Top tips for engaging with people with dementia

Lots of our member groups perform in care homes across the country, taking their music to people who might not otherwise have a chance to attend a live performance. In many care homes there are people with dementia, and some homes specialise in care for people with this illness.

What is dementia?

Dementia is a progressive disorder that affects how your brain works and in particular the ability to remember, think and reason. It is not a disease in itself – but a group of symptoms that may accompany a number of diseases that affect the brain. Dementia is not a consequence of growing old but the risk of having dementia increases with age. In 2014, of the estimated that 850,000 people who were living with dementia in the UK, 773,502 were aged 65 and over.

In most cases, the symptoms that characterise dementia come on gradually and get worse over time, often over a number of years. Symptoms can vary according to the disease causing them and from person to person. They affect your daily life and are more than just occasional lapses. Find out more about the symptoms of dementia.

There is a large body of research proving that music can help to soothe and/or stimulate the thoughts of a person with dementia, and bring to mind long-forgotten memories. By taking their music into care homes, our members provide a necessary and appreciated service.

It is therefore useful for performers to give some extra thought to their music making in a care home situation. Your approach will necessarily need to be a little different than usual, as your audience will be different than usual. With the help of Kellie Morrissey, a Newcastle University Research Fellow specialising in Digital Social Care, we’ve put together some top tips for working with people with dementia.

1. Call ahead before making your plans

It would be very useful for you to know in advance some more information about the individual care home you are visiting. A discussion with staff about various aspects of life in the care home will allow you to tailor your set of music to the session to make it longer, shorter, more interactive, less interactive (etc) as required. Making a quick call to the home one or two weeks before the performance can help to clarify some of these issues. Some questions you could ask are:

• What is the usual level of dementia, and the usual level of wakefulness, at the time of day on which you will be visiting? Does this differ depending on the day of the week? This allows you to know what to expect when you are visiting, and to judge how interactive (or otherwise) your session is likely to be.
• What is the layout of the room, and what temperature will it be? This will allow you to plan how your group will be positioned, and also to be prepared for any tuning issues created by the temperature, as well as to plan for the personal comfort of both residents and performers.
• Will there be staff members available (and how many will there be) to sit through the entire session? It is a good idea to ensure that the care home have staff available for the session if possible: they will know their residents better than you, they are trained to look after them and will be better placed to look after any issues that may arise during the session. They can also join in with the session, which will support and encourage the residents to do so too. Their presence will allow you to get on with the music and may also reassure the residents in what may be an unfamiliar or unusual situation to them.
• Is there the option of sitting amongst the residents during the performance? In some care homes with lower staff involvement, it may be useful for some performers to sit among residents, sing along with them or crouch near them so that they can better hear the melody and feel encouraged to join in. Again, the staff at the care home will know best whether this is a suitable approach for you to take.
• What is the average age of the residents? This will help you to plan appropriate repertoire – more about this below.
• What cultures are represented amongst the residents? Being sensitive to this will also help you plan your repertoire – more on this below.
• You might find it useful to know in advance if there are any musicians (former or current) amongst the residents so that you can tailor the level and amount of information in your talks and demonstrations appropriately - experienced musicians may appreciate more 'technical' information or a deeper insight into the music than you would normally give. You could also ask this question directly to the residents at the start of your session to help you identify where they are in the room.

2. Make introductions

Your conductor or leader for the session should be prepared to introduce the group and the individual pieces that you are performing. It may also be appropriate for other individuals from the group to talk at various points, such as when introducing instruments (see below). This is an important part of starting and maintaining a dialogue between the performers and the audience. Remember to:

• Speak loudly and clearly so that everyone can hear
• Keep an eye/ear out for residents who may interrupt you with questions. If you’re reading from a script you may not be so aware of this happening, so do pay some attention to what else is happening in the room around you.

3. Introduce and demonstrate any instruments

If you have brought instruments along, then introducing them one at a time to your audience during the session adds a nice touch of personalisation – showing the real people behind the instruments. There is no need to go into too much technical detail about how a sound is produced – you can simply name the instrument and the person playing it, and have the player perform a short scale or extract so that the audience can hear the sound in isolation. This is a particularly good thing to do with more unusual instruments. Remember that residents may not feel confident about asking you questions so anticipate everything that they might wonder about and try to explain these things during your session. It is therefore a good idea to brief your performers beforehand so that they have a chance to think about what they might say or play.

4. Include both solo and group performances

Solos can work really well in a setting with high levels of dementia or medicated residents. Moving the solo performer to the centre of the performing group or even into the audience is very engaging and provides a break from the usual. Try to have a good balance of numbers which have solos and numbers which are for the whole group, and use the solo items as opportunities to demonstrate instruments if you have them with you.

5. Pay attention to familiarity of songs

One of the most important themes that comes up again and again in research around this topic is that residents like music with which they are familiar. Consider some of the following:

• Cut out unfamiliar pieces of classical music in favour of more familiar pieces
• Include more regional and/or folk tunes
• More lively pieces of music usually go down well
• Bear in mind the average age of your residents when planning your programme. On the whole, people in care homes are still predominantly aged 85+, which means the music they personally identify with will mainly come from the period 1950-1970

6. Don’t let the music get too high in pitch

This is another common issue – when residents try to join in singing, they often have difficulty reaching the high notes. Consider lowering the pitch of any songs that are intended as ‘singalong’ numbers so that everyone can sing them comfortably.

7. Cross-cultural considerations

Many of the people living in care homes in the UK did not begin their lives here, or they identify with a different culture. If you know that there are likely to be people from other cultures in the audience, check that you have a good balance of repertoire that reflects this. For example, you might think about including songs from the countries and cultures that are represented, and at Christmas you might consider including some non-denominational songs.

8. Cut down on the chatter amongst performers

Whilst it is necessary for performers to interact with each other musically during a performance, try to cut down on any chatter amongst the group in between pieces. Something going on in the background that isn’t aimed towards the audience can be confusing and distracting, and the audience may not easily recognise what is going on if this happens. However, little jokes such as singing happy birthday to each other or poking fun at each other – so that the audience can hear! – can add a nice fun touch to proceedings and humanise the performers.

And finally.......

Don't forget that you will be working with vulnerable people, and your safeguarding policy will apply. For best practice, ask that a member of staff is present at all times, and ensure that members of your group who do not hold a current DBS certificate are not left on their own with a resident(s). For more information about safeguarding, view our guidance.

Our thanks to Kellie Morrissey, University Research Fellow at the University of Newcastle, for her help in the preparation of this article.

We hope you find this Making Music resource useful. If you have any comments or suggestions about the guidance please contact us. Whilst every effort is made to ensure that the content of this guidance is accurate and up to date, Making Music do not warrant, nor accept any liability or responsibility for the completeness or accuracy of the content, or for any loss which may arise from reliance on the information contained in it.