"Alive Inside" – 3 Important Points And An Incomplete Solution

Alive Inside movie poster

If you love music or older adults or both, you MUST see this movie! “Alive Inside” follows social worker Dan Cohen, who started the non-profit organization Music and Memory. This program provides nursing home residents with iPods loaded with music tailored to their individual preferences. Through video footage of older adults listening to their personalized music and interviews with nursing home workers, family caregivers, and experts in the fields of music and long-term care, we see the impact that music is having for many people across the country. You can tell from the preview that this film is as heartwarming and energizing as it is entertaining. Check it out: https://www.youtube.com/watch?v=IaB5Egej0TQ This film is so much more than that, though. Through the lens of the Music and Memory program, this film actually makes much larger points about people, music, and aging in general.

Here are three major points made in this documentary:

1. People in nursing homes are human beings, fully alive.

Perhaps we shouldn’t need a movie to show us this, but old age can be scary in our youth-centric culture, especially since none of us have experienced being old until we get there. But even when we can’t understand what it’s like to be aging, experiencing memory loss, or living in an institution, we can identify with the uniquely human experience of being moved by music. Throughout this film, we see older adults transformed as they put on headphones and listen to their favorite tunes. The smiles and the laughter and the dancing and the singing that we see are so moving to watch because they are such beautifully human experiences. We know what that joy feels like. Even if you’ve never been close to someone with end-stage dementia, you can see the humanity of Henry or Gil or any other older adult featured here. One of my favorite aspects is that the filmmaker underscored his subjects’ humanity with the juxtaposition of video and photos of them when they were young. It can be too easy to forget about all the life experiences that came before the difficulties of the present moment; by seeing this footage, we’re reminded that these folks have had full lives and are deserving of the love and care due any human being. Of course, the love and care in this movie come in the form of shared music, which brings us to the next major point:

2. The combination of music and personal interaction is powerful.

At one point, Cohen says that it’s giving people music and “a little focused attention” that makes all the difference. This is an important point. This film is about so much more than giving people iPods. It’s about using music to help people connect with the world around them. Our glimpses into people connecting through music are incredibly potent. For example, we watch as a man with advanced dementia listens to a song with his wife. She asks, “can we hold hands a little bit?” They do so, and a moment later, the man says, “I love you.” I defy you not to get your tissues out at that point. We see these moments of human connection through music throughout the film. It’s uplifting for sure. But, we are inevitably reminded that the immensity of this joy makes the most sense when we realize how isolated these folks can feel. That brings us to major point #3:

3. Nursing homes can be dehumanizing, and systemic change is tough.

The counterpoint to all this joy is the reality of how isolating dementia and life in a nursing home can be. Although many wonderfully caring people work in nursing homes, and although many organizations are working very hard for culture change, life in a nursing home can still be very difficult. Why is this? In “Alive Inside,” the experts interviewed explain how nursing homes developed into the medicalized institutions they are today and lament the overuse of medications. We also learn about the demographic shifts that are creating this problem, with more and more people in the oldest age bracket, more and more people suffering from dementia, and fewer young people to care for them. Then, we see Cohen and others bumping up against the conventional wisdom involved in running these institutions and we see the difficulty of implementing any change, even one that makes such a visible difference in the quality of life for the older adults shown in the film. Most of all, we see the pain in the eyes of Gil, and Steve, and Denise – all vibrant people whose vibrancy has been dulled by life in the nursing home. We want this to change, and we see that music can help.

So, here’s the big question:

Is music the solution?

After setting up the problem, this film offers a solution: Music collected in personalized playlists distributed via iPods and headphones to people in nursing homes across the country. This is the Music and Memory program. Hundreds of nursing homes across the country are now implementing this program. The film ends with a plea to donate iPods and headphones and funding for local Music and Memory programs.

This is an incomplete solution.

Cohen says he wants to see this as a standard of care in nursing homes. So do I. But there are a few problems that have to be solved before music can make a profound difference for everyone in every nursing home across the country. For one, we have to find a better way to empower the people who will be sharing music with seniors. Although the movie shows the importance of social interaction (“a little focused attention”) alongside the music, I’ve heard too many people assume that simply loading the right music onto an iPod will be just the tool needed to solve a myriad of problems for people in nursing homes. This just isn’t true. Music works because is is a connective, human experience. To work, it must be shared. So, to extend that point, those caregivers who are going to implement this program on a large scale need to understand the power of the tool they are wielding. In this film, we see how music can lift people’s spirits and help them cope with confusion and loneliness and sorrow, but we must also recognize that music can cause the opposite reactions as well. Hearing a particular song at a particular time could trigger feelings that are overwhelming or unmanageable – grief, fear, or sorrow. Certain songs may remind someone of their losses and increase feelings of loneliness, or worsen someone’s confusion and increase disorientation. Caregivers must be positioned to help someone through the intense feelings that are difficult as well as those that are joyful. And what about those folks who don’t seem to get much out of the recorded music? Or who have unexpected or negative reactions? How do you make sure that this program is used well, that as many people as possible are served through music? And how do you get groups of residents interacting with each other? Is there a solution for that?

Music therapists complete the picture.

Music therapists are the experts on music in eldercare. That’s why a board-certified music therapist is on the board for the Music and Memory organization and interviewed on “Alive Inside.” (You can see music therapist Dr. Connie Tomaino’s call to action here.) Clinical music therapy happens through live, in-person musical interactions that are completely customized according to the client’s needs and goals. Besides providing this direct music therapy service, though, music therapists often act as consultants. In this capacity, they may assist caregivers in putting together playlists on iPods for listening outside of the music therapy session, just like those that are shown in “Alive Inside.” Still, this use of music represents just a tiny fraction of what music therapists can do for older adults with dementia and other people who live in nursing homes. So, how do you choose between the Music and Memory program and music therapy? You don’t have to. These programs are not the same, but they complement each other well. Even more so, music therapists are the people who can make an iPod program run best in your community.

If there is one takeaway from “Alive Inside,” it is the fact that MUSIC can make a huge difference in the quality of life for people with memory loss.


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