Will music improve MDS 3.0 scores?

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Will music improve MDS 3.0 scores?
Will music improve MDS 3.0 scores?
Neuroscience research during the past 10 years has made great strides in documenting the relationship between music and the brain. The New York Academy of Sciences Music, Science and Medicine conference recently brought together leading researchers to share what we now know about music and its impact on Alzheimer's disease, pain, Parkinson's, coma and autism. 

Optimally, every long-term care facility would benefit from the expertise of a music therapist. Short of that level of expertise, long-term care facilities have an inexpensive tool that can have a positive impact on resident quality of life, which, in turn, should be reflected in an important subset of MDS 3.0 scores.

Using iPods to reconnect residents with their favorite music is a simple intervention with great upside potential and no side effects. According to the New York State Department of Health, individualized music reduces dementia-related agitation by up to 80%. Feedback from hundreds of residents (and staff) is that behavior and mood improves, and residents are more cooperative, attentive and engaged.

Why this works for long-term care:

It breaks through the group activities hurdle

Just think about the top five ways we like to spend our own free time. How many of those are group activities? The answer is typically very few. We tend to think nothing of our anytime access to music. Yet we provide all manner of group activities while we look for ways to be more person-centered. Little is more personally meaningful than our own music.

It enables personally meaningful activity 7/24

Two unpublished nursing home time-and-motion studies reveal that 90% of a resident's non-ADL time is spent idle. How much of our personal non-ADL time is spent idle? It's difficult to imagine (although it might sound good in some respects for those of us who are so busy!).  But for residents whose primary activity between meds and meals is sitting waiting, how does one entertain someone with advanced dementia when the group activity ends? And for those without dementia, it helps them pass the time and better their mood and become more social by allowing them access to their favorite music, whether religious hymns, Broadway shows, big band, folk, Calypso, country, rhythm and blues, easy listening, or music from their country of origin.

It helps improve social ability for persons with dementia

According to Dr. Concetta Tomaino, Executive Director of The Institute for Music and Neurologic Function, “In a study funded by the New York State Department of Health, a music therapist playing familiar music three times a week for people with mid- and late-stage dementia for ten months. At the end of ten months, these people had improved their mini-mental status scores, they were recognizing their loved ones, they were talking to each other, having conversations. We had neuroscientists assess them for their social ability and found that there was no difference between them and people who did not have dementia.  We know that using this type of music consistently, day-in and day-out, does, in fact, stimulate memory and recall, and improves it over time.”  In the past, applying this approach was not practical. But now with digital music players, we have the opportunity to generate such outcomes.

It improves morale of staff AND families

Disruptive, verbally or physically abusive residents demand more than their share of staff time, resulting in lower staff morale, injuries and possibly facilitating turnover. Although there is no guarantee of impact, residents often dramatically change their behavior when they can "get into" their music. What a positive distraction for them and a boon for caregivers.  When families see any kind of improvement in their loved one, they are thrilled.  Families are eager to get involved with this process.   Their first thought is: "Why didn't I think of this!"

It may reduce failure to thrive, depression, social isolation, anxiety and even symptoms of schizophrenia

That's quite a range of potential therapeutic outcomes. But this is the feedback from staff about residents who have access to their music. That those with a failure to thrive (God, take me!) change just by being reconnected with their music (and reminded of good times and loved ones), was an unexpected outcome of our efforts.  So, too, was the feedback from Recreation Therapists that some schizophrenic patients tended to have improved behavior and mood, perhaps because the music is so engaging, helping them to avoid more problematic thought patterns.

Top administrator questions:

1.  What about theft and loss?

Loss of dentures and hearing aids is a sore point. They are expensive and arguments with families about who should replace them are not unusual. Facilities have varied in their experiences with iPods. Some have lost none or only a few. Others have had losses exceeding 25% of inventory per year. Different users merit different approaches to minimize loss. With iPods now being donated at a faster pace, this makes replacement a more trivial issue. By planning for shrinkage, it does not present the same challenges as more expensive items that are lost.

2.  What are the costs?

The iPods, the music and training. iPod shuffles cost $49 and downloaded music typically costs $0.99 per song. Begin an iPod donation program to secure used iPods and iTunes gift cards to pay for the music. This is a straightforward community service effort for local schools, colleges and community groups. Migrate the audio CDs you already have into iTunes, and supplement this by budgeting $50 to $100 to purchase new music monthly.     We have set up a web-based certificate training options to ensure a successful program launch.

3.  Staff is already stretched to their limit.  How can we add another "program"?

Some residents are self-sufficient. If they can operate a TV remote, they can operate the iPod shuffle. For those with dementia or other limitations, staff find that the music helps in transitions during the day. As care often takes less time, they gladly spend the few seconds needed to operate the device.

4.  Isn't this isolating?

This is a common concern. In fact, just the opposite happens. Interaction increases.  Residents are MORE social. They're enjoying their music and want to share it with others. They want to talk about music or the memories it evokes.

5.  Does it help in meds reduction?

Staff report that this question comes up in care plan meetings. Now that this individual is in a better mood and more cooperative, can we reduce the psychotropics? Can we reduce their pain meds? 

Web-based certification programs are provided by Music & Memory (http://www.musicandmemory.com) in collaboration with the Institute for Music and Neurologic Function, the global leader in applying therapeutic benefits of music to health. 

Training covers how to: follow Apple and music industry rules, secure iPods and iTunes card donations, integrate with care plans, properly set up iTunes to manage hundreds of playlists, apply iPod use for residents with varying conditions, and implement policies and procedures appropriate to this approach.

Will music improve MDS scores? We will know soon enough. We are looking for a small number of sites to beta test a data assessment tool to find out.

The author is the Executive Director of  Music & Memory and can be reached at dcohen@musicandmemory.org. To learn more, call Well-Tuned: Music Players for Health at (718) 519-5840.

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