Using the information from Chapters 1 to 4, you can now create playlists for the person living with dementia under your care. There are a number of options available to you for creating these playlists including:
- Using streaming services such as Spotify or Youtube
- Downloading music files to a storage or playback device
- Using music files that are already available to you such as from compact discs
Which option you choose depends on factors such as:
- the equipment you intend to use
- whether or not you will have internet access during music listening sessions
- your technical know-how, and
- whether or not you will use a free or paid source.
We will outline more information about each of these options below as well as considering issues surrounding the choice of playback devices, headphones and speakers.
Streaming services
Streaming services include Spotify, Apple Music, and Youtube/Youtube Music. These services all play music over the internet and do not require files to be downloaded. A wide variety of music is available on these services, and most songs can be found quickly and easily. Playlists can be created directly within the streaming platform. In general most streaming services require a paid monthly or annual subscription, but they are often reasonably priced and can be cheaper than purchasing multiple individual songs. Free versions are often available but usually include advertisements which may be distracting and confusing for people with dementia. Some streaming services may also require that you have access to the internet while listening to the music, although some have options for accessing playlists when not connected to the internet. Two streaming platforms, Spotify and Youtube, will be discussed in more detail below.
Spotify. The Music for Dementia website contains detailed information on how to use Spotify to create playlists, save music for offline use, and more. If you follow the Five Step process on the website, you will also receive some tailored playlists for you to use as a starting point. Spotify has both free and paid subscription options. The paid subscription provides advantages such as no advertisements during listening, flexibility in organising the order of songs in a playlist, and the ability to save songs to a device for offline playback. Family accounts are also available which enable playlists to be created for multiple individuals. These are generally available to residential aged care facilities as well. A free account will require continuous internet access to play music, is limited to having 15 playlists, and will play advertisements approximately every fifteen minutes. Spotify has a diverse range of songs, artists, and styles to choose from, is available on both handheld devices and computers, and is relatively intuitive to use.
Youtube. Youtube has the benefit of being relatively easy to use, and is available on both handheld devices and computers. However, unless you pay for a subscription you will receive advertisements before each song, and for longer songs you may encounter ads during songs. This can be distracting and confusing for people living with dementia, and so is not ideal. Also, Youtube has both audio and video playback and so will use much more internet data than a strictly audio streaming service like Spotify, although settings can be adjusted so that only audio is used (see also, Youtube Music). For Youtube members with a paid subscription you can also save and download songs, playlists, and albums for offline use.
Downloading Music Files
It is also possible to download songs for later playback from stores such as Apple Music or Seven Digital. For offline use, the songs have to be individually purchased, downloaded and then organised into playlists on a computer. They can then be loaded onto a storage device (such as an SD card or a USB thumb drive), or directly onto a playback device (such as a smartphone, an iPad, tablet, or MP3 player). The advantages to downloading files is that there will be no need to worry about advertisements while playing, and that no internet connection is required during music listening sessions (although it is required when downloading songs).
Songs are purchased individually for a reasonable price (usually around $1-2 AUD). However, it can be more time-consuming to set up playlists using this method, and in some circumstances can be more expensive, particularly where a large number of songs are required. Furthermore, the downloading of digital files is becoming less popular than the use of streaming services and therefore equipment for playing music files may become obsolete in the future and options for downloading music may become more limited.
Using music you already have
If the person with dementia who you care for has an extensive music collection of CDs ,you may want to take advantage of this to create their playlists. It is seldom useful (for the purposes discussed in this Guide) to simply use the CDs in their current form. Most albums tend to include a mixture of music including some that is calming and some that is energising. Some songs may be particularly meaningful to the individual with dementia and others they may not like at all. Therefore it is best to use a computer to extract songs that are most important to the individual and organise these into playlists according to the features discussed in previous chapters.
If your computer has a CD drive you will be able to copy song files from the CD and organise them into playlists that can then be loaded onto a storage or playback device as discussed in the previous sub-heading. External disc drives can also be purchased to be plugged into computers that do not have disc drives. More information about how to do this can be found online (https://www.classical-music.com/features/articles/how-to-digitise-your-cd-and-record-collections/) There are also individuals and companies who can digitise music collections for you for a fee.
Using the music you already have has the advantage of being cheap. A current music collection is also a great way to assess personal preferences. However, as noted above, devices and technology which allows this are slowly becoming obsolete and may be less readily available in the future. It is also worth noting that for copyright purposes, you should only copy music tracks from CDs for the use of the individual to whom the CDs belong.
Headphones and Speakers
For some people living with dementia, unfamiliar music can be an unwelcome addition to the background noise of a residential care facility, and add to their confusion and distress (Joosse, 2012). Therefore, ideally, music playlists should be developed specifically for an individual and listened to by that person alone using good quality headphones. This can be a useful way to block out distressing noise in the environment and allow the listener to focus on the music. Some headphones have enhanced noise-cancelling qualities if environmental noise is particularly problematic.
Some people with dementia may want to move around while listening to the music and wireless headphones can be ideal for this. Bluetooth headphones which connect wirelessly to the music playback device are commonly available, relatively inexpensive, and are reliable, as well as providing the advantage of not providing trip hazards or potentially distressing the listener if they become tangled in the cable. However, bluetooth devices have the disadvantage of needing to be regularly charged, and can be inconvenient for this reason. Brands such as JBL, Sony or Edifier can be an affordable option for headphones that have good sound quality, are reliable, well-priced, and are relatively easy to use. It is generally best to choose on-ear headphones. These can often be used even when the individual uses a hearing aid and tend to be more comfortable and safer than ear buds. Ensure that the model you choose is padded both in the earcup and the headband for optimal comfort, and that the sizing is adjustable. If headphones are being shared it will be important to sterilise headphones between users with an appropriate antibacterial wipe.
When using headphones, it is important to be careful of the volume of the music. Music above a comfortable listening level can not only irreversibly damage hearing, but can also evoke a negative response to music. Be sure to check the sound level of every device before playback begins. A good rule of thumb is to begin with the music softer than you would expect, and then slowly bring it up to the desired level once you confirm the volume level is comfortable for the listener.
If you are using downloaded music files is also possible that different songs in a playlist will have different loudness levels; for example a pop/rock song may be substantially louder than a classical song that was recorded many decades earlier. Spotify automatically matches loudness levels of songs in a playlist, providing an additional advantage in using this platform. The loudness levels of Youtube clips are dependent on the person who uploaded it, and so this platform may have a lot of variation in loudness.
Many playback devices have a ‘sound check’ option that automatically lowers the level of a song that has been produced louder than normal. This can be helpful, although it may not fix issues such as a piece that contains dramatically louder and softer sections. Due to this, it is recommended to check all songs thoroughly before they are included in a playlist. Some long pieces of classical music may be quite changeable, starting softly and then increasing in loudness in the middle. Care should therefore especially be taken when selecting long classical pieces; if in doubt, try to choose shorter classical examples and check the sound levels all the way through.
There may be occasions when another person may wish to join in to the music listening. For example a carer, fellow resident, or family member may want to listen to the same music for the purposes of sharing memories, or observing the individual’s response to the music. In this case, a splitter can be purchased which allows two sets of headphones to connect via cables to the playback device. Bluetooth wireless splitters can connect two sets of wireless headphones to the same device. Another option in this situation is to use a speaker rather than headphones. For some people with dementia wearing headphones is too uncomfortable or unfamiliar and can cause some distress, particularly if they are connected by cable to a device. When that is the case, a small wireless or cabled speaker can be a good option. For bluetooth loudspeakers the JBL ‘Charge’ series or the Ultimate Ears ‘Boom’ are suitable and affordable options. The Apple ‘Homepod’ will also work, although it must be controlled entirely via the listening device and so may be less intuitive for some users.
Playback devices
Given the importance of monitoring listener responses to music, one of the key considerations in selecting a music playing device is the degree to which the device allows the carer to see which song is being played at any given time. Some people with mild dementia may also like to have the option of controlling the music player themselves. For this reason a playback device that has large, clear buttons often works best. An iPad or tablet with wireless capacity has the advantage of being able to be connected to the internet to enable both use of streaming services such as Spotify, or the download of music files which can be organised into playlists directly on the device. The songs being played are easily visible to both the listener and the carer, and can be easily accessed and played. iPads also have timer options which can allow the music to be switched off automatically after a certain period of time.
A smartphone is also a suitable option, but the smaller size can make it more difficult for older adults to use. Some Smart TVs also have the capacity to play music using streaming services such as Spotify, or for SD cards (data cards) or USB devices containing music files to be inserted. These can also be relatively easy for many older adults to learn to operate themselves. Other options such as smart speakers can be programmed via the Google Home app (for example) to turn the music on at particular times of day. However, such automatic programming of music use would only be recommended after a trial period in which the response of the individual to the music has been closely monitored.
Smaller devices designed specifically for playing music such as iPods or MP3 players are becoming less commonly available for purchase and tend to have small screens and buttons that are difficult to operate. These also offer less ease of visibility for the person monitoring the playlist use. Headphones with built in players are also generally not recommended since they typically do not allow the carer to see which songs are being played, and need a separate SD card (a data card) changed over for each new playlist.
Chapter 5 summary
- There are many methods you can use to play music and create music playlists. Choose an option that works best for you depending on the equipment you have, your internet access, technical know-how, and budget. You can also see additional information to how to use platforms like Spotify on the Music for Dementia website.
- Use of wireless headphones connected to a tablet or iPad is a good choice of equipment, but there are many other options available if this is not suitable.
- The information in this chapter relates to ‘Step 2’ on the Music for Dementia website.