Although there is a growing body of evidence suggesting that combining music therapy and reminiscence in a structured and complementary way may yield positive well-being outcomes for people with dementia, there is a gap in the literature combining both in equal measure. Furthermore, there are no known studies exploring the use of ‘associative items’ as part of the combined intervention and no known standardised protocol or method currently exists. This mixed methods study aims to explore whether combining music therapy and reminiscence with associative items for people with dementia may promote positive mood and engagement levels and shared interaction through (a) musical expression, (b) reminiscence and (c) verbal interaction. Five weekly reminiscence-focused music therapy (RFMT) sessions with associative items were conducted with a group of five people with dementia living in a residential care unit. Results from the Dementia Care Mapping (DCM) revealed that the RFMT intervention was highly effective in promoting positive mood and engagement levels and shared interaction. Participants exhibited considerable positive mood and engagement (+3) 51.6%, and high positive mood and engagement (+5) 38.2%, of the total time observed. The three most frequent behaviours across the five RFMT sessions included musical expression, which was observed 53.2% of the time, reminiscence, observed 23% of the time, and verbal interaction, observed 34% of the total time observed. Data from the music therapist’s reflective journal and session summaries revealed that the associative items prompted reality orientation, verbal interaction, and cognitive stimulation. The music elements were found to increase group cohesion, stimulate cognition, and act as an anchor, re-orientating group members intermittently. Implications of practice are considered, and future recommendations of practice are outlined.
She liked being reminded of butterflies. She remembered being six or seven and crying over the fates of the butterflies in her yard after learning that they lived for only a few days. Her mother had comforted her and told her not to be sad for the butterflies, that just because their lives were short didn't mean they were tragic. Watching them flying in the warm sun among the daisies in their garden, her mother had said to her, see, they have a beautiful life. Alice liked remembering that.
Extract from ‘Still Alice’ by Lisa Genova (
Dementia represents one of the most prevalent neurodegenerative conditions worldwide.
According to the World Health Organization (
Reminiscence refers to the active or passive process of recalling memories from one’s
past (
Our lives are embedded in music and song, and music plays a unique role in the lives of
older people (
Although cognitive loss is the hallmark of dementia, and language deficits are
frequently observed (
Preferred music can be a valuable tool in assisting people with dementia to connect
with their identity and life history, acting as a springboard for reminiscence (
There is an accumulating body of evidence that suggests music therapy is a creative,
non-pharmacological, and a cost-effective intervention for older adults (
There are a variety of interventions used by music therapists in dementia care, with
an emphasis on the therapeutic relationship and process (
When working with people with dementia, reminiscence often organically occurs as a
result of singing familiar songs. This has been documented anecdotally but has not
been extensively studied. Ashida (
Five studies combining music and reminiscence therapy interventions in elderly
populations were identified in a systematic review by Istvandity (
Reminiscence work, whether prompted or structured, generally involves group sessions,
and is an appropriate tool for linking people with dementia who may be isolated back
into a wider social fabric (
There is a lack of conceptual clarity surrounding reminiscence, thus leading to poor
consistency of terminology and taxonomy in the field (
Similar to reminiscence, there is inconsistency around the terms for the prompts used
to foster reminiscence, for example: ‘artefacts’ (
Both music therapy and reminiscence work are widely used in dementia care and were
highlighted as valuable in promoting well-being in the NICE Guidelines updated
quality standards on dementia (
Although ‘reminiscence music therapy’ is cited sparsely in the literature, and a
small number of studies have demonstrated positive effect, previous studies lack
rigour and consistency (
The evolution of person-centred care has changed dementia care from a medically
orientated approach to a humanistic, supportive, and individualised approach, focusing
on the whole person, rather than their diagnosis (
After observing the improved mood, engagement, and alertness that older people
experienced when they attended a therapeutic choir on clinical placement at a
residential care facility, the first author was curious to know how alternative
methods could encourage these responses in people with dementia. The second author’s
(research supervisor) involvement in a previous sensory intervention study (
The aims of this study are follows:
1. To explore if RFMT can temporarily promote positive mood and engagement levels and shared interaction through (a) musical expression, (b) reminiscence, and (c) verbal interaction.
2. To reflect and gain a deeper understanding of the intervention considering the music input, the role of the associative items, and experience of the facilitator.
3. To provide a comprehensive overview of the design and implementation of RFMT.
4. To explore the implications of practice and provide a facilitation guide for music therapists.
The study was reviewed and approved by the Research Ethics Committee (REC) in the
Faculty of Arts, Humanities and Social Sciences at the University of Limerick,
Ireland. Initial consent for the research was sought with information provided in an
appropriate way to help the participants fully understand the study. It is important
that people with dementia are supported and take part in research if they wish to do
so (
This mixed-methods study employed a concurrent transformative design (
Dementia Care Mapping (DCM) is an observational tool for evaluating and improving the
quality of care and well-being of people with dementia (
The inclusion criteria of this study required that participants have a diagnosis of
moderate Dementia with a score of 13 > 20 in the Mini-Mental State Examination
[MMSE] (
Five themed sessions were planned for the RFMT programme. Themes and corresponding music and associative items were brainstormed and chosen beforehand. The themes included: Christmas, Spirituality, Autumn, Going to Dances, and Childhood (Table 1). Taking a person-centred approach, the chosen songs considered participants preferred music.
In each of the sessions the same greeting song was used to welcome and orient group members. Similarly, a familiar goodbye song was used to close the session each week. The structure of the session was as follows: (a) verbal conversation, (b) singing of a familiar song, (c) introduction of the associative items, (d) time for interaction with associative items, (e) repeat chorus of familiar song with associative items, and (f) move on to the next song. Four songs and four groups of associative items were chosen for each RFMT session to allow adequate time to interact with each participant and allow sufficient time for responses.
Session themes in the RFMT programme
THEME | MUSIC | ASSOCIATIVE ITEMS |
---|---|---|
Autumn | Leaves, Acorns, Chestnuts, Pinecones, Turf, Caps/Scarves/Gloves, Wool/Yarn & Needles, Playing Cards, Bovril (smell / taste) | |
Christmas | Pinecones, Photographs (Christmas Trees, Crib, Advent wreath), Tinsel,
Bells |
|
Spirituality | Rosary Beads, Miraculous Medals |
|
Going to Dances | Shawl, Handbag, Pearls, Broaches, Mirror, Red Lipstick, Old Money,
Photographs (Dance Halls in Dublin), Apple Blossom and Lily of the Valley
|
|
Childhood | Sand, Seashells, Ocean Drum |
The RFMT programme took place between November 2019 and January 2020. It was an
exploratory and procedural study with a focus on establishing the methodology;
therefore, no control sessions were compared to the RFMT intervention. The first
author acted as the facilitator and delivered the RFMT sessions, while the second
author acted as an observer and ‘mapper’ and carried out the Dementia Care Mapping
using DCM-8 guidelines (
DCM involved the mapper taking observations of a small group of individuals at 5-minute intervals. Behaviours of the group members (talking, self-care, leisure, expression, reminiscing etc.) were systematically coded from a possible list of 24 behaviour code categories (BCC). The behaviours were mutually exclusive; therefore, an individual could only be recorded engaging in one behaviour in any one particular time frame. If multiple behaviours occurred, operational rules prioritise behaviours with greater potential for higher mood and engagement. For example, ‘Reminiscence’ or ‘Expression’ takes precedence over passive engagement or being withdrawn. Simultaneously the mapper coded the mood and engagement value (ME). The ME value assessed the mood/affect and engagement experienced by each person during every 5-minute time frame. Mood was scored on a six-point scale from –5 (great signs of negative mood) to +5 (high positive mood), while engagement was scored from –1 (withdrawn) to +5 (deeply engaged). These scores were then tallied to arrive at the coded ME value. Although individual behaviours and ME values were recorded and reflected upon, they are not presented in this paper due to intermittent attendance.
DCM 8 Scale of ME Values (
Mood | ME Value | Engagement |
---|---|---|
High positive mood. Very happy, cheerful. | +5 | Very absorbed, deeply engaged/engrossed |
Considerable positive mood. |
+3 | Considerable engagement |
Neutral. Absence of overt signs of positive or negative mood | +1 | Brief or intermittent engagement. |
Small signs of negative mood. | –1 | Withdrawn and out of contact |
Considerable signs of negative mood. | –3 | |
Very distressed. Great signs of negative mood. | –5 |
Contemporaneous field notes taken by the second author recorded responses of the group members to stimuli (musical, visual, kinesthetic, tactile, olfactory, gustatory) and the associative objects. In addition, they captured musical expression, reminiscence, and verbal and non-verbal interactions that occurred between group members and their peers, and between group members and the facilitator. Post session, these notes were cross-referenced against the behavioural codes and ME scores, and further developed with the facilitator to provide comprehensive session summaries.
In the final step of the process, the facilitator completed a reflective journal for
each session. This aimed to acknowledge the subjective nature of the researcher’s
interaction and interpretation of the data, provide a decision-trail within the
public domain, and transparency of the processes leading to conclusions being
presented (
The DCM data were imported into a specifically designed excel-based programme, which
supports automated generation of individual and aggregate scores and graphs for
reporting (
Qualitative content analysis (
The quantitative data (DCM and session summaries) will be integrated and presented alongside the related qualitative data from the reflective journal. The combined ME scores and the combined behaviour code categories will firstly be presented. These scores are totalled together (i.e. all participants scores from all five sessions were added together) to provide a comprehensive overview of the mood and engagement levels and behaviours observed. Analysis of the DCM revealed that RFMT with associative items for people with dementia was highly effective in promoting positive mood and engagement levels. Across the combined sessions, participants were observed to be in considerable positive mood (+3) 51.6% of the time and in high positive mood (+5) 38.2% of the time. Shared interaction through musical expression was observed 53.2% of the time, reminiscence for 23% of the time, while verbal interaction was observed 34% of the time.
Similarly, the qualitative content analysis of the music therapist’s reflective journal generated four themes which included (a) the role of music in the session, (b) reminiscence and the role of the associative items, (c) verbal interaction, and (d) facilitation. The first three themes relate directly to the variables examined in the DCM: (a) musical expression, (b) reminiscence, and (c) verbal interaction, and therefore they will be presented alongside one another.
RFMT had a positive effect on mood and engagement levels. The ME scores of all participants were combined to give an average score across the five sessions and are presented in Figure 1 below. For over half of the time (51.6%), participants were observed to be in considerable positive mood and engagement (+3), and for more than one-third of the time (38.2%) were found to be in high positive mood and engagement (+5). Participants were observed to be in a neutral mood (neither positive nor negative) for just over 10% of the time. No negative mood and engagement scores were recorded throughout the study. Considerable positive mood and engagement (+3) and high positive mood and engagement (+5) were high across all sessions. When combined the range was from 77% to 98% with a mean of 89.6% and a median of 93%.
DCM: Combined Mood & Engagement Levels from the 5 RFMT sessions
The session that resulted in the highest combined ME was ‘Childhood’, where participants spent 55% of the time in high positive mood and engagement (+5) and 43% in considerable positive mood and engagement. This was followed by ‘Christmas’ where participants spent 56% of the time in high positive mood and engagement and 41% in considerable positive mood and engagement (+3). It is notable that the ‘Childhood’ session was also the session which resulted in the highest level of reminiscence. The session with the most observed neutral behaviour was ‘Autumn’. The ME scores across all 5 sessions are presented in Figure 2.
DCM: Mood and Engagement Levels across the 5 RFMT sessions
Participants engaged in a range of behaviours and 10/24 of the possible behaviours code categories [BCC] were observed. The aggregate percentages of these behaviours across the five RFMT sessions were calculated and are presented in Figure 3 below.
DCM: Combined Behaviour Code Categories (BCC)
Expression (E) was the most frequent behaviour observed 53.2% of the time. For almost one-quarter of the time (23%) participants were engaged in reminiscence (G) and for 11% of the time they were engaged in verbal interaction (‘Articulation’ - A). It is imperative to note that verbal interaction occurred more frequently than 11%, especially during and combined with other behaviours. However, according to DCM Protocol, verbal interaction is only explicitly coded when no other active behaviour is present.
In following DCM coding protocol, the behaviour that occurs most frequently in a 5-minute segment is the one that is coded. For this reason, many behaviours that were observed throughout the session were noted but did not appear in the data. These behaviours often occurred in combination with other more prevalent behaviours such as reminiscence or verbal interaction. ‘Sensory Exploration’ (T) was minimally coded in 3 sessions for an average of 4.3% of the time. ‘Engaging with Objects’ (O) coded for 0.6% of the time. While participants frequently engaged with associative items and objects in all sessions, they were often passed from participant to participant, while the group engaged in related discussion or resulting reminiscence. ‘Leisure’ (L) was coded once in the ‘Autumn’ themed session (0.4%) when a group member began knitting when yarn and needles were presented as an associative item. ‘Intellectual’ or engaging in cognitive tasks (I) was only coded in the ‘Christmas’ themed session (8%) when a group member tried to recite ‘The Christmas Alphabet’ from memory and another member recalled the ingredients used to make a Christmas cake. Although not coded, it was also recorded when group members attempted to remember and explain the rules of a childhood game in the ‘Childhood’ session.
DCM revealed that participants were frequently engaged in musical expression and engaged in this behaviour up to 67% of the time during a single session (Figure 4). This took many forms: singing a familiar song, movement to music, body percussion, reciting poetry, or acting. The session resulting in the highest percentage of expression was ‘Childhood’ (67%) which also resulted in the highest percentage of high positive mood and engagement (55%).
DCM: Observed Expression across the 5 RFMT sessions
A significant moment recorded in the facilitator’s reflective journal was when all
group members sang along to
Music played a supportive role in the sessions, acting as an anchor during periods of disorientation. Furthermore, it stimulated shared interaction and group cohesion. It was also noted that the music changed the energy and engagement levels of the group members.
“All group members gazed into the distance and sat in silence while I gathered my guitar and got ready to start the session… Once I began to pluck the chords on the guitar in an upbeat, syncopated rhythm, the energy in the room began to lift while the group members tapped along with their hands or fingers. All members smiled and sang ‘hello’ on the musical cue”. (Reflective Journal)
The music stimulated group members' cognition. This was clearly highlighted in the
‘Childhood’ themed session when singing
“It was interesting to note that all members of the group sang each other’s names effortlessly as the music therapist changed the word Bonnie to the name of each group member. When finished the first verse, they waited until the music therapist sang the name of the person in the first line and then sang their name thereafter until the next verse”. (Reflective Journal)
Additionally, the music facilitated and supported verbal interaction, particularly in the opening ‘Hello Song.’ One example of this was in the ‘Childhood’ themed session during the opening song as the music therapist musically welcomed each group member sitting around the table:
“J turned to her left and looked at L saying, “what’s your name?”. L responded, “L. What’s your name?”. When J responded, L replied “lovely”. The music supported this interaction, holding the space until the conversation had finished to move on to singing hello to both members”. (Session Summaries)
Reminiscence was prevalent in all five RFMT sessions. DCM revealed it occurred 32% in the ‘Childhood’ themed session, 29% ‘Going to Dances,’ 22% ‘Christmas, 20%’ ‘Autumn’, and 14% in the ‘Spirituality’ themed session. Across the five sessions, much of the reminiscence shared was from childhood, adolescence and younger years with happy memories of playing games on the street or dancing with a boyfriend, early working days, as well as more difficult memories of being disciplined in school or a family bereavement. Some examples of verbal reminiscence captured in the session summaries are provided in Table 3.
Examples of Verbal Reminiscence from the 5 RFMT sessions
Theme | Examples of Verbal Reminiscence (Session Summaries) |
---|---|
|
[Talking about colcannon] [Holding turf]
|
|
|
|
[After singing] “ [Talking about school] [Talking about Communion Day] [In response] “ |
|
[Arms wrapped around herself] [Touching jewellery] [After a familiar romantic song] |
|
[Talking about going to the beach] |
Notes from the reflective journal suggested that the session theme, chosen music, and associative items elicited individual memories for each participant, and sometimes reminiscence was not directly linked to the session theme. For example, during the ‘Spirituality’ session, group member J disclosed that her brother had passed away.
J – “I had a brother. He was only 47 when he died. Smoking killed him” (Session Summary)
The theme of ‘reminiscence and the role of associative items’ that emerged from the reflective journal analysis identified a number of considerations. Reminiscence versus procedural memory emerged in reference to the session based on the theme of ‘Spirituality’, when some members began reciting prayers. In some instances, reminiscence also prompted self-expression, as presented in the example below. L spontaneously initiated a hymn upon listening to S speak about heaven and all participants joined in.
S [talking]: “You’re in heaven when you sing them. You come out in heaven. It’s lovely when they are all singing together…when you’re in the church and they are praying and singing, you’re in heaven”
L [singing]: “Oh queen of heaven, the ocean star…” (Session Summary)
The function of the associative items varied between group members and each session. In Session A (Autumn), the associative items encouraged spontaneous self-expression. Both the associative items and the music were connected by the overarching theme of the session.
“L explored the pinecones and conkers before picking up a leaf and beginning to sing the chorus of ‘Autumn Leaves’ again while holding out the leaf in her hand.” (Reflective journal)
The associative items encouraged conversation among the group members and with the facilitator. For example, in the ‘Childhood’ themed session while looking at photographs together, the group members engaged in verbal conversation which also encouraged reality orientation and reminiscence.
“The photos (visual prompts) provided reality orientation for the group. S asked, ‘is that Moore Street?’. B commented ‘ah, that brings back memories’, while R commented ‘I wonder are the people in that photo still alive?’” (Reflective journal)
Although the emphasis of the RFMT sessions was to elicit memories from the past and shared interaction, sometimes engagement with the associative items orientated the group members to the present moment, perhaps providing a focus. Some examples of this are presented below:
[Looking at shawls and jewellery]: “That’s my favourite”
[Holding robin decoration in her hand]: “Aww isn’t he gorgeous”
[Looking at advent wreath in photograph]: “They are Christmas candles I think”
[Flicking pages of prayer book]: “This must be really old.”
However, the role and the significance of the associative items was not always clear. In the ‘Spirituality’ session, the impact of rosary beads and prayer books] was questioned by the music therapist.
“The first thing that came to my mind was the fact that the associative items
in this session seemed insignificant and I wondered if they had any impact on
the music therapy session. Of course, the group members interacted with the
items through touch, but they did not lead to large amounts of communication or
interaction with other group members or the therapist”.
Verbal interaction was defined through DCM as verbally engaging with peers and the facilitator but did not include reminiscence. The mean verbal interaction levels (‘Articulation’ – A) across the five sessions was 11% and in individual sessions were: ‘Autumn’ (22%), ‘Christmas’ (14%), ‘Going to Dances’ (11%), and ‘Spirituality’ (8%). The ‘Autumn’ session contained more verbal interaction, perhaps due to much of the discussion being based in the present and because there was less musical expression than other sessions. When verbal interaction and reminiscence were combined the levels increased to: ‘Autumn’ (42%), ‘Going to Dances’ (40%), ‘Christmas’ (36%), ‘Childhood’ (32%), and ‘Spirituality’ (22%) (Figure 4). The mean verbal interaction including reminiscence across the 5 sessions was 34%.
DCM: Verbal Interaction & Reminiscence across the 5 RFMT sessions
Verbal interaction provided orientation to time and was cognitively stimulating for some members of the group. For others, the more ‘verbal-heavy’ parts of sessions sometimes caused participants to become overstimulated or disorientated, depending on how they presented that day.
“When discussing the rhymes that they used to sing when playing games such as skipping or hopscotch, all members remembered the rhyme Old King Cole. I had researched some rhymes online and asked them whether they knew the one about their birth month. They looked confused when I said the rhyme but when I asked them when their birthdays were, all members could tell me what month they were born in”. (Reflective journal)
Verbal interaction was generally promoted by the facilitator asking questions around the subject theme. However, there were numerous occasions where verbal contribution and interaction was initiated without any input from the facilitator. Verbal interaction between the group members was generally supportive and encouraging as well as sometimes humorous.
S: “We could stay out late. My mammy died when I was a kid so there was no one to hold us in”
B [sympathetically]: “Ahh … I’m sure you missed her”
S: “She was wonderful”
S [looking at photos]: “Ah…the swing on the lamp. I loved that”
R [sarcastically]: “I’m sure you did!”
S [Rosary beads get stuck around J’s head]: “Look! You’ve got a halo!” [all members laugh together] (Session summary)
On several occasions, verbal interaction facilitated the group members to express their feelings and discuss difficult topics. However, periods of negative emotions were short-lived.
S [talking to facilitator]: “You were working all your life until you retired….two holidays a year and now look at where we end up. We can’t run anymore” (Session summary)
Numerous questions regarding the facilitation of the sessions were raised by the music therapist in the reflective journal. Sometimes the sessions were client-led, and the facilitator questioned her own role, especially when unknown song material was brought to the group by the group members.
“I even at times looked around the room and wondered whether I was leading this
session as the therapist. What was my role in this session? Was it okay that I
did not know the song that they were singing together?”
RFMT was highly effective in promoting positive mood and engagement levels (+3 = 51.6%, +5 = 38.2%), and no negative scores were recorded. Qualitative data from the reflective journal and session summary notes supported and illuminated the DCM findings. The mood of the group members, although remaining positive, was changeable throughout the sessions. Sometimes group members were more reflective and sombre, especially during the ‘Spirituality’ session when discussing difficult memories or the loss of a loved one. However, negative feelings were short-lived, as the music or associative items redirected the conversation. On other occasions, the mood was playful as group members interacted with associative items or danced in their chair to a familiar song. The wide range of moods recorded is reflective of the flexible nature of the RFMT sessions, which were client-led and person-centred.
Group members remained actively engaged in the RFMT sessions through singing,
reminiscence, verbal conversation, and interaction with the associative items. The
act of group singing kept the group members highly engaged and alert, as well as
promoting a positive mood. On several occasions during reminiscence and verbal
interaction, some group members became overstimulated. This led to periods of
disorientation or disengagement with the activity. Song is known to be a modality of
connection, even as we live with the changing constellations of cognitive impairment
(
When designing the sessions for this study, songs were chosen by the authors based on
group members' preferred music. However, group members often spontaneously
contributed songs from their past that were prompted by the theme of the session or
the associative items. For some members of the group different songs evoked personal
associations. Tomaino (
“I had a friend called Molly and she hated me singing that song!” (Session Summary)
Similarly, another group member spontaneously sang
The act of group singing provided a sense of togetherness and group cohesion. In
contrast to turn-taking social activities such as talking or reminiscing, music can
be facilitated with everyone simultaneously expressing themselves, while every
individual is still heard (
A multitude of associative items were used throughout this study, incorporating auditory, visual, tactile, olfactory, and gustatory stimuli to elicit memories and encourage musical expression, reminiscence, and verbal interaction. As no standardised protocol for choosing associative items existed, the authors brainstormed and consulted with other colleagues in relation to the selection of associative items. This exploratory study informed the authors of the responses that certain items elicited and their appropriateness in this context. Certain associative items had sensory appeal, such as the fragrance of perfume, the texture of sand and seashells, and touching pearls and fabrics. However, ultimately the function of the associative items was not to directly engage the senses but to elicit memory and encourage shared interaction. This perhaps suggests why sensory stimulation (T) was only recorded for 2.6% of the overall time during this study while reminiscence was recorded for 23%.
While the associative items predominately encouraged reminiscence, they fostered
verbal interaction and some members used detailed language to describe them. They
also stimulated cognition, and participants attempted to recall childhood game rules,
recipes, and the structure of the rosary. These can be referred to as procedural
memory, the ability to unconsciously recall information we learn by rote, such as
tying one’s shoe, playing an instrument, singing a song, and praying and are often
enduring skills in people with dementia (Klimkowicz-Mrowiec et al., 2008; Poldrack
& Gabrieli
Furthermore, some of the associative items [photographs] supported reality orientation and acknowledgement of present circumstances and feelings:
“I met my husband at the Olympic, don’t know where he is now…Gone with the wind.”
“You were working all your life until you retired. Two holidays a year and look where we end up. We can’t run anymore.” (Session Summaries)
The incorporation of overarching themes in this intervention aimed to provide a platform for musical expression, reminiscence and verbal interaction. Although reminiscence often occurred organically upon presentation of the session theme, different memories were elicited for each group member, some of which were related to a song or an associative item.
RFMT allowed group members to socially interact and share stories from their past,
which were stimulated by the chosen music and associative items. The supportive
social environment of the music therapy space enabled group members to communicate
both musically, gesturally and verbally, maintain social relationships with their
peers, and be included in a group activity despite their dementia. The small group
size was invaluable in allowing members to mutually support and comfort one another
while reminiscing (
Spirituality was experienced in the sessions, through musical expression, prompted by
the associative items and supported by reminiscence. Experiencing spirituality can
give people the ability to look for meaning and purpose in life, instill hope and
growth, and provide an inner force to go beyond one’s personal circumstances (
“That was really nice that she knew all of the words… They were really nice times when we all sang together” (Session Summary)
These group members grew up in the heart of the traditional Catholic faith, convent schools choirs, Corpus Christi, May processions and Sunday mass. While singing these remembered and implicitly known hymns, frequent eye contact within the group was observed. Furthermore, it appeared to evoke a sense of self confidence and identification with one another, the familiarity of their shared faith providing a sense of security and comfort.
Some of the music and associative items had powerful connotations for members of the
group. For example, when holy water was offered on their finger, all members
automatically blessed themselves, making the sign of the cross. On two occasions
unprompted religious responses were observed: L looked at the miraculous medal and
said, “
Topics of spirituality came up across many of the sessions related to Catholic
schooling and religious ceremonies. For many older people in Ireland, the Catholic
Church was pivotal in their upbringing and continues to be central in their lives.
Therefore, spiritual care is as important as physical and psychological interventions
(
The process of implementation and facilitation was key to the effective delivery of
RFMT. Kitwood (
The successful facilitation of reminiscence work within a music therapy framework
involves blending best practice in person-centred music therapy and experience in
facilitating reminiscence. Due to the social and psychological consequences of
dementia, we must work in ways which enable people with dementia to participate
without fear of failure, by recognising their difficulties and navigating ways around
them. It is essential to play to their remaining strengths while being sensitive of
their feelings (
RFMT may also be used successfully with people with more advanced dementia.
“Recognition persists long beyond the point, where people can remember and relay
their memories independently,” and therapists can foster recognition with the
sensitive use of individual biographies alongside specific associative items (
Due to time constraints, it was beyond the scope of this study to compare RFMT to traditional approaches of both music therapy and reminiscence work or to standard care alone. Future research may compare the results of RFMT with other controlled measures. This exploratory study also had a small sample size and therefore the findings should be interpreted with care. Future studies could compare behaviours observed during the intervention with pre-intervention behaviours, while mapping behaviours post intervention could evaluate persistence effect.
DCM is noted to be “suited to smaller scale within-subject or group comparison
intervention evaluations”; however, due to its coding rules, it has been criticised
for a bias toward highlighting positive behaviours and underestimating socially
passive and withdrawn behaviours, unlike data collected with continuous time
sampling, which would capture all behaviours equally (
It would be of interest to investigate spontaneous dyadic interactions with an RFMT group when compared to standard care alone. In a more controlled study with a strictly defined protocol, spontaneous verbal interaction within the group could also be examined in more detail, to measure the effect of the facilitator.
The first author had a complex dual role as both a researcher and facilitator. The research involved reflecting upon personal experiences of facilitating the sessions, and theorising and contextualising this experience. If this study were quantified in the future, the authors would recommend that the data be collected and analysed independently of one another by separate researchers to avoid subjectivity and bias.
This study highlights the complex nature of RFMT with associative items. As previously
noted, it is expected that music and reminiscence are being combined on an informal
basis by a variety of practitioners in their work with people with dementia. However,
thus far no previous studies or resources are available to music therapists offering a
comprehensive guide for using reminiscence and associative items in this context.
Istvandity (
This research aimed to provide a convergence of perspectives in order to gain an in-depth understanding of the phenomena in question. DCM and session summaries captured the ‘lived experience’ of the group members during the intervention, identifying behaviours, mood and engagement levels, expression, reminiscence and verbal interaction. The reflective journal recorded thoughts, perceptions, and feelings of the music therapy facilitator. Together, they illuminated the layers of a very nuanced experience.
This study demonstrates that the focused combination of both music therapy and
reminiscence with associative items is an effective way of promoting positive mood and
engagement levels, shared interaction, and reminiscence for people with dementia. When
dementia is associated with so many losses, we have “an ethical reason for a particular
approach to therapy: one that aims to restore, even if temporarily, the kind of social
agency” that the person with dementia once had (
Lisa Kelly is a music therapist based in Galway, Ireland. She holds a BA Irish Music and Dance and an MA Music Therapy from the Irish World Academy of Music and Dance at the University of Limerick where she is currently undertaking a PhD in music therapy. Lisa's research interests include music therapy in dementia care, reminiscence, reminiscence-focused music therapy, and telehealth music therapy services for people living with dementia and their family carers.
Bill Ahessy is a senior music therapist and clinical supervisor based in Dublin, Ireland. He trained as a music therapist in Australia and then completed a Masters by research in Spain. Bill holds post graduate qualifications in Person-Centred Dementia Care and Creative Supervision. He currently works within the Irish health and education systems with older adults and with children and adolescents who have additional needs. Bill’s research interests include choir interventions with older adults, therapeutic songwriting, music therapy in dementia care, and creative arts therapies practice.