Friday Five: Staying age appropriate with older adults

Older adults are not like preschool children, so why do so many people talk to them as such? Bent over, face close, hands clasped, gaping smile, voice raised an octave and, "Evelyn, it's time for music, yay! Would you like music? How about some music!" I wrote the other day that older adults absolutely love when you talk enthusiastically with them. But I'm sure that they do not appreciate anyone talking down at them, trying to get them excited for something as if they are offering them a treat for good behavior.

Below are some tips on staying age appropriate with older adults. Forget the "sweeties" and "honeys," but don't be offended when they turn around and use these words with you.

1) Consider your volume. Of course, we often have to talk a lot louder than normal to compensate for any hearing loss. I have had to work a lot at this because I normally speak softly. However, don't assume right away that you'll need to put so much power into your voice that it vibrates your entire chest. I suggest starting at a normal volume (for me, that is a little louder than I am comfortable with), then take some quick cues from your clients as to how you should adjust it. When you see them squinting, tilting an ear towards you, or furrowing their brow as though they are concentrating a little too hard on what you're saying, take a hint that you may have to speak up a bit. Also, continue to remind yourself to speak consistently at that volume. If they have to ask, "Pardon me?" again and again, they may begin to feel discouraged and frustrated with making conversation.

2) Watch your tone of voice. It was something mom always told us, and I will say it again. Not for the same reason, of course. Watch your tone to make sure it doesn't start creeping up the register. We will talk to babies and dogs in this voice, but it is not okay to talk this way to an individual who has lived long and accomplished much.

3) Let them make choices. A lot of adults in hospice or nursing homes may feel like they have had all their freedom taken from them. They often don't get choices in what they wear, what they eat, etc. Create opportunities to offer them choices. Should we play "Let Me Call You Sweetheart" or "Danny Boy"? Also, if they get up to leave, there is usually not much you can or should do to keep them in session. They are adults, and you can't beg them to stay, or raise your voice, or block them off at the entrance. You can however, offer them an opportunity to join again when they feel like ready.

4) Keep conversation. Show genuine interest in your client. Talk with them on subjects they care about. I wrote a post the other day called Keeping Conversation When It Counts. Use this for topic ideas: family, travel, hobbies, memories, etc.

5) Play preferred music. You've heard this a hundred times, I'm sure. Learn as much as you can about your older adult's choice of music. If you know nothing about your client or group, you can take a smart guess at their music preference. People tend to like the music they listened to in their twenties and early thirties. Take their age, calculate when they were this old, then begin with whatever was popular at that time. Also consider gender, religion, and ethnicity. If it comes down to it, it does not hurt to ask. In fact, they may see you asking as a sign of complete respect.

Pepsi Refresh Project

You may have recently seen Pepsi's commercial on TV for the Refresh Project. People are submitting their ideas for people to vote on throughout the month of May. On June 1st, Pepsi will award a grant to the most voted-for ideas: 2 grants at $250,000; 10 grants at $50,000; 10 grants at $25,000; 10 grants at $10,000.

This month, a music therapist has submitted her idea to provide bedside and group music therapy to children in Denver's hospitals. Please, if you have read this entry, go now and vote for Valerie.

If you're really dedicated, vote once each day in the month of May. It's really easy to sign in if you sign in through Facebook or Twitter. I would really like to see this idea happen not only for the patients in Denver, but because I hope it will gain respect for our profession and help us in the long run.

Keeping conversation when it counts

Some of my happiest music therapy moments come from working with older adults in hospice and intergenerational choir. They absolutely glow when you smile and talk with them enthusiastically. But it can be hard to keep a conversation at times. As I returned each week to see my patient in hospice, it was hard to tell if she remembered who I was or what we've talked about before. I was also hesitant to approach certain topics because I didn't know how to segue from one thing into the next. I found it most helpful to know ahead of time some conversation starters. Here is a list of just a few:

1) Career. What did they do with their life, did they keep more than one job, where did they work, what did they enjoy about it?
2) Hometowns. Where were they born, did they spend much time there, did they live any other places, what was their favorite home, what was their house like, did they have good neighbors?
3) Travel. Where have they traveled, what was their most memorable trip, who did they go with, how long did they stay, what would they suggest someone see if they were going to travel to that place, do they have any stories they could share?
4) Family. Spouse, children, grandchildren, names, ages, their education, their careers, where do they live, how often do they visit, pets?
5) Hobbies. What is your favorite activity, how much time do you get to spend doing this, what would you like to learn, do you share this hobby with anyone else?
6) Current events. Have you heard about (blank), what do you think about that, what do you think we should do about it?
7) Things around the room. Decorations, jewelry, clothes, pictures, personal items.
8) Weather.
9) Religion. Be careful to respect their religion and don't offend. Don't share much of your own beliefs, especially if you disagree with theirs. Do show interest. Where do they go to worship, do they participate in choir, are they involved in any other way?
10) Friends. Where did they meet, what interests do they share, how long have they been friends, do they have kids/grandkids? You can basically ask everything above all over again in relation to their friends.
11) Future. What are they looking forward to doing today, do they have exciting plans in the near future, do they have family visiting soon?
12) Holidays. What are they doing to celebrate, do they have any good memories about that holiday past, what is their favorite holiday, what do they enjoy most about that holiday?
13) Memories. Wedding, birthdays, holidays, major events?
14) Other interests. Music, food, movies, television shows, books, games, sports etc.?

Singin', Why I Got the Blues

There will be a point when you realize that you cannot plan every detail in a music therapy session. When you know you've considered every possible interaction between you and your client, you will be proved wrong.

I have no doubt that this is why music therapists often find songwriting sessions so intimidating. You are actually allowing and encouraging your clients to surprise you. For a new therapist, this is surely cause for stress. But I think you'll find, as I've heard from MT professionals, that song writing is not something to fear. It can be such a powerful tool in your clients' progress.

The activity I am posting today is a fill-in-the-blank songwriting activity. Fill-in-the-blank songs are a smart way to lead a session for several reasons. First, a client will often be much more intimidated by a song writing activity than you are, believe it or not. Giving them a simple sentence to complete is much less overwhelming than handing them a blank sheet of paper and telling them, "Write a song." Second, you will set yourself up for success by having half the song already written on paper. Also important in unstable populations is maintaining focus. Giving them free reign with a blank sheet of paper can be inviting a world of trouble into your session. As you will see in the following song sheet, I have put my clients on track with an appropriate sentence-starter. By starting a line with "I take my mind off the blues by...", I have gotten them started thinking about coping skills.

Use this song sheet to prepare a successful song writing session. It uses a blues chord progression, as you'll see by the roman numerals I've included. Choose a key and decide your own melody. I got the idea for writing about the "blues" from a practicum at the hospital. It will probably prove useful with a variety of populations: clients in hospital, hospice, psychiatric hospital, eating disorder clinic, etc.

And please, don't avoid the most empowering part of a music therapy session. Offer your clients a chance to share their song by playing it yourself. You can do it, you've prepared for this!

Wanted: song lyrics

If you've ever tried to write a song for a music therapy session, you may understand how difficult it can be. Sure, I could write simple chord progressions and a melody line within minutes. But ask me to put lyrics with that and I'll be sitting with a guitar in my lap all day.

If you're anything like me, you know what I mean. This website can remedy that. It is called Songs for Teaching, and breaks down dozens of songs into categories like mathematics, science, language, and life skills. Now, you won't find free recordings of these songs and you won't find chords for them at all. But the site does give you lyrics to all of their songs. Use these lyrics as inspiration for your own songs. You might add your own melodies and chords. With a little imagination you can put your own chords and melody to the lyrics. And with a little inspiration you may be writing songs of your own.

Building a rainstorm in any group

To celebrate the approaching summer, incorporate a rainstorm activity in your music therapy session.

I've seen this used a lot with kids as a socialization activity, but that is only the tip of an iceberg of potential. Use this in large counseling groups to represent a "passing storm" of loss, depression, and anxiety. Use it to facilitate a healthy release of guilt, regret, and sorrow. Understand that in a counseling setting, this activity can become something very emotional and significant in moving past an unpleasant time.

However, on that note I must give some words of advice... (1) Take your time in building the rainstorm. When we stand in front of a group, it is easy to rush. Remind yourself to go slow. Give your group time to sit in the moment as they listen to their storm. The moment can be a very special one, but if you don't give your clients a chance to reflect on this, then you lose the therapeutic element.

(2) Because this activity is so adaptable, you must be mindful of age appropriateness. Don't assume that your adults will enjoy playing the thunder tube. Kids may make a rainstorm with small percussion instruments (ocean drums, thunder tubes, etc.), teens may make a storm with their bodies ("shhhh," rubbing hands together, patting thighs, etc.), and adults may use larger drums and various percussion instruments (bass drum as thunder, etc.). Consider your own group and decide what you can do to get the most positive response.

The video below can be an inspiration for your own session. In the first two minutes, the choir builds a rainstorm without any instruments at all. Since I came across this link, it has been bookmarked in Firefox. It is a performance that should not be forgotten because of its potential for use therapy.