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Monday, November 29, 2021

Evidence-based music use is a fundamental component of meeting the aged care quality standards – it’s time it was recognised as such

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Music is more than entertainment; in fact, it is redefining the frontiers of allied health therapy for a range of conditions, including dementia and palliative care.

It is a form of therapy that was specifically called for by the Royal Commission into Aged Care Quality and Safety, wherein Commissioner Lynelle Briggs called for the employment of ‘at least one… music or art therapist’ per residential aged care facility (RACF), alongside other allied health services.

Hayley Antipas, registered music therapist and director of her own newly established company Attuned Health, provides music therapy directly to aged care and NDIS recipients, as well as advisory services to aged care providers and peak bodies.

She tells Aged Care News that music is a vital, but often overlooked, avenue of care for older Australians.

“Music is part of a person’s identity, so it’s really important that we understand how to promote musical choice and to use music in evidence-based ways that fosters a person’s identity and allows them to connect with other people,” she says.

Although music therapy is not necessarily new, it has largely taken a backseat due to erroneous assumptions within the psychological academia.

Music is part of a person’s identity, so it’s really important that we understand how to promote musical choice and to use music in evidence-based ways that fosters a person’s identity and allows them to connect with other people.

Music therapist and Attuned Health director, Hayley Antipas

Steven Pinker, a Canadian-American psychologist, called music an ‘auditory cheesecake’ in his 1997 book How the Mind Works, suggesting it has no higher function than being “a pure pleasure technology”.

Antipas says that this outdated view “may drive how people are using music in aged care”.

“It’s something pleasurable, it’s something enjoyable, it’s nice to have …  some places say consistently: ‘let’s just always have music on’.

“But when we break that down to look at it from a brain perspective, and a psychology perspective, there’s actually lots of nuances.”

Hayley Antipas is a music therapist and director of her own company, Attuned Health. She says the key to providing best outcomes through music therapy is the integration of music therapy principles into daily living within facilities.

She says that without intervention from registered music therapists, RACFs often find it hard to provide a balanced programme of music; both underuse and overuse is commonplace.

“What I see when I go to aged care facilities is a lot of good intent, but a lack of understanding around how people actually might respond to music.”

“I think it’s very important that aged care providers think of music, for lack of a better description, like a drug, and that they make sure the staff understand how to use that in the most effective way and how to monitor for side effects.”

I think it’s very important that aged care providers think of music, for lack of a better description, like a drug, and that they make sure the staff understand how to use that in the most effective way and how to monitor for side effects.

Hayley Antipas

Promising addition to dementia care

Music therapy is recognised by Dementia Australia as a promising non-pharmacological treatment option for the symptoms associated with dementia.

In fact, a recent meta-analysis found that music therapy can improve cognitive function and reduce depression long-term in those living with dementia.  

The effect was seen to be most profound in intervention related to listening to music, followed by singing

It’s a highly fascinating area of research for Antipas, who has just begun a PhD at the University of Melbourne on the topic.

“Some studies indicate positive outcomes of playlists for agitation, anxiety and a reduced dependence on anti-psychotic medications,” she says.

In her own practice she says she experienced a “beautiful” outcome with a patient living with advanced dementia.

Joan* had been referred to Antipas as a ‘last resort’ after other treatment avenues proved largely ineffective in alleviating her symptoms.

“Joan was starting to become quite aggressive towards the staff in the morning when they were trying to assist her with showering and personal care… likely because she was understandably confused and scared about that situation.”

The nurse came running down the corridor, grabbed me and said, ‘that is like magic… I’ve been in aged care for more than 20 years and this is the best thing I’ve ever seen. I wish everybody had this.

Hayley Antipas

After a music therapy assessment, Antipas discovered that Joan was especially responsive to country music.

Using a music therapy technique called the iso-principle, Antipas created a playlist that matched music to Joan’s initial psychological state but, as the playlist progressed, slowly shifted the tone of the songs towards a more desirable, positive state.

“So the playlists started with something that was quite tense and a little bit confused and anxious, and then gradually, the music shifted in mood to help her feel more calm.”

“Then I worked with the care staff who was supporting her, to help them understand how they might best orient Joan towards the music, using rhythm and a bit of singing.”

Antipas returned to the facility a week later, finding Joan to be calmer than ever and her support staff amazed.

“The nurse came running down the corridor, grabbed me and said, ‘that is like magic… I’ve been in aged care for more than 20 years and this is the best thing I’ve ever seen. I wish everybody had this.”

Adaptive approach needed

When treating individuals with music therapy, there is no one-size-fit-all approach.

“If we think about any person, particularly any adult, the way they use music is different,” Antipas says.

“Some people wake up and the radio goes straight on. Some people like some silence. Some people need the music on to get motivated to do their housework, and others might find that distracting.

“So it’s really about finding out what that individual likes.”

When dealing with emotionally charged music, aged care workers must be especially sensitive.

“The way a person emotionally reacts to music has a lot of components,” Antipas says.

Some people wake up and the radio goes straight on. Some people like some silence. Some people need the music on to get motivated to do their housework, and others might find that distracting. So it’s really about finding out what that individual likes.

Hayley Antipas

“But it’s very much driven out of a person’s memories or associations with a piece of music as well as the particular musical qualities.”

And responses can vary not only in the general preferences a person may have, but in their responses to the same music day-to-day.

“There’s certainly particular songs that might be more or less likely to evoke strong emotional responses,” Antipas says.

“So songs like Danny Boy that is frequently used at funerals: a person when they hear that song might associate it with a funeral of a loved one… or songs that might have been used commonly as wedding songs, for example.

“Now, if a person has lost their partner, that could be a really positive thing: it reminds them of their loved one, and that can be a nice experience.

“But on another day, that might be quite upsetting for somebody.

“So it’s just being mindful that, you know, one day it could be this response and the next day, it could be quite different.”

Care must be especially taken when introducing music to those living with dementia.

“When we’re talking about people who are living with dementia, it might be more difficult for them to communicate what they want, or if the music is becoming a bit too much for them, it might be difficult for them to get that across.”

Being a disability support worker really gave me that insight into what’s it like 24/7 for people living with complex disabilities, and I think that drives how I think about capacity building now as a therapist, thinking about those people beyond the hour I see them.

Hayley Antipas

A view to the full ecology of care

Antipas tells Aged Care News that her previous experience on the front-line, working as a disability support worker, is “foundational” in the approach she takes as a registered music therapist.

“Being a disability support worker really gave me that insight into what’s it like 24/7 for people living with complex disabilities, and I think that drives how I think about capacity building now as a therapist, thinking about those people beyond the hour I see them.

 “I have a strong ecological approach, which means I like to work with the system around a person, as well as the individual.”

She says that the key to providing best outcomes through music therapy is not a sole reliance on contact hours with the registered therapist, but in the integration of music therapy principles into daily living within facilities.   

“I do a lot of training with support and care workers so that they can use music effectively… rather than it just being that one hour a week that they see the music therapist.

“I want [the benefits] to be sustained throughout the week.”

“By consulting with and working with registered music therapists, organisations can build clinically robust programmes, the policies and procedures.”

[It’s] providing the support for staff, including training and education so that staff feel comfortable, but also capable to use music in a way that’s driven by evidence, rather than it being driven by a sense of, ‘oh, this is fun – let’s put a CD on and hope that cheers everybody up.’

Hayley Antipas

“But it also means providing the support for staff, including training and education so that staff feel comfortable, but also capable to use music in a way that’s driven by evidence, rather than it being driven by a sense of, ‘oh, this is fun – let’s put a CD on and hope that cheers everybody up.’”

Medicare yet to catch on

Despite the therapy’s promising clinical results, the Australian Government is yet to fund music therapy to the extent it does other forms of allied health.

Whilst it is subsided through the NDIS, it is not listed on the Medicare Benefits Scheme (MBS) like other allied health services.

“So it really relies on [aged care providers] seeing the value in this and understanding that evidence-based music use is a fundamental component of meeting the aged care quality standards” Antipas says.

“It affects the environment; it affects a person’s care; it can affect their medication; and, most importantly: it’s their choice.

“It’s part of their identity.”

To find out more about music therapy, visit the Australian Music Therapy Association website.

*name changed for privacy

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