The beat generation

It was perhaps the most inspiring concert I had ever attended. An unusual quartet - flute, oboe, cello, harp - joined by five nurses and seven elderly dementia patients, sitting in a circle in a room at Acton hospital in west London, improvising, developing musical ideas, finding out about each other. It was a triumph for music, the NHS and simple goodness (why am I embarrassed to use that word?).

Sinfonia 21, the resident orchestra at London's Imperial College, has just embarked on a three-year research study at Acton, called the Shimmer Project, to assess whether musical interaction - there is no other satisfactory term to describe it - can benefit dementia patients. The idea is that, rather than play a conventional programme for patients, a group of professional musicians comes in each week and plays with them, letting the patients dictate where the music goes. The patients conduct, beat drums, pluck strings, sing, engage in any way they wish. The hope is that dementia sufferers who, in some cases, have lost the capacity for coherent speech can find a new outlet through music.

The scheme is rooted in the notions of empowerment and identity. At the beginning of the one-hour session, each of the patients - all of whom are resident at Acton hospital - is asked his or her name. Some lack the confidence to say it; others can no longer remember it. By the end, the whole group is reciting each name in turn, creating a mesmerising chant that overlays the musical theme. It is a striking assertion of identity - individual and collective.

The project is a collaboration between Sinfonia 21 (whose musicians have had two years of training for work in hospitals), Music for Life (which provided the training), and a medical research team led by Christopher Bulpitt, professor of geriatric medicine at Hammersmith hospital. "Music interaction involves the response of musicians to patients and vice versa," says Prof Bulpitt. "It must be contrasted with just playing suitable music. Music may help the confused elderly person in the short term, but the hope is that interacting with musicians and the music will also produce benefits long after the music stops."

Prof Bulpitt's researchers will log patients' behaviour during and after sessions to see whether there is any change. The hope is that the effects of being empowered, the confidence it engenders and the socialisation provided by this group activity will have a knock-on effect on the wards, providing a demonstrable improvement in dementia sufferers' quality of life.

Quantifying improvements may prove difficult, but there is no doubting the evidence of one's eyes and ears. At the session I attended, one patient was very reluctant to enter the room - she could be heard crying in the corridor outside - but as soon as she did join the group, she relaxed, embraced the harpist and took part in the music-making. Barriers were quickly broken down, wary silence gave way to laughter, and the music took shape.

It was both funny and moving to see patients conducting the musicians, with the latter following precisely their hand and eye movements in an attempt to give expression to their feelings. "Music is a natural form of communication that can perhaps be easier than language," says Katy Dent, development manager at Sinfonia 21, which combines educational and outreach work with concerts majoring in contemporary music (its role at Imperial College is part of an initiative to bring the arts and sciences into some degree of harmony).

"The aim is that the music should be affected by what is coming from the residents," says Linda Rose, director of Music for Life, which trains musicians to work with frail elderly people in an interactive way. "Untrained musicians might provide a straight performance. You wouldn't know whether the listeners had been affected or not; the relationship wouldn't build in the way that it does in this project. Here the music is affected by the patients. The musicians may take in a repertoire of four or five ideas, but these are only starting points, and what develops from those is a result of the interaction."

Rose emphasises the demands made on the musicians. "It can be very stressful just to walk into a room with people with dementia, to feel a reality that is different from our own reality," she says. "It's difficult to know how to respond, and it takes a lot of emotional stamina to do this work, just as it does for the carers. The relationship with the carers and with the patients' families [who can, if they wish, attend the sessions] is a very important part of the work. We are developing a sort of community."

"It is a way of seeing another side of somebody," says Sarah Dunn, a research nurse on the project. "It might have been thought that the more severely affected in the group would not have been capable of learning new things, of interacting, of communicating. This shows the carers a different side of their residents."

The Shimmer Project is an example of what Rose calls "person-centred care". "We are taking account of the person behind the dementia, rather than looking at dementia as a condition," she says. It isn't just the patients who need to be reminded of their identities; society too must be encouraged not to objectify and marginalise people with dementia.

"We want to say that these people should be treated with respect, not just hidden away and forgotten," says Katy Dent. "Other cultures seem to have more respect for the elderly. Developing emotional care for people with dementia is on the increase; there is now a move towards person-centred care and this project fits into that." Dunn agrees: "We live in an ageist society: young is beautiful, old is ugly, and you have double jeopardy if you are an older person with dementia."

Rose stresses the risks the musicians run in taking part in these sessions - there is nowhere to hide musically or emotionally - but she says the rewards can also be considerable. "The musicians benefit as artists: their music is developing and their perceptions are developing. They are highly motivated."

That is certainly true of flautist Tony Robb, who took part in the session I sat in on. "You have to treat this with as much respect and concentration as you do when you sit down to play a piece by Schoenberg," he told me afterwards. "There are two main points to doing this work. The first is to look after the patients and make sure they are never compromised or distressed. The second is to be true to oneself as a musician, so we try at all times to maintain the highest possible musical standards within an improvisatory framework, which is a tall order.

"The key is to be true to them and what they are doing. It's very easy to go into a situation like this, play a few pre-arranged pieces, get them all to clap or maybe beat time to it, and feel 'Right, we've done a bit of community work.' We don't try to impose our ideas on them, we try to get them to take control, and it's wonderful if they instigate the music. If we can get them to take control of some aspect of their lives, which most of the time they don't get the chance to do, then we feel we've done a good job."

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