Musical Routine: Using Music To Help With ADLs

Why ADLs Can Be So Hard To Complete ADLs are those routine aspects of daily life that we all just have to do: dressing, bathing, fixing our hair, brushing our teeth, moving from place to place…and the list goes on. Healthy adults probably don’t think about them too hard, but for folks with physical or cognitive challenges, ADLs become a big deal. In fact, losing the ability to do some of those activities is what calls for extra help in the first place, whether help comes from family and friends, from home care and hospice professionals, or from a move to some place with professional help in-house. There are many reasons why ADLs can be such a challenge for seniors and for caregivers. They are different for everyone, of course, but some of these might be contributing factors: Physical pain. Seniors and people with physical challenges often deal with pain, and even when their pain is well-controlled with medication, the work of completing ADLs can still hurt. In particular, because older adults usually have decreased range of motion in their extremities, tasks like dressing can be rather uncomfortable. It’s hard to be sweet when you hurt. Our job is to make it hurt less. Feelings of shame. Especially for folks who are aware of their circumstances, the mere fact that they need someone to help with basic activities can feel really bad. Add on to that the fact that they may need help dressing or bathing – sometimes by someone of the opposite sex – and those daily activities can bring up powerful feelings of shame. It may or may not get easier to accept care. Our job is to give the highest priority to preserving dignity. Agitation or aggression. For folks who are confused because of dementia or delirium, those feelings of pain or shame can turn into aggression – fighting back against the person who seems to be hurting them. You can imagine how difficult it must be to be going about your regular activities – reading the paper, drinking coffee – and then being wheeled into the shower room and made to undress. As difficult as it is, we cannot react to the senior’s aggression or agitation with our own irritation or anger. Our job is to understand what the senior must be feeling and to take steps to solve the underlying problem. Difficulty following directions. People who are confused enough that they can’t complete their own self-care chores may also have difficulty following the caregiver’s simple directions to help. It gets more difficult to process verbal information in the later stages of dementia, and it becomes increasingly difficult to get your mind and your body to work together to get something done. This requires a LOT of patience on the part of the caregiver. Our job is to give clear directions and cues while staying calm and patient. Add these together, and completing ADLs can be quite tough, for the senior and for the caregiver.

Music can help!

I’m not joking. In fact, I really wish more people knew this. Here’s how music can help: Music communicates caring. Of course, eldercare must always start with caring, but for folks who are being asked to do something that is painful or shameful or just plain perplexing, the caregiver can seem more like a taskmaster than a loving, helping hand. Singing – no matter the quality of your voice – instantly communicates that you are a safe person. Music maintains dignity. When you talk with someone about their favorite music, you are getting to know them as a person. When you put their favorite radio station on during bathing, you are creating an experience that is more spa, less hospital. When you use grown-up music to help with cueing a person who is confused, you are treating them more like an adult, less like a child. Music supports routine. For people who are confused, music can be invaluable in signaling what is going to happen next. Not only can you set the mood for waking up, doing exercises, and relaxing in the evening, but, for example, you can use the same song before bathing every time as the introduction to the task at hand. Music provides a vehicle for verbal instructions. We do this with kids all the time. (Sing it with me: “clean up, clean up, everybody everywhere…”) With some modifications, you can do this with adults, too. Try taking an adult tune and change the words. You’re giving verbal instructions within a musical structure that helps the senior to organize their thoughts long enough to complete the task, in a manner than preserves the senior’s dignity. Music helps the caregiver stay calm, too. It’s really hard to grit your teeth and feel like yelling when you’re singing. The side effect of singing and playing music to communicate caring is that we remember how much we really do care, too. One mental health professional I know described these ideas as “a diamond in the rough” for caregivers. These ideas are so simple and so natural to use in caring for the youngest members of our society, there is no reason why we can’t make age-appropriate adjustments to use these same ideas with the most senior members of our society, too. Have you tried any of these methods with the people you care for? What has worked? What hasn’t? Please share your thoughts in the comments section!]]>

9 Comments

  1. Ann Becker-Schutte (@DrBeckerSchutte) on October 12, 2012 at 12:27 pm

    Rachelle,

    I know that music makes things easier around the house with my kids–it makes sense that it would help with routines for those who face physical or mental challenges as well. I can’t wait to hear more about the Soundscaping resource!

    Ann

    • soundscapemusictherapy on October 16, 2012 at 8:27 pm

      Thanks, Ann! I think the trick is using music in a way that works but isn’t childish. That just takes a little forethought and practice.

  2. redrose856 on October 14, 2012 at 6:53 am

    Rachelle – thanks for these reminders about how the self-esteem of seniors can really plummet as they lose their former status in society . Nicely done.

  3. JoAnn Jordan (@JordanEM) on October 17, 2012 at 8:50 pm

    Great points as always. And adding music safely in the bathroom has become easier with all the “new” waterproof speakers on the market. If this is type of post your new resource will include, it will be a must have for healthcare providers!

  4. Carolyn Stone on October 23, 2012 at 2:57 pm

    Hi Rachelle,
    I love how you describe the reasons that elders have difficulty with ADLs and then put our (caregivers) responsibilities in italics. It’s our job to make things less shameful and painful.
    I love the idea of including music in a respectful way. I hope someone will do that for me some day!
    Carolyn

  5. […] ones better than anyone else. So, if you find something that “works” – helps to establish a routine, or calm someone down, or encourage exercise – then by all means, keep doing it! As a music […]

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