Mar 2, 2012

Rhythm for Dementia Care – Help with Sundowning and More

Persons with dementia who experience confusion and agitation in the late afternoon and onset of evening, are said to be “sundowning”.

By Monica Heltemes

I read Tom and Karen Brenner's article, Make a Joyful Noise Drum Circles, with great interest.

I attended a course on the use of drumming to help people in rehabilitation and for wellness prevention. At the time, I was all gung ho to bring this back and incorporate it at the memory care facility where I worked, but the constraint of everyday duties got in the way. So I am excited to re-visit this topic!

Rhythm is inborn to all of us.

Yes, some more than others, but we all were nurtured with a mother’s heartbeat in the womb. We react emotionally and physically to rhythm. In fact, some parents of newborns play tapes of heartbeats to them, due to the familiar, calming, rhythmic effect.

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Rhythm can be accessed by all ages and cultures. It does not necessarily need equipment. It could be a hand clap or taps on the knees.

Our internal rhythms may vary throughout the day and from each other. For me, there are parts of the day I feel upbeat and the rhythm is fast. Other times, the pace is slower, which with some concentration, can be a time of full relaxation.

When a group gathers to drum together, like I experienced in the course I took, our rhythms start to match. Once matched, the group can move together from there, choosing a faster or slower pace. My role in the group was the base drummer, setting the constant background beat, while others could join in matching my beat or filling in with their own rhythms.

Tom and Karen pointed out their experience of watching some persons with dementia who were angry when they started drumming, become more relaxed as the drumming went on. Today I read about another great use of drumming with persons with dementia – to relieve the anxiety of those with sundowning syndrome.

Persons with dementia who experience confusion and agitation in the late afternoon and onset of evening, are said to be “sundowning”.

The cause of this phenomenon is not clear cut, but the outcome can be pacing, crying, or anger. The facility I read about, used a drummer a few times a week at 3:00pm to come into their memory care program, that had several people who sundowned. The drummer would start drumming at the intensity of the energy in the community. Over a period of about 30 minutes, he would bring the drumming down to a much softer, calmer tapping which in turn decreased the energy in the community.

This approach seems so easy and inexpensive that I wanted to share about it. It also resonates with the Validation Therapy work of Naomi Feil – meeting the person in the time, place, and rhythm that they are at.

Watch this video of Naomi as she work to draw out Gladys, a person with late stage dementia who is essentially non –verbal. See Gladys tap her hand and swing her foot at the beginning – a rhythm in her that is still going?

See how Naomi matches the rhythm that Gladys sets? Watch until the end to see the eventual response from Gladys that it brings.

As Naomi states in her video, this may not work every time it is tried. But it does support the thought that internal rhythm remains as the disease progresses. In fact, it is movement and music, along with touch, that persons at late stage dementia can still respond to.

It would be great to hear if some of you try using rhythm or drumming to relieve some of that end of day anxiety and share the outcome. I know I plan to go back to the memory care program I work with and see if this time, we can give it a go. Fortunately, there is a music therapist on staff to help it start!

MindStart Puzzle

Monica Heltemes is a practicing occupational therapist and owner of MindStart™. MindStart designs hobby-style items, such as games and puzzles, specifically for persons with memory loss. They keep persons with dementia active, while giving support to caregivers, and are quick and easy to use. Visit MindStart (Activities for Persons with Memory Loss) to learn more.

More Insight and Advice from the Alzheimer's Reading Room

Original content Monica Heltemes, the Alzheimer's Reading Room