In recent years, the Norwegian TV series 'Demenskoret' [The Dementia Choir] has helped raise awareness about dementia. New research from the University of Agder establishes that singing can be of great value to those with the disease, as well as to others.
Helene Waage has studied co-singing, or the act of singing together, in families living with dementia. According to Waage, singing can be very beneficial in daily life – both for people with the disease and their loved ones.
"Singing can be a part of the interaction whether you are at home, in the car, on a walk, or visiting a care facility," Waage says.
Singing holds an advantage in that the human voice is present wherever we go. It is always available, requires no special equipment and usually no training. Although listening to recorded music that we enjoy can also provide enjoyable experiences, more resources are needed.
"The human voice is there at our disposal, making singing unique when compared to other forms of musical togetherness," says Waage.
What songs are most effective?
In her research project, Waage collaborated with an older woman living with dementia and her daughter. Waage wanted to help them incorporate singing into their everyday activities, based on their own preferences and interests.
An important objective was to explore how the mother and daughter could utilise singing as a means of spending time together.
"We started with the songs they liked the most and had a personal connection to," says Waage.
"It doesn't matter what kinds of songs are used as long as they align with their preferences and tastes," she adds.
Initially, the women engaged in singing sessions where they sat down together and sang or hummed familiar tunes. Gradually, they noticed that singing could be used for so much more.
"They became more spontaneous and started using singing in ways that didn't require any sort of planning."
New ways of singing together emerged, such as singing along to familiar tunes in the car or while cooking. Together with Waage, they also experimented with singing while exercising and dancing.
"It turned out that rhythmic singing was particularly helpful during walks, enhancing their coordination and movement," Waage says.
"The daughter also expressed that walking together in a shared rhythm strengthened their sense of togetherness and enjoyment."
Singing in every aspect of everyday life
Through their collaboration, four areas of musical togetherness emerged:
- Singing together as a means of communication and reminiscence;
- singing intertwined with everyday activities;
- singing incorporated into simple exercise and dance; and
- singing during walks, whether indoors or outdoors.
"While there are numerous other ways to utilise singing, these four forms of musical togetherness emerged during our research collaboration," Waage says.
Waage was taken aback by how the notion of what singing can be changed for both the participants and herself. Singing shifted from being something a little formal to something that arose and unfolded spontaneously.
"They were able to integrate singing into the little moments of everyday life. Singing became a way for them to be together on an equal footing," Waage describes.
"The daughter put it beautifully: ‘Singing can be something small, something exclusive to us’."
Many can make valuable contributions
Through her work in dementia care, Waage has seen the great value of singing as a form of togetherness. She has met many individuals with dementia and their family members and has seen that they often face challenges.
"But many also have valuable contributions to make," she says.
During her doctoral research, Waage discovered that while much research had been conducted on the role of music in dementia care, there had been less focus on singing as a resource in everyday life, outside of institutions.
For this reason, Waage sought to increase knowledge about the role of singing for families living with dementia. She believes that singing can be just as important for loved ones as it is for those with dementia.
“I feel that family members deserve to have approaches that can bring them happiness and support, and singing is an accessible resource that can achieve that,” says Waage.
Waage clarifies that her thesis is based both on existing theory and research, as well as her own empirical data. The aim of her research collaboration with the mother and daughter was to uncover nuances and possibilities in singing together, rather than draw universal conclusions. Additionally, Waage acknowledges that not everyone may enjoy singing and that other activities may be more suitable for some.
Why is singing so beneficial?
People with cognitive impairment, such as dementia, are more easily unsettled because they are unable to regulate unpleasant impressions in the same way as before.
“When I jump at the sound of a slamming door, I can quickly override and disarm it with my thoughts and move on.”
“A person with dementia may not be able to do that. They may become stuck in a state of alarm,” says Waage.
This state of alarm, also known as the ‘fight-flight-freeze’ response, describes defence mechanisms in the nervous system that kick in automatically to help us survive when we experience danger and insecurity.
“However, our survival system also includes a social system. Not everyone is familiar with that aspect,” Waage notes.
Singing activates some of the same nerve connections and muscles as when the social system is up and running. Thus, singing can aid in creating a sense of security.
Singing can facilitate and reinforce social signals, making it easier to stay in the social system rather than falling into survival mode.
“This is one of the aspects of singing together that has been very interesting for me to explore in relation to dementia,” says Waage.
Singing brings out what is healthy
Singing is a recognised and valued tool for creating safe boundaries, such as within grooming and care in nursing homes. In addition, we know that across cultures and throughout history, parents have sung lullabies to their children.
“Singing is a way of expressing care that is deeply ingrained in us,” says Waage.
Music and singing are often praised for their ability to promote health. Waage does not claim that singing improves the health of individuals with dementia:
“No, that would be presumptuous of me. But what I can say is that singing can enhance quality of life because it brings out what is healthy.”
She emphasises that there is always a combination of illness and health within a person's body and mind.
“People with dementia also have something healthy in them. Singing has a unique ability to connect with and support these healthy aspects,” says Waage.
“Singing can be a way of facilitating moments of joy in families living with dementia.”
Reference: Helene Waage: Musified togetherness − Co-singing in families living with dementia.