music & memory: transforming lives of people residing in ... · results between 2015-2018 cms...
TRANSCRIPT
Music & Memory: Transforming Lives of People Residing in NFs and SSLC
One iPod at a TimeNovember 13th 2018
Office of the Quality Monitoring
Program and InnovationMedicaid & Chip Services Department
Medical and Social Services
1
Welcome
Health and Human Services Quality Monitoring Program & Initiatives (QMP) Music & Memory (M&M) Project
Presenters:
• Therese Palombi, M&M Project Manager, QMP, Program Development and Innovation (PDI)
• Dr. Michael Gayle, DPT, Director, QSR
2
Agenda
• What is Music & Memory (M&M)?
• Purpose of M&M & Why it Works
• QMP Music & Memory Project Overview
• Accessing the Power of Music to Stabilize Mood & Behavior
• State Supported Living Centers Music & Memory Program
3
What Does Music Mean to You?
• How many of you would say you couldn’t live without music?
• How many of you listen to music every day?
• How many of you sing? Play an instrument?
4
Technological advances in brain imagery
• Technological advancements in FMRI and PET scan imagery are helping neuroscientists pinpoint exact areas of the brain that become activated when listening to music
• This imagery also reveals differences as to how the brain responds when listening to preferred music, singing music and from playing music.
5
What Music Helps Us With
• Reduces anxiety and agitation
• Significantly reduces pain
• Decreases wandering, which decreases falls and injuries
• Attention
• Engagement
• Language
• Improves the body’s immune system
6
What Music Helps Us With
• Learning
• Increased motor movement and control
• Reduces symptoms of Parkinson's disease
• Decreases the stress hormone cortisol
• Stabilizes mood and emotion, reduces depression
• Increases staff morale in residential and healthcare settings
7
What Is Music & Memory?
• Music and Memory (M&M) uses digital music technology to create personalized music playlists for people with Alzheimer’s and other types of dementias.
• These personalized playlists are songs associated with deeply emotional life events to the individual that allow access to long- lost memories
8
What is Music & Memory?
• Trains staff through the certification webinars
• Enables those struggling with Alzheimer’s, dementia and other cognitive and physical challenges to reconnect with the world through music-triggered memories.
• M&M is a tool that can help you reach your residents in a new way and build better relationships that comes from the sharing of music
9
Purpose of the Program
• To reduce the use of antipsychotic medications
• To enable people with dementia/other cognitive challenges to reconnect with the world through music-triggered memories
• To achieve a richer life for people by providing personalized music through digital music technology
10
Let’s Meet Henry
This clip is from the documentary film Alive Inside
The film chronicles the birth of the M&M program with Founder and CEO Dan Cohen
11
QMP M&M Program Summary
• Pilot - 32 Nursing Facilities (NF) July 2015
• Phase I - 93 NF certified in April 2016
• Phase II - 43 NF certified in the October 2016
• Phase III - 158 NF will received certification in March and April of 2017
12
QMP M&M Program Summary
• Phase IV – 49 NF certified April 2018
• Phase V – 43 NF certified Oct/Nov 2018
• Phase VI – Jan 2019 – Dec 2019
• UT Center for Long-term Care is conducting a study on Phase V to determine the efficacy of the M&M program
13
Results Between 2015-2018CMS National Partnership to Reduce the Use of AP• In 2015 when HHSC started the program, Texas was
ranked 51st in the U.S. (25.70%) as the highest prescriber of antipsychotic medications (AP) for long-term stay residents AD
• As of October 1st, 2018, we are now 17th (13%) in the nation.
• This is the first time Texas is below the national average of 15% (represents % of residents in NFs dx with Alz/Dementia taking an antipsychotic)
14
Categories of Music to Explore• Songs
• Operas
• Cartoons – old cartoons often have classical or opera music
• Faith-based music
• TV theme songs
• Movie theme songs
• Videos
• Commercials
• Radio shows
15
Example of Utilizing the Power of Music• If you listen to music that beats like your heart, researchers in
Hong Kong found that participants who listened to music 30 to 45 minutes before bed every night for three months fell asleep more quickly, slept more deeply, and felt more rested the next morning.
• But not just any music. These songs featured tempos between 60 and 80 beats per minute— which is the approximate heart rate when we fall asleep.
• Source: https://www.klova.com/blogs/the-daily-snooze/good-sleeping-songs-scientifically-proven-playlists
16
If you're ever having trouble falling asleep or just need some help calming down
Try playing "Weightless" or any of these other top-ten relaxing songs uncovered during Mindlabs' eye-closing study.
10 "We Can Fly," by Rue du Soleil (Café Del Mar)
9. "Canzonetta Sull'aria," by Mozart
8. "Someone Like You," by Adele
7. "Pure Shores," by All Saints
6. "Please Don't Go," by Barcelona
5. "Strawberry Swing," by Coldplay
4. "Watermark," by Enya
3. "Mellomaniac (Chill Out Mix)," by DJ Shah
2. "Electra," by Airstream
1. "Weightless," by Marconi Union
17
Anecdotal evidence
QMP has reviewed thousands of data sheets submitted by NF providers and received hundreds of emails consistently reporting the following:
• Decrease in pain (residents even asking for their iPod to “help me with my pain”)
• Decreased falls – one facility reported after three months of program implementation, it reduced falls from 50-60 per month to 11-13 per month
• Reduced anxiety, agitation and depression
• Increase engagement with loved ones and staff
18
Music Log
Facility Name:_____________________________________________
Music & Memory Music Use Log for: ____________________________ Month__________________
Week Amount iPod Used Overall Feeling about
Listening
Overall Behavior
while Listening
Change in Behavior as a
Result of Listening
Overall Mood
while Listening
Change in Mood as a Result
of Listening
Week 1
(1st - 7th)
# of days offered ____
# of days used ____
Loved _____
OK with use _____
Take it or leave it _____
Did not like _____
Hated _____
Calm _____
Aggressive _____
Agitated _____
Talkative _____
Quiet _____
Wandering _____
No Change _____
Improved _____
Worsened _____
Happy _____
Bored _____
Flat _____
Nervous _____
Sad _____
Angry _____
No Change _____
Improved _____
Worsened _____
Week 2
(8th - 14th)
# of days offered ____
# of days used ____
Loved _____
OK with use _____
Take it or leave it _____
Did not like _____
Hated _____
Calm _____
Aggressive _____
Agitated _____
Talkative _____
Quiet _____
Wandering _____
No Change _____
Improved _____
Worsened _____
Happy _____
Bored _____
Flat _____
Nervous _____
Sad _____
Angry _____
No Change _____
Improved _____
Worsened _____
Week 3
(15th - 21st)
# of days offered ____
# of days used ____
Loved _____
OK with use _____
Take it or leave it _____
Did not like _____
Hated _____
Calm _____
Aggressive _____
Agitated _____
Talkative _____
Quiet _____
Wandering _____
No Change _____
Improved _____
Worsened _____
Happy _____
Bored _____
Flat _____
Nervous _____
Sad _____
Angry _____
No Change _____
Improved _____
Worsened _____
Week 4
(22nd - 28th)
# of days offered ____
# of days used ____
Loved _____
OK with use _____
Take it or leave it _____
Did not like _____
Hated _____
Calm _____
Aggressive _____
Agitated _____
Talkative _____
Quiet _____
Wandering _____
No Change _____
Improved _____
Worsened _____
Happy _____
Bored _____
Flat _____
Nervous _____
Sad _____
Angry _____
No Change _____
Improved _____
Worsened _____
Week 5
(29th - End of
Month)
# of days offered ____
# of days used ____
Loved _____
OK with use _____
Take it or leave it _____
Did not like _____
Hated _____
Calm _____
Aggressive _____
Agitated _____
Talkative _____
Quiet _____
Wandering _____
No Change _____
Improved _____
Worsened _____
Happy _____
Bored _____
Flat _____
Nervous _____
Sad _____
Angry _____
No Change _____
Improved _____
Worsened _____
Notes
Why Music & Memory Works
• Music & Memory gives us a way to harnesses our brains response to listening to favorite music.
• This can be tailored to produce a desired benefit for the person in the same way a prescription medication can, but without negative side effects.
20
21
Emotions & Memory
When we listen to music that is associated with emotional life events, e.g., graduation, marriage, birth of a child, it brings back memory of those events. This is the “Henry affect”
Music activates our deepest emotions, and emotions connect us to our memories
22
Emotions and MemoryThe more intense the emotion is the more deeply embedded memory becomes.
For example:
Most people will remember the day they got married. Many will remember: their family members who attended, certain gifts they received, specific conversations, types of flowers, anything that went wrong or that was funny, location where the ceremony and reception occurred, etc.
23
QMP Music and MemorySuccess Stories
Music & Memory - Susie
25
I wanted to share my first I-pod set up and start up with Susie. She is seen here on her way to dialysis This was our first day for us both trying it. Look how happy she is when she started hearing the music?? I hope the pictures came through. I am so happy and can’t wait to do more. More photos to come. Just wanted to share. Pamela Moore-Woods
Susie Before Music
Susie After Music
Mrs. M before and after music
Music & Memory Harnesses the Power of Music
Music & Memory gives us a way to connect with someone who may be unreachable without the music
29
Music is Medicine
• Listening to preferred music can produce the same affect antipsychotic medication (AP) does
• Listening to preferred music for 15-30 minutes produces a 4-8 hour effect of engagement, and connection
30
M & M Expansion
• Positive feedback in Nursing Facilities
• Expanded in to the State Supported Living Centers
• Implemented with clients who have intellectual and/or developmental disabilities
31
Texas State Supported Living Centers “Music for the Soul”
Music and the effects on Brain Anatomy and Function:
Musicians Brains
Drones and Music
Music and Multitasking
Individuals with IDD compared to Individuals with Dementia
32
Texas State Supported Living Centers “Music for the Soul”
SSLC Habilitation Therapy Conference October 2015, the documentary and overview of the program was presented.
Therese Palombi, Diane Eberhart and I collaborated to have the Austin SSLC pilot the Music & Memorysm program for Individuals with IDD.
Our music therapist, Roslyn Howard, was certified in December of 2015, the Austin SSLC certified by the Music & Memorysm
Program in January 2016.
The first pilot began in March 2016.
33
Texas State Supported Living Centers Music and Memorysm
Why It Worksa. Music activates large portions of the brain and activates
memoryb. Personalized, preferred music enables the listener to
reconnect, regain social skills and live more fully
Therapeutic Benefits of Personalized Music a. Enjoyable, meaningful activity for individualsb. Increases engagement and attentionc. Reduces agitation & sundowningd. Enhances communication and socializatione. Valuable tool for the effort to reduce reliance on anti-
psychotic medications
34
Texas State Supported Living Centers Why use M&M in a SSLC?
a. Quality of life – improve emotional well being
b. Promote social and cognitive engagement through meaningful listening/music experiences
c. A way for individuals with cognitive and physical challenges to connect with the world
d. Innovative approach to engaging individuals with varying abilities
e. Enjoyable solution for individuals
f. Individuals who have difficulty participating in activities, Music & Memorysm
facilitates participation
35
Primary Goals “Music for the Soul” Pilot
a. How do we implement the Music & Memorysm program at our facility and have it fit with the individuals and their homes daily activities.
b. Does the M&M program improve mood for individuals
c. Does the M&M program improve cognitive engagement for individuals
d. Gauge the amount of resources needed to sustain and expand the program
36
Key Factors for Implementing
One home (medically fragile and behaviorally complex) with 13 individuals designated as our first pilot group
We had a general knowledge of each individuals music preference and we refined for the Music & Memorysm program
Core group for implementation:
Therapist, Volunteer, OT, COTA, PTA, direct care staff
We picked the time of day where all 13 individuals would be in one primary area
We implemented Monday thru Friday, but not all individuals received it each day initially (goal was minimum 3 x week)
37
Key Factors for Implementing
We had to modify for the individuals and for the home schedule.
After four weeks, our team had formalized a process that works with our individuals and homes.
During weeks five thru eight we trained direct care staff and mentored them for consistency with implementing and trouble shooting.
During weeks nine thru twelve, we monitored and mentored direct care staff.
We then piloted on a second home while monitoring that the first home was still implementing.
38
SSLC Pilot ResultsDoes the M&M program improve mood?
a. Wong-Baker Facial Grimace Scale, standardized test
39
Individual Baseline Mood Follow-up Mood Baseline Time Follow-up Time Notes
SSLC Pilot ResultsDoes the M&M program improve mood?
40
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12
PositiveImpact
Stable
NegativeImpact
Overall average improvement in mood 73%
SSLC Pilot ResultsDoes the M&M program improve cognitive engagement?
41
Customized assessment, “Yes” or “No” responsei. Startles/shows physical response to social engagement
ii. Startles/shows physical response to music
iii. Attends to human voice
iv. Vocalizes
v. Verbalizes
vi. Sings along to music recording
vii. Makes eye contact
viii. Expressive facial affect
IndividualBaseline
ResponseFollow-up Response Baseline Time
Follow-up Time Notes
Sally Y Y 11:30 12:15 Vocalized
Courtney N Y 11:45 12:45 Eye Contact
SSLC Pilot ResultsDoes the M&M program improve cognitive engagement?
42
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7 Week 8 Week 9 Week 10 Week 11 Week 12
Pre-ListeningResponse
Post-ListeningResponse
Overall increase in cognitive engagement 52%
SSLC Staff noted responses
43
Staff reported increased compliance during/after music listening
i. Med-passii. Mealtimesiii. Check-and-change procedures iv. Transitions
Staff reported enjoyment of interacting with individuals using iPod devices
i. Ease of engagement with activitiesii. Ease of engaging with non-verbal individuals
SSLC Video
44
SSLC Case Examples
• Individuals and compliance with medical tests
• Individuals with increased movement activities
• Individuals at risk for weight loss
• Individuals at with negative behaviors and SIB
45
Texas State SupportedLiving Centers• Based on the results we have seen with the QMP program
and the Austin SSLC pilot, QMP and Roslyn Howard collaborated with the SSLC leadership to expand the program.
• At this time, all thirteen State Supported Living Centers (SSLC) are certified in Music and Memory.
• The SSLC Music and Memory program is managed by Diane Eberhart and Roslyn Howard, Board Certified Music Therapist.
46
Research Related to M&M
Brown University
• Individualized Music Program is Associated with Improved Outcomes
for U.S. Nursing Home Residents with Dementia:
https://doi.org/10.1016/j.jagp.2017.04.008
International Journal of Rehabilitation
• Music and Memory in Dementia Care:
https://www.omicsonline.org/open-access/music-and-memory-in-
dementia-care-2376-0281-1000255.php?aid=88116
47
Research Related to M&M (cont.)
Duke University Medical School
• Project connects patients with dementia to music that sparks
memories: https://medicine.duke.edu/medicinenews/project-
connects-patients-dementia-music-sparks-memories
Link to Current Research Listed on M&M page:• Updated here: https://musicandmemory.org/music-brain-
resources/current-research/
48
Helpful Links
QMP Music and Memory Page https://hhs.texas.gov/doing-business-hhs/provider-portals/long-term-care-providers/nursing-facilities-nf/quality-monitoring-program-qmp/resources/music-memory
National Music and Memory Pagehttps://musicandmemory.org
Contacts
• HHSC M&M Initiative:
• Therese Palombi, Program Manager
• 512-438-3050
• Music and Memory:
• Stephanie Hoffman, Regional Director
Music and Memory
50
Questions?
51