Life Review and Reminiscence: Essential Tasks For Positive Aging

Reminscing with book - senior womanYou probably know from personal experience that reminiscence is something we all do. Heck, my three-year-old starts plenty of sentences by saying, “When I was a baby, I….” – it seems to be her way of making sense of where she is in the world now. The same happens on the eve of graduation for high school seniors, at wedding rehearsal dinners for brides and grooms, and for people of all ages and stations at birthday and anniversary parties, awards ceremonies, and retirement celebrations. We all have a need to review our pasts as we head into the future.

For seniors, though, life review and reminiscence are a key component of aging and ending life well. What are life review and reminiscence? And what makes them so important?

Why Does This Matter?

Although we all look back on our lives as a way of dealing with the present and looking to the future, older adults and people with life-limiting illnesses have a developmental need to look back on their lives. Psychological theorist Erik Erikson named the developmental stage for people aged 65 and older as Ego Integrity vs. Despair. In this period, people look back to determine whether they’ve led happy, successful lives. If they feel that they’ve been successful and productive, they develop feelings of contentment and “integrity,” but if they see their lives as being unsuccessful, they may feel depression and “despair” instead.

Life review and reminiscence processes can help older adults complete this important developmental task of contemplating on one’s life, and can help people to reframe and resolve past events and relationships that may be contributing to depression and despair in the present. Many researchers have examined life review and reminiscence in various contexts, and studies have indicated that these processes can decrease depression and obsessive reminiscence, and increase self-esteem, quality of life, and a sense of well-being.

Life review and reminiscence can be formal processes or informal, spontaneous or planned, and superficial or really deep in their exploration of conflicts and relationships. When thinking about these processes of looking back on one’s life, it is helpful to make some distinctions.

What’s The Difference?

Life review and reminiscence are two terms that are often used interchangeably, even by researchers and academics. There are some differences to note, however, especially if you are a clinician using these interventions with clients.

Reminiscence often refers to a more more informal, spontaneous process that can happen anytime, anywhere, and with anybody. Reminiscence often stays on a pretty superficial level, with an emphasis on recalling happy memories and simpler times – the famed “golden years” – without so much effort spent on examining and resolving past conflicts and regrets. Reminiscence is the word that comes to mind when I think about my grandfather paging through his photo albums with me and telling stories about the folks in the pictures. We weren’t really interested in learning about specific events in his past so much as enjoying time together.

Life review, on the other hand, can be more formal, structured, and comprehensive than reminiscence. Researchers have developed formal protocols for structured life review, meant to be implemented by psychotherapists and other trained professionals helping older adults dealing with clinical depression or dementia. These protocols may include step-by-step review of the major events of a person’s life, starting at the beginning, rather than focusing on the highlights, as might happen in informal reminiscence. Often, these approaches are also meant to help people uncover and work through past conflicts and regrets. Because this can be difficult work, this kind of life review process is best facilitated by a professional – someone who can support a person through this exploration of difficult issues without judgment or condemnation, and eventually enabling that person to find resolution.

If you are a clinician, you should make a distinction in your documentation regarding which processes you are using with clients. Outside of the clinic, though, it doesn’t matter much which term you use, and many researchers and academics use these terms interchangeably anyway. What matters is that those of us who love elders should be finding ways to help them share their stories and review their pasts.

How Can I Help?

If you want to help seniors with this important developmental task, what are the best ways to do it? In my next two posts, I’ll give you some concrete tips on how to facilitate reminiscence with the older adults in your life.

Until then, leave a comment below with your favorite way to spark reminiscence or a story of how reminiscence made a difference for you.

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Song Spotlight: “Yakety Sax”

Sax cartoon

  • Mood: Humorous, Farcical
  • Theme: Instrumental (no lyrics)
  • Tempo: Upbeat
  • Genre/Style: Pop-Jazz Instrumental

Here’s a purely instrumental song that goes a long a way in creating a certain energy in a group: “Yakety Sax.”

Written by James Q. “Spider” Rich and Homer “Boots” Randolph III, this song was popularized by Boots Randolph in his 1963 recording. Randolph plays the saxophone, and through the course of the song pays homage to several popular fiddle tunes.

The overall tone of the song is energetic and goofy, making it perfect for accompanying outlandishly humorous scenes in TV and film. In fact, “Yakety Sax” was used so frequently to accompany chase scenes on “The Benny Hill Show” that this song is sometimes recognized as “The Benny Hill Theme.”

How To Use This Song With Seniors

Since this song has no lyrics, it is a perfect accompaniment to movement to music experiences, because you can give verbal instruction without talking over the words in the song. Try adding some goofy movements and facial expressions along with your regular moves for some variety that fits the spirit of the song.

If ever you wondered how to use a vibraslap, slide whistle, or canary stick with a recorded song, know that this song also offers great openings for novelty instruments. Wait for the pauses and add those instruments as a humorous accent. This is a great, low-pressure way to offer solos to participants.

Finally, although there are no lyrics to discuss, you may certainly find yourself talking with participants about “The Benny Hill Show” or funny car chase scenes. For a visual element, choose several photos or movie stills of humorous adventures and invite participants to make up a story to fit the photo and music.

By the way, for some pure entertainment value, check out 15 Iconic Movie Scenes Ruined by “Yakety Sax.” It will definitely give you the sense of this song’s goofiness!

This post is part of an occasional series on special songs to share with your loved ones. For more song spotlights, click here.

5 Songs for Springtime

TulipsIn honor of this season, I have five songs to recommend adding to your bag of tricks if they aren’t already there. Add these songs to your “Springtime” playlist, use them to spark conversations with individuals or small groups, or integrate them into large group activities:

1. When It’s Springtime in the Rockies
This song is especially perfect for those of you in the upper Midwest who still have snow on the ground. It’s written from the perspective of a guy in a cozy apartment in the city, thinking about when he’ll be able to travel again to see his sweetheart in the mountains.

2. It Might As Well Be Spring
Listen closely to the lyrics of this Oscar-winning song for a description of spring fever, and use this to start a discussion about signs of springtime. Add pictures of babies in swings, crocuses or rosebuds to add a visual element to your discussion. Sharing the video from the film State Fair is also a great idea.

3. When the Red, Red Robin Come Bob, Bob, Bobbin’ Along
The red robin might be the most recognizable sign of springtime, so this song fits perfectly with the season. Be ready with this song when you can watch robins out the window.

4. When You Wore a Tulip
Tulips and roses are among the first flowers to bloom in the springtime, so this song also fits with the season. Again, have photos on hand or live flowers indoors or outside the window. (You can read a longer post on this song here.)

5. The Birds and the Bees
Along with a discussion about the birds and bees coming out again in the warmer weather, this song might spark discussions about young love, too – that “spring fever” mentioned above.

These are just a few of the songs that might say “springtime” to your older adults. What other songs are on your springtime list?

I’m Glad Fred Phelps Died On Hospice Care

Fred Phelps

Fred Phelps

Last week, a celebrity from my home state died. Fred Phelps is about as notorious as Kansans get. As the founder of the Westboro Baptist Church in Topeka, Kansas, Phelps was at the helm of one of the most publicly, vehemently hateful groups in our country. We like to think that we’re nice people in the Midwest, so the hate and vitriol spewed by this group is both profoundly confusing and deeply embarrassing. I’ve been speculating on the source of Phelps’s hatred with fellow Kansans since my high school psychology class. The fact that our biggest national news stories have often been focused on the Phelps family? That’s something we take personally.

So it’s safe to say that Kansans weren’t terribly sad to see Fred Phelps go. I wasn’t. I hope that by losing their founder, the Westboro Baptist Church will also lose some of their steam and quit hurting so many people in our communities and across the country. And I hope the national news outlets will turn their attention from the Phelps family to something more positive, like a new universal preschool program or nation-leading innovations in the Department of Aging and Disability Services. (Are you listening, Governor?)

There is one piece of the Fred Phelps story that I really do want to highlight, though, and that is something that came to light in his estranged son Nathan’s Facebook page several days before his death. In that post, Nathan Phelps reported that his father was “now on the edge of death at Midland Hospice house in Topeka, Kansas.”

Did you catch that?

Fred Phelps died in hospice care.

That fact makes me tear up, out of great pride for my fellow hospice workers, and deep humility for the profound work we are called to do.

I believe at the deepest core of my being that everyone – EVERYONE – deserves grace and kindness and comfort and peace at the end of life. And that’s exactly what hospices provide.

I don’t know anyone who works at Midland Hospice and can’t say anything about the care they provided to Fred Phelps. But there is little doubt in my mind that Phelps was treated with all the dignity and respect and care that hospice professionals give to every patient at the end of life.

I may not have worked with Phelps, but as a hospice music therapist, I have worked with people who have done many horrible things. I’ve worked with people who had deep remorse over awful things they had done in the past, people who did not at all regret acts and beliefs that I personally didn’t agree with, and probably plenty of people who had ugly stories that remained hidden right through the very end. For every single one of them, my hospice colleagues and I did whatever we could to give them comfort and to treat them with kindness and compassion in their final days.

That is just what hospice professionals do.

Fred Phelps was a hateful man who did a lot of despicable and disgusting things, but it gives me hope to know that he was on hospice care at the end of his life. I hope that he experienced the grace and compassion that he denied to so many others and that somehow it made a difference.

What Song Was #1 On This Day 50 Years Ago?

50yrsagoBeatles

Answer:

I Wanna Hold Your Hand by The Beatles

This song was a hit at the very beginning of Beatlemania in the U.S.

People of all ages will remember this song, but keep in mind that folks in their 60s were teens when this came out, while people in their 80s were probably the parents of those Beatles-loving teens.

You can see The Beatles performance of “I Wanna Hold Your Hand” on The Ed Sullivan Show below:

Want more songs to share with your clients and loved ones?

Be sure to check out the song spotlights series.

Song Spotlight: “Don’t It Make My Brown Eyes Blue”

I work in eldercare settings, but that doesn’t mean all of my clients love Frank Sinatra and Hank Williams. In fact recently, I’ve been learning a bunch of of songs from the 1970s, so I can have new ways to connect musically with people in their 50s and 60s, who might be caring for loved ones in their 80s and 90s or on hospice or long-term care services themselves.

One tool I’m using is The Grammy Awards Song of The Year 1970-1979. As the title suggests, this songbook includes all of the songs nominated for the Song of the Year during the 1970s. Does that mean these are the best songs to use in music therapy for people who were young in the 1970s? No. But it’s an excellent place to start an exploration.

The song that has struck me recently was a 1977 hit for Crystal Gayle: Don’t It Make My Brown Eyes Blue. Written by Richard Leigh, this song has a jazzy piano line that probably helped it to become Gayle’s first and biggest crossover hit. This song reached #1 on the country charts and #2 on the Billboard Hot 100, and it won Gayle a 1978 Grammy Award for Best Female Country Vocal Performance.

Uneasy senior woman praying for sick manThere are a few things about this song that work really well for clinical and caregiving situations:

Sing-ability. Another fun fact? This song was recognized by ASCAP in 1999 as being one of the ten most-performed songs of the twentieth century. That means a lot of people are doing live cover versions of this song, and I bet that’s because its narrow range makes this song pretty easy to sing.

Honest feelings and unanswered questions. This song is about someone leaving and the person being left not quite understanding why. One thing is clear: the singer is sad and lonely and trying to cope with it all. Beyond that, though, there is plenty of room for interpretation about the details of what happened. The listener can put a lot of their own feelings and experiences into this song.

Simple, repetitive lyrics. When you’re dealing with difficult feelings, sometimes all you can do is say how bad it feels. The repetition of the line “don’t it make my brown eyes blue” underscores the sadness and loneliness, while making the song more singable, too.

That crossover appeal. Because this song was popular with country and pop music audiences, chances are a lot of people will be familiar with this song. That makes it a good one for opening a discussion about love and loss, or starting a deeper musical exploration.

Try This: Songwriting Experience

This song also works quite nicely for a simple fill-in-the-blank songwriting experience.

Especially for family caregivers, this song could be a great container for some of the difficulties you’re experiencing in your caregiving work. Try adding your own words to this framework:

I don’t know when I’ve been so blue

Don’t know what’s come over you

You’ve __________________

And don’t it make my brown eyes blue

I’ll be _______________ when you’re gone

I’ll just ____________ all night long

Say it isn’t true

And don’t it make my brown eyes blue

Tell me ________________ and tell me ___________

Give me ________________, give me _____________

Tell me you love me and don’t let me cry

Say _____________ but don’t say ________________

I didn’t mean ____________________

I didn’t know ____________________

But honey ______________________

And don’t it make my brown eyes

Don’t it make my brown eyes

Don’t it make my brown eyes blue

Some of those phrases sound just like what I’ve heard from people who are caring for loved ones with Alzheimer’s Disease or other forms of dementia:

I don’t know what’s come over you.

Tell me…

… you love me.

… you know my name.

… I’m doing the right thing.

I didn’t mean…

… to make you upset.

… to leave you alone.

… to get so angry.

I didn’t know…

…it would be this hard.

…it would end like this.

…how scared I’d feel.

I think there is comfort in having our deepest thoughts and feelings expressed through music. Perhaps using the framework of this song can give you some comfort in expressing your own experience.

What do you think of this song? What lyrics would you fill in the blanks? Leave a comment below, and let us all know.

This post is part of an occasional series on special songs to share with your clients and loved ones. For more song spotlights, click here.

Music Therapists Do It Differently: Supporting Movement

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part ten of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

Our bodies have a natural tendency to move with music. In fact, classical music concerts are kind of weird for the expectation that people are to sit quietly in assigned seats. The truth is music and dance have almost always gone hand in hand, in cultures around the world. It just feels natural – and really darned good – to move in time with music. You could even say that moving to music is musical all by itself.

"Methinks it's time for a conga line."

“Methinks it’s time for a conga line.”

Still, dancing and moving to music are not that common in the live music situations you might encounter in an eldercare community. Most often, I see folks listening quietly to entertainers, applauding quietly at the end of each song. When it gets a little jazzy, you might spy a few people tapping their toes, or clapping to the music if the performer tells them to. If you’re lucky, some brave soul may stand up and start dancing to the music, and for a brief but brilliant second, you think maybe a dance party is going to get going. On the other hand, if the poor entertainer is performing during a party while people are being served refreshments, her audience will be too busy with conversations and snacking to get into dancing.

I’m not sure why this is. Do we expect our elders to be polite and sedate? Are they just tired or hurting to the point that moving doesn’t feel good? Or are our seniors embarrassed to be seen moving the way they do now, rather than how they did decades ago?

In any case, I know two things to be true:

  1. Most people should be moving more. Research has demonstrated that regular physical activity can lead to improved mobility and strength,  better sleep, preserved cognitive functioning, decreased depression, and stronger feelings of self-efficacy and personal control. Yet adults over the age of sixty-five are the most sedentary age group.
  2. Moving your body as a form of musical expression feels great. People have always known this on a human level, but now neurological research is starting to show us why movement and music go together so well, too.

This is why I deliberately encourage movement to music when I am doing live music with older adults. Rather than just hoping for people to “get into the music” and move spontaneously, as you might do in an entertainment-oriented program, I view movement as an important form of musical communication and consciously facilitate movement to music. This is one more way that music therapists do live music differently.

#10. Supporting Movement

Sometimes music therapists are very direct in facilitating movement to music with verbal, visual, or tactile cues; and sometimes music therapists focus on reflecting and amplifying the movement that arises spontaneously for people that are doing music with us.

Let me share some examples of how this works.

Directing Movement

Imagine Janet’s music therapy group in a memory care community. One song fitting into her “weather” theme is “Over the Rainbow.” Knowing that the wide range of this song makes it difficult for many of her clients to sing, Janet plans to integrate movement with this song. She demonstrates expressive arm movements to match specific lyrics (e.g. reaching one arm over the head to draw a rainbow shape for “somewhere over the rainbow”), then leads the group by singing a cappella and demonstrating the movements visually. When participants have the arm movements learned well, Janet adds a guitar accompaniment, for an even more layered musical creation.

Planned movement experiences could work in a one-on-one session, too. For example, maybe Jennifer knows that her hospice patient Maude craves touch. Rather than playing guitar, Jennifer often holds Maude’s hands and sings a cappella. When Maude seems to have the energy, Jennifer says, “will you dance with me?” and sways Maude’s hands gently while singing, “My Bonnie Lies Over The Ocean.” If Maude resists this movement or feels tense, Jennifer stops dancing with her, but on some days, Maude seems to take over moving to the beat. Jennifer notices that Maude is more likely to make eye contact and smile on these occasions.

Reflecting and Amplifying Spontaneous Movement

Of course, those planned experiences aren’t the only ones that get participants moving to the music. Perhaps Janet is playing “Singin’ in the Rain” as several residents sing along, and she notices that Glenda, who is usually pretty withdrawn, looking up in her direction and kind of waving her fingers to the beat. Janet says, “you’ve got the beat, Glenda!” and taps her guitar in imitation of Glenda’s movement. In this case, Janet is supporting movement in a different way: reflecting and amplifying Glenda’s movement.

Again, the same thing can happen in one-on-one sessions, too. Perhaps Jennifer notices Joe nodding his head slightly to her rendition of “Hound Dog.” Jennifer mirrors his rhythm, swaying to the beat while continuing to sing and play guitar. Seeing Joe’s movements get even bigger and more deliberate, Jennifer abruptly mutes her guitar on the line “you never caught a rabbit,” then points at Joe and sings, “and you ain’t no friend of mine.” He smiles broadly and points back at her, while Jennifer strums an appropriately rock-n-roll beat to end the song. Here, Jennifer was amplifying Joe’s movement and showing him where to add an accented movement, too. Now Jennifer and Joe are collaborating in the music on a new, deeper level.

Helping music therapy clients move to music means that they can shift from passive listening to more active engagement in the music-making. What’s more, music therapists see participants’ movement as being an essential part of the music itself.

Facilitating movement to music is one more way that music therapists do live music differently.

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“You Are Here” – A Song From The Perspective of Someone with Early-Onset Alzheimer’s Disease

A while back, I shared a song with you written by Bakhus Saba, a caregiver who had just gone through the heart-wrenching experience of placing his mother in a care facility due to her worsening Alzheimer’s Disease. Now, Bakhus has another song to share. This one is written from the point of view of someone with early-onset Alzheimer’s Disease, with music by Karen Morand, and lyrics by Karen Morand, Dale Butler and Bakhus Saba. With their permission, I have shared the studio recording and the full lyrics below:

You Are Here

God knows what’s happening here
I’m all alone in my fear
“Early onset” is what I’ve been told
I’m too young to be old

All the memories I’ve known
Are fading into the unknown
The life I lived with the people I love
Are ghosts that haunt me now
And I need to know somehow…

You are here
You are near
Hold my hand
One thing remains through the year
You are here.

I look in the mirror and what do I see?
The eyes of a stranger stare back at me
The look is familiar but something is wrong
Like an old forgotten song
Can you help me sing along?

You are here
You are near
Hold my hand
One thing remains through the year
You are here.

All that I know is this moment right now
You may be a stranger but love me somehow
In time you will get to know
Love’s hardest lesson is in letting go

One day you’ll pack up my things
I’ll leave you behind spreading my wings
Forgetting confusion, losing the pain
But I’ll remember your name
And I’ll love you just the same

You are here
You are near
Hold my hand
One thing remains through the year
You are here.Old woman looking in mirror

Bakhus shared with me that this song had a few sources of inspiration, including the novel Still Alice and the story of Jan Petersen, a former CBS foreign correspondent. He also said that the second verse came from his own experience of his mother not recognizing herself in the mirror.

Personally, my favorite line came in the second verse: “The look is familiar but something is wrong/Like an old forgotten song/Can you help me sing along?” I often get to help people sing along to songs they thought they had forgotten, and I know that music can bring back memories in other ways, too. I feel privileged to be together with people at those times.

I hope you find this song as achingly beautiful as I did. If you haven’t already, make sure you hear Bakhus’s song “Still A Child,” too.

Music Therapists Do It Differently: Adding Instruments

In this series, we are exploring how music therapists do live music differently than other musicians, even though it may not be easy to see. This is part nine of a ten-part series. You can find an introduction and links to all ten posts here.

(P.S. Are you loving this series? There’s more where that came from! Jump on our email list for specialized, exclusive content, just for subscribers. Click here to subscribe.)

If you’ve been keeping up with this series, I’m sure you’re getting the point now:

Music therapists don’t just stand up, strum, and sing.

When we do live music in clinical sessions, we aim to relate to and interact with our clients through the music, based on their needs and goals in that moment. Sometimes, our clients are mostly listening, in what we call receptive music experiences. But other times, clients become more active participants in the music-making:

#9. Adding Instruments

One key way that people can become more actively involved in musicking together is by playing instruments. As do most music therapists, I carry around bags of rhythm instruments in my car, and I always have a drum or shaker or two with me when I see a client. I don’t always use instruments, however, and this aspect of live music is not as simple as handing out the instruments and asking folks to play.

It takes clinical skill to choose when and how to invite people to play instruments.

"Nice drums!"

“Nice drums!”

Here are some questions I ask myself:

1. Is this respectful and age-appropriate?

For some clients, playing an instrument may be a rewarding way to contribute to the music, but for others, it may feel childish. Much of this has to do with the instruments we use and how we frame the music experience.

In my practice, I use the highest-quality, most ethnically-appropriate instruments I can. So, I might bring in tambourines and frame drums with mallets, then support participants musically as they find the beat to an Elvis Presley song.

By contrast, if you hand someone a cheap plastic maraca and urge them in a high-pitched, preschool-teacher voice to “shake it, Mary, shake it!” – that may feel demeaning or childish. Then again, pairing cheap plastic maracas with virgin maracas at your Cinco de Mayo party may be just the right kind of fun. (See – these decisions take forethought!)

2. Is this musically-enhancing or distracting?

Sometimes, playing an instrument enhances a client’s engagement in the music, allowing them to play an important role in the music even if they can’t or don’t want to sing along. But sometimes the instrument causes a distraction.

Having too many instruments, or participants who struggle with finding the beat, can turn the whole session into more noise than music. Or, someone may be engaged by playing a drum for a song or two, but then feel too tired to keep playing. The music therapist may decide to use fewer or different instruments, to have fewer people play at one time, or to give people permission to listen for a while rather than play.

3. How can I support their music-making best?

Beyond deciding when and with whom to use instruments, the music therapist also has to determine how best to support a client’s music-making experience. Are we going for exploration of various instruments? Syncing rhythms across a group? Playing in parts, like a small ensemble? Targeting particular physical needs? Pointing back to a verbal discussion? (P.S. These musical decisions can point back to creative, social, cognitive, physical, and emotional goals, respectively.)

Always considering what the client’s needs or goals happen to be, music therapists are deliberate in choosing when and how to use instruments in live music-making experiences with clients.

That’s another way music therapists do live music differently.

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