We all understand the power a song can have to recall vivid memories, seemingly sending us back in time. Professor Ellen McCreedy is a musician whose gerontology research harnesses music’s power to recall memories. She’s testing an intervention that brings personalized music playlists to nursing homes in order to help ease dementia symptoms for patients, without using medication. Driven to give dementia sufferers—and their caregivers—moments of having themselves back again, McCreedy joined Humans in Public Health to discuss her work, its challenges and the grandmother who originally inspired her.

In the past few years, the field of public health has become more visible than ever before, but it's always played a crucial role in our daily lives. Each month, we talk to someone who makes this work possible. Today, Ellen McCreedy.

Can you name a song that transports you to a particular time or moment in your life?

*Carey fades in*

For me, it’s Carey, by Joni Mitchell. My mom always played that song when she was making dinner. I can see myself sitting on the stairs next to the kitchen while she stirs something on the stove.

For today's guest, professor Ellen McCreedy, the song that brings her back, is Use Somebody by Kings of Leon

*Kings of Leon fades in*

[00:01:13] Megan Hall: She says, it doesn't matter where you are, or what you're doing, the moment that song comes on...

[00:01:30] Megan Hall: But Ellen says, this isn't just a fun nostalgia trip, but it's actually medically useful.

[00:01:51] Megan Hall: Now, Ellen combines that music therapy background with her research- studying diseases that affect elderly patients.

[00:02:07] Megan Hall: Specifically, she works with patients who have dementia.

[00:02:16] Megan Hall:  Ellen is an associate professor at Brown's School of Public Health's Center for Gerontology & Healthcare Research. She leads a project called Music and Memory which tries to figure out how the music dementia patients loved when they were young can bring back their memories now, and ease their symptoms.

[00:02:42] Ellen McCreedy: What we think is happening in the brain, is a few things. So there's some really exciting fMRI research that shows that the parts of the brain that store early learned music. So music you liked when you were younger. We say between the ages of 16 and 26, but like, honestly, there's no magic to those numbers, but something about the music that you learned when you were younger is stored in a part of the brain that's actually preserved even into the later stages of dementia, and that's not true about later learned music.

The other piece of it that really came out of the pandemic and it's very cool as well. I get really like geeked out about thinking there's like a mechanism behind what we all feel is true, is there was a lot of loneliness research done in the pandemic and what that research showed was that for otherwise healthy adults, that early preferred music, your favorite songs from high school, reduced loneliness, in a way that other music doesn't.

[00:03:55] Ellen McCreedy: People who live with dementia experience neuropsychiatric symptoms, one of which is agitation. So in a long-term care facility, someone comes to help change my clothes and I'm startled. I don't remember – I don't know that someone's supposed to be interacting with me and I might, you know, try to bat them away with my hands or my feet. Those behaviors get other people agitated, especially in congregational living settings. like if one person's upset and starts calling out, then it can start to get other people upset and calling out.

[00:04:29] Ellen McCreedy: And the medications that we have. They don't work too well, but they also increase the risk of falls and death in people living with dementia. So there's a real need in the clinical community to find a way to manage those behaviors safely and effectively. So that's where music comes in.

[00:04:52] Ellen McCreedy:The theory is that you're disrupting kind of the pattern of behavior enough that you don't need those medications. And so it can be managed with something much more human.

[00:05:07] Ellen McCreedy: Exactly. So it is a distraction and hopefully also it's reducing the loneliness that we think drives it.

[00:05:24] Ellen McCreedy: He was experiencing these types of behaviors, particularly after lunch. And the staff was starting the program, the music and memory program is what they called it on the ground, and they thought that Mr.Earnest would be a great candidate. Now, the special thing about Mr. Earnest – two special things – is one, he has a living spouse,

[00:05:48] Ellen McCreedy: Often we don't have a living spouse, but in this case, we had a living spouse who regularly visited, and was able to tell the staff that he loved Merle Haggard when he was younger. So that was an awesome start, you know, they lucked out with that. And then they sort of found out in the process that he also was a musician. So what happened was that they sat Mr. Ernest down and they said, we have your music for you.

*music fades in here*

You know, in later dementia. There's not a lot of verbal communication left. So to be able to really course find the chords, but also find the lyrics was certainly a gift to both the staff in the nursing home, and to his wife.

He did not need medications. They were able to use this effectively as a substitute in this case.

To the person living with dementia, it's hard to quantify the biggest effect, but for the caregivers, certainly it gives them moments of having the person that they love back.

And if I had to say what's the biggest effect, you know, to the NIH I might say the agitation, but to the human level, those moments are priceless. I think those moments are everything about why I do the work.

It's really important and hard to quantify the value of those moments, but that's the whole ball game, really. Like that's the whole thing that we're doing is we're giving people living with dementia a moment of having themselves back again. Like we are talking about very early on, like that feeling you get when you're driving around and you hear that song, you're like, oh! Like hopefully giving those internal moments to people living with advanced dementia and we're giving caregivers a moment to be like, “Yeah. I'm not in caregiver mode now. I'm seeing this, you know, guy that I married and why I married him.” You know, like I think that's everything.

[00:08:39] Ellen McCreedy: The big caveat is it has a short half life. It works. Like in the moment, it works at reducing behaviors. Then you stop it and you see those behaviors start to go back up almost immediately within the half hour. It looks like they don't go up to baseline levels, so that might be enough to sort of reduce the acute need to use these medications, but they certainly go back up.

[00:09:12] Ellen McCreedy: There's a lot of folks who don't have that loved one. They're in our nursing homes and they don't have someone visiting them regularly who can speak to their early preferences. And the staff in nursing homes are very overworked and underpaid.

[00:09:40] Ellen McCreedy: We just got a grant to look at technology that would help us personalize it. So you know, playing selections, and looking at facial expressions to see which ones elicited a positive facial response and automatically adding those to your Spotify playlist. There's also using a smartwatch, we call it a biometric wearable, but smartwatch, to see which songs kind of get you more engaged or aroused and then like putting those songs on your playlist.

[00:10:12] Ellen McCreedy: The other big hurdle is timing these to early signs of agitation. You know, mostly these are happening when they're not engaged in something, you know, staff are doing other things that they need to be doing, so they're not doing the direct engagement. So noticing the early signs before they become kind of full blown, and then these are less effective.

[00:10:36] Ellen McCreedy: Sometimes that looks like, you know, a CNA that has the songs on her cell phone and is going around the facility just doing the normal things. But like has everybody's songs on the cell phone and sometimes it's DJ hour where everybody's got one song on the list and they're, you know, up and dancing with them.

[00:11:01] Megan Hall: If your work is effective in 10 years, what will it look like to use music to help people with dementia?

[00:11:53] Megan Hall: Ellen's work now is to get the treatment to people, because she knows it makes a difference. And she knows that, because of her research, but also because she's seen it in her own life. Her grandmother played the piano before she developed dementia.

Everything was surrounding the church, her social network, but she would have people over and would at some point in the night, would sit down and play the old, like Irish standards and everyone would sing and she would be kind of the center of this, universe and most of my memories of being at her house are around, sitting at the organ and trying to figure out the old songs.

*I’ll take you home again Kathleen fades in*

[00:12:55] Ellen McCreedy: You know, that was a big piece of our connection was playing that music and, and listening to her sing and just have a break from some of the most difficult parts. Distraction as you mentioned earlier. I think like, you know, it's very painful to see people that you love go through some of the pieces of this disease getting angry. Um, you know, just a lot of pain that comes with it and just to see relief for the few minutes that I was playing and she was back at the party being the bell of the ball.

Um, it was great.

[00:13:44] Ellen McCreedy: Great, thank you so much.

That song you just heard is I'll take you Home Again Kathleen, written by  Thomas P. Westendorf.

Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the podcast studio at CIC Providence.

I'm Megan Hall. Talk to you next month!