Naomi Thompson, Music Therapist and Research Fellow at the Cambridge Institute for Music Therapy Research, discusses how personalised music therapy is transforming dementia care through the MELODIC study and the creation of musical care plans.
We all know the power of music to support our wellbeing by connecting us with others, accessing memories, lifting mood and expressing how we are feeling; this is no different for people experiencing dementia. Music therapy is a psychological treatment delivered by a trained music therapist who is registered with the Health and Care Professions Council. Music therapists work alongside the individual, team of professionals and family caregivers supporting the individual. In a similar way to how physiotherapists work, music therapists provide structured sessions to reach a clear goal which is individualised and responsive to need in the moment. This could be in group or individual sessions depending on the person’s need. They can then advise the individual and those supporting them of ways music can be used in their daily lives to support wellbeing, a bit like how doctors might prescribe a drug. This could be to support aspects of care, such as dressing, washing, walking and eating, and to support the use of person-centred activities throughout the week.
Musical care is an accessible way to support people across the dementia care pathway. One element of the dementia care pathway are mental health dementia wards which are health care services for people with dementia who are experiencing crises. Most are run by the NHS, but some are privately run. The purpose of the stay is to help understand what might be causing the crisis and provide care and treatments so the person can leave the ward. A treatment package should also be provided at the place where the person is discharged to, which might be to their home or to a care home, to help prevent further crises and admissions.
The MELODIC Study: MELODIC stands for Music therapy Embedded in the Life Of Dementia Inpatient Care. It is funded by the National Institute for Health and Care Research and run by Anglia Ruskin University and Cambridgeshire and Peterborough NHS Foundation Trust, partnering with Dementia UK and NCF. The project wanted to outline best practice of music therapy on NHS mental health wards to help manage distress.
The researchers worked with a team of people with personal and professional experience of mental health dementia wards and care settings to create a manual outlining how music therapy should be delivered on these wards. This collaborative way of working is called co-design and is innovative in research, being led by family and staff experience and expertise. Liz Jones, Policy Director from the National Care Forum, has been part of the MELODIC project’s Steering Committee from the start, sharing her insight and advice to bridge the social care and NHS healthcare sectors. One family member on the research team said “I do hope that the way this trial has been designed, the co-design of this trial, does inspire other research groups… we will get better research and better outcomes because of that”.
What happened as part of the study? The MELODIC manual aimed to embed personalised music to prevent and manage distress. It had four main parts: a music therapist embedded in the ward team, working 15 hours a week; delivery of group and individual specialist music therapy sessions; personalised musical care plans for all patients to be used by the nursing staff; and training and support for staff and families. We piloted this approach on two NHS dementia wards to see how it worked in different settings and improve it based on feedback.
Mental health wards for people with dementia experiencing acute mental health crises are complex health care settings. We found that it was both possible and helpful to deliver personalised music therapy and musical care plans. Patients, staff and families took part in individual and group music therapy. Patients told us that “[music] lifts you up away from what’s going on round you”.
Musical care plans: The music therapist worked with the staff team, families and patients to create personalised musical care plans for each patient. These described favourite music and music to avoid, as well as when music should be used as part of an individual’s care. Staff were supported by the music therapist to use these musical care plans in everyday care to help prevent and manage distress, increase meaningful activity, and complete care tasks. Staff reported that “it makes our work … easier. We relate more to them as well”. Benefits were also reported by family members, with one saying “I feel calmer myself because … [my relative has] got something he can connect to.” Overall, MELODIC supported the whole ward, with one staff member saying “there just seems to be a good atmosphere on the ward when the music therapy’s taking place”.
What did the MELODIC study show? This project has shown how music therapy can support and improve care in the most difficult dementia care settings. Musical care plans are an easy and accessible way for staff to learn ways they can use personalised music for everyone. These were incorporated into everyday care with support from the music therapist and shared with the next care placement for the individual. Naomi Thompson, music therapist and researcher, said “Everybody was telling us that this was helpful. Managers, staff, families, patients were asking us how they could have it for longer, how they could access it for longer.”
Aspects of MELODIC, such as the musical care plans, could be incorporated into other dementia care settings to help harness the power of music to support wellbeing for people with dementia. Liz jones said “This was an important study showing that music therapy and wider musical care plans can be delivered in complex health care settings, and that they bring benefits to people in those settings and their families as well as to the staff. The concept of a musical care plan can be translated into a wide range of other settings supporting people with dementia. We hope that this resource will prove helpful to care providers their staff, the people they support and their families.”
