Preventing Falls In the Elderly With Music Therapy
August 16, 2011
This past week I attended an 87-year-old female with a history of severe balance and walking problems, as well as a history of falls. She was unable to stand or walk without the aid of a walker and felt unsteady on her feet. In the past year, she has fallen twelve times which of course is dangerous for the elderly as falls can lead to immense suffering and death in many cases. In persons 65 and older, falls are the leading cause of death and the most common cause of nonfatal injuries and hospital admissions for trauma each year.(1) In addition, there is the psychological effect of not being able to stand, simply walk across the room, or take a stroll on a nice day. Many elderly people associate mobility with independence.
During the examination, my patient was unable to stand without assistance and appeared very unsteady while walking with a walker. While standing without the walker, she would rock back and forth, alternately lifting each foot off the floor several times to help her “feel more stable.” She said she “just wanted to be able to stand without feeling like I’m going to fall over.” Understandably, she was emotionally upset. Since the brain relies heavily upon the visual system for balance and stability, I had my patient close her eyes while standing. She was much more unstable without using her eyes.
In addition to balance issues, my patient is currently experiencing memory loss, joint stiffness, and other health problems. So what do we do to improve her balance? Well, I usually start with a stimulus that is very simple, not fatiguing to the system, and enjoyable for the patient if they are required to perform it at home as part of their home therapy.
Referencing a study done in 2007 that showed posture improvements in the elderly after listening to music daily(2), I decided to try music therapy. We had her listen to Mozart, Chopin and other classical music for 10 minutes with headphones. We then had her stand up to observe any changes. She was able to stand with much less rocking and lifting of her feet. She said she felt “much more stable.” We then had her walk down the hall using her walker. Her gait appeared a little smoother and she reported that she felt “it was easier to walk.”
I instructed her to listen to music on a regular basis. Mozart, Chopin, Glen Miller, whatever she likes for at least 10 minutes a day in the background at home. She admitted that she loves music and said that she didn’t really know why she didn’t listen to it more often.
Of course my examination was much more detailed than I have time to go into here and I plan to incorporate more therapies in the office such as gentle joint mobilization, stretches, etc. to improve her flexibility. We will look at how we can improve her vestibular system with many different modalities that are appropriate for her case.
I just wanted to illustrate how powerful a “trivial stimulus” such as music can be to someone suffering from a decrease in brain activity. In a healthy brain, the impact of music may not be as noticeable. The brain is multimodal, meaning that if you affect one area, for example the lobe that perceives sound, you can have a larger effect upon the entire brain, including the balance centers. Since the brain can change at any age, I look to help her improve her brain and most importantly improve her balance to prevent falls. We still don’t know how much she can improve, but we will do our best to improve her quality of life.
References:
(1)Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Web-based Injury Statistics Query and Reporting System (WISOARS) online. Assessed November 30, 2010
(2)J. Altern Complement Med. 2007 Jun;13(5):519-26 Posturographic changes associated with music listening Carrick FR, Oggero E, Pagnacco G.
