How Music and Laughter Can Tap Into the Emotions of People with Alzheimer's

On a recent book tour visit at an assisted living home, Elaine Durbach, of Maplewood, New Jersey, addressed a roomful of older adults in wheelchairs. They sat motionless with their eyes open. No one appeared interested until she asked, "How many of you remember your first love?"

"That's when the wicked grins and broad smiles formed," Durbach says. "Some sat up and raised their hands, offering to share their stories." They listened when she read from her novel, Roundabout, which is about a long-ago first love. 

"She tapped into an important memory," says Sam Fazio, senior director of Quality Care and Psychosocial Research at the Alzheimer's Association. "It's a memory most of us can recall quite well. It also opens up our emotions when we connect to something important to us or something we care about."

I noticed this when I brought my young child to visit a friend's mom living in a nursing home for people with Alzheimer's disease. My friend's mom and the others in the unit slumped in their chairs and showed no emotions.

We could see them through a glass partition. They sat like statues. When I opened the door, and people saw my two-year-old, almost everyone became animated. They wanted to hold my child and talk to him.

"The child sparked an emotion in some people," Fazio says. "Not everyone responded. Perhaps a dog would get a response from others in the room. To get a response, you must make the right connection with the individual. It's like listening to music. What we like is personal."

According to Fazio, several studies prove music benefits those with Alzheimer's. Scientists have observed significant improvements in memory, orientation, depression, and anxiety in people with mild and moderate Alzheimer's who listened to music.

"Getting a reaction comes down to your musical preferences," Fazio says. "If you love classical music, you'll respond. If you don't, you won't respond."

Deborah Kaufmann, the co-founder of Healthy Humor, an arts organization that brings music, laughter, and joy to older adults and children in several U.S. hospitals and senior residential care facilities, remembers one patient lying in bed staring at the ceiling.

"He was unresponsive for a while," she says. "I took his hand in mine, talked to him, and suddenly he started singing 'I Can't Give You Anything But Love Baby.'" 

Kaufmann and another performer of Healthy Humor's Vaudeville Visits, a program specifically designed for older adults, sang it a second time. "This time, I stopped after "I can't give you anything but," and he filled in the blank," she says.

Vaudeville Visits' performers create easily recognizable iconic characters from the stage, screen, and culture. These include a Hollywood song and dance team, a chef, a bride, a used car salesman, and others.

In addition, the performers use music, juggling, puppetry, storytelling, and improvisation to entertain and engage. "When Vaudeville Visits' performers entertain, we don't rush," Kaufmann says. "It may take a bit of time to connect with someone."

Penny Cook, president and CEO of Pioneer Network, a nonprofit organization working to transform the institutional culture of nursing homes to person-centered care, agrees, "we need to take the time to connect. Our primary goal is to move eldercare to a place where all care and support are person-directed; it's taking time to know the person and engaging with them."  

"Person-centered care means listening to our patients and focusing on their needs," Cook explains. "It's about setting up the day to make it enjoyable. For instance, most of us enjoy that first cup of hot coffee in the morning. It's a simple pleasure we miss when we don't have it. But missing it can change the trajectory of the day."

"That cup of coffee is a simple pleasure that makes such a big difference. It's important to provide that to people as they get older," she says, adding they know this small gesture of person-centered care benefits the patients.

At age 93, Cook's stepfather moved into a nursing home. He had dementia and mobility issues. At the assessment, the nursing home staff asked personal questions and found out he loved listening to classical music; they placed a CD player by his bed.

"He had no idea how to use the CD player," Cook says. "And it was placed in a hard-to-get spot that my mom couldn't reach when she visited. It would be so easy having a staff member press 'play.'"

Patients, especially those in long-term care, want their doctors to know their likes, dislikes, and needs. In addition, studies have shown that collaborative care can improve physical and psychological health and strengthen a patient's confidence.

"The staff also benefits," Fazio says. "They interact more with their patients, and there's less turnover."

Dikki Ellis, who has performed with Vaudeville Visits, often hears praise and thanks from overworked medical personnel. When visiting patients, the mood on the floor is light and joyful. "Laughter makes people more accommodating," Ellis says.

"Someone who may not be cooperative or in a bad mood is easier to work with because of the humor from these interactions. It's something the staff appreciates," he adds.

Often the mood is joyful. Sometimes sorrow appears. "Either way, we have to be there for the patients," Ellis says. "Using humor, song or dance creates pathways to their memories. We enter the patient's room and look around for clues. There might be a photograph we can discuss. It might be a song or a joke."

One woman started weeping when they played a song that reminded her of her husband. "All of a sudden, she wanted to talk about him," Ellis says. "She missed him, and despite the tears, we didn't back away. We listened. It was an honor to be there."

The nurses' station is one of the first stops in a hospital or elder care facility. Ellis and the other Vaudeville Visits performers inquire about the patients, their likes, and their ages. "Age can tell us about the music they grew up listening to," Ellis says. 

One woman, who didn't communicate, loved bubbles. "There's a child inside each one of us, and the bubbles brought the kid out in her," he says. "She watched the bubbles and smiled. She has adult memories and childhood ones. We touched on one of those memories."