Elderly people are no longer members of a small minority group and according to statisticians, more than 11 million people are currently aged over 65 years in the UK. The topic of music and dementia is therefore particularly salient due to the ever-increasing current health and social care challenges of an ageing society. With dementia being one of the main causes of disability in later life, work in this field continues to demonstrate the health benefits of musical interaction, such as Playlist for Life, Singing for the Brain and Lost Chord. Contemporary academic literature highlights how music can act as a powerful therapeutic tool for dementia sufferers. While the Music Lasts sits comfortably within this cohort of practical and scholarly studies, allowing us access to the world of the dementia patients, musicians, caregivers and project organisers collaborating in this music and wellness project managed by the Wigmore Hall, London.
The book is laid out in a highly detailed quasi-journal-article style, and from the beginning engages the reader in an approachable and clear narrative. In exploring all aspects of this eight-week music and dementia interactional project in care homes, the authors provide unique insights into the experiences of all involved. A key message of the book is that participating in music can reveal the person hidden behind the dementia, and that novel learning processes are uncovered by the music practitioners thereby nurturing their own professional development. From the outset a clear distinction is made between Music for Life and music therapy, with music being the core from which communication and participation emanate as opposed to being a vehicle that is secondary to the clinical outcomes.
The book begins with a short introduction on Music for Life, which is followed by a comprehensive and valuable outline of this person-centred approach to creative music-making within the dementia community, including an explanation of the relevance of applied improvisation as a shared experience. Chapter 3 focuses on Grounded Theory as the choice of qualitative methodology as it facilitates subjective perceptions of those involved and of the social situations under investigation. Data are collected principally through interviews, field notes and reflective journals.
The next chapter, which forms the analysis part of the book, is divided into four main parts: Identity, Communication, Participation and Development. The first section covers issues of identity which are crucial to the practitioners, carers and residents. Identity is strongly linked to professional integrity and there is an awareness that the musicians should remain vigilant of allowable parameters in working with people with dementia. Care staff experience a development of personal and team identity and the residents are empowered through recognition of their musical pieces. Quotes from practitioners such as ‘[it's] an amazing privilege’ to ‘be able to communicate with people without words’ highlight the benefits of giving the residents a voice to be heard.
‘Communication’ then deals with the many aspects of shared understanding. The authors analyse the use of tonal centres, dynamics, instruments and timbre to gain impact and highlight the need for reflexivity and new ways of comprehending joint participation. Interaction is seen to be difficult when dealing with dementia sufferers due to the inconsistencies in their attention span and awareness: creating space and time provides reassurance and allows for new ways of communicating and understanding.
A discussion within ‘Participation’ underlines the problems of the reality of working in this environment where ‘being in the moment’ can often result in an interruption of the residents’ involvement. Resident well-being is always at the core of the workshops and emphasis is placed on the need for the staff to continually communicate and evaluate in this highly dynamic and often problematic environment.
The section on ‘Development’ questions its meaning in the world of dementia care and highlights its position as a shared experience by all the participants. A dichotomy exists between the significance of development as an urgent, continuous, and active, learning process and as a call for deceleration in order to contemplate novel ways of understanding dementia within human progression. The authors thereby state the uniqueness of Music for Life as a ground-breaking project in this field. Balanced against a substantial analytical section, the conclusions and discussion in Chapter 5 are somewhat succinct, with the reflections and presentations of the various chapters being mirrored in just 11 pages.
An important feature of the book is the aim of highlighting this practice from the musicians’ perspectives and this gives it a sense of humanity. The inclusion of intimate thoughts and reflections by the musicians bring out the reality of working within this field. The interspersion of musical scores creates an interesting addition to the book, allowing the reader to observe the format of some of the practical deliveries. I wonder however if some of the content from the concise and clear Appendix 1 at the end, meant for future practitioners, would be better served at the start of the book, incorporated into Chapter 1, in order to provide an all-inclusive outline of the project.
The book's emphasis on the perceptions of all involved in the project provides a welcome contribution to the body of research being conducted into the various uses of music in the health and well-being of people with dementia. It should be noted that the short length of the project limits the generalisability of the results; however there is much scope for further similar approaches to studies in this subject area. It is a little lengthy, with some unnecessary repetition, and the quotes would have been better presented in bold and centred in order to be more visually apparent for the reader. The desire of the authors to reveal the person behind the dementia has been successfully achieved and I highly recommend this book to teachers, students and musicians who wish to engage in this meaningful and relevant field of music and health in the aged.
