Over three million U.S. nursing home residents were diagnosed with Alzheimer’s disease and related dementias (ADRD) between 2017 and 2019. As our population continues to age, and with the number of nursing home residents expected to double by 2050, the prevalence of ADRD is projected to rise significantly in the coming decades.
Ellen McCreedy, associate professor of health services, policy and practice at Brown, works to improve the lives of people with ADRD through an intervention called Personalized Music or “Music and Memory.” She is leading an ongoing study to test whether the music that residents enjoyed in their youth can reduce loneliness, isolation and neuropsychiatric symptoms like verbal and physical agitation that often accompany dementia.
On the latest episode of Humans in Public Health, Professor McCreedy discusses how music can transport us to times past and create moments of comfort and relief for people living with Alzheimer’s disease and related dementias.
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Most of us can name a song that brings us back to a particular time or moment in our life. For Professor Ellen McCreedy, it’s “Use Somebody” by Kings of Leon.
Ellen McCreedy: Whenever I hear it, I can imagine myself driving with it playing, just laughing and joking around with my friends. It reminds me of how carefree and silly we were—and I think that’s something most people can relate to.
Ellen says it doesn't matter where you are, or what you're doing, the moment that song comes on...
All of a sudden, you’re not just remembering a time in your life—you’re reliving it. You feel young again, full of life.
But Ellen says this isn't just a fun nostalgia trip, it's actually medically useful.
I'm trained as a health service researcher. I have my Ph.D. in public health and health service research, but my first degree was in music therapy and psychology. I play piano and guitar for therapy, and flute for myself.
Today, Ellen combines that music therapy background with her research, studying diseases that affect elderly patients.
I do older adult research or gerontology. I really started to see the power of music to transport people, to take people back in time like you're saying.
As a former music therapist and as a researcher today, do you have any idea what's going on in the brain when we hear this music? What's happening?
What we think is happening in the brain is a combination of things. Some exciting fMRI research shows that music learned and loved earlier in life—typically between the ages of 16 and 26, though there’s nothing magical about those exact numbers—is stored in specific brain regions that remain relatively preserved even in the later stages of dementia. By contrast, music learned later in life does not seem to be stored in these more resilient areas.
The other piece of this came out of research during the pandemic, and it’s very cool as well. I geek out when there’s a mechanism behind what so many of us intuitively feel is true. Studies on loneliness during that time found that for otherwise healthy adults, early preferred music—those favorite songs from high school, for example—reduced feelings of loneliness in a way that other types of music did not.
The goal of Ellen's work isn't to cure dementia with music, or even slow it down. Instead, it's to ease the difficult symptoms that often come along with the disease.
People who live with dementia experience neuropsychiatric symptoms, one of which is agitation. In a long-term care facility, someone comes to help change my clothes and I’m startled. I don't remember; I don't know that someone’s supposed to be interacting with me, and I might try to bat them away with my hands or my feet. Those behaviors then get other people agitated, especially in congregational living settings. If one person’s upset and starts calling out, then it can start to get other people upset and calling out.
Right now, the best option to treat that agitation is with medication.
And the medications that we have don't work too well. They also increase the risk of falls and death in people living with dementia. So there’s a real need in the clinical community to find a way to manage those behaviors safely and effectively.
That’s where music comes in.
Here's the idea: caregivers use the music that patients still remember at moments when they're about to become agitated.
The theory is that you’re disrupting the pattern of behavior enough that you don’t need those medications. And so it can be managed with something much more humane.
So, part of the idea is almost distracting them or interrupting the flow where they usually exhibit these behaviors?
Exactly. It is a distraction and hopefully it’s also reducing the loneliness that we think drives it.
Ellen says, when this approach is done right, it can really make a difference. That was the case for Bob Earnest, a dementia patient who was living in a nursing home in Lincoln, Nebraska.
He was experiencing these types of behaviors, particularly after lunch. And the staff was starting the program–the Music & Memory program is what they called it on the ground–and they thought that Mr. Earnest would be a great candidate. Now, one of the special things about Mr. Earnest is that he has a living spouse.
That meant there was someone who might know what kind of music he liked to listen to when he was young.
In many cases, there isn’t a living spouse to provide background information, but in this case there was—and she visited regularly. She told the staff that her husband had loved Merle Haggard when he was younger, which gave them a great starting point. As they learned more, they discovered that he had also been a musician. So, the staff sat Mr. Ernest down.