The Medicine of Music: Can Personal Playlists Reduce Medication?
Take a moment to think of your favourite song.
Why did you choose this particular piece of music? Where does it take you? What emotions and memories does it stir up?
Listening to and enjoying music is a universal experience. It has many benefits; it can reflect and direct our mood and contribute to the formation of our sense of self. For people with dementia—even those who have lost the ability to communicate or who are receiving end of life care—music can be a powerful tool to elicit positive feelings and connect with other people. It can evoke emotions and memories that help us to reconnect with key moments in our lives—lullabies from childhood, the first kiss, a theme tune from a favourite TV show, the first dance at a wedding, or even just simply of a certain person.
Music is neurologically special, stimulating many parts of the brain at once, which means that even if there are parts of the brain which are damaged, music can still reach other parts. Decades of scientific research has shown that music intervention has powerful psychological benefits in the setting of dementia, highlighting that listening to a personal playlist with meaningful music can generate a sense of safety and comfort through evoking emotions and memories, enhancing quality of life and having a positive impact on the lives of those affected by dementia, their families, and carers. In fact, in 2021, researchers at the University of Toronto found that listening to personally meaningful music can improve brain function in patients with mild cognitive impairment or early Alzheimer’s disease.
The World Health Organisation undertook a major review in 2019, investigating the evidence on the role of the arts in improving health and well-being. A section on dementia found evidence of multiple specific benefits utilising music intervention including reducing agitation, anxiety, and depression; improving attention and concentration, cognition, and speech and non-verbal communication skills; and reducing the need for antipsychotic drugs as well as fewer and shorter stays in hospital.
A major review in 2017 investigating non-pharmacological interventions to treat behavioural disturbances in older patients with dementia also confirmed that music intervention was the most effective in reducing behavioural symptoms, specifically agitation and aggressive behaviour, and a second major review in 2017 investigating the effects of music on agitation in dementia attests to this by claiming that music intervention can significantly reduce agitated behaviours in people with dementia.
Playlist for Life has been trialling music intervention through a Playlist Request service for those living with dementia at home or in a care home. This music and dementia charity was founded in 2013 by writer and broadcaster Sally Magnusson after the death of her mother, Mamie, who had dementia. Its vision is to make a unique, personalised playlist available to people at all points of the dementia care pathway. This ‘soundtrack of your life’ harnesses the powerful effects of meaningful music through a personal collection of songs that serve as a prompt for reminiscing to help people living with dementia connect with themselves as well as their family, friends, and carers.
“My mother was always singing. We realised, as her grip on things began to loosen, that her connection to songs was as strong as ever. After singing, she was more alert. It was taking her back to a place of familiarity and belonging. Music more than anything else was keeping my mother with us. And this was more than just a lucky effect. Research revealed that personally meaningful music offers a universal key to unlocking individuality and supporting family and wider social connections. My family gained times of real happiness playing personal music to my mother. I hope Playlist for Life gives you and your family some moments of joy too.”
Sally Magnusson. Founder, writer and broadcaster.
The Playlist Request allows the person with dementia—or those who knows them—to speak with a trained “music detective” either online or over the phone who can help them create a playlist which can be sent on an MP3 player, a CD, or through a link that can be listened to online. This session is recommended to last about thirty minutes where the “music detective” will find out about a person’s culture, faith, interests, and so on to create a soundtrack of their life where each song can elicit emotions and memories that help provide a link to their past and promote interconnection with their families and caregivers.
Playlist for Life also offers many recourses to help those living with dementia and those who knows them to create their own personal playlist— the Soundtrack of Your Life Booklet is a perfect tool to help get started with a playlist, the Conversation Starters provide prompts to building a personalised playlist, and the Personal Music Journal provides space to write down tunes and memories.
Here are a few questions which can help stimulate ideas on what to put in a personal playlist:
- Think of someone who’s important to you. Which songs remind you of them?
- What songs remind you of your childhood and youth? Were there any particular lullabies, nursery rhymes, or television shows that you loved?
- What songs remind you of your hometown and/or home country?
- What songs get you dancing and/or singing along?
- Think of a special moment in your life. Which songs remind you of this?
- Which songs remind you of a favourite holiday?
- Are there pieces of music that link to your hobbies, interests, and/or beliefs?
- Are there television shows with theme tunes that you will always remember?
The foundation of Playlist for Life’s practice is based on the evidence-based Gerdner Protocol 5th Edition developed at Stanford University over the course of 20 years, particularly promoting the use of ‘therapeutic scheduling’, such as timing listening sessions. In fact, research of this undertaken in various small-scale evaluations within the NHS has shown that listening to a personalised playlist for half an hour before difficult activities, or during times of stress and distress, can bring about a reduction in the use of psychotropic medication and restraints, fewer falls, and an improvement on mood and well-being.
This year, the Fife Health and Social Care Partnership’s Older Adult’s Community Mental Health team in West Fife reported an 80% reduction in the use of medication since the integration of personal playlists of meaningful music into their care of people living with dementia. In fact, out of the group of 10 adults who participated, an 80% reduction in certain types of medication was recorded since personally meaningful music was integrated into their care plan, with one individual having a 100% reduction in medication.
Michelle McCreadie, a Community Mental Health Nurse, shared one person’s story with permission from their partner and carer:
“As the dementia progressed, their world became more confusing. They were disorientated, unsettled, and agitated and were prescribed daily doses of PRN (as required) medication. The one person providing safety and comfort in their ever-changing world was their partner, who they followed everywhere. While it was great for them to feel safe, it caused their partner great distress.
After using Playlist for Life techniques to source songs and create a playlist for them, it was observed, that after listening to their personalised music, they were more alert and engaging and for the first-time in a long-time, initiating communication with their partner.
Their playlist is used strategically during his daily care to support them and give them comfort in times of confusion and unrest. This also gives their partner the much-needed respite they need in order to stay together at home. They use this listening time for themselves so that they can do things like shower while they sit in the comfort of memories while listening to the music that they both share together.
They now require no PRN medication, just their music.”
A similar outcome was seen back in 2018 when it was reported that music intervention helped to bring about a 60% drop in the use of sedative drugs at Lillyburn Care Home and the Birdston Day Care Centre in Glasgow, proving the powerful effect that personal playlists has on mood. In fact, since introducing playlists into dementia care, the GPs who work with the home have been so impressed with results that they are entering playlists on the residents’ medical records.
“Initially I was a bit sceptical that prescribing it was actually going to make a difference, but it seems as though it reinforces to the staff that this is a good thing to use, which then means they need to use less medication.”
Dr Janet McMillan, Lillyburn Care Home, 2018.
In February 2018, the BBC visited Lillyburn Care Home to meet the staff and residents to find out more about the power of music intervention and personal playlists. It was here that they spoke with resident Lorna whose smile attests to its powerful psychological benefits in the setting of dementia. You can watch the BBC report below.
You can read more on the power of personal playlists and how these reduce the need for medication here. Please note that Young at Heart ULO CIC can also create personal playlists with you, having completed the Playlist For Life Music Detective training, and provide an MP3 player complete with up to 15 of your meaningful songs free of charge with this thanks to the Purple Angels charity.
Please feel free to share some of your meaningful songs in the comments or request your personal MP3 player by completing the form below.
