Dan Cohen watches from a corner of the community room at a home for veterans in Stony Brook, observing residents diagnosed with dementia enjoying his gift of music.
The residents, wearing headphones plugged into music players, are listening to a selection of tunes customized for each of them. As founder and executive director of Music & Memory (musicandmemory.org), a nonprofit that provides personalized music via iPods and MP3 players to Alzheimer's patients and others, Cohen, 62, is keen on seeing their reactions.
Marine Corps veteran George Greening, 56, who has been living in the dementia unit at the Long Island State Veterans Home since September, closes his eyes as he hears a song, his expression turning to bliss. "Harry Chapin is my favorite," says Greening. The music, he says, revives happy feelings from years ago, even before he was working on generators for Verizon and raising five children with his wife, Peggy, in Farmingdale. His 16-page playlist of songs includes artists from the '70s that are the favorites of many baby boomers -- Earth, Wind and Fire, the Bee Gees, Creedence Clearwater Revival.
Studies have shown that music reduces agitation in Alzheimer's patients and can improve cognitive skills. And individualized music is recommended by the New York State Department of Health and the national Alzheimer's Association.
But there has been a gap between knowing an intervention's worth and providing it.
"In 2006, I heard something on the radio talking about how iPods are ubiquitous, and I started thinking, 'If I'm ever in a nursing home, would I be able to have access to my '60s music?' " says Cohen, a former social worker and tech professional from Mineola. He Googled "iPods and nursing homes" in the United States and concluded that "none of the 16,000 nursing homes used iPods."
That's when he began his journey to provide simple technology to help patients who have difficulty communicating, he says. Now, more than 400 nursing homes in 38 states -- as well as in Canada, the United Kingdom, the Netherlands, Israel, Australia and Singapore -- have adopted his Music & Memory program.
Music spurs the memory
Families also benefit because, "instead of someone saying, 'I'm not visiting Grandma; she doesn't know who I am,' when we have music in the room, it changes the experience, and everyone is more social," explains Cohen. "The person with dementia is actually remembering old stories. People will stay longer to visit."
Mary Ann Malack-Ragona, executive director of the Alzheimer's Disease Resource Center in Bay Shore, says, "We support Dan in what he's doing, and we'll help him in any way we can with his mission -- and help make this a standard of care in all facilities that are working with patients with a diagnosis of dementia or Alzheimer's disease."
Malack-Ragona says many nursing homes and assisted living facilities use different kinds of music therapy -- and, in fact, "Why Music for Alzheimer's?" will be a topic at the Alzheimer's Disease Education Conference & Expo 2014 at the Melville Marriott Long Island on March 6.
Acting on his idea of using iPods in nursing homes in 2006, Cohen called Mary Grace Lynch, therapeutic recreation director at the A. Holly Patterson Extended Care Facility in Uniondale, asking if he could bring in iPods to work with residents. "At first I wasn't thrilled with the idea. . . . He wanted to donate iPods, but he was going to give us only 10 -- but we have 589 residents," Lynch recalls. After reconsidering, she decided, "It's a no-brainer."
Cohen volunteered at Patterson biweekly for 18 months. Then Lynch got a call from the Shelley & Donald Rubin Foundation, looking to fund a music program for Alzheimer's patients. Cohen met with foundation leaders, and "he got them to buy us a laptop, and I think we started with 100 iPods," Lynch says.
Patterson now uses iPods with various residents -- to calm them, manage pain, help them socialize -- making them "more satisfied," Lynch says.
In 2008, two years after Cohen brought the iPods to Patterson, the Rubin foundation gave him a $60,000 grant for a pilot program at four nursing homes. Donald Rubin's late mother had dementia, says Asha Kaufman, the foundation's manager of outreach and development. Rubin, who, with his wife, founded the Rubin Museum of Art in Manhattan, would visit his mother, but she was unable to connect with him, Kaufman says.
However, on one visit, he noticed that she responded to music. "His mother sort of came alive, and he could really see the impact it had on her mood, on her ability to connect with him and on her general well-being . . . so he started looking for someone who was doing work, bringing music to elders," Kaufman says.
The foundation had a filmmaker follow Cohen for three years. The result was "Alive Inside: A Story of Music & Memory." The documentary, by director-producer Michael Rossato-Bennett, shows patients responding to personalized music. At the Sundance Film Festival this year, it won the Audience Award: U.S. Documentary. A clip from the film on YouTube shows Henry, a 90-ish dementia patient who becomes animated and talkative when listening to music on an iPod. The video has garnered more than 8 million views.
Cohen says the key to his program is personalized music, which is different from playing Sinatra tunes over a public address system. Some patients might prefer Dean Martin. Or Gospel. Or Mozart. "Everybody's favorite music is really like a fingerprint," he says.
Music over meds
Malack-Ragona of the Alzheimer's resource center says the result of personalized music is "amazing . . . you see what happens with individuals who virtually are unable to communicate verbally, and yet can sing a song . . . If we can provide good behavioral interventions, we can succeed in getting better outcomes with individuals with Alzheimer's disease, as opposed to pharmacological intervention." That's in keeping with a 2012 requirement by the U.S. Centers for Medicare and Medicaid Services for nursing homes to reduce the use of psychotropic medications for Alzheimer's patients.
Cohen says his current budget is about $300,000, from numerous grants, including continuing support from the Rubin foundation, as well as payments from nursing homes. The program costs about $2,000 per nursing home, including iPods and video training sessions.
Personalizing music can take time, Cohen says. "You go to their family and you ask, 'What did Mom or Dad listen to when she or he was very young? What did they play on the radio? Did they have any records? Did they play instruments? Did they sing in a church choir?' "
For patients who have no family, it's more trial and error. To build playlists, a staff member sits with several patients, plays songs from their youth and watches their reactions. For Alzheimer's patients who live at home, Cohen says, a playlist should be put together by family members as soon as a diagnosis of the disease is made.
"This music really brings them to a time and space when they're . . . not just sitting in a nursing home . . . but to a time when it was more fun," says Dr. Lory Bright-Long, psychiatric gerontologist at the Stony Brook veterans home and medical director at Maria Regina Residence Home in Brentwood, which also uses iPods.
At the Stony Brook veterans home, Mike Padilla, 93, a World War II vet, beams as a Latin tune streams through his headset. Music therapist Marcella Lien says Padilla, who's been in the dementia unit for about 2½ years, "likes anything with rhythm. With Mike, the staff can use the iPod as a tool to redirect behaviors . . . wandering or restlessness. Sometimes, on the dementia unit, some of the guys are looking for a way to go home. It's something they can listen to to kind of relax them."
Padilla's wife, Katherine, 85, of Sayville, says that "with the iPod, he does like the music and he can stay with it for a long period of time during the day. You don't know what's going through his mind, but . . . when it comes to music, he loves it."
For Greening, his playlist brings comfort and joy, says Peggy, his wife of 36 years. The music has helped him and the rest of the family deal with his heartbreaking diagnosis. "He says, 'I have my iPod and I listen to it at night, and when I start to think about my illness and everything else, I tune it out,' " she says. "And if that's all it does for him, I'm happy -- and, honestly, I think it does a lot more."
Greening agrees. "It makes you feel good," he says. "Any kind of problems you think you have, you kind of feel better."