English Summary: Exploring person-attuned musical interactions in dementia care. A flexible research design

This article-based PhD thesis constitutes an exploration of person-attuned musical interaction (PAMI) with persons with advanced dementia living in nursing homes. The thesis consists of three studies all exploring PAMI or elements of PAMI from different perspectives to ensure an understanding of the concept that can be applied in an interdisciplinary context. The findings of the three studies are presented in three articles.

The thesis aims to generate knowledge concerning interdisciplinary use of PAMI in dementia care. Research has shown that music therapy and music- based activities can have a positive effect on well-being and decrease neuropsychiatric symptoms for persons with dementia. The positive effects of music therapy and music-based activities may be transferred to caregiving contexts, with music therapists to supervise the application of musical interactions. From this indirect practice, in which music therapists support and supervise caregivers in how to apply musical interactions, it is still not clear which nonverbal elements caregivers can apply in their practice, and how caregivers experience the application of musical interactions in their practice.

The concept of PAMI served as a reflexive starting point for exploring nonverbal and musical interaction between the person with dementia and caregivers. The concept is grounded in the person-centered approach to care formulated by the psychologist Tom Kitwood and the theory of communicative musicality by Colwyn Trevarthen and Stephen Malloch.

In article 1, I examine the research literature concerning attunement between caregivers and persons with dementia, with the aim of exploring how attunement is used and understood. Six studies were included in a scoping review, and a meta-ethnographic analysis revealed three interwoven themes describing attunement in dementia care. The three themes were: (1) taking the perspective of the person with dementia and the importance of a person- centered approach, (2) developing understanding through an empathic approach, and (3) using musical parameters in the interaction; tempo adjustments, timing, and the use of music. The findings in the review indicate that person-centered care and musical parameters are embedded in the application of attunement in dementia care.

In the study presented in article 2, I explore how six expert music therapists experience nonverbal interactions between themselves and persons with dementia. Explorative focus group interviews were conducted with two groups of three music therapists in each. In the focus groups, the music therapists wrote lived-experience descriptions about their nonverbal interactions with persons with dementia. The transcripts from the focus group interviews were analyzed using a phenomenological approach, and the revealed findings were elaborated and validated by two of the participating music therapists using musical improvisation as an arts-based approach. The findings describe the music therapists’ experience of nonverbal interactions with persons with dementia with five interrelated themes: (1) vitality, (2) disciplined subjectivity, (3) attunement, (4) therapeutic presence, and (5) validation.

In article 3 I describe how six professional caregivers apply and understand musical interactions in their practice. Through a collaborative learning process, the caregivers and I, in the role of music therapist, explored how musical interactions can be used and understood in daily interactions between the caregiver and the person with dementia. The caregivers contributed to the data generation by validating and elaborating narratives describing their application of musical interactions in their work. The workshops from the collaborative learning process were transcribed and included as data in the study. The data was analyzed by applying a hermeneutic ethnographic approach and revealed the following four themes that illuminate how the caregivers use and understand musical interactions in dementia care:

1. Vitality and communication
2. Connectedness through attunement,
3. A life story soundtrack
4. From anxiety to reassurance.

The linking text outlines the overall research framework and background and includes a discussion of the applicability and the limitations of PAMI as a concept in indirect music therapy practice. Based on this discussion, I conclusively propose recommendations for PAMI training for caregivers. I suggest that music therapists facilitate the PAMI training, as they are specialized in interacting nonverbally and musically.

The thesis is part of the PAMI project located at Aalborg University and is funded by the Velux Foundation and Alzheimer-forskningsfonden.

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