Recommended
Recommended
More Related Content
Similar to 26 sept18 arts and wellbeing ppt
Similar to 26 sept18 arts and wellbeing ppt (20)
More from ILC- UK
More from ILC- UK (20)
Recently uploaded
Recently uploaded (20)
26 sept18 arts and wellbeing ppt
- 1. A Research to Policy Seminar: Arts engagement and wellbeing in ageing societies Wednesday 26th September 2018 This event is kindly supported by Newcastle University's Institute for Ageing #artsandageing
- 2. Welcome Paul Cann Co-Founder of the Campaign to End Loneliness & former Chief Executive of AgeUK Oxfordshire This event is kindly supported by Newcastle University's Institute for Ageing #artsandageing
- 3. Dr Anna Goulding Research Associate Institute of Health and Society, Newcastle University ‘The contribution of cultural engagement to resilience in later life’ This event is kindly supported by Newcastle University's Institute for Ageing #artsandageing
- 4. Dr. Anna Goulding Institute of Health and Society Newcastle University @AnnaMGoulding Cultural Engagement and Resilience in Later Life
- 5. Everyday creativity: Gardening, communal housing, displaying objects, reading, craft Resilience – successful ageing not achievable for all Creative methods (Policy Press; December 2018)
- 7. Omnivorous • White, educated, younger-old • Widowhood; bereavement; later life divorce; anxiety and depression; declines to physical health
- 8. Downward comparisons • ‘… you could see … parallels and … that … helps to enable you to deal with certain things in your own life. Even if it was written two hundred years ago … those … things don't change … you reflect on something that you’ve read … and you say well it’s not as bad as this … they could get over it or … I’m very lucky … you can use it to reinforce positively your behaviour.’ (Male, age 68, Town Planner)
- 9. Social relationships • ‘If you have a friend then there’s a certain degree of shared knowledge of one another, if you’ve got an acquaintance then you can just dump all that and just be the person who’s interested in similar literature.’ (Female, aged 64, Learning Manager)
- 10. Private participators • I love her books. I read them all the time. Her first husband was a bad man….she met an American Air Force pilot and they’ve got friendly. I don’t know if they are going to get together… • I’m a great reader and I don’t get out very much now because I have a bit of a bad problem walking but four walls does not appeal to me at all…I like to have a wander round the library and I like to go in the reference library…I’m very inquisitive…if you don’t read and you don’t take an interest in things you just lose it and I don’t intend to lose it.
- 11. • I get letters from the library…but…it’s quite a hike. • I don’t know if I would like it or not but I just think that’s me night-time hobby…I get bodily tired…at ten o’clock the telly goes off, me book comes out, me music goes on.
- 12. Facilitated contact • I’d probably go with someone if one of the others were going…I just love music...I’d like to live the life I was living before it all happened, I had a good quality of life, we used to go out…I enjoyed going out. • Most of them won't go anywhere by themselves because their boundaries are very small. Confidence is very little. When their husbands were alive…they were dependent on them…if they are illiterate in their own language learning a second language becomes even harder…So we had pen and article…people were a bit reluctant…saying, ‘We are not getting anywhere with this, we’d rather just socialise’. • I’d like to have more contact with other people otherwise it gets very, very lonely. Ever since my wife died I’ve been tired, sad, depressed, weary and lonely…Sometimes wish I could get suicide pills on prescription.
- 13. Facilitated contact • …trips…curiosity, to get out of the house. • Because I could bring my knowledge to add.
- 14. Summary • Omnivorous - self-organise; socialised to engage in public forums; important preventative health • Private participators – not getting the social benefits • Facilitated contact – facilitation critical – the Voluntary Sector Organisational side drawing together group in the first instance, then for the Cultural Organisations to have an ‘offer’
- 15. Conclusion • Caution over arguments for ‘everyday’ over ‘official’ or ‘legitimate’ culture in debates around resource distribution. Cultural sector - official cultural organisations outreach officers essential • Local authorities – voluntary sector organisations; social workers; link workers, alongside cultural organisations.
- 16. Professor Andrew Newman Professor of Cultural Gerontology School of Arts and Cultures, Newcastle University ‘Dementia and Imagination – implications for the care home sector’ This event is kindly supported by Newcastle University's Institute for Ageing #artsandageing
- 17. Improving the quality of life of those living with dementia through the arts Professor Andrew Newman University of Newcastle upon Tyne
- 18. Dementia and imagination • Three sites and four waves of three months each: – NE England (Care homes) – Midlands (National Health Service assessment wards) – N Wales (Domestic environments)Interviews qualitative – residents, carers/family • DEMQUAL, Clinical Dementia Rating Scale, Holden Communication Scale • Socio-demographics, survey forms (social contacts, activity, prior arts engagement) for residents and carers/family members • Video recordings of arts activities • Interviews with PWD and carers/family members
- 19. Creative activities in care homes • This involves participatory artists working with residents – Not focused upon memory – although that comes in – Time Slips approach– creating something new and looking forward – Might involve a number of different art forms – painting, theatre, sculpture – More associated with contemporary art than skills in drawing – playing with form and colour – Multi-sensory (for those with more advanced dementia) smell touch etc.
- 21. Improvements in wellbeing • Enables expression – difficult for those with more advanced dementia (particularly if language has been lost), no normal opportunities. • Improves connectivity – relationships are often lost – people with dementia often withdraw from relationships. • Relationships with care staff are those of dependency and care.
- 22. Connectivity • As part of a session they sang the local song the Blaydon Races unprompted which reflects that culture they shared. • The participatory artists, carers or family members who were from a different age cohort and were often from elsewhere in the country were unable to contribute to the content. • The narrative they created referenced things they were aware of in the news as well as remaining memories that they had woven together which are associated with the preservation of self.
- 23. Resilience/adaptation • Individual and collective creative expression is the everyday process of adaptation, which is normally hidden, becoming visible. • Adaption is the motivating force behind the creation and re- creation of meaning and identity.
- 24. Underestimating abilities • I loved hearing people read, and was surprised how confident the readers were. I suppose I'd underestimated how capable people with dementia are and had assumed they would find this difficult. You underestimate people don’t you, you think ‘oh they’re not going to do that’. The sessions allowed people to achieve their full potential as they were no assumptions that they may not be able to do things.
- 25. Learning more about the lives of residents • Care home staff can learn more about the lives of residents and therefore are more able to support their selfhood.
- 26. For the future • It is important that activities cease to be done as an intervention and become more embedded in the running of care homes.
- 27. For the future • The issue of funding also needs to be addressed so it is less dependent on fundraising and becomes something that might be attractive to potential residents and families. • A way of achieving business plans?
- 28. UN Convention on the Rights of Persons with Disabilities • Arts enrichment activities have a part to play in fulfilling the UN Convention on the Rights of Persons with Disabilities for those with dementia enabling them to make decisions and to be active members of society.
- 30. Sally Bowell Research Fellow ILC-UK ‘The Commission on Dementia and Music: Considering what works and how to influence change’ This event is kindly supported by Newcastle University's Institute for Ageing #artsandageing
- 31. Quick facts – Dementia • 850,000 people with dementia in the UK – est. 1 million by 2025 • 700,000 unpaid carers for people with dementia – est. 1.7 million by 2050 • Annual cost of dementia to the UK is £26.3bn – est. £50bn in next 30yrs • Dementia costs more than cancer, stroke, and chronic heart disease combined
- 32. Quick facts – Dementia [2] • Delaying onset of Alzheimer’s by 5 years could result in £100bn saved between 2020 and 2035 • c.80% of PWD in care homes have behavioural and psychological symptoms of dementia (BPSD e.g. agitation, depression, anxiety)
- 33. Creating the Commission on Dementia and Music Context • Differing definitions of ‘music-based interventions’ • Sporadic and highly variable provision • Emerging understanding of effectiveness, but with significant gaps • Suspected low awareness amongst public, practitioners, policy makers etc
- 34. The activities of the Commission • Brought together 12 high-profile expert Commissioners • Literature review • Site visits • Oral & written evidence • Report and launch event • Media traction
- 35. Defining ‘music-based interventions’ We chose to use the phrase ‘music-based interventions’ throughout our analysis and report, to refer to what we discovered to be a very broad range of activity and approaches. As we explored in our report, reflecting on all of the evidence to hand, examples of ‘music-based interventions’ can include: • Listening to music • Personalised, recorded music • Learning and playing an instrument • Live music in care homes • Music therapy • Community-based musical performances and events • Community-based music groups
- 36. Current state of play – what did we find? • Sporadic – well-developed in some areas but minimal, or even entirely unavailable elsewhere • Lack of information about: – Availability – Locations – Delivery partners – Effectiveness – Cost
- 37. Benefits of music-based interventions • Music and the brain • Minimising the behavioural and psychological symptoms of dementia (BPSD) • Tackling anxiety and depression • Retaining speech and language • Enhancing quality of life • Impact on caregivers • Palliative and end of life care
- 38. Effective delivery – what to bear in mind • Important that music is not used indiscriminately • Making music personal – ‘Memory bump’ • Communication and listening
- 39. Barriers and challenges • Lack of real traction in the policy environment – nationally and locally • Data collation and centralisation • Funding – Challenge of defining incurred costs – Who pays? – Demonstrating cost-effectiveness and savings • Recognising the therapeutic potential
- 40. Barriers and challenges [2] • Instilling confidence, enthusiasm and belief • Reaching the hard-to-reach • Reflecting and promoting diversity
- 41. Opportunities • Funding – Personal Health Budgets and Integrated Personal Commissioning – Other funding options e.g. leveraging existing resources, trusts & foundations, music industry, innovative fundraising • Training – For ‘everyday’ use of music – For specialist and periodic interventions • Signposting and referrals
- 42. Opportunities [2] • Recent media attention • Broader dementia landscape • Evaluation • Technology
- 43. Conclusions • We see devoted advocates operating in a complex and poorly coordinated ecosystem • There is sporadic provision, currently delivered only to the few • The sector is supported by a promising emerging evidence base, which is gaining traction • There are minimal levels of funding – importance of developing cost- effectiveness research • The low level of public awareness needs to be addressed
- 44. Recommendations • Coordinate delivery and build intelligence • Develop the research base • Raise public awareness • Coordinate and grow funding
- 45. Panel Debate and Q&A
- 46. A Research to Policy Seminar: Arts engagement and wellbeing in ageing societies Wednesday 26th September 2018 This event is kindly supported by Newcastle University's Institute for Ageing #artsandageing
Editor's Notes
- Preventative health, people living in community, younger-old, quality of life/wellbeing – resilience Decentralised responsibilty for health and social care to local authorities Public health – social prescribing – psychosocial models of care Not so much talk about the health and wellbeing arguments –evidence there. Response to Creative Health: the Arts for Health and Wellbeing All-parliamentary group on arts, health and wellbeing inquiry report 2017 Barriers attitudinal rather than legislative or inherent on formal policy Health and Social Care Act 2012 – existing public funding systems capable. Health and Social care > understand (appreciate) arts better Arts > understand how they can engage with Health and Social Care systems. Research. Look at how people are engaging with culture on the ground
- 40 participants 64-98 years
- 40 participants 64-98 years
- 11 64–77, younger than in the other groups, below 68, all White British. educated to post-graduate level, and had held professional-executive occupations. extensive range of cultural activities mainly in social contexts. classes on history of art, literature or music; reading group; film group; music classes; choirs; self-led reading groups taking place in members’ homes; reading or painting privately at home; independent visits to music concerts and art galleries. 3/4 different cultural activities a week independent cultural visits to art galleries or classical concerts about twice a month.
- Firstly, participants used the aesthetic encounter to contribute to meaning-making processes. The arts provided invaluable insights into human experience and presented alternative subjectivities. Participants actively drew from the experiences faced by characters in novels to make downward comparisons with the challenges they faced in their own lives, which was found to be reassuring.
- facilitating loose-tie social networks – participants who had experienced later-life divorce and those who wanted independence from their spouse post-retirement were not seeking friendships. Instead, they welcomed discussions focused around the content of the art form as opposed to enquiries about their wider lives.
- Private participators, (N=4) 76-78 White British groups. No formal education Factory; salesperson Participants visit the local art gallery about twice a year when they see an exhibition that interests them in the local newspaper. They visit the local library once a fortnight and are avid readers. Another participant takes photographs. Coach to Manchester to see Michael Flattley
- Psychosocial barrier Reduces it – omnivorous talk in existential terms about how art makes them understand what it is to be a human
- Facilitated contact (25) 60-98 drawn from White British, Pakistani, Bangladeshi, Indian, and Chinese ethnic groups. 2 professional qualifications (one the equivalent of postgraduate) but the majority did not have any formal educational qualifications. Chinese and South Asian participants had experienced only a few years of formal education at most in their native countries. Their former occupations were as follows: One professional-executive, nine intermediate, and fifteen working class occupations. Two participants from the ‘Live at Home’ schemes and one Chinese participant were full-time carers to spouses. One respondent from the ‘Live at Home’ scheme was dependent on professional carers after having a stroke. Five participants had visited established cultural institutions when they were middle aged, fourteen had only visited when facilitated by the charities and six had never engaged.
- Dementia and Imagination – introduction Struggling to remember things that happened recently, even though you can easily remember things from longer ago. ◾Struggling to follow conversations, particularly in groups. ◾Forgetting the names of people or things. ◾Struggling to follow a story on television or in a book, or understand magazine and newspaper articles. ◾Having trouble remembering the day or date. ◾Having trouble remembering where you put something, or where things are kept. ◾Being unaware that you are repeating yourself or losing the thread of what you are saying in mid- sentence. ◾Difficulty completing familiar tasks. ◾Struggling to do things you used to find easy. ◾Feeling confused even in a familiar place. ◾Having problems controlling your mood, or controlling your emotions. Quite a lot of evidence that the quality of life of those living in care homes is poor.
- For this presentation will use Now completed -
- Cranlea – Kingston park
- Are they doing better than expected?
- Persons with disabilities are not viewed as "objects" of charity, medical treatment and social protection; rather as "subjects" with rights, who are capable of claiming those rights and making decisions for their lives based on their free and informed consent as well as being active members of society – we have a long way to go until this is achieved for PWD.
- Hello, my name is Sally Bowell and I’m a Research Fellow at a non-partisan think tank called the International Longevity Centre. I’m here to give you a quick overview of the work of the Commission on Dementia and Music, which involved a collaboration between the ILC and The Utley Foundation, a charitable foundation with an interest in supporting music-based interventions for people living with dementia. I was involved in the set-up and the day-to-day running of the Commission, and acted as a co-author on its final report. For many, music is a part of the fabric of life. Encompassing different cultures, genres and eras, music brings people together, promotes communication and helps with emotional expression. Music is also indelibly tied to memories; a nursery rhyme, the song for the first dance at a wedding, or a favourite Christmas carol can take us back to a time, place and feeling. Ultimately, at the heart of this debate is the right for people with dementia to have not just a life, but a good life and to be comforted and enlivened by the power of music.
- 850,000 people with dementia in the UK – est. 1 million by 2025 700,000 unpaid carers for people with dementia – est. 1.7 million by 2050 Annual cost of dementia to the UK is £26.3bn – est. £50bn in next 30yrs Dementia costs more than cancer, stroke, and chronic heart disease combined
- Delaying onset of Alzheimer’s by 5 years could result in £100bn saved between 2020 and 2035 c.80% of PWD in care homes have behavioural and psychological symptoms of dementia (BPSD e.g. agitation, depression, anxiety)
- At the outset of the collaboration between the ILC and the Utley Foundation, we identified some of the contextual issues that we felt would be important to this piece of work. Colleagues at the Foundation, in particular, had expertise and insight into important factors due to their prior work in the field. For example, the Foundation has collaborated with the musician Beatie Woolf who has performed in care homes around the country for people with dementia. During the scoping phase for the work, it became clear that the following were important contextual issues for the work: Definitions of music and dementia varied widely, with little consensus on exactly what should be encompassed. We chose to use the phrase ‘music-based interventions’ to define our parameters and I will talk through the definition of this in more detail shortly. We noted that the UK has sporadic and highly variable provision of music-based interventions for people with dementia. Notably, understand the exact degree and variation of provision was challenging due to the lack of a centralised record of availability, type or quality. There is a growing evidence base on the use of music with people with dementia, and an emerging understanding of its effectiveness, but there still remain significant gaps During the scoping phase, we suspected that there was a generally low awareness amongst public, practitioners, policy makers etc of the potential for using music with people with dementia.
- We brought together 12 high-profile expert Commissioners to support and help guide our work. Literature review: The literature review aimed to draw together the main arguments and aspects of the debate around dementia and music. ILC-UK were supported and guided in this process by Commissioners, those who submitted written and oral evidence, and a current PhD student in the field. Site visits: Site visits were organised so that ILC-UK researchers could observe a range of activities in practice, to enhance understanding. Commissioners joined to observe practice and to provide further insight during visits. Call for written evidence: We designed a template for written evidence submissions, which included a range of key questions. ILC-UK then shared this with a list of expert individuals and organisations, identified during a stakeholder management session, as well as with ILC-UK networks. Commissioners also disseminated the Call to their networks. We received over 55 evidence contributions from a range of different people and organisations. This qualitative data was then used to guide the writing of the final report, and novel ideas were cited and featured. Oral evidence sessions: Two evidence sessions were held in the House of Lords, with contributions from eleven experts in total. The first session focussed on the current ‘state of play’ of music and dementia and we heard from those currently working in and engaged with the field. The second session was designed to help us to develop recommendations for the progression of this field of work. Report and launch event: In January 2018, ILC-UK published the final report from the Commission, launching to an audience of over 200 guests in the House of Lords. The report was launched alongside two short films produced to help illustrate the value of music for people living with dementia. Since its publication in January, the report page on the ILC-UK website has been viewed by over 3,200 people. Media traction: We were delighted that the work of the Commission was featured on BBC Breakfast News, the Financial Times Health Podcast, and several national newspapers. I’ll be discussing more about further dissemination and next steps a little later on.
- We chose to use the phrase ‘music-based interventions’ throughout, to refer to what we discovered to be a very broad range of activity and approaches, both formal and informal. As explored in our report, reflecting on all of the evidence to hand, examples of ‘music-based interventions’ can include a range of different activities, in many different settings. At a glance, we summarise three main ways of engaging with music: ● Music therapy, delivered either one-to-one or in a group setting, by a qualified and registered music therapist. In the UK, music therapy is a state-registered health discipline. There are currently 7 music therapy MA training courses for professional music therapists in the UK. Over 100 music therapists are qualified each year, although not all will specialise in music therapy for people with dementia. ● Listening to music, either live or recorded, is another type of intervention. Playlists can be tailored to an individual’s preferences in some instances, for example by making use of online apps or personalised CDs. In other examples, care homes can become venues for musicians to play live music to a group of individuals living with dementia. Some individuals may be given the opportunity to attend orchestral or choral performances. Live music can be tailored to the group, for example by purposively designing playlists which draw on childhood music. Music can be listened to either solo or in a group, and clients can actively participate, for example by expressing their musical preferences or by moving to music. ● Playing music and/or singing is a further form of intervention. Again, this can be in either an individual or group setting. Individuals can be supported to continue playing an instrument, thereby maintaining a lifelong skill, or to join in singing along to well-known songs. Examples include a multitude of community choirs, singing groups and orchestras which are open to people with dementia.
- Music-based provision has been delivered sporadically for many years within the UK, and appears to be fairly well-developed in some areas. However, there is a complicated and often confusing picture of the different options and provision available. Provision appears to be patchy and there are many important, outstanding questions to be answered. Not enough is understood about what is being done, by/with whom, and why, and there is little in the way of simple and effective information for the public. The Commission has highlighted the importance of simplifying and making-accessible information about the availability of music-based provision for people with dementia. It is clear that music-based provision is not consistent and operates with a high degree of variability. This is despite pockets of standardised delivery such as professional music therapy practice. Penetration of the market appears to vary between regions (although there is a lack of quantitative evidence to demonstrate this), and there is no centralised database of activities and provision. The closest available database is likely the Alzheimer’s Society’s Dementia Connect tool, which includes some music-based provision but does not yet fully reflect the landscape. A charity called Arts 4 Dementia also helpfully signposts arts opportunities for people with dementia in communities around the UK.
- Music and the brain: Regions of the brain associated with musical memory may overlap with regions relatively spared in Alzheimer’s disease. Meanwhile, music is multi-dimensional and underpinned by widespread cortical plasticity, suggesting that even if certain areas of the brain are badly affected by dementia, a person may still be able to understand and enjoy music. Music may help in the recall of information for people with dementia, in a similar way to mnemonics, and playing a musical instrument may be associated with a lowered likelihood of developing dementia. Minimising the behavioural and psychological symptoms of dementia, known as BPSD: Music-based interventions have the potential to help minimise BPSD, including agitation, abnormal vocalisation and aggression. Tackling anxiety and depression: Music-based interventions could help to reduce anxiety and depression amongst people with dementia. Some research has suggested that the impact of music therapy on anxiety and depression could potentially be lasting, but more evidence is required. Retaining speech and language: Music-based interventions may have the potential to improve the retention of speech and language for people with dementia. Enhancing quality of life: Research suggests that music-based interventions can help to facilitate increased social interaction or ‘flow’, improve well-being, decrease stress hormones and enhance the quality of life of people with dementia. Impact on caregivers: Early-stage research indicates that improvements in caregiving after music-related training are reported by care givers, families, service providers and music therapists. Feedback suggests that engaging carers in music-based interventions can help them to better understand residents. Further research is needed to help demonstrate behaviour change of carers and statistical significance of changes. Palliative and end of life care: There is a paucity of studies relating to the use of music in the palliative and end of life care of people with dementia. Qualitative evidence suggests that music therapy in end of life care may help to minimise anxiety and discomfort, but a lack of quantitative data makes generalisations about the value of music near-impossible, in particular in dementia end of life care.
- It is important that music is not used indiscriminately. Carers and loved ones must note the value of silence, as well as that of sound. Music should be tailored to the interests and preferences of people with dementia in order to minimise distress, and to be in keeping with the principles of personalised care. E.g. In residential settings, carers should avoid leaving the radio on all day. Some people with dementia become fearful or intolerant of sound, whilst others may enjoy short and purposeful sessions of music, but may become distressed if music is played for too long, too loudly or in an unregulated way. In making music personal, it is important to bear in mind factors such as: Personal interest and abilities Local culture Ethnicity Heritage Location Type of dementia It is also important to factor in the emerging evidence of a ‘memory bump’ for people with dementia. It appears that people with dementia retain clearest memories for music they enjoyed and heard between roughly the ages of 10 and 30. When designing playlists or performances for people with dementia, this can be a useful tool for better tailoring and personalising interventions. Music is also a valuable means of communication. Through music, carers and loved ones can develop a greater understanding of a person’s history but, also of the here-and-now e.g. do they have pain they can’t communicate verbally? Listening and observing is a hugely important and valuable part of the process.
- We noted that there is a lack of real traction in the policy environment, at both a national and a local level. References to music-based interventions for people with dementia in policy documentation are tentative and non-specific. For example, the Department of Health’s 2009 national [English] strategy for living well with dementia made just one very small reference to arts therapies. Meanwhile, NICE’s guidelines on assessment, management and support for people living with dementia and their carers (updated this year) do not specificially mentioned music as an intervention. Due to a lack of robust and convincing evidence, NICE guidelines on Interventions to delay or prevent onset of dementia, disability and frailty have not specified music as a recommended means to help prevent the onset of dementia. In terms of local agendas, a report by the Baring Foundation examined the position of local authorities in securing a creative and healthy later life for their populations. The report noted that local authorities have responsibilities for local arts, public health and wellbeing, social inclusion, community cohesion and older people’s services. Yet most local authorities are yet to fully engage with and recognise the potential of older people and the arts. Data collation and centralisation is another challenge for the field. In order to make reliable estimates of the cost-benefit of music-based interventions, and to compare to other interventions, medications and therapies, it will be necessary to centrally collect data on what is being provided across the country, the content of provision and its scale. The Alzheimer’s Society’s Dementia Connect tool is a really valuable area of work. Whilst this will undoubtedly prove to be a highly useful tool for people with dementia and their carers and loved ones, it does not provide a sufficient coverage or the right level of detail to be used for research purposes such as cost-benefit analysis and extrapolation at this stage. This ambition also, understandably, falls outside the remit and intention of such a tool. Funding frequently came up as an area of concern in many evidence submissions. There is, of course, the broader landscape of local authority budget cuts etc., as well as cuts to the Department of Health and Social Care. This tight financial environment will place pressure on those delivering music-based interventions to clearly define their unit costs, and to focus on developing cost-effectiveness studies. This is particularly important for those music-based interventions outside of the music therapy realm. There are also attitudinal barriers to address, to change the conversation from music as a ‘nice-to-have’, to music as a form of therapy, to be built purposefully into care plans.
- It can be challenging to instil the necessary confidence and enthusiasm for music in carers, family and friends of people with dementia. People often think they are not musical enough, but the idea that a carer needs a high level of musical ability in order to deliver a music-based activity is not necessarily true; whilst some types of interventions are suited to delivery by trained professionals, others thrive when delivered by day-to-day carers. As with many interventions designed to support vulnerable individuals, reaching the most in-need is an inherent challenge to delivery. Identifying those individuals who may be the most socially-isolated, those with severe anxiety or depression, or those who are not receiving any statutory or voluntary support, can be very difficult. Schemes such as local area coordination and care navigation may help in reaching the most vulnerable individuals. It is highly important that we recognise the need and right to musical diversity. Musical preferences and understanding vary not just by culture, but also by generation. The challenge is to ensure that professionals are mindful and attentive to this diversity and engage with people with dementia in a way which is most suitable. Encouraging ‘bottom-up’ programme design is one way of trying to ensure that music-based activities embody diversity. Training is also highly important. Music therapists, for example, are trained to work across cultures and to utilise a range of musical styles; this comprises an integral element of music therapy qualifications.
- Whilst funding was noted as a challenge to the field, there are also opportunity areas to seize. Personal Health Budgets (PHBs) and Integrated Personal Commissioning (IPC) can offer routes to personalised funding for some people living with dementia, in particular those with the highest identified level of need. Other funding opportunities could include Leveraging local resources, such as intergenerational projects using existing school and university music groups, or bringing local music venues on board. Private philanthropic individuals and organisations could play a valuable role in funding various strands of activity in this field moving forwards. E.g. by directly funding provision, and also providing support and financial backing to awareness-raising activities and campaigns. Innovative approaches to fundraising allow some care homes to offer music-based interventions where otherwise this might not have been possible. For example, MHA currently fundraises just over £500,000 per year for music therapy which is provided free to the residents living in the organisation’s 60 care homes with a dementia care service. In terms of the ‘everyday’ training of carers, there is a lack of consistency. One suggestion could be to create tools and recommended approaches for care staff to use. Endorsement of these nationally-relevant tools, for example by the NHS, Skills for Care and/or Skills for Health (and other relevant bodies) would be highly valuable. Formalising the process through which people with dementia are referred to music-based interventions could prove to be a highly effective way to reach more people and to ensure a steady flow of participants to activities such as community choirs and other music groups. Integrated working will be crucial in ensuring that the most vulnerable and in-need individuals can be referred to suitable music interventions and services.
- Undoubtedly, the message that music can be a powerful resource for dementia is starting to gain traction in mass media and amongst the public. A clear opportunity exists in capitalising on work already done in this field and promoting the message still further, for example through a coordinated national campaign. Continuing work to ensure that society is becoming ever-more dementia-friendly should help to encourage the idea that music-based interventions do not necessarily need to be dementia-specific, especially for those with mild-to-moderate dementia. Pursuing a welcoming and inclusive society for people with dementia will help to avoid stigmatisation and ensure that people with dementia are able to continue being active and valued members of the community. Ensuring the effective evaluation of provision is also key. Establishing and utilising a standardised evaluation practice, including standardised outcomes tools, could offer a valuable way for quality and value for money to be assessed. It would be useful to create different ‘tiers’ of evaluation best practice. This would mean that smaller organisations and charities could undertake evaluation activities which would be feasible in terms of overall programme expenditure, and organisation size and capabilities. Finally, emerging technologies offer a huge number of opportunities for this field of work. Digital music, for example, is popular with many due to its relative affordability, the fact that it can be used at any time, anywhere, and its replicability. Harnessing new types of technology could mean using virtual reality to simulate watching an orchestra perform, or being at a concert. Exciting developments could be made in this field if technology companies and the music industry are brought on board.
- To conclude, throughout the work of the Commission, we identified the following five broad themes: We see devoted advocates operating in a complex and poorly coordinated ecosystem There is sporadic provision, currently delivered only to the few The sector is supported by a promising emerging evidence base, which is gaining traction There are minimal levels of funding – importance of developing cost-effectiveness research The low level of public awareness needs to be addressed
- The report made extensive recommendations, which were targeted towards identified stakeholders and which focused on being actionable (be than in the shorter- or longer-term). I won’t go through each of these recommendations in detail, and instead would refer you to the full report which can be found on the ILC-UK website. However, at a glance and on an overall level, our report recommended the following as key steps in further the agenda of dementia and music: Coordinate delivery and build intelligence Develop the research base Raise public awareness Coordinate and grow funding