Music Therapy in Gerontology:

A Review and a Projection

MARIAN PALMER, RMT-BC
Oldsmar, Florida

GUEST EDITOR’S ABSTRACT: The author prefaces her remarks

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boomers” reach this age, it will be the largest segment of our
concerning the use of music in gerontology by quoting demographic
data which suggests that by the year 2000 there will be two million population. These are the people who are living indepen­
residents in the nation’s nursing homes. This number is partly due to dently in the community, but who will rely on some inter­
the baby boomers “coming of age.” Four distinct categories describe vention techniques if they are to remain independent and
the current field of gerontology. They are the independent and “well maintain a good quality of life.
elderly,” those living at home, those under the care of a professional
In between these categories are the elderly who are living
caregiver, and those living in nursing homes. The author Presents
three scenarios describing how music therapy could be utilized. The in the community with a caregiver and relying on community
music therapist could be in a consultive capacity to the director, health services to meet their diverse needs, as well as those
assistant in attracting new members by providing stimulating pro­ who are living independently, or with acaregiver, and utilizing
gramming, and the use of contractual arrangements with community the services of day care programs to meet their health care
agencies to provide home visitations. In reference to education and
needs. Both of these groups account for large numbers of the
training implications for music therapists, the author offers that while
traditional methods are adequate for working with residents in ex­ elderly which are just now beginning to be identified.
tended care facilities, a broadened concept is essential to be part of
the wellness movement. Expanding Opportunities
The field of gerontology today can be categorized in the
following four groups, each of which offers special oppor­
Demographic Overview
tunities for music therapists:
In order to discuss music therapy in the field of gerontology 1. The “well elderly”-those individuals who are living in­
it is necessary, first of all, to understand the demographics of dependently in the community and currently see no need for
the aging in our society. any intervention techniques.
The field has changed dramatically in the last decade and 2. Those elderly who are living in their own home, or that
is continuing to change because of the demographic shift. of a caregiver, but spend three to five days a week in a day
According to a National Census Bureau study entitled An Aging care program.
World (1985), “rapidly expanding numbers of older people 3. Those elderly who are being cared for in their own home,
represent a social phenomena without historical precedent or that of a caregiver, with support from a community agency,
and one that is bound to alter previously held stereotypes of usually a hospital or community center.
older persons” (p. 7). This report goes on to say that the over­ 4. The debilitated elderly who are living in extended care
80 age group now is the fastest growing segment of our pop­ facilities or nursing homes.
ulation.” The stunning growth of the elderly population has It should be noted that hospice patients may fall into either
various economic implications, particularly in terms of meet­ category 3 or 4 since some hospice programs utilize a portion
ing the relatively greatest health needs of the older popula­ of an existing facility for their program while others work with
tion” (p. 7). community-based patients.
Since the proportion of the aging who are over 75 is ex­
pected to rise to 45% by the year 2035, we can expect the category 1
number of nursing home residents to rise to almost two mil­ This is the group of elderly who consider being on their
lion by the year 2000, and to almost three million by the year own as proof of physical and mental vigor. “They think it is
2030 (Stotsky & Stotsky, 1983). All of this points to a society an accomplishment. Symbolically it is very important to them”
which will have a large number of frail elderly who will com­ says psychologist Ann Pitlow from the University of Southern
prise the majority of those in nursing homes. California. (U.S. News and World Report, 1983). It is this group
At the other end of this spectrum are the “well elderly.” that is now receiving a great deal of attention from businesses
Currently, one in nine Americans is over age 65 (although only for they represent a vast new market for services of all kinds.
5% of this number will require nursing homecare). Thisgroup Housing, travel, and health industries see them as a key part
is also growing rapidly and, in about 20 years when the “baby of their expanding market. Unfortunately, many of these pur­
veyors are only interested in exploiting the people in this
group rather than being genuinely concerned about the qual­
ity of their lives.
Gerontology: A Review and a Projection 53

These people need no specific treatment plan or interven­ communities, the distinction between the community/senior
tion techniques, in the sense we usually think of such a pro­ center and the day care center is very fuzzy!
gram. However, they do need opportunities for good mental At a conference of community center directors, attended
and physical stimulation as well as appropriate social experi­ by more than 100 directors from a large geographic are?, the
ences if they are to maintain their independent status. Most consensus was that they had the following three great chal­
of them do not see this as a need; yet studies have shown that lenges currently facing them: (a) developing new and inno­
without such experiences those living alone can quickly and vative programs which will meet the varied needs of their
easily slip into a dependent state, requiring care either from diverse clients, (b) attracting to their centers the” well elderly”
the community or from some institution (Davis, 1982). in the community who need this kind of involvement, and (c)
A study was done under the auspices of Denison University overcoming the old stereotypical concept of a community

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to investigate the life satisfaction of the elderly through par­ center (Ohio Association of Senior Citizens, 1986). These di­
ticipation in a music therapy group (Streiff, 1986). The results rectorsare, for the most part, dedicated people with a genuine
are very conclusive in determining that the life satisfaction of interest in helping all of their clients find the best possible
the group was greatly enhanced by involvement in the music quality of life, but they have not had the professional training
therapy group, which emphasized reminiscence through mu­ which would enable them to meet these challenges. It is pre­
sic. While this study was conducted in a residential setting, cisely this kind of expertise that music therapists could offer
other studies done with community clients have reached the them.
same conclusion, such as the one by Kearney, Plax, and Lentz
(1985). A report by Santrock (1985) further investigated life category 2
satisfaction among retired persons. This study reached the Adult day care centers are springing up all over the country
conclusion that there is a distinct correlation, not only be­ to deal with those elderly who need some kind of supportive
tween lifesatisfaction and involvement in a meaningful activity or supervised care during the day, but who are capable of
such as music therapy, but also between longevity and such returning to their own home, or that of a caregiver, at the
involvement. end of the day. In 1979 the National Council on Aging de­
Senior centers across the country have been a good source veloped the National Institute of Adult Day Care (NIADC)
of stimuli for the well elderly; however, in the past the pro­ because of the growing interest in the area (1986). In 1985
grams at these centers have been loosely structured. For the NIADC published the results of its first national survey. This
most part they were planned by the director who tried to report offers an understanding of the growth of adult day care
offer interesting trips, activities, and speakersas the members services in this country.
requested. The major role of the director was to see that Briefly, the report documents that adult day care centers
appropriate arrangements were made for field trips, and to are located in practically every state in the union, with 31%
make space available for other activities, most of which were of them being in four states-Florida, Massachusetts, Califor­
carried out independently by the members. These directors nia, and Minnesota. The information in this report also indi­
did not think of their programs as being any kind of an “in­ cates that there is a commonality among these centers, al­
tervention technique.” However, now that some of these cen­ though there is great diversity in their operation, funding and
ters are 8 to 10 years old, they find that their original members programming.
can no longer participate in the type of activities they have The primary objectives, stated by all respondents, were (a)
traditionally scheduled. They are also finding a greater diver­ to provide an alternative to premature or inappropriate in­
sity in the interests and abilities of their clients and are be­ stitutionalization, (b) to maximize the functional ability of the
ginning to recognize that they must alter their programming client, and (c) to provide respite to caregivers and give psycho/
to accommodate the needs of all their clients. These same social support services to their clients. These day care centers
center directors are facing still another challenge. have been established, in some instances, to work with specific
In many communities there either is no day care center, or clients, such as Alzheimer’s victims. However, the majority of
the day care program is being closed due to lack of funds. these centers find that they have, as their clientele, a varied
These clients are now coming into the senior centers which group of people with widely diverse abilities and interests.
are not prepared to handle this type of client. The directors Since these centers developed as grass roots programs, there
are finding it challenging to develop appropriate and mean­ are no federal, and few state, guidelines. In some areas they
ingful activities for this mixed bag of clientele and are seeking fall under the jurisdiction of social service agencies and in
assistance from professionals who are trained to develop the other areas they come under various health agencies, with
kind of therapeutic program which is needed. While most funding coming from a variety of sources. Some states are
centers have criteria for acceptance of a client/member, in now offering tax credits for day care expenses.
many instances these criteria are set aside. Clients who do not The average day care center operates five days a week and
meet their standards are accepted simply because the direc­ services usually include meals, transportation, recreational
tors recognize their needs and know there is no alternative services and, sometimes, music and art, with these services
program available to them. At this point in time, in many being contracted for as needed.
54 Music Therapy Perspectives (1989), Vol. 6

A further study is being developed to take an in-depth look and published to be made available to the other areas of the
at the centers summarized in the first NIADC study. This new country where such a program could be replicated.
study should be of great interest to music therapists, in order
to see how they can fit into this work. It is an area which is category 4
in a state of flux and needs good professional guidance in These are the elderly who need nursing home care and, as
order for it to fulfill its potential. pointed out earlier in this paper, the number of such residents

For the most part, music therapists who choose to work in the field of gerontology
are being trained to work only with residents in extended care facilities.

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Category 3
will increase significantly in the next few years. An article in
Recently, insurance providers and the federal government the Journal of Music Therapy, “Music in a comprehensive pro­
have indicated interest in keeping the elderly in the com­ gram of treatment and rehabilitation for the geriatric resi­
munity, even when they need medical assistance, by providing dent, “addressed the needs of those who are in extended care
such services through community-based agencies. All of this facilities (Palmer, 1977). The material presented in that article
is an attempt to keep those elderly from becoming nursing is still valid for that particular segment of the population;
home patients and further burdening an already over-bur­ however, even in this setting the challenge will be to adjust
dened health care area. The concern of these insurers is more to what will be and is already happening. There is a change
economic than altruistic, for as this portion of the elderly in the type of resident now coming into such facilities. They
population increases we find that we cannot provide for their are much more frail and much more debilitated. The music
needs in the traditional method, i.e., nursing home care. It is therapy program offered will have to be altered to accom­
simply too expensive-so alternative solutions are being modate these changes.
sought. As always, music therapists can continue to be valued mem­
This emphasis on community-based health care is a fast bers of the treatment team in such a setting, working in a
growing movement. Federal grants have been established to rehabilitative program where appropriate, and also working
study the problem and demonstrate the efficacy of such a to provide the best possible quality of life for those who are
program, particularly in the more rural areas of our country. terminally ill,
The results of these pilot programs have been very encour­ These, then, are the four categories now open for music
aging. They have shown that, first of all, there frequently are therapists who want to venture into the rewarding field of
caregivers who are willing to accept this responsibility, and, gerontology. It is the hope of the author that the music ther­
secondly, this can be a successful and cost-effective program apy profession will recognize these different areas and will
when run in cooperation with a community agency where tailor the current training programs to meet these diverse
the necessary services are available. The concern of these pilot needs.
programs is the quality of life for both the caregiver and the Scenario 7: In a day care center where there are typically
client, which entails more than just meeting physical needs. 21 to 35 clients who come 3 to 5 days a week, from 8:30 until
Both parties in this kind of a caregiving situation could benefit 5:00, the music therapist would work as a consultant to the
from music therapy which could be offered as part of the director and conduct the assessment of the clients in order
contractual services from the community agency. to plan appropriate activities for them. The therapist would
Just such a grant was conducted recently in Pomeroy, Ohio, also conduct specific music therapy sessions for certain clients
under the auspices of the Department of Health and Human while supervising the music activities conducted by other staff
Services (Family Support Network, 1982). The pilot program or volunteers, meeting with them regularly to evaluate the
developed under this grant offered, to a group of caregivers, ongoing program and make any necessary changes. Such a
the necessary supportive services to guarantee a good quality program might consist of daily exercises to music, a music
of life for all involved in the situation. The figures from the therapy group for mental stimulation and/or reality orienta­
study are impressive as to cost saving. Unfortunately, it is not tion, music listening for those unable to participate in any
as easy to assess the quality of life. However, in many situations other center activities, individual or group instruction on rec­
such as this one, the familiarity of home and family can out­ reational instruments, and individual tapes for those with spe­
weigh the benefits offered by an institution. For many people cial needs, to name just a few possibilities.
this would be their choice, since they would be unable to Scenario 2: In a community center, which has a large mem­
handle the expense of a nursing home and, also, because their bership of 80 to 100 persons, the music therapist would work
culture dictates this kind of family caregiving. This particular with the center director to evaluate the current program and
program utilized the services of a music therapist as part of help plan the type of activities that would attract the “new
the training sessions for the caregivers, and as consultant to elderly.” Many of these clients/members might come with
the program director. The results of this study were compiled their instruments and could be encouraged to develop cham-
Gerontology: A Review and a Projection 55

ber music or some other orchestral ensemble. Others might is concerned with keeping the client well, thus delaying or
be interested in becoming part of a singing aggregation. (Here eliminating nursing home care from their future.) Music ther­
the music therapist might have an opportunity to use, perhaps apists need to understand the broad spectrum of elderly in­
for the first time, all the training in orchestral and choral cluded in the term “gerontology,” and recognize that the
conducting.) A round or folk dance group might be scheduled elderly can no longer be grouped into one convenient cat­
for those interested in such activities. Those interested in egory. Educational programs should be designed which will
ballet, opera or symphony could form a group to discuss, have content applicable to all the elderly.
attend a performance, and then have follow up discussions To work with the elderly being cared for in the community,
on the event. The important thing for the therapist is to rec­ therapists will need to be trained to provide services both to
ognize that these people have had a great many musical ex­ the one being cared for and the caregiver. This will require

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periences and bring with them much knowledge and ability. a special understanding of the problems being faced by the

Music therapy has already proven its effectiveness in working with the institution­
alized elderly. The need now is to prove its effectiveness in the broader field of
gerontology.

Scenario 3: In order to work with those living with a care­ caregiver in what is often a very stressful situation, as well as
giver, the music therapist would enter into a contractual understanding the condition of the patient. Individual “care
agreement with the commuity agency supplying the “quality plans” will need to be developed for each party.
of life” services. After obtaining assessment information from Regarding day care and community center programs, the
the other team members, the therapist would meet with the therapist will need to be trained to assess these clients and
caregiver for any additional helpful information regarding the then design appropriate activities which the directors can
total situation, and might then work with the caregiver on integrate into their programs to meet the diverse needs of
stress management and relaxation techniques. When appro­ their clients. The challenge will be to build a program that
priate, the therapist could develop for the caregiver a very utilizes clients’ past experiences, builds on their interests, and
personalized tape to be used when needed. (The music on provides them with appropriate ways to continue these in­
such a tape could range from Bach to Steve Halpern, or other terests, commensurate with their functioning level. These
New Age music, and might include music from any of the programs, then, become the intervention technique that will
intervening periods.) The therapist would then meet with the keep them mentally and physically alert while providing them
patient for a series of sessions designed to determine just what with good and enjoyable social experiences. The music ther­
music preferences would evoke reminiscences. This music apist can have a vital role in both settings, as a consultant to
then would be used to assist the patient in bringing closure the director, as well as supervising and conducting appro­
to life. It could also assist both the caregiver and the patient priate music therapy sessions for certain clients.
to accept and prepare for the inevitability of death. Such music
could range from Gay Nineties music, to WWI songs, to music Conclusion
of the patients’ young adult years, to country western, blue­ Music therapists now have the opportunity for new and
grass, Lawrence Welk hits, or familiar hymns, to name just a expanded roles in the field of gerontology. They now have
few possibilities. The goal of the therapist would be to assist the opportunity to show that they are uniquely qualified to
in providing the best possible quality of life for both the care­ meet the diverse needs in ways that are both creative and
giver and the patient. cost-effective. This could well be worth the attention of NAMT
since it is not a temporary situation. On the contrary, as the
Training Implications demographics point out, there will be an ever-growing need
For the most part, music therapists who choose to work in for health care services to this segment of the population. The
the field of gerontology are being trained to work only with opportunity is there to be in the foreground of this move­
residents in extended care facilities. Such training will, of ment-this new emphasis on health care for the elderly which
course, need to be continued, with the refinement needed concerns itself with the quality of life for all the elderly.
to meet the challenge of the very debilitated residents who Music therapy has already proven its effectiveness in work­
will comprise the majority in such facilities in the future. How­ ing with the institutionalized elderly. The need now is to
ever, the training will also need to be broadened to prepare prove its effectiveness in the broader field of gerontology. It
the new therapists for working with the other groups of el­ is the opinion of this author that day care and community
derly, as defined earlier in this paper. Music therapists will centers directors will welcome our expertise as consultants.
need to be trained to become part of the “wellness move­ We can follow the elderly through their many stages from the
ment,” and all that it implies, so that they can become an well elderly to those needing some community-based support
important part of “preventive health care.” (Preventive care services to the nursing home resident and hospice patient.
56 Music Therapy Perspectives (1989), Vol. 6

We have much to offer at each step of the way. All that is

required is that we understand the challenge, and our ability
to meet the challenge, and then venture forth with our ser­
vices.
The challenge is there for anyone who is willing to accept
it. The question is-How will music therapy, as a profession,
respond to this challenge?

REFERENCES

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An Aging World. (1985, April). Columbus Dispatch, p. 7.
Davis, N. (1982). Perspectives on leisure and aging in a changing society. Colum­
bia, MO: Dept. of Recreation and Parks Administration.
Family Support Network-Grant No. 90AM0085. (1982). Dept. of Health and
Human Services.
Kearney, P., Plax, T. G., & Lentz, P. S. (1985). Participation in community
organizations and socio-economic status as determinants of seniors’ life
satisfaction. Activities, Adaptation & Aging, 6, 31-37.
National Institute of Adult Day Care. (1986). Adult day care in America. (Pre­
liminary report of the results of NIADC 1985-86 survey.)
Ohio Association of Senior Centers (OASC)—1986 Conference Report.
Palmer, M. (1977). Music therapy in a comprehensive program of treatment
and rehabilitation for the geriatric resident. Journal of Music Therapy, 14(4),
190-197.
Perschbacher, R. (1984). An application of reminiscence in an activity setting.
Gerontologist, 24, 343-346.
Santrock, J. S. (1985). Adult developing and aging. Dubuque, IA: Wm. C. Brown.
Stotsky, B. A.. & Stotsky, E. S. (1983). Nursing homes: Improving a flawed
community. Hospital and Community Psychiatry, 34(3), 238-242.
Streiff, E. S. (1986). The use of music and reminiscence to increase life satis­
faction in geriatric populations. (Unpublished Denison University Seniors
Honors Project report.)
U.S. News and World Report. (February 21, 1983). Millions who are old and
alone, p. 56.