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Giving Voice

This article was originally published in The Journal of the Minnesota Medical Association.

By: Barbara Greene, MPH

“He has no idea what he did for a living, where he is living now, or what he did ten minutes ago. Almost every memory is gone. Except for the music. (Yet) he opened for the Radio City Music Hall Rockettes in Detroit this past November … The evening he performed, he had no idea how to tie a tie … he got lost on the way to the stage—but the performance? Perfect … He performed beautifully and remembered all the parts
and words.”

This patient story, shared by internationally renowned neurologist Oliver
Sacks, MD, in his 2007 publication of Musicophila: Tales of Music and the Brain, is not an isolated case. Sacks also described a meeting with his patient several weeks after the Radio City Music Hall performance. When asked how he was feeling, his patient responded, “I think I am in good health.”

How can you be in good health after an Alzheimer’s diagnosis? We are learning as a society that one way is through music and other arts. We are becoming increasingly aware that for persons living with Alzheimer’s, music occupies a special realm. Music can move us to great emotional heights or depths. It can lift us out of depression and move us to dance. Music actually occupies more areas of our brain than language. And we are learning that for persons living with Alzheimer’s disease, music is a salve like none other.

In 2017, researchers from the University of Victoria, British Columbia, noticed that patients with Alzheimer’s who were engaged in singing in a community-based chorus experienced a greater sense of enjoyment, sense of purpose and personal empowerment. For caregivers singing in the chorus, a greater recognition of support and respite occurred, as well as an increased community awareness of dementia outside the chorus. This 2017 study and others like it suggest that participatory choral programs for persons living with Alzheimer’s and their caregivers can result in better quality of life for both groups.

A 2016 Finnish study described the positive impact of an unusual music intervention where caregivers of persons with dementia were coached to use singing or listening to music as a regular part of their everyday care. Additional international pilot studies between 2008 and 2016 employing non-pharmacological interventions such as choral singing also resulted in promising patient findings. In a variety of these studies, the introduction and continued involvement with new relationships, ongoing personal communications and regular group support in a quiet, reflective space under the direction of a chorus director and supportive program administrator was noted to have highly valued social benefit for both singers and their families.

A Twin Cities metro chorus called Giving Voice, launched in 2014 to enrich the lives of persons living with dementia and their caregivers, is discovering similar results. Giving Voice founders Mary Lenard and Marge Ostroushko recognized the potential of music’s healing power and music memory to improve well being, increase mental ability and decrease depression and isolation. In an initial pilot with the MacPhail Center for Music, the first chorus of 30 singers grew to 65 singers and staged two public concerts. Since then, interest and impact has exploded.

Today, three distinct Twin Cities’ choruses of more than 170 singers bring a broad range of music abilities to weekly rehearsals and public concerts. Most recently, the national organization, American Composers Forum, funded a world premiere of new music based on the personal stories of and performed by singers in Giving Voice Chorus. This sell-out performance at the Ordway Center for Performing Arts Concert Hall in St. Paul affirmed the power of stories by those living with dementia and the transformative joy of singing together in community.

In 2018, with a generous grant from the Mt. Sinai Community Foundation, Giving Voice Chorus also broke new ground by expanding its reach to metro-area and statewide healthcare professionals. Three carefully designed continuing education healthcare seminars brought together audiences of physicians, faith-community-based nurses and baccalaureate nursing students. In addition to standing ovations in all three distinct performances, overwhelmingly positive healthcare evaluations were received based on the weaving together of Alzheimer’s disease education, intimate singer stories and the celebration of music.

After delivering a moving education session and singer performance for more than 250 physicians at this year’s Minnesota Academy of Family Physicians conference in St. Paul, several physicians described their experiences with the chorus.

Michael Rosenbloom, MD, behavioral neurologist and clinical director, HealthPartners Center for Memory and Aging

Individuals can be quite devastated from their compromise in memory. Memory factors into one component for many people: self. Individuals with this diagnosis suffer from an identity crisis. They feel they cannot contribute to society. They are also burdened about feeling dependent on their family members.

Music and singing provide us with a profound way to preserve value in living—even through advanced stages of this disease. Music is a form of talent and a way for us to express our creative intelligence. I am pleased that many of my patients are part of the Giving Voice Chorus. When I ask them what they are doing, their stories about the chorus are positive and fulfilling. They are not intimidated by the music or music direction. They are proud of cultivating new music skills.

As HealthPartners Center for Memory and Aging continues its research study with Giving Voice singers, we look forward to seeing some important quality of life changes. I hope the study will demonstrate positive changes in socialization and reduced isolation among these patients. This research may also have a strong impact on how the medical field views the role of music in the lives of persons with Alzheimer’s.

Victor Sandler, MD, medical director, Fairview Homecare, and associate medical director, Fairview Hospice; adjunct professor, University of Minnesota Medical School, Department of Family Medicine & Community Health

Music is a powerful way of reawakening the mind. Anything we can do to catalyze and greater open and rekindle the mind is a positive step. I’ve seen the power of music in my father and uncle who both suffered from Alzheimer’s. I’ve also seen the impact with my own patients. On a regular basis, I hear about patients who are mute from the effects of Alzheimer’s and how they become verbal again when singing. I have no doubt that this is a modality we wish to promote.

I heard a world-renowned medical specialist on Alzheimer’s some years ago. I had the chance to ask him the question, “If we could take all the dollars spent on pharmaceuticals used to treat Alzheimer’s and use it instead for music therapy for Alzheimer’s, which would you choose?”

He answered, “Without a doubt, music therapy would be more beneficial. We are a very long way from understanding and remedying the inner cause of this disease. There is no question that music would have a greater impact as a therapy than all the drugs being used for patients right now.”

I strongly believe that we need to reshape the culture of medicine as to how we approach the treatment and palliation of many chronic diseases. We should be actively investigating the powerful impact of modalities such as music. What will really help patients is when nurses, physicians, social workers, and other health care team members think much earlier about music as an effective therapy. These interventions are far from “fluff”—they are terribly consequential. We should be thinking about music “front and center”—as a top priority for individuals living with Alzheimer’s.

Jon Hallberg, MD, associate professor, Department of Family Medicine and Community Health, University of Minnesota Medical School

I was struck by how the Giving Voice Chorus so deeply resonated with the assembled family physicians at a recent statewide MAFP conference. This audience of doctors from across the state is at the front lines of dealing with the overwhelming task of taking care of patients at various stages of memory loss. Given that they—that we— have so few tools to combat this disease, it was a complete revelation that art, that singing collectively, could come along and offer hope and dignity and joy the way the chorus does. The standing ovation that the presentation received was, of course, well deserved. But it also represented something more than just an acknowledgment of a job well done. I think it also represented an acknowledgment that here was a form of healing that they could, relatively easily, turn to wherever they live and practice.

Jane West, MD, retired ophthalmologist and Giving Voice choral volunteer

I witnessed the impact of Giving Voice Chorus when a volunteer chorus friend and her husband living with Alzheimer’s invited me to a public performance. I was incredibly moved by the experience that everyone in the chorus was having. The sound of the chorus was terrific and for the most part, I couldn’t tell who had the disease and who were family members or volunteers. They were all in this moving artistic experience together—on a level playing field.

Both my parents had Alzheimer’s and they both loved music. My mother accompanied  herself on the piano while singing and my father was a pianist. They would have loved this chorus experience under the guidance of a professional music director. As a weekly activity throughout the year, the chorus has created a solid community of persons who feel a special bond toward each other. Rehearsals are an amazing shared weekly highlight for the person living with Alzheimer’s as well as the family member and volunteer. People feel a unique solidarity as they experience their capacity to sing under professional music guidance, learn new parts, and learn new music. As a physician, I believe this experience helps to maintain cognitive functions and stimulates the brain and well-being at the same time.

Barbara Greene, MPH is a health care consultant on issues of aging and community engagement. She is an officer of the board of directors for the Giving Voice Initiative.

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