Music Therapy for older adults takes place in nursing homes, senior citizen's centers, adult day care settings, and assisted living facilities. Grants funding music therapy programs are available under state plans appropriated by the Older Americans Act.
Within the geriatric setting, music therapy interventions are utilized to enhance, maintain, or increase skills related to physical, mental, and social/emotional functioning. The music therapist adapts musical equipment and structures success-oriented activities in order to match the capabilities of each individual, so that prior musical training is not required to participate. The therapist chooses from a myriad of approaches in order to meet treatment goals and objectives. For instance, rhythm band and movement activities can be used for maintaining and improving range of motion, flexibility, strength, and endurance. They can also be used to maintain and improve perceptual motor and fine motor skills. Music can be used as a structure for improving rhythmic walking in individuals with gait disorders. Simple wind instruments can be used to increase respiratory abilities. Music activities can be used for reality orientation programming, with seasonal and topical songs reinforcing concepts of day, year, time, and setting. Movement to music can be utilized in reinforcing spatial and body concepts. Call and response (antiphonal) singing requires attention, auditory discrimination, and immediate recall. Participation in a performing group (ie. choir, bell-choir, or small instrumental group) promotes social functioning and feelings of belonging. Through singing, playing, and discussing relevant music, individuals are provided with an outlet for their emotions. Music can serve as a focal point for talking about anger, loss of self-worth, helplessness, and other issues during song writing and lyric analysis. Emotional support is provided by the therapist and peers, and feelings are validated within a group setting.
Special considerations are made when programming for older adults. For example, to compensate for increased reaction time, music therapy sessions include songs that are sung slowly, with verbal instructions presented slowly and clearly. Songbooks feature large characters of great contrast to the page, and are only used for short periods of time in a well lit room. Music is selected which evokes the clients' long-term memory processes and stimulates reminiscence, particularly the music from their young adult years. The following three types of groups are discussed below: the drum circle, the handbell choir, and the music activity group.
DRUM CIRCLE (OR RHYTHM-BASED MUSIC THERAPY)
This kind of group would utilize new group percussion strategies and techniques to maintain current levels of functioning through self-esteem, social involvement, and physical and mental activity.
Membership: Active Older Adults
Supplies: A hand drum for each participant (these may be purchased by the participants), rhythm sticks, egg shakers
Number in Group: 20-30
Warm-up: Rhythmic Names- Begin by clapping familiar names. Say the name out loud in rhythm several times. Next begin to say then clap the rhythm of the name as a call and response. Progress from clapping to rhythm sticks, then drums. Find the rhythm for each participant's name and have them lead the call and response.
Group Focus: Patschen Knee Pat- Begin by having everyone in the circle play a steady ostenato, whether it be a right-left knee pat, or a steady pulse egg shake. When the group has entrained, without stopping demonstrate what eight measures of two beats feels like by counting it out loud, 1 / 2 / 3 / 4 / 5 / 6 / 7 / 8 /. While the group continues to play the ostenato have each participant play an eight measure solo. Cue each person on the "and" of 8, ("and Joe" with Joe being used as beat one). Continue around the circle several times. Once this has been mastered reduce the count to 4 then 2 and finally 1. Try each of these several times as was done above. Have the group continue to play the pulse while you give the instructions for each new section. Point out that each change cuts the time in half and that the solos will move around the circle twice as fast as in the previous segment.
Rhythm / Drumming: Call and Response- This activity begins by having the group leader sing a four-beat rhythm while modeling the playing technique by holding arms out in front as if playing a conga drum. As each rhythm is chanted, the participants are asked to echo the phrase first by singing it, then by singing and playing their "air" drum. There should be no rest between the time the leader plays and their response time. As participants become comfortable with this routine begin to have them play rhythms with body sounds, such as clapping or knee patting. You may also stop having them sing the rhythm and begin to concentrate on just playing it.
Closure: Choose songs to sing, drum or move to at the end of the session.
This kind of group would increase mental focus, promote socialization through common experience, and provide an aesthetic outlet for stress and emotion.
Supplies: Set of handbells for choir use (traditional handbells can be very costly, therefore I recommend the Tonechime Hand Set by Suzuki, which can be used without gloves), music stand or easel, poster board charts
Membership: Residents who are referred by nursing staff, who have problems socializing, or who have a difficult time focusing
Number in Group: 6-12
Warm-up: Hand each player one bell. Instruct each player to ring their bell as you point to them with your thumb. Assist anyone having trouble producing a clear tone. Introduce two bells per person, instructing them to play the right bell when you use a closed fist to direct, and the left bell when you use an extended hand.
Activity: Do an arrangement of "Let Me Call You Sweetheart" with everyone playing one bell. Emphasize taking turns and watching the conductor. Then have each player play two bells at the same time. Practice cueing chords, one bell shake, and two bell shake. Do an arrangement of Pachebel's "Canon in D".
Closure: Discuss the sounds that were produced when everyone played together, as well as feelings players had while making music as a group.
MUSIC ACTIVITY GROUP
This kind of group would vary in content, from rhythm instrument playing to music movement and singing activities to enhance quality of life, provide sensory and tactile stimulation, and encourage reminiscent discussion. The following session plan was also found to increase the production of melatonin (for better sleep patterns) and growth hormone (for less aches and pains) in older adults 6 weeks after beginning the intervention.
Supplies: Rhythm instruments, piano or guitar, large print songbooks, xylophone set up in pentatonic, mallets, and paddle drum with beater.
Membership: Residents who are referred by nursing staff, who are isolated or withdrawn, who are depressed, anxious, or confused, who have difficulty sleeping, or who have difficulty expressing themselves.
Frequency: Once a week
Number in group: Up to 8
Arrange group members in a circle. Sing the "Hello Song" while performing the actions (shake hands, pat knees, give smiles).
Sing familiar songs from songbooks, using the guitar or piano for accompaniment.
Give each person a choice of instruments. Ask for a volunteer to play the xylophone. Explain what it means to improvise, emphasizing that because of the way the xylophone has been prepared that it is not possible to make a mistake. Encourage everyone to take a turn playing a solo while the rest of the group plays rhythm instruments as support.
Have everyone take turns playing the paddle drum and improvising their own rhythms.
Sing the closing song.