Singing has long been credited with a wide variety of physical, mental, and social health benefits (Hunter, 1999). Recent scientific inquiry points to the efficacy of singing toward enhanced cardiovascular and pulmonary performance (Bonilha, Onofre, Vieira, Prado, & Martinex, 2009), verbal communication (Wan, Rüber, Hohmann, & Schlaug, 2010), and immune functioning and attendant affective states (Kreutz, Bongard, Rohrmann, Hodapp, & Grebe, 2004; Kuhn, 2002; Unwin, Kenny, & Davis, 2002). Among older adults, singing has been linked with improved mood, better quality of life, greater happiness, stress reduction, and emotional wellbeing (Clift et al., 2010).
In our own work, we have noticed repeatedly the benefits of singing with older adults with Alzheimer's Disease and related dementias (ADRD). Individuals who show signs of hyper-arousal (i.e., restlessness, agitation, and/or purposeless or perseverale behavior) tend to become calmer and more meaningfully involved after just 20 to 30 min of active engagement in singing. Individuals who are hypo-aroused (i.e., sleepy, depressed, and/or nonresponsive) tend to become more alert, physically active, and socially interactive by the end of a session in which singing has been a primary focus. In this way, singing appears to serve a regulative function, as posited by Aldridge (2007) - that is, it has the capacity to compose and soothe individuals who are disorganized or anxious and arouse those with abnormally diminished levels of physical and cognitive activity, thereby moving both profiles to more optimal functioning. Additionally, our perception has been that this improved functioning often "carries over" into other daily activities. These observations regarding singing led us to question whether pre-meal singing might be an efficacious way to combat the malnutrition to which so many individuals with ADRD are vulnerable.
Review of Literature
ADRD and Malnutrition
ADRD are progressive, neurodegenerative disorders that affect the part of the brain that controls memories, thoughts, and language skills (Alzheimer's Association, 2011). As such, a person's ability to complete critical daily activities is typically compromised. One of these daily activities is eating; in fact, feeding difficulties and resulting malnutrition become pressing concerns as dementia progresses (Volicer & Hurley, 1 997). Individuals in the middle stages of ADRD may forget to eat or how to feed themselves. Those in the later stages are at particular risk for malnourishment in that they may lose their ability to chew and swallow (Rouse & Gilster, 1994) and food may fall out of their mouths due to lack of proper oral manipulation (Watson & Green, 2006). Poor communication between patients and their caregivers may also be a factor contributing to malnutrition, as those affected by dementias grow increasingly dependent on others and yet are less able to verbally express their needs and understand others' directions (Athlin & Norberg, 1989; Lou, Dai, Huang, & Yu, 2007). Without a doubt, malnutrition can compromise physical and cognitive functioning, thereby negatively affecting the quality of life for individuals with ADRD and contributing to terminal decline (Hurley & Volicer, 2002).
Background Music in the Dining Environment
The incorporation of recorded background music in the dining environment has been found to decrease agitation and other characteristic symptoms of ADRD that impede productive eating, such as wandering, irritability, and depression (Chang, Huang, Lin, & Lin, 2010; Denney, 1997; Goddaer & Abraham, 1994; Ragneskog, Brane, Karlsson, & Kihlgren, 1996; Ragneskog, Kihlgren, Karlsson, & Norberg, 1996; Richeson & Neill, 2004; Thomas & Smith, 2009). In fact, background music appears to be the most frequently studied intervention toward the alleviation of feeding difficulties among individuals with various dementias, according to a systematic review by Watson and Green (2006). …