Improving quality of life for Department of Veterans Affairs nursing home residents through music and art.

The large dining room is quiet. Residents sit in a grouping around the piano. Several are wide awake, their eyes bright with anticipation; two are conversing with the young lady in a white lab coat, others are dozing in their seats, and still others are walking aimlessly around the room. A young man enters carrying a music case. He greets several residents by name, welcoming them to the group. He goes to the piano, opens his case and pulls out his trumpet, and begins to play a tune. The conversation stops, sleeping residents wake up, aimless ambulation is directed toward the sound, and all attention is focused on the young man. If you look to the entrance, additional residents are making their way into the room. When the young man finishes the song, questions erupt, “What was that? How do you do that?” The young man begins to tell about how a trumpet is played, what kind of music can feature a trumpet, and the enjoyment he gets from playing music. This launches a discussion about who played an instrument, who enjoyed music, and who would like to listen to more music featuring a trumpet. One resident Mr. A, who had been sleeping and rarely spoke, became very alert and told the group that he had played the trumpet, a fact that had not been known about the resident. The young man brought out an alternate mouthpiece and let the resident play. This resident, who was lost in his world of dementia, placed the trumpet to his lips, found the proper position, and played a few notes. The look of joy on his face was exquisite, allowing all around to clearly see the man he had been before dementia robbed him of himself. A Department of Veterans Affairs (VA) Nursing Research Initiative grant has supported the study, “The effect of exercise on muscle function and cost in VA nursing home residents.” Our hypothesis was that exercise would support and increase functional abilities, but we felt more than just exercise was contributing to the improvement. Therefore, we devised a study that compared an exercise group with a nonexercise group that receives a comparable level of staff attention and positive reinforcement to determine whether changes in function normally associated with low-intensity exercise are from the exercise or other factors. This study is currently being conducted and the intervention phase will conclude in March 2006. The nonexercise group participants attend a music and art activity three times a week. Two sessions are art-oriented and the third music-oriented. The responses to the music and art programs have reminded us that even residents with profound dementia retain their humanity. Although a resident may seem completely lost to the world, he or she may still be able to respond intellectually. For example, Mr. B’s dementia had robbed him of intelligent speech; he rarely spoke and when he did, it was largely nonsense sounds. Yet he participated in the art programs, watched alertly, and responded emotionally to the pictures. When asked if he enjoyed the pictures, he was able to comment, “They are so beautiful.” During a presentation about Norman Rockwell, he wept while looking at a picture of an old man with his grandson who were watching a ship sail away. His humanity and emotionality overcame the dementia for those moments. Not all residents respond to the program; many who have had limited exposure to art and music are difficult for us to engage. Cultural background may also contribute to a resident’s lack of participation. We found that individualizing the approach helped involve residents. Mr. C, an African-American resident, did not enjoy European art, but he enjoyed programs on Mary Grant, RN, MA Clinical Nurse Specialist, Geriatrics Long Term Care, VA Maryland Health Care System