Music & Memory: Transforming Lives of People Residing in NFs and SSLC

One iPod at a TimeNovember 13th 2018

Office of the Quality Monitoring

Program and InnovationMedicaid & Chip Services Department

Medical and Social Services

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Welcome

Health and Human Services Quality Monitoring Program & Initiatives (QMP) Music & Memory (M&M) Project

Presenters:

• Therese Palombi, M&M Project Manager, QMP, Program Development and Innovation (PDI)

• Dr. Michael Gayle, DPT, Director, QSR

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Agenda

• What is Music & Memory (M&M)?

• Purpose of M&M & Why it Works

• QMP Music & Memory Project Overview

• Accessing the Power of Music to Stabilize Mood & Behavior

• State Supported Living Centers Music & Memory Program

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What Does Music Mean to You?

• How many of you would say you couldn’t live without music?

• How many of you listen to music every day?

• How many of you sing? Play an instrument?

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Technological advances in brain imagery

• Technological advancements in FMRI and PET scan imagery are helping neuroscientists pinpoint exact areas of the brain that become activated when listening to music

• This imagery also reveals differences as to how the brain responds when listening to preferred music, singing music and from playing music.

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What Music Helps Us With

• Reduces anxiety and agitation

• Significantly reduces pain

• Decreases wandering, which decreases falls and injuries

• Attention

• Engagement

• Language

• Improves the body’s immune system

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What Music Helps Us With

• Learning

• Increased motor movement and control

• Reduces symptoms of Parkinson's disease

• Decreases the stress hormone cortisol

• Stabilizes mood and emotion, reduces depression

• Increases staff morale in residential and healthcare settings

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What Is Music & Memory?

• Music and Memory (M&M) uses digital music technology to create personalized music playlists for people with Alzheimer’s and other types of dementias.

• These personalized playlists are songs associated with deeply emotional life events to the individual that allow access to long- lost memories

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What is Music & Memory?

• Trains staff through the certification webinars

• Enables those struggling with Alzheimer’s, dementia and other cognitive and physical challenges to reconnect with the world through music-triggered memories.

• M&M is a tool that can help you reach your residents in a new way and build better relationships that comes from the sharing of music

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Purpose of the Program

• To reduce the use of antipsychotic medications

• To enable people with dementia/other cognitive challenges to reconnect with the world through music-triggered memories

• To achieve a richer life for people by providing personalized music through digital music technology

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Let’s Meet Henry

This clip is from the documentary film Alive Inside

The film chronicles the birth of the M&M program with Founder and CEO Dan Cohen

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QMP M&M Program Summary

• Pilot - 32 Nursing Facilities (NF) July 2015

• Phase I - 93 NF certified in April 2016

• Phase II - 43 NF certified in the October 2016

• Phase III - 158 NF will received certification in March and April of 2017

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QMP M&M Program Summary

• Phase IV – 49 NF certified April 2018

• Phase V – 43 NF certified Oct/Nov 2018

• Phase VI – Jan 2019 – Dec 2019

• UT Center for Long-term Care is conducting a study on Phase V to determine the efficacy of the M&M program

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Results Between 2015-2018CMS National Partnership to Reduce the Use of AP• In 2015 when HHSC started the program, Texas was

ranked 51st in the U.S. (25.70%) as the highest prescriber of antipsychotic medications (AP) for long-term stay residents AD

• As of October 1st, 2018, we are now 17th (13%) in the nation.

• This is the first time Texas is below the national average of 15% (represents % of residents in NFs dx with Alz/Dementia taking an antipsychotic)

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Categories of Music to Explore• Songs

• Operas

• Cartoons – old cartoons often have classical or opera music

• Faith-based music

• TV theme songs

• Movie theme songs

• Videos

• Commercials

• Radio shows

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Example of Utilizing the Power of Music• If you listen to music that beats like your heart, researchers in

Hong Kong found that participants who listened to music 30 to 45 minutes before bed every night for three months fell asleep more quickly, slept more deeply, and felt more rested the next morning.

• But not just any music. These songs featured tempos between 60 and 80 beats per minute— which is the approximate heart rate when we fall asleep.

• Source: https://www.klova.com/blogs/the-daily-snooze/good-sleeping-songs-scientifically-proven-playlists

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If you're ever having trouble falling asleep or just need some help calming down

Try playing "Weightless" or any of these other top-ten relaxing songs uncovered during Mindlabs' eye-closing study.

10 "We Can Fly," by Rue du Soleil (Café Del Mar)

9. "Canzonetta Sull'aria," by Mozart

8. "Someone Like You," by Adele

7. "Pure Shores," by All Saints

6. "Please Don't Go," by Barcelona

5. "Strawberry Swing," by Coldplay

4. "Watermark," by Enya

3. "Mellomaniac (Chill Out Mix)," by DJ Shah

2. "Electra," by Airstream

1. "Weightless," by Marconi Union

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Anecdotal evidence

QMP has reviewed thousands of data sheets submitted by NF providers and received hundreds of emails consistently reporting the following:

• Decrease in pain (residents even asking for their iPod to “help me with my pain”)

• Decreased falls – one facility reported after three months of program implementation, it reduced falls from 50-60 per month to 11-13 per month

• Reduced anxiety, agitation and depression

• Increase engagement with loved ones and staff

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Music Log

Facility Name:_____________________________________________

Music & Memory Music Use Log for: ____________________________ Month__________________

Week Amount iPod Used Overall Feeling about

Listening

Overall Behavior

while Listening

Change in Behavior as a

Result of Listening

Overall Mood

while Listening

Change in Mood as a Result

of Listening

Week 1

(1st - 7th)

# of days offered ____

# of days used ____

Loved _____

OK with use _____

Take it or leave it _____

Did not like _____

Hated _____

Calm _____

Aggressive _____

Agitated _____

Talkative _____

Quiet _____

Wandering _____

No Change _____

Improved _____

Worsened _____

Happy _____

Bored _____

Flat _____

Nervous _____

Sad _____

Angry _____

No Change _____

Improved _____

Worsened _____

Week 2

(8th - 14th)

# of days offered ____

# of days used ____

Loved _____

OK with use _____

Take it or leave it _____

Did not like _____

Hated _____

Calm _____

Aggressive _____

Agitated _____

Talkative _____

Quiet _____

Wandering _____

No Change _____

Improved _____

Worsened _____

Happy _____

Bored _____

Flat _____

Nervous _____

Sad _____

Angry _____

No Change _____

Improved _____

Worsened _____

Week 3

(15th - 21st)

# of days offered ____

# of days used ____

Loved _____

OK with use _____

Take it or leave it _____

Did not like _____

Hated _____

Calm _____

Aggressive _____

Agitated _____

Talkative _____

Quiet _____

Wandering _____

No Change _____

Improved _____

Worsened _____

Happy _____

Bored _____

Flat _____

Nervous _____

Sad _____

Angry _____

No Change _____

Improved _____

Worsened _____

Week 4

(22nd - 28th)

# of days offered ____

# of days used ____

Loved _____

OK with use _____

Take it or leave it _____

Did not like _____

Hated _____

Calm _____

Aggressive _____

Agitated _____

Talkative _____

Quiet _____

Wandering _____

No Change _____

Improved _____

Worsened _____

Happy _____

Bored _____

Flat _____

Nervous _____

Sad _____

Angry _____

No Change _____

Improved _____

Worsened _____

Week 5

(29th - End of

Month)

# of days offered ____

# of days used ____

Loved _____

OK with use _____

Take it or leave it _____

Did not like _____

Hated _____

Calm _____

Aggressive _____

Agitated _____

Talkative _____

Quiet _____

Wandering _____

No Change _____

Improved _____

Worsened _____

Happy _____

Bored _____

Flat _____

Nervous _____

Sad _____

Angry _____

No Change _____

Improved _____

Worsened _____

Notes

Why Music & Memory Works

• Music & Memory gives us a way to harnesses our brains response to listening to favorite music.

• This can be tailored to produce a desired benefit for the person in the same way a prescription medication can, but without negative side effects.

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Emotions & Memory

When we listen to music that is associated with emotional life events, e.g., graduation, marriage, birth of a child, it brings back memory of those events. This is the “Henry affect”

Music activates our deepest emotions, and emotions connect us to our memories

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Emotions and MemoryThe more intense the emotion is the more deeply embedded memory becomes.

For example:

Most people will remember the day they got married. Many will remember: their family members who attended, certain gifts they received, specific conversations, types of flowers, anything that went wrong or that was funny, location where the ceremony and reception occurred, etc.

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QMP Music and MemorySuccess Stories

Music & Memory - Susie

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I wanted to share my first I-pod set up and start up with Susie. She is seen here on her way to dialysis This was our first day for us both trying it. Look how happy she is when she started hearing the music?? I hope the pictures came through. I am so happy and can’t wait to do more. More photos to come. Just wanted to share. Pamela Moore-Woods

Susie Before Music

Susie After Music

Mrs. M before and after music

Music & Memory Harnesses the Power of Music

Music & Memory gives us a way to connect with someone who may be unreachable without the music

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Music is Medicine

• Listening to preferred music can produce the same affect antipsychotic medication (AP) does

• Listening to preferred music for 15-30 minutes produces a 4-8 hour effect of engagement, and connection

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M & M Expansion

• Positive feedback in Nursing Facilities

• Expanded in to the State Supported Living Centers

• Implemented with clients who have intellectual and/or developmental disabilities

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Texas State Supported Living Centers “Music for the Soul”

Music and the effects on Brain Anatomy and Function:

Musicians Brains

Drones and Music

Music and Multitasking

Individuals with IDD compared to Individuals with Dementia

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Texas State Supported Living Centers “Music for the Soul”

SSLC Habilitation Therapy Conference October 2015, the documentary and overview of the program was presented.

Therese Palombi, Diane Eberhart and I collaborated to have the Austin SSLC pilot the Music & Memorysm program for Individuals with IDD.

Our music therapist, Roslyn Howard, was certified in December of 2015, the Austin SSLC certified by the Music & Memorysm

Program in January 2016.

The first pilot began in March 2016.

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Texas State Supported Living Centers Music and Memorysm

Why It Worksa. Music activates large portions of the brain and activates

memoryb. Personalized, preferred music enables the listener to

reconnect, regain social skills and live more fully

Therapeutic Benefits of Personalized Music a. Enjoyable, meaningful activity for individualsb. Increases engagement and attentionc. Reduces agitation & sundowningd. Enhances communication and socializatione. Valuable tool for the effort to reduce reliance on anti-

psychotic medications

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Texas State Supported Living Centers Why use M&M in a SSLC?

a. Quality of life – improve emotional well being

b. Promote social and cognitive engagement through meaningful listening/music experiences

c. A way for individuals with cognitive and physical challenges to connect with the world

d. Innovative approach to engaging individuals with varying abilities

e. Enjoyable solution for individuals

f. Individuals who have difficulty participating in activities, Music & Memorysm

facilitates participation

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Primary Goals “Music for the Soul” Pilot

a. How do we implement the Music & Memorysm program at our facility and have it fit with the individuals and their homes daily activities.

b. Does the M&M program improve mood for individuals

c. Does the M&M program improve cognitive engagement for individuals

d. Gauge the amount of resources needed to sustain and expand the program

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Key Factors for Implementing

One home (medically fragile and behaviorally complex) with 13 individuals designated as our first pilot group

We had a general knowledge of each individuals music preference and we refined for the Music & Memorysm program

Core group for implementation:

Therapist, Volunteer, OT, COTA, PTA, direct care staff

We picked the time of day where all 13 individuals would be in one primary area

We implemented Monday thru Friday, but not all individuals received it each day initially (goal was minimum 3 x week)

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Key Factors for Implementing

We had to modify for the individuals and for the home schedule.

After four weeks, our team had formalized a process that works with our individuals and homes.

During weeks five thru eight we trained direct care staff and mentored them for consistency with implementing and trouble shooting.

During weeks nine thru twelve, we monitored and mentored direct care staff.

We then piloted on a second home while monitoring that the first home was still implementing.

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SSLC Pilot ResultsDoes the M&M program improve mood?

a. Wong-Baker Facial Grimace Scale, standardized test

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Individual Baseline Mood Follow-up Mood Baseline Time Follow-up Time Notes

SSLC Pilot ResultsDoes the M&M program improve mood?

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12

PositiveImpact

Stable

NegativeImpact

Overall average improvement in mood 73%

SSLC Pilot ResultsDoes the M&M program improve cognitive engagement?

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Customized assessment, “Yes” or “No” responsei. Startles/shows physical response to social engagement

ii. Startles/shows physical response to music

iii. Attends to human voice

iv. Vocalizes

v. Verbalizes

vi. Sings along to music recording

vii. Makes eye contact

viii. Expressive facial affect

IndividualBaseline

ResponseFollow-up Response Baseline Time

Follow-up Time Notes

Sally Y Y 11:30 12:15 Vocalized

Courtney N Y 11:45 12:45 Eye Contact

SSLC Pilot ResultsDoes the M&M program improve cognitive engagement?

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0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12

Pre-ListeningResponse

Post-ListeningResponse

Overall increase in cognitive engagement 52%

SSLC Staff noted responses

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Staff reported increased compliance during/after music listening

i. Med-passii. Mealtimesiii. Check-and-change procedures iv. Transitions

Staff reported enjoyment of interacting with individuals using iPod devices

i. Ease of engagement with activitiesii. Ease of engaging with non-verbal individuals

SSLC Video

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SSLC Case Examples

• Individuals and compliance with medical tests

• Individuals with increased movement activities

• Individuals at risk for weight loss

• Individuals at with negative behaviors and SIB

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Texas State SupportedLiving Centers• Based on the results we have seen with the QMP program

and the Austin SSLC pilot, QMP and Roslyn Howard collaborated with the SSLC leadership to expand the program.

• At this time, all thirteen State Supported Living Centers (SSLC) are certified in Music and Memory.

• The SSLC Music and Memory program is managed by Diane Eberhart and Roslyn Howard, Board Certified Music Therapist.

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Research Related to M&M

Brown University

• Individualized Music Program is Associated with Improved Outcomes

for U.S. Nursing Home Residents with Dementia:

https://doi.org/10.1016/j.jagp.2017.04.008

International Journal of Rehabilitation

• Music and Memory in Dementia Care:

https://www.omicsonline.org/open-access/music-and-memory-in-

dementia-care-2376-0281-1000255.php?aid=88116

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Research Related to M&M (cont.)

Duke University Medical School

• Project connects patients with dementia to music that sparks

memories: https://medicine.duke.edu/medicinenews/project-

connects-patients-dementia-music-sparks-memories

Link to Current Research Listed on M&M page:• Updated here: https://musicandmemory.org/music-brain-

resources/current-research/

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Helpful Links

QMP Music and Memory Page https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/nursing-facilities-nf/quality-monitoring-program-qmp/resources/music-memory

National Music and Memory Pagehttps://musicandmemory.org

Contacts

• HHSC M&M Initiative:

• Therese Palombi, Program Manager

• Therese.palombi@hhsc.state.tx.us

• 512-438-3050

• Music and Memory:

• Stephanie Hoffman, Regional Director

Music and Memory

• shoffman@musicandmemory.org

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Questions?

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