the music hits the mark, the resident may smile, tap their feet or hands, move their body rhythmically, or just start speaking when they haven't for months, he said.
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      The program works best when it is used consistently. Facility leadership should stress its importance in the face of the federal crackdown on antipsychotic use.
      Photo courtesy of Michael Rossato-Bennett
      Finding the money for iPods, headsets, and music purchases can be challenging. However, Mr. Cohen observed where there is a will, there is a way.
      “Families often are willing to purchase the necessary items for a loved one,” he said, especially when it means less medication and a better quality of life. When family support isn't possible, Mr. Cohen recommended reaching out to the community to request donations of used iPods and iTunes cards, or partnering with community organizations, such as churches or service organizations. Elsewhere, state or federal grants may be available to fund the program.
      “The program actually is very cheap, and a champion who really believes in it can make it happen,” he said.

      Keeping the Melodies Flowing

      Once the program is implemented and residents are experiencing positive results, Mr. Cohen said, it is essential to keep it going.
      “If a patient is screaming at 3 in the morning, it won't do any good if the iPod is locked in the activities room,” said Mr. Cohen. Caregivers, nursing staff, and others need to be involved and embrace the program. “Everyone has to be engaged in this. If the physician and [director of nursing] are enthusiastic, this is helpful as well.” At the same time, the intervention needs to move between settings. “If a resident goes to the hospital in the middle of the night without his or her iPod, he or she can resort to old behaviors and develop new ones. It is essential to communicate with hospital staff the importance of the music, its impact, and the possible repercussions of discontinuing its use,” Mr. Cohen said.
      Maintaining momentum can be challenging, he noted. “The program starts enthusiastically, but when other demands hit the nursing staff — meals, medications, other care needs, and unexpected issues or problems — the music program can fall off. You have to emphasize that results are linked to consistency.” Facility leadership should stress that the federal crackdown on antipsychotic use is increasing the pressure on facilities, and staff have a responsibility to use nonpharmacologic behavioral management tools whenever possible.
      Fortunately, when facility staff witness the results of personalized music, they often become dedicated advocates.
      “We started the program as a pilot and saw results quickly,” Ms. Curry said. “Residents were tapping their feet, their facial expressions changed, and they were humming.” The Sea View staff quickly sought donations for more iPods and docking stations so that they could expand the program based on the activity therapists' recommendations and assessments. Over 3 years, the program has served from 15 to more than 50 residents.
      'This has proven to be an important nonpharmacologic approach that may help shorten stays and improve recovery.'
      Mr. Cohen described another success story: “One resident was hitting, lashing out, and agitated. Staff didn't know much about him, but they knew he was a veteran. So they recorded an assortment of patriotic music, and as soon as they put the headphones on him, he snapped to attention. Another resident rarely talked, but when she started listening to music selected for her, she said, 'Thank you. That music reminds me of when I met my husband.' ”
      He also recalled an individual who had been discharged from several facilities because of her behavior, but she became calm and cooperative when she had on her headphones with her music. He added that there is evidence that music can have a positive impact on pain and fall risk as well. Mr. Cohen suggested getting feedback from physicians and other caregivers, and sharing the stories with everyone on the clinical and administrative teams.
      “I hear all the time what a great program this is,” said Mr. Cohen. “We need more research, but this has proven to be an important nonpharmacologic approach that may help shorten stays and improve recovery. It encourages people to be more alert, social, and cooperative, and it contributes to comfort and quality of life.”
      Mr. Cohen will present his closing keynote address on Sunday, March 20, at the Gaylord Palms Resort and Convention Center in Orlando, FL.
      Senior contributing writer Joanne Kaldy is a freelance writer in Harrisburg, PA, and a communications consultant for AMDA and other organizations.

      For More Information

      Dan Cohen, MSW, will be the closing keynote speaker on Sunday, March 20 at the AMDA 2016 annual conference. Space is filling up fast for hotel rooms in the AMDA block at the Gaylord Palms Resort and Convention Center, so be sure to book your room soon. Meeting registration and hotel information can be found at www.paltcmedicine.org/. Don't wait!