The words symphony and saliva testing are not usually found in the same sentence. But through an innovative research project by Arizona State University (ASU) in conjunction with the Maravilla Care Center and the Phoenix Symphony, they do go together.

By bringing music—from Neil Diamond’s “Sweet Caroline” to classical compositions—to the Phoenix-based nursing care center’s patients with Alzheimer’s disease (AD), or neighbors, as Maravilla calls residents, researchers are learning how the power of the symphony’s playing affects persons with cognitive and behavioral impairments.

And to do this, saliva testing is performed to compare anxiety levels of selected neighbors when listening to the music versus their most stressful regular activity: bathing.

A Community Experiment

David Coon, PhD, associate dean and professor of nursing and health innovation at ASU, says the question driving the research is clear.

“What is the impact of a community-level, music-based intervention offered by an interdisciplinary team (symphony musicians, music therapists, nurses, and behavioral scientists) on the mood and behavior of residents with dementia residing in long term care communities?” he says. “Is such an approach feasible for and acceptable to the community?”

Initial results of nurse ratings suggest there have been positive changes in resident mood (for example, increases in positive affect) and behavior (increases in interaction).

Nurse ratings of the environment in the evenings during baths, on the days that morning music events had occurred, “were more positive in terms of levels of resident cooperation and mood, in comparison to evenings without morning music events,” Coon says.

“Finally, the intervention was rated highly by musicians, facility staff, and family caregivers in terms of its overall benefit to residents and themselves.”

Symphony Reaches Out

Jim Ward, president and chief executive officer (CEO) of The Phoenix Symphony Association and a key proponent of the program, says the idea to bring musicians to the nursing care center went hand in hand with the organization’s mission, which is in part to give back to the community and align the symphony’s needs with the needs of the community.

The fact that Arizona has a healthy number of elderly residents helped point the symphony to the nursing care setting, and specifically to the AD community.

“One of the key issues around AD is quality of life. And the key driver for quality of life is stress levels, not only the stress level of patients themselves but also of the caregivers of the facilities who have the difficult task of dealing with AD and family members who are going through the grieving process because of the loss,” Ward says.

“So we asked, is there a way that we could affect those stress levels and enhance quality of life?”

And a program was born.

Nursing Center Welcomes The Research

But to make the Phoenix Symphony’s outreach come to life, a willing nursing center was needed, and in Maravilla, under the stewardship of CEO Jeffreys Barrett, they found one.

Barrett says the ASU research team, working with the symphony, approached him about its effort to look at music and memory by utilizing not only standard research protocols of observation, but also through the saliva testing procedures as they relate to stressors in the brain. “And what this also took us into wasn’t just the encounters with the musicians but also bathing. Now, how could bathing potentially be looked at from a music standpoint? Well, it is an intriguing program,” Barrett says.

To explain further, he notes that the program, which concluded in December, started with a concert for the entire Maravilla community, followed by seven encounters lasting around 30 minutes, matching musicians with smaller subsets of neighbors with AD.

How Program Played Out

“We broke the musicians into two groups, and we broke our neighbors down into groups, so the musicians and the neighbors were assigned to each other over the next seven Mondays,” he says. The saliva measurements took place following the seven encounters, and were compared with levels taken separately following a neighbor’s regular bathing.

Staff Help Researchers

To prepare for the events, facility staff also took preparations. “Several of our [certified nurse assistants] went through training to be research assistants, as well as our licensed nurses. So the entire intent was to see music and memory and throw it in on how it all relates to bathing,” Barrett says.

Valerie Bontrager, director of education and community engagement for the Phoenix Symphony, says Maravilla actually marked the second round of collecting research, with the first round happening at another facility. “But we needed to look at a larger group of data to verify some of the initial findings,” she says.

Bontrager notes that the ASU team also included the musicians in the research by taking their saliva measurements as well to collect data on how performing outside of the regular symphony space and in the community impacted them.

“Some really interesting larger questions started to emerge,” she says, like how does a symphony and art community provide information for other art communities and other long term care facilities.

Musicians, Neighbors Form Bonds

To get ready for the experience at Maravilla, Bontrager says, the 20 musicians selected went through mandatory training on AD and dementia and the specifics of the research. “We did these interventions on Mondays because those are the dark days for our musicians. It is the only day they are not scheduled for their regular rehearsal and bigger concert contracts,” she says. “So, they are opting to do this project on their own time and on a day off.”
And in doing so, in going to Maravilla, something more than research took place, Barrett says, as the entire community of musicians and their matched AD neighbors formed not only a bond via the research, but also personal connections.
“They made close attachments to neighbors,” he says, and in turn the neighbors also are now missing their new friends. “One of the most amazing developments was the relationships that were built over this period of time. The musicians developed relationships with special and unique people and crossed that bridge of humanness that is very often overlooked in our profession,” Barrett says.
The nursing care center profession, he explains, is seen as something less than what it is. “And when you have a group come in like the Phoenix Symphony, it validates processes as well. And celebrates work and what we do as a profession,” Barrett adds.