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Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Music activities can improve behaviour, (particularly agitation), mood, and cognition in persons with dementia. Listening to familiar music can elicit pleasurable responses such as smiling or liking judgments (Cuddy and Duffin, 2005; Quoniam et al., 2003). Participating in music activities or singing has been shown to improve behaviour, mood, and cognitive functioning in persons with dementia (Narme et al., 2014; Sakamoto et al., 2013; Särkämö et al., 2014). Physiological effects such as changes in heart rate (Raglio et al., 2010) and hormone levels following music therapy sessions in these individuals have also been documented (Suzuki et al., 2004). Other research has even proposed that playing a musical instrument decreases the risk of developing dementia (Verghese et al., 2003) and delays the onset of age-related cognitive decline (Hanna-Pladdy and Gajewski, 2012). All these findings suggest that music functions might remain relatively preserved compared with other verbal or spatial abilities (Tzortzis et al., 2000; Warren et al., 2003). This potentially spared ability has motivated the development of music interventions in dementia.

In a large-scale group study in 50 patients with Alzheimer’s disease (AD), Cuddy et al. (2012) showed that both familiar tunes and familiar lyrics were well recognized across all stages of AD. Due to close associative bonds formed early in life between highly familiar song tunes and lyrics, the ability to recognize such information seems to be still functional in patients with AD.

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Mrs Meredith (pseudonym) is 85 years old and was diagnosed with Alzheimer’s disease approximately nine years ago.

My mentor asked if I would assist her in helping Mrs Meredith get out of bed explaining that Mrs Meredith did not like waking up and would often be distressed and uncooperative. Mrs Meredith was disorientated in time, place and person as well as difficulties in communicating verbally.

It was decided we would not wake Mrs Meredith but carry on assisting other patients until she woke up naturally. When Mrs Meredith woke we quietly entered her room. I noticed that my mentor was smiling and spoke in a soft voice; she introduced herself and explained that it was Friday morning and that she was there to help her get up from bed.  My mentor knelt down by the side of the bed and asked if she could pull back the blankets and help her to sit up. Mrs Meredith did not seem to understand and just looked at my mentor. After a few minutes my mentor began to slowly pull back the blankets explaining what she was doing.  She placed her hand around the back of Mrs Meredith and supported her whilst she sat up. She explained that this was a hospital and reassured her that she was in a safe place.

My mentor asked Mrs Meredith if she would like to listen to the radio and Mrs Meredith smiled warmly. The radio was switched on and played quietly in the background. She asked Mrs Meredith if she would like a cup of tea whilst she listened to the music. Mrs Meredith smiled and my mentor asked if I would sit with Mrs Meredith whilst she made a cup of tea. I did this and we listened to the radio together whilst Mrs Meredith occasionally hummed to the music.

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Dementia is the name given to a set of symptoms that involves the ongoing decline of brain function including memory loss, difficulty understanding and communicating, a decrease in problem solving abilities and difficulties carrying out day-to-day activities. Alzheimer’s disease is progressive neurological disease that is the most common form of dementia. As Alzheimer’s progresses, proteins build up in the brain to form structures called 'plaques' and 'tangles'. This leads to the loss of connections between nerve cells, and eventually to the death of nerve cells and loss of brain tissue (Turkington and Mitchell 2010).

The early signs of Alzheimer’s disease are usually minor memory problems, such as forgetting recent events or conversations however as the disease progresses this becomes much more severe. Other symptoms can include an increasing confusion and disorientation, personality changes such as becoming aggressive and low mood and anxiety. In the later stages of the disease, people can also develop problems moving around without assistance and eating and drinking and other day-to-day activities (NHS, 2016)

There is currently no cure for Alzheimer’s disease although the progress of the disease can be slowed with medication for some people. There are also therapies, such as cognitive stimulation therapy which can be beneficial to support speech and language and problem solving skills. The prognosis of Alzheimer’s disease is an average lifespan of between 8 and 10 years following diagnosis (NHS, 2016).

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An estimated* 850,000 people; that's 1 in 14 people over 65 & 1 in 6 people over 80 (Alzheimer's Society, 2017), are living with dementia in the UK (Dementia Statistics Hub, 2017).
In Wales, from 2007 to 2015, the number of people on the dementia register rose from 13,234 to 19,239, an increase of 45%. The dementia diagnosis rate in Wales was 54% in 2016 (Welsh Government, 2017).
In the UK last year, dementia was the leading cause of death for women. 15.4% of women died due to Alzheimer's disease and other dementias.
For men it was the second leading cause of death in the UK last year with 8% dying due to Alzheimer's disease and other dementias (Dementia Statistics Hub, 2017).
65% of people living with dementia in the UK are women meaning that just 35% of the people suffering with dementia are men.

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The guidelines provided by NICE offer the best available evidence based practice.

An underlying principle that should govern how nursing of patients with dementia should be approached would be person centred care.

"Principles of person centred care underpin good practice in the field of dementia care" (nice.org.uk 2006)

With the example of Mrs Meredith her individual needs were taken into account resulting in an intervention that was based on her personal needs.

Mrs Meredith's behaviour could be challenging, this was addressed by assessing her needs to establish the possible causes of her distress. In this case waking up and being disorientated could have been factors.

"Individually tailored care plan that helps carers and staff address behaviour that challenges should be developed, recorded in their notes and reviewed regularly" (nice.org.uk 2006)

The morning routine was centred around trying to reassure Mrs Meredith and limit the amount of distress she would feel on waking. This would avoid unnecessarily upsetting her and making her uncooperative at that time.

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The 6C’s are a set of values and beliefs that encompass how a nurse and other health care professionals to gain a better understanding of what encompasses good care. These values and beliefs exist as part of the Compassion in Care campaign which aimed to ensure patients are receiving good care as well as good treatment (Watterson 2013).

CARE- care can be described as the core principle of nursing as the care that is provided by various professionals can help the individual patient as well as the local community. It’s important that staff ensure the patient is at the centre of their care and are involved as well as the individual’s support network e.g. family members (Watterson 2013). Throughout the scenario the mentor demonstrated care on multiple occasions an example can be allowing Mrs Meredith to wake up naturally. This allowed Mrs Meredith to wake up in the morning without distress or agitation which she normally became when she was woken up. Another example of the mentor demonstrating care can be allowing Mrs Meredith to get up at her own pace, the mentor waited for Mrs Meredith to respond to certain questions and when it appeared Mrs Meredith had a lack of an understanding she continued to explain what she was doing (Watterson 2013).

COMPASSION – this is the way that care is delivered through rapport with patients that have been built on providing dignity, empathy and respect. By delivering compassion it allows nursing staff to respect the individual needs of the patients equally (Watterson 2013). An example of how the mentor did this can be how she informed the patient of the time and place as the mentor would have known that Mrs Meredith was not aware of time, place or self. Another example can be that the mentor understood that in the morning Mrs Meredith likes to listen to the radio with a cup of tea which can reduce the levels of agitation as it maintains her individual routine. (Watterson 2013)

COMPETENCE – allows nurses and other professionals to have an understanding of the health and social needs and problems patients face. Using recent, relevant and valid research and evidence ca help develop the nurse’s knowledge and apply this to practice. In the scenario the mentor puts the radio on for Mrs Meredith who has Alzheimer’s; research has shown many benefits of patients with dementia listening to music e.g. better mood (Watterson 2013).

COMMUNICATION –  communication has significance importance to the delivery of care and treatment within health and social care. It allows nurses to build successful relations with patients and to work effectively within a team (Watterson 2013). A way that effective communication is demonstrated in the scenario can be the way the mentor reads Mrs Meredith’s nonverbal communication as she has difficulty communicating verbally. This is shown when Mrs Meredith is asked if she wants a cup of tea, instead of responding yes verbally, Mrs Meredith smiled instead. (Watterson 2013)

COURAGE – allows nurses to act in a way that is ethically right and to report concerns and worries that professionals may have about their patients. It also allows nurses to suggest new care pathways and treatments that could benefit their patients (Watterson 2013). Within the scenario the mentor does this by taking into consideration the autonomy that Mrs Meredith has the right to; the mentor does this by allowing Mrs Meredith to choose when she wakes up, if she wants the radio on and if she wants a cup of tea. Another way the mentor does this is by regularly gaining informed consent from Mrs Meredith (Watterson 2013).

COMMITMENT – being committed also allows nurses to build a relationship with patients whilst leading by example whilst influencing change. In the scenario the mentor does this several times by focusing the care of Mrs Meredith around her individual needs e.g. by helping Mrs Meredith sit up as the mentor recognises that Mrs Meredith needs support with this (Watterson 2013).

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Age is the biggest risk factor for Alzheimer's disease as it mostly affects people over 65. After 65, the risk doubles every 5 years.
Genetically speaking, there is only a significant risk in developing Alzheimer's in families where dementia develops a lot before 65. If a close relative develops Alzheimer's after 65 then the risk is only subtly increased and Alzheimer's is not inevitable.
The reasons behind why there are almost twice as many women living with and dying as a result of dementia are unclear. While it could be argued that that women, on average, live longer than men, Alzheimer's Society (2017) say that this does not fully explain the vast difference in these statistics. They theorise that the increased risk of Alzheimer's in women could be linked to a lack of the female hormone oestrogen after the menopause.
That being said, there are a number of medical conditions such as diabetes, heart disease and obesity for example that can increase the risk of Alzheimer's disease, as can depression.
While certain risks cannot be changed or controlled (age, gender etc), the risk of developing Alzheimer's disease can be reduced by living a healthy lifestyle and keeping mentally, physically and socially active (Alzheimer's Society, 2017).

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In this scenario Mrs Meredith lacks the ability to verbally consent to the help with getting up. The mentor understood this and used her previous knowledge of Mrs Meredith to ensure she was able to make her own decisions about getting up, as even though she appears to be in the later stages of Alzheimer’s Mrs Meredith would still have a preference that she would be able to indicate (Doyle and Rubinstein 2013).  The mentor gave Mrs Meredith time to answer in her own way, she also made sure Mrs Meredith was given information to help her orientate herself to time person and place so that she would be able to make these decisions.

Although the choice of having the radio on or off may seem trivial to some the ability to have a choice in her morning routine probably helped Mrs Meredith feel safer and happier. This is important as it is mentioned that Mrs Meredith can become distressed when waking up in the mornings. Also making sure Mrs Meredith wasn’t left alone when she was likely to be confused was the right decision as it ensured she was kept safe (NMC 2015) .

It is also worth noting that the mentor allowed Mrs Meredith to wake up naturally as being woken was likely to distress her further, all of the above actions have been done with Mrs Meredith’s dignity in mind preserving it and encouraging person centred practice.

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It was taken into account that she didn’t like waking up and could be distressed and uncooperative. Therefore, the decision to let her to wake up herself was better for her individual needs as she woke up and was not as distressed.

Good communication skills: Verbal - introducing herself, explaining each process, providing reassurance. Non-verbal – smiling, soft voice, knelt down by bed so the patient could see her.

Empathy: Reassured her she’s in a safe place. It’s important as she may have had many falls which she may now be scared of. She’s confused so explaining the day and where she is is important.

Dignity and Respect were remained at all times.

Autonomy: whilst she lost some independence such as her mobility, it was ensured she was always asked for her personal preferences –  the radio on, cup of tea.