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Santa Maria Sun / Cover Story

The following article was posted on August 8th, 2018, in the Santa Maria Sun - Volume 19, Issue 23 [ Submit a Story ]
The following articles were printed from Santa Maria Sun [santamariasun.com] - Volume 19, Issue 23

Art of healing: Caregivers incorporate music to stave off and manage the effects of Alzheimer's and dementia

By Joe Payne

"You've got to ac-cen-tuate the positive/E-lim-inate the negative/Latch on to the affirmative/Don't mess with Mister In-Between"

The 20-plus members of the Oasis Senior Center Choir all sang in unison with the piano accompaniment. Gruff baritones and lilting sopranos blended together, filling the room with melody.

Karen Eastey led the group from the piano, where she plunked vocal lines before giving the full, jazzy accompaniment while the group of seniors sang the classic tune first published by Harold Arlen and Johnny Mercer in 1944. The song was made famous by the era's most popular baritone, Eastey explained after the last chord struck.


ACCENTUATE THE POSITIVE
Karen Eastey leads the Oasis Senior Center Choir (pictured) as well as several sensory awareness classes for Allan Hancock College at care facilities in Santa Maria. The classes use music and visual aids to help keep seniors stimulated and mentally active to help stave off or manage symptoms of cognitive decline.
PHOTO BY JAYSON MELLOM

"All right, well that was from Bing Crosby," she said. "But now let's go to 1964, from a Broadway show called The Roar of the Greasepaint–The Smell of the Crowd, 'On a Wonderful Day Like Today.'"

The group was ready with the words in hand and the tune already in their memories as Eastey moved them quickly through one of the last songs of their usual Thursday afternoon session. It's a regular gathering, Eastey told the Sun, where anyone is welcome to join each week, regardless of musical skill or background.

But that wasn't even Eastey's first gig that day.

She had already performed at a rest home for seniors unable to travel to a community center or join a choir, but are under constant care. Many are experiencing cognitive decline, and suffer from Alzheimer's disease and other forms of dementia.

Eastey performs and sings those same standards as an Allan Hancock College instructor, through the college's Community Education Department, teaching sensory awareness classes. For the residents in her classes with dementia, Eastey has seen firsthand the power that music has to connect them with their memories, providing moments of joy and lucidity, especially with those old songs.

"Those are the favorite songs that we know, the ones from our high school years and when we're in our 20s," she said. "It helps the Alzheimer's and dementia patients particularly to recall old memories through music, the music they grew up with and loved."

A drug trial announced in July may provide a possible breakthrough in slowing the cause of Alzheimer's, but for those currently living with the disease, it remains incurable. But years of research, including studies from the National Institutes of Health, have proved that music is a powerful tool to help manage the symptoms of Alzheimer's and dementia.

Researchers have also found that engaging in music, especially in social settings like the Oasis Senior Center Choir, has been shown to stave off cognitive decline as well. Caregivers have shifted the way they approach patients with cognitive decline to align with that research, finding that music and other arts provide tangible and meaningful results.

In the Santa Maria Valley, Eastey's program isn't the only one that brings music to the ears of dementia patients, better connecting them with their caregivers, their families, and their own minds.

Disease without a cure


ARTISTIC TREATMENT
Numerous medical studies have shown that playing or listening to music can improve neuropsychiatric symptoms of Alzheimer’s disease, like anxiety and depression, and raise the quality of life for those living with the disease, according to Dr. Verna Porter, a neurologist with the Pacific Neurosciences Institute in Santa Monica.
PHOTO BY JAYSON MELLOM

At least 57 types of diseases are known to cause dementia, according to Donna Beal, the vice president of program services for the Alzheimer's Association's California Central Coast Chapter. But of those, the most common is Alzheimer's disease.

Researchers have known for years that music is helpful for managing symptoms of Alzheimer's and dementia, she said, which is important considering the current treatments available.

"Alzheimer's disease is the only disease in the top 10 in the United States with no real treatment and no cure whatsoever," Beal said. "There's five kinds of medications on the market that do anything to treat the disease itself, and those don't cure it all, and they have much more therapeutic uses in the earlier stages, but they in essence really just slow the progression."

Some of the biggest changes in the past decade regarding Alzheimer's have to do with its public perception, Beal explained. Advocates have argued for more funding from the National Institutes of Health for research into a cure, and Congress has pledged more money over the years, she said.

And how the disease is understood publicly has improved as well, she said, from the compassion from caregivers to the awareness that erratic behavior could possibly be caused by Alzheimer's or dementia.

"It's a much more complicated disease than people thought for many, many years," Beal said. "People in the community are much more aware that what's going on is an actual disease that's impairing the person's ability to get dressed, take a bath, have a conversation, and those types of things. That's one of the big changes I see."

Alzheimer's disease is caused by an excess of amyloid tau proteins in the brain, according to Dr. Verna Porter, a neurologist and director of programs for Alzheimer's disease, dementia, and neurocognitive disorders at the Pacific Neurosciences Institute at Providence Saint John's Health Center in Santa Monica.

A new breakthrough drug, announced at the Alzheimer's Association's International Conference in July, reduced the amount of amyloid tau buildup in the brains of more than 800 patients with early onset of Alzheimer's, according to a release from the Alzheimer's Association. The drug, called BAN2401, is an anti-amyloid antibody that may help slow the progression of Alzheimer's.

The drug is still in its trial phase, Porter said, so for now caregivers and medical professionals are stuck dealing with the outcome of amyloid tau protein buildup, which she said "essentially gum up the works of the brain."

"They interfere with nerve signaling and with the appropriate transmission of information, so they're essentially blocking a network of finely connected and interwoven neurons that normally would be able to spread information effectively throughout the brain, which is essentially memory," Porter said. "It's blocking those networks and making it far less efficient, which is manifesting as memory cognition problems."

Those blockages also affect executive functions, Porter explained, which include "reasoning, judgement, and problem solving." That's why dementia patients may wander off, or have an irrational fear of water, which makes something as simple as a bath or shower a nightmare for the patient and caregiver.

That's where music comes in handy. Porter said that just listening to music has been shown to improve executive function in patients with dementia, as well as improve attention, psychomotor speed, and memory.

"So its seems that listening to music actually increases the overall global cognition for patients with Alzheimer's disease," she said. "So clearly that's a positive."

Even more positive is that music offers those effects without the need of any psychotropic intervention, or medications, Porter said. That fact is what inspired one local care center to implement a music-based program while the organization that started it was expanding nationally.

Music and Memory

At Country Oaks Care Center in Santa Maria, music plays throughout the halls. From the twanging guitars of classic country to the full jazz orchestra of the big band era, there's always something on.


CREATIVE CARE
Volunteer Dorothy Tilley, right, chats with Shirley Thomas, center right, at Country Oaks Care Center in Santa Maria, which provides numerous activities to keep residents engaged and active physically and mentally.
PHOTO BY JAYSON MELLOM

And there's always something for residents to do at Country Oaks if they want, Activities Coordinator Randi Vargas said from the sunlit lobby of the care facility. She spoke over the chirps of several birds inside a glass-walled aviary there, which residents enjoy spending time in front of as they watch the birds flutter and preen, she said.

"You can have all the medication in the world, but if you're still depressed and have no one to talk to and no activity to keep your mind stimulated, or socialization, what kind of quality of life do you have?" Vargas said. "My department can make you happy, so I think it's a great combination of the medical care and the quality of life that we bring. I think that's super important; one is just as important as the other."

About three years ago, Country Oaks joined the first phase of a program called Music and Memory, which provides care facilities with MP3 players, computers, and music download gift cards to help create tailored playlists for patients with dementia and cognitive decline. Music and Memory is also a nonprofit, founded by Executive Director Dan Cohen, that purchases the technology and distributes it to care homes that join the program.

Country Oaks' owners Dr. John and Sharon Henning had seen the documentary Alive Inside, which details what music can do for those with dementia, Vargas explained, and wanted to incorporate it at their care facility. Since then, Country Oaks has been an active participant in Music and Memory as the program has expanded, Vargas said.

"During that time there wasn't a whole lot that people thought they could do for people with dementia and Alzheimer's, so it gave us great hope to give others hope with people suffering from dementia, to give them some sort of quality of life," Vargas said.

Of the 57 residents currently at Country Oaks, around 26 of them participate in Music and Memory, Vargas said, and finding the right music for each patient is a process.

Many residents tell Vargas exactly what they love, from gospel music to old jazz standards, but for those with progressed dementia, some detective work is involved. She talks to their families, asks about music that would be tied to positive, happy memories, especially memories from their youth, like what played at their high school prom, or the first dance at their wedding.

"What I've found with people with Alzheimer's and dementia, is their long-term memory isn't as affected, it usually affects their short-term memory," she explained. "That's why people tend to regress back, and so if we personalized the music, they are able to connect with those memories that were associated with a certain song and kind of bring them back to the present, make them kind of alert."

According to Dr. Porter with the Pacific Neurosciences Institute, the ability of music to activate the emotional centers of the brain, especially when storing and recalling memories, explains why beloved music is so helpful in managing dementia.

"Those are all things that help re-establish connections in the brain that are hardwired over many, many years," Porter said. "So it can help to reinvigorate those areas in the brain."

Learn more
The Alzheimer’s Association’s California Central Coast Chapter connects locals to resources in Santa Barbara, SLO, and Ventura counties. Information is available at alz.org or by calling (805) 892-4259. The chapter’s Santa Maria offices are located at 120 E. Jones St., and can be called at (805) 636-6432.

Music and Memory has been so effective at Country Oaks that it's actually helped caregivers reduce the amount of psychotropic medications needed for patients there, Vargas said, earning the facility an award from the nonprofit. Because of the power of music, staff have been able to help those residents navigate sometimes challenging tasks like bathing, without drug intervention.

Music and Memory is also a program that Vargas turns to for residents on end-of-life care, "whose health is declining fast and they could go at anytime," which they also call "comfort care."

"The last thing to go is hearing, and there's nothing like putting a set of headphones on and letting them listen to some soothing gospel music or something their family says, 'Hey, this is what she loved, and what she's always loved.'" she said. "I play a lot of old gospel hymns, but this one lady I had who loved country music, that good ole country music, and I tell you, by the end of her days, if she wasn't tapping her foot, smiling to Merle Haggard ... ."

Community caring

For Eastey, who leads Hancock's sensory awareness class from the piano bench, nothing beats a live performance.

She plays at care facilities like Country Oaks, Villa Maria Care Center, and the Santa Maria Wisdom Center, most of which have acoustic pianos, she said. That's what the majority of residents grew up around, like she did.

"They were born, a lot of them, in the '20s and '30s," Eastey said. "I was born in '44, so I grew up with all the same songs they know because my mom played the piano and we didn't even have a TV until I was 10. Everybody sang around the piano still."

Those who attend Eastey's classes aren't just passive listeners, they're active participants, singing along, clapping, and more. Making music has been linked to neurogenesis, or the generation of new brain cells, Dr. Porter explained, as well as "various repairing mechanisms in the brain."

But more than just getting the cognitive benefits of singing and listening, residents are also connecting socially.

Social interaction may also be beneficial to staving off dementia as well, according to a study the National Institutes of Health released in 2016. The study suggests that programs "that encourage social interactions, light physical activity, and cognitive activities among older participants may be effective for preventing cognitive decline."

The pro-social and creative benefits of Hancock's sensory awareness classes aren't lost on the college's Community Education Department. The department's dean, Sofia Ramirez Gelpi, told the Sun that Eastey's class is one of several that are designed to keep local seniors active and engaged.

"We provide a series of courses besides this one to help older adults stay fit mentally, physically, cognitively," she said. "We have art classes that are geared towards artistic development, but hidden within the class are concepts like keeping eye coordination, gross motor skills, fine motor skills, things of that sort."

Eastey's sensory awareness classes are a lot like what she does directing the choir at Oasis, except she incorporates visual aids, like computer projections that include photos of the artists. She doesn't have all that technology at Oasis, though most same benefits are there, she said, and she uses the same songbooks.

For most of the members of the choir at Oasis, staving off cognitive decline wasn't their motivation to join the throng.

Sandy Boyd, an Oasis member, decided to join after she saw the group perform at an organization event. She's aware of the studies that link music and social interaction with brain health, but that's not why she's there every Thursday.

"I just like to come and sing," she said. "It looked like so much fun that I wanted to be part of it."

Engaging in creativity, especially in a group, is almost like a Trojan horse of cognitive care. Seniors are motivated to sing, paint, or quilt, especially when it means they get to meet with friends or family.

But another hidden benefit is for the caregivers, whether professionals like Vargas at Country Oaks or family who take care of a loved one at home. According to Dr. Porter, there are health benefits for the caregivers themselves who employ music and creativity in their care.

"If the patient is doing better, then that improves the quality of life for the caregiver and gives them perhaps a little more free time and a better ability for them to socialize and do other things that they need to do for their cognitive health and well-being," Porter said. "So interestingly, there's more research now going into looking at not only the direct effects of music therapy on the patient, but the secondary benefits on the caregiver."

For Vargas, there's no study necessary to illustrate the benefits of music therapy to her life as a caregiver at Country Oaks.

Not only does she infuse her family life with a variety of music when not at work, but every resident at Country Oaks either introduces her to something new or connects with her over a favorite musical genre or artist. And what that means to her patients' families is important as well.

"It's from the heart," Vargas said. "It's memory, it's art, it's all those things at once, and it's such a great feeling. ... Even if it's for a brief moment that we can bring them back and give them a quality of life, I think we've accomplished something."

In Eastey's case, even though she's in her 70s now, she hasn't planned to stop teaching through Hancock or leading the choir at Oasis. The payoff for her is too great to give up.

"It makes me cry," she said through tears. "It just makes me so happy to see that it's helping. I saw it in my own father and my aunt, and it just makes me so happy and blessed to be able to be going around to these people.

"And I think I'll never be able to retire," she added. "I'll one day fall off the piano bench, because I just can't."

 Contact Managing Editor Joe Payne at jpayne@santamariasun.com.




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