When the ending is really beginning

When the Ending is Really Beginning is a spring 2004 column I wrote in Solutions magazine as a regular contributor. I just found this piece tonight, and I’d like to share it with you in the hopes that, if this is now your world, you’ll know you’re now alone. So this is what I’d written…

We truly try to do our very best in the process of supporting our parents and their wellbeing.

As they age ever onward, we watch with awe and trepidation; we act with care and compassion; we feel a certain measure of fear daily and relief when they seem reasonably well.

But the time comes—as it always does—when the inevitable ending really is beginning.

Such is the case now with my father, who is going on 99 long years of age.

For the past eight weeks, he has been bedridden. He seldom eats solid food at all. He sips on fruit juices, some Ensure, and soda water. He is on a daily sodium chloride drip, and has a condom catheter attached to him.

Sometimes he is quite lucid. More often, he is delusional and delirious and hallucinates.

There is actually nothing physically wrong with him. He doesn’t have any definable illness. He just didn’t get up one day eight weeks ago, and now can’t.

His exceptionally caring family doctor, who comes to see him weekly, and I have spoken numerous times about the options: to be aggressive (read hospitalization), or passive (read keep him at home and make him as comfortable as possible).

My father says he wants to stay home. I agree with him. There is nothing they can do in a hospital to make him better; he won’t walk again, let alone dance again, or think any better again, or do much of anything again.

The doctor and I also have discussed the option of tube feeding. Aside from the discomfort of the process, I have real trouble grasping what benefit that might be, other than making him live longer than he might wish. Keeping him alive now is for my benefit, not for his; to tube feed him really would be an act of selfishness on my part.

Tube feeding begs the debate of the sanctity of life versus the quality of life.

These past weeks, I have continued to visit him as often as I can. I ask what I can do for him, and he says there is nothing. I share memories from my childhood, and fun and meaningful experiences together, in the hope of giving him some pleasurable mental moments and a sense of satisfaction.

I rub his neck and back, and massage his feet and legs, which he enjoys greatly.

In my heart, I so want him to be better, but in my head I know he won’t be.

I report on his condition to my mother on my regular visits at her nursing home. My mother clearly has mixed emotions, but as often as not, is being remarkably astute given her condition. She observes that her husband is old; that he has lived a long life, and that he should not suffer.

Last week, I arranged for her to have a visit home so they could share some time together. It worked reasonably well, and if developments permit or demand, we’ll do it again.

So now I watch, wait and worry about what else might be done to make him safe and comfortable.

He has great care. One home care service, Spectrum, sends a man daily to bath and shave him. A Saint Elizabeth nurse comes daily to hook up his IV bag and check on him. Our live in caregiver attends to him around the clock with patience and quiet resolve.

But watching him wilt away, listening to him ramble on about people and events from his distant past or some terrible event imagined in his mind, and feeling him ever so slowly but surely sliding toward the personal conclusion of his life, is an agonizing experience for me.

I love my father, as deeply as I do my children.

And I know I must accept that he will die in the near future.

My profound hope is that he will die at peace with himself, in the knowledge that he did so many wonderful things, and that he is respected and loved by those of us near to him.

And when he dies, I hope I will have the strength and resolve to grieve as I must, celebrate all we shared, carry good memories, and march on. Because that’s the way of the real world, like it or not.

Coping Strategies:
• Do what’s right for your dying parent, not what may feel right for you.
• Fortify your mind and body, because the challenge at hand will drain you.
• Spend as much time as you can with a dying parent; share fond memories and know that just being present, quietly, is important.
• See what palliative care services are available and might be helpful.
• Make as many funeral arrangements in advance as possible.
• Get personal support and help—you’ll need and welcome it.

Hearing the same thing over and over: be patient and listen

In my geriatric practice one of the complaints of families is how often their loved one tells them the same thing over and over.

They use that symptom as evidence of cognitive decline – the inability to recall what was said previously. This symptom, although common and often indicative of cognitive functional decline, is also a manifestation of the common human propensity to focus on the narrative of one’s life and to recount it as part of one’s process of self-identity and validation. But, what is the separation between the normal attribute of recounting the narrative of one’s life and the pathology of cognitive impairment that fails to recognize the recent repetition of that story to a loved one?

The importance of stories

The telling of stories is important. In normal relationships and conversations, we spend much effort recounting life events to others. The tendency to be repetitive is universal, as anyone in a long-standing relationship will admit. If the topics of conversation between spouses are tracked over time, we would probably find the same topics repeated in one form or another repeatedly.

For instance, one partner in a marriage usually knows the political views of the other. When the topic comes up in a social setting, they often patiently listen to their partner express their views to presumably a new audience (although this is not always the case) with rare rude interruptions such as: “We’ve heard your views before. If you don’t have a new one, just stop talking.”

The challenge for those facing the extremes of repetition by a loved one who is experiencing cognitive impairment is knowing what to do. Family members usually learn to avoid interrupting the recounting of an event with “You told me already” or “I know,” as this may cause conflict with a denial that the conversation has taken place.

In the context of normal aging, family members may find that the retelling of one’s life narrative frequently occurs. This is one way we validate our lives, which is important as the past becomes increasingly important compared to the limited options for the future. This human need to tell our narratives is reflected in the interest by many in writing autobiographies and memoirs and in reading them. Being patient with our narrative-telling loved ones is important to them and ultimately to us.

Be patient and listen

The best recommendation I can make about this inevitable process is to find ways to be patient with your loved one and accept that even though you have heard the story before, acknowledging it and expressing an interest in it is helpful and even therapeutic to both of you, but especially to that aging loved one.

Plan good holidays for elderly loved ones

We posted this blog a year ago. Got lots of good feedback, so posting again and hope it's of help.

Best for the holidays from us both and back in the new year.

When you’re planning for the festive season, remember that older parents and other aging loved ones often have different needs than our children or we do.

Because they’re such an important part of our sense of family and the holidays, we need to plan good holidays for elderly loved ones. Too often we take for granted that our older family members can be as fully involved as we’d like. The fact is elderly family members may be lacking the stamina we’d wish they had.

That’s why it’s so important to plan all holiday events to ensure aging loved ones can enjoy them fully and that we can have the pleasure of their company.

Here are five steps for you to consider and apply in order to assure elder enjoyment at your family events this holiday season.

1. Reduce ‘wait time’. You can spend a lot of family wait time while meals are being prepared or people are dressing, or getting to a religious ceremony early in order to have good seating. But these are actually tiring times for the elderly. Help them by planning the latest time you can bring them to the event. That way, they don’t have to spend tiring ‘wait time’ doing nothing.

2. Build in ‘down time’. Make sure there’s at least half an hour or hour of rest time between events so your elderly parents can relax and perhaps catch a catnap or at least just have some personal quiet time. Their batteries run down faster now, and some recharge time becomes important.

3. Make meals more manageable. The more courses and the longer time a full meal takes, the more agitated little kids become… and the more aggravated older people become. Elderly parents will find long, drawn out meals fatiguing, even if they pretend to be enjoying themselves. So plan meals to be shorter, or plan strategies to respectfully give them options during a drawn out dinner so they’ll have some rest time.

4. Smart wrap for gift giving. Opening gifts that are tightly taped and tied with lots of ribbons is often difficult for the elderly. With reduced dexterity and maybe some arthritis, they can be stymied by some of the packages we present. Make it easier—and eliminate the embarrassment of being unable to open a package—by either wrapping their gifts much more loosely, or better yet, by putting them into attractive gift bags, covered with colorful issue paper.

5. Slow down and speak up. The elderly tend to process less quickly and don’t hear as well as once ago. To help them get the most out of your holiday events, slow down how fast you talk or do things, and speak more slowly and louder. Be sure to watch their reactions and body language very carefully for clues about how well they’re staying with you in terms of what’s being done and said.

And it’s also important to consider that for an elderly person who has lost a loved one, this is an especially difficult time of year. The loss, and the memories that inevitably freely flow especially during religious festivities, combine to create a level of personal hurt and pain we often don’t understand or respect to the extent we could and should.

When we consciously plan to meet the oft-unexpressed needs of our elderly family members, we’re ensuring they’ll be active participants in our holiday events. And we’ll know that their engagement is satisfying to them and to every person in the family.

Memories: flashback, flash forward

Written in 1955 and popularized by Canada’s folk music group The Travellers, just about every one of us remembers the lyrics to what became the unofficial national anthem of the 1967 Montreal summer Olympics Games.

In case there’s any doubt, this is the first stanza—sing along!
   This land is your land, This land is my land,
   From Bonavista, to Vancouver Island
   From the Arctic Circle to the Great Lakes waters,
   This land was made for you and me.

Long time ago. Good time ago. Good times. Memories: flashback, flash forward with me.
We were young, free, foolish, angry, and innocent. Except for some places the other side of the globe, most the world never looked so good because most of us could conveniently ignore any blasts of reality.

That was then, and this is now. Now, we can still take that same snappy, happy song and sing it, but perhaps with different lyrics. Try these—
   My parents are aging, your parents are ailing,
   From diabetes, to Alzheimer’s disease
   From colon issues to heart conditions
   Our new world was made for you and me.

The mid sixties marked the real end of the Boomer birth period. It marked the end of a couple of decades of amazing growth and grace across North America. Our parents and other older loved ones were still vibrant and fully engaged in their vocations and vacations.  And we older Boomers were oozing out of our adolescence and teen years.

Who among us would have given much if any thought to what has become a challenge we face today—the challenge of ensuring our parents’ comfort, stability, and safety?
It’s a long, long way from sucking in Woodstock to sizing up Waddayadonow.

We’re now older, maybe wiser, more formed and formidable. We’re also pretty well all in the same big boat on the river of life. We’re having to not only look at our own personal lives, but the relationships with spouses and partners and kids and… aging parents.

They need us, and we need to define how we can do that best, while balancing our lives to the tune of the best of the rock and roll we can still vocalize off key.

 

3,500 coat hangers: cleaning out and selling my parent’s empty home

Once I inherited my parent’s now empty house, I resisted for a while. I found all sorts of reasons to hold on to the house, but in the end, I knew selling what had been their home for 31 years was the right thing to do.

What an adventure. First, I recruited a real estate agent who gave me invaluable advice. Then, I started the clean-up-and-out process. It was a nostalgic, sad exercise, punctuated with many funny things. It’s rather remarkable what our parents can accumulate.

Me, a pack rat?

Thankfully, I had the lady who had been helping for several years at the house to help me. She stood by me throughout the exercise, challenging me with, “If you keep putting all those things in the ‘to keep’ boxes, you’ll have kept just about everything.” I thought that was a bit harsh, but I realized after the first day of cleaning that she was right. That’s when I became more ruthless!

Okay, so it was easy tossing the roughly 3,500 coat hangers. Then came the bags. I don’t know why, but for some reason my parents seemed to have thrived on keeping stashes of plastic grocery bags: thousands of them, in boxes, in cupboards, inside other bags in drawers. I found boxes of mothballs probably 20 years old, and the retired old wringer washing machine that I remember from my childhood.

And clothes. Clothes they hadn’t worn for at least a decade. Clothes even the charities wouldn’t want. And furniture stored in the basement that no one in his or her right mind would take for free. So I cleaned. For more than two weeks, for several hours most every day.

A twinge of guilt

I have to admit that, as the piles of old furniture mounted outside and as the dozens upon dozens of large, black, plastic garbage bags accumulated in the garage, I did feel a sense of guilt.

It was as if what I was doing was irreverent or somehow disrespectful; it was as if I were somehow tossing away very real bits and pieces of their very lives. After all, every item in that house was theirs, a part of them, a part of their personal histories.

Don’t look back

When the job was done, there sure was a lot more open space in the house. The “for sale” sign went up, and anonymous people poured through for days.

Suddenly, it was done: their house was sold. After the closing, I was never able to go back, to touch their world, to feel their lives, to poke at memories. And that’s a shame.

Even though I believe I did the right thing not hanging on to the house, it’s something I’ll miss. After all, there were some lifetimes of memories lurking in that home: theirs and mine.

How important are your aging parents… and what do they need from us now?

Once upon a time, many years ago, we were all innocent, giggling dream-filled little children.  Now we’re grown-up, with kids of our own, got careers to nurture, bills to pay and futures to plan. And parents to care for, parents who are aging and vulnerable and perhaps in need of the same kind of attention they gave us way back when.

Even if your parents are still independent and in good health, don’t kid yourself, they may not be for much longer. And if they are already frail or in declining health, you may already be deep into coordinating their care. Either way, our parents who sacrificed so much for us, now our attention, involvement, concern, care, commitment and advocacy. And, perhaps most importantly, the simple knowledge that we are there from them now, as they once were for us.

Prioritize your parents

If you’re like me, your life is cluttered with demands and priorities – including your
own need for space and ‘downtime’. It’s all the more difficult to help your parents
because this scenario wasn’t even on the radar screen. How important are your aging parents… and what do they need from us now?

The reality is that we have to find a way to support them through the final chapters of their life story. That’s why we must take stock of our lives and ensure that our parents are among our priorities and work towards ensuring the quality of care they deserve.

It can be a difficult task, and one that will only get tougher with time. We’ll never get it right. No matter what we do we’ll always feel that we could have done more. All we can hope for is that at the end of the day, we can look at ourselves in the mirror and know that we did the best we could.

If you need motivation, just think back to those special moments of your childhood. If we recall how our parents worked so hard to give us those moments, we will find the inspiration to do our best for them now.

Just giving back for all they gave us

I know I’ll never forget when I was a terribly uncoordinated seven-year-old, playing catch in the backyard. My father would throw me the ball in a way that was impossible not to catch – building my confidence and not embarrassing me in front
of my friends. It was a small, yet incredibly loving thing to do. I also remember by mother, patiently going over the multiplication tables the night before a big math test.

In so many ways my parents were there for me, as I’m sure yours were for you. You just have to delve back into your memories. Sure you will come across moments of frustration, but it’s the good memories you should latch on to. They are the important ones – the ones to cherish.

Use the past as a signpost to the future. One built on a foundation of the love, affection and support our parents gave us. One that will give us the strength and courage to support them both today and tomorrow.

 

Plan good holidays for elderly loved ones

When you’re planning for the festive season, remember that older parents and other aging loved ones often have different needs than our children or we do.

Because they’re such an important part of our sense of family and the holidays, we need to plan good holidays for elderly loved ones. Too often we take for granted that our older family members can be as fully involved as we’d like. The fact is elderly family members may be lacking the stamina we’d wish they had.

That’s why it’s so important to plan all holiday events to ensure aging loved ones can enjoy them fully and that we can have the pleasure of their company.

Here are five steps for you to consider and apply in order to assure elder enjoyment at your family events this holiday season.

1. Reduce ‘wait time’. You can spend a lot of family wait time while meals are being prepared or people are dressing, or getting to a religious ceremony early in order to have good seating. But these are actually tiring times for the elderly. Help them by planning the latest time you can bring them to the event. That way, they don’t have to spend tiring ‘wait time’ doing nothing.

2. Build in ‘down time’. Make sure there’s at least half an hour or hour of rest time between events so your elderly parents can relax and perhaps catch a catnap or at least just have some personal quiet time. Their batteries run down faster now, and some recharge time becomes important.

3. Make meals more manageable. The more courses and the longer time a full meal takes, the more agitated little kids become… and the more aggravated older people become. Elderly parents will find long, drawn out meals fatiguing, even if they pretend to be enjoying themselves. So plan meals to be shorter, or plan strategies to respectfully give them options during a drawn out dinner so they’ll have some rest time.

4. Smart wrap for gift giving. Opening gifts that are tightly taped and tied with lots of ribbons is often difficult for the elderly. With reduced dexterity and maybe some arthritis, they can be stymied by some of the packages we present. Make it easier—and eliminate the embarrassment of being unable to open a package—by either wrapping their gifts much more loosely, or better yet, by putting them into attractive gift bags, covered with colorful issue paper.

5. Slow down and speak up. The elderly tend to process less quickly and don’t hear as well as once ago. To help them get the most out of your holiday events, slow down how fast you talk or do things, and speak more slowly and louder. Be sure to watch their reactions and body language very carefully for clues about how well they’re staying with you in terms of what’s being done and said.

And it’s also important to consider that for an elderly person who has lost a loved one, this is an especially difficult time of year. The loss, and the memories that inevitably freely flow especially during religious festivities, combine to create a level of personal hurt and pain we often don’t understand or respect to the extent we could and should.

When we consciously plan to meet the oft-unexpressed needs of our elderly family members, we’re ensuring they’ll be active participants in our holiday events. And we’ll know that their engagement is satisfying to them and to every person in the family.

More about music and elderly with dementia

We recently posted a blog about music; specifially, how I got my mother, with her advancing Alzheimer's, to get engaged with music that she seemed to remember from her younger years.

Today, CNN online carried the following story that underscores and amplifies my posting. Hope you will read this and find expanded interest in applying music and other active forms of involvement for your aging parent. He or she may have a host of limitations, but music can do so much, as can art, pets, kids… stimulates that engage the brain, regardless of its current state.

 

(CNN) — At 101, Frank Iacono still plays the violin. The concertmaster for the Providence Civic Orchestra of Senior Citizens in Rhode Island, he particularly enjoys playing polkas and jigs.

"It keeps my mind active, and it gives me a lot of pleasure," Iacono said.

The orchestra's executive director and co-founder, Vito Saritelli, said Iacono is extremely sharp for his age.

"Music has played a good part of his longevity," said his wife, Mary Iacono, 94. "We're blessed that we're both in good health."

Music meets medicineMusic meets medicine

 

As scientists race to figure out how to promote healthy aging of the brain, and prevent dementia, their preliminary advice for senior citizens has become a chorus of voices: "Stay active! Have hobbies! Be socially engaged!"

Playing music, for some people, is a natural answer to all of those recommendations. Frank Iacono, for instance, has been playing violin since he was 13 — just because he loves it.

But does music playing in particular stave off dementia? What about just listening to music? How many years do you need to engage in music before it benefits your brain?

Researchers are exploring these questions in the face of staggering statistics about the aging population. The number of Americans 65 and older with Alzheimer's is expected to triple nearly by 2050 — 13.8 million from 5 million now. The annual cost of dementia in the United States in 2050 will be $1.2 trillion, according to the Alzheimer's Association.

Early research suggests playing music may hold back dementia symptoms by about five years — which would be significant if it proves to be true, said Brenda Hanna-Pladdy, assistant professor of neurology at Emory University, who studies cognitive functioning among musicians.

"If you can delay the presentation (of dementia) by five years, then you add an extra five years of functioning to an individual at the end of the life span," she said. "In terms of fiscal cost and everything, that's actually quite a lot."

Being engaged

A large study using Sweden's twin registry is looking at intellectually and physically stimulating lifestyle factors that could help stave off cognitive decline. One component of this effort is exploring whether playing music protects against dementia. The results, discussed at the Interdisciplinary Society for Quantitative Research in Music and Medicine meeting in July, are not yet published.

Twin studies carry special importance in science. Usually, when people participate in a study, they each carry a different set of genetics and may have had different upbringings. Those factors could influence whatever researchers want to investigate. Fraternal twins, however, share about 50% of genes, and identical twins share almost all. Twins also likely grew up in the same environment.

"To me, the most intriguing aspect is, in a twin pair, if one becomes demented and the other doesn't, what did (one not do)? Or what did the one who did become demented do that might give you some clues about ways that other people can mitigate their risk?" asked Margaret Gatz, director of the Study of Dementia in Swedish Twins, and professor at the University of Southern California.

Researchers examining the broader twin data have found that, for women specifically, participating in intellectual and cultural activities was linked to lower dementia risk in one study. Activities such asexercise at midlife for both sexes are also protective against dementia, the study suggests.

"All of these kind of add up in suggesting that a more engaged lifestyle is a good thing for the aging brain," Gatz said.

Why would an "engaged lifestyle" help prevent dementia? The idea is that brain stimulation may counteract brain changes that occur because of cognitive decline so that a person can function for longer, Gatz said.

Music playing in particular is something that people can continue to enjoy for longer than their occupations, or strenuous physical activity, Gatz said. It also has cognitive, physical and potentially socially components, so it engages many brain networks.

Unfortunately the twin study has so far only looked at associations between lifestyle factors and dementia; it doesn't prove that music can protect you against cognitive decline. The study also doesn't include brain imaging or autopsies, so the precise mechanism — how engagement in activities would prevent dementia — is unknown.

Music therapy: When patients have 'music emergencies'

The brain's backup

There is other emerging evidence that playing music could help prevent dementia.

Hanna-Pladdy, the Emory neurologist, is interested in exploring the biological underpinnings further. Her theory agrees with Gatz's: Brain networks that have been strengthened by musical engagement compensate to delay the detrimental effects of aging, a process called cognitive reserve.

So far her research has demonstrated that extensive musical instrumental training, even in amateur musicians, provides a cognitive benefit that can last throughout a person's life. Her studies were published in 2011 in the journal Neuropsychology and in 2012 in the journal Frontiers in Human Neuroscience; they included instrumentalists, not singers.

Hanna-Pladdy and her colleagues found in their first study that even if participants did not continue playing music as they aged, they still performed better at tasks of object-naming, visuospatial memory and rapid mental processing and flexibility than those who didn't play at all — as long as they had played for at least 10 years. That's critical because as they age, people may lose motor skills or eyesight that prevents them from playing their instruments.

 

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The study also suggests the cognitive benefits of instrumental training can last a lifetime.

One of the study's participants said in an interview that he felt like having played for so long was akin to "an insurance policy," Hanna-Plady said.

The researcher's more recent study showed that musicians who began playing before age 9 had better verbal working memory functions than those who started later or didn't play at all.

This finding is consistent with verbal language acquisition — linguistics studies have shown that there is a critical period during which the brain is open to learning a language, and fluency becomes far more difficult after a certain age in childhood.

It also jives with the findings of a 1995 study that showed professional musicians who began training before age 7 had a thicker anterior corpus callosum, part of the pathway that links the right and left hemispheres of the brain.

And participants who continued to play their instruments at older ages tended to perform better on tasks of visuospatial judgment, "suggesting that there continues to be plasticity in advanced age," Hanna-Pladdy said.

"Finding a way to harness this plasticity is probably one of the biggest hopes we have for treating brain disorders or dealing with cognitive decline in advanced age," she said. "Similarly, continuing to play music in advanced age added a protective benefit to individuals with less education, which has previously been demonstrated (to be) one of the most robust ways to create cognitive reserve. Thus, musical training appears to be a viable model for cognitive stimulation, and can be conceptualized as an alternate form of education."

Should we start now?

Is it worth it then to teach an older person to play an instrument, perhaps one who already shows signs of cognitive decline? Recent research suggests it's harder, but still possible, to modify the brain in an older person. But no one has a definitive answer on whether teaching an elderly person a new instrument would lead to the same kinds of benefits that scientists have found in lifelong musicians.

"It would be pretty challenging, considering they're having a hard time remembering," Hanna-Pladdy said of dementia patients. "It may be beneficial to provide musical stimulation to individuals in the earlier phases (referred to as mild cognitive impairment) or to re-initiate musical practice in individuals who are no longer engaged."

Regardless, since people find music enjoyable, trying to learn an instrument won't hurt. But more research is needed over a long period of time to assess fully the benefits of music among elderly people, Hanna-Pladdy said.

Music: It's in your head, changing your brain

Evidence may continue to emerge that long-term music playing has a preventive effect against dementia, but that's not to say that nonmusicians are totally out of luck, Hanna-Pladdy said.

Music is becoming a hot area of study because it's easier to quantify the number of years that people play music than, for instance, the length of time reading or playing games.

"This is just meant to be a model for cognitive stimulation, and how cognitively stimulating activities can change your brain," Hanna-Pladdy said.

So music may be good for you, but so may other pastimes.

After all, violinist Frank Iacono and his wife, Mary — married for 66 years — play Scrabble together every night.

Tuning in

For patients who already have dementia, music can be used in a different way to help the mind.

The emotional response that people get from listening to music, and the brain chemicals associated with pleasure that get released in the process, are distinct from the structural changes in the brain that playing music over time may instigate, scientists said.

Dr. Sanford A. Shmerling, who has Alzheimer's, joined in drum circle activity recently at his nursing home in Atlanta.
Dr. Sanford A. Shmerling, who has Alzheimer's, joined in drum circle activity recently at his nursing home in Atlanta.

 

Trends emerging from research show that music exposure — whether through casual listening or more formalized music therapy — can help reduce the incidences of behavioral issues and generally calm dementia patients, said Beth Kallmyer, vice president for constituent services at the Alzheimer's Association.

"Anecdotally what we hear is that people can be upset, even a little agitated, and when they're listening to music, even in the late stages, people can appreciate music," Kallmyer said.

Family members should help caregivers choose music that is meaningful to a person with dementia, she said. "The most important thing is keeping your interventions person-centered as much as possible."

Naomi Ziv of the Academic College of Tel Aviv Yaffo in Israel and her colleagues showed in a Journal of Music Therapy study that background music is associated with an increase in positive behaviors — laughing, smiling, talking — a decrease in negative ones, including aggressiveness and crying.

Music attracts attention; it also enhances focus and affects emotion, Ziv told CNN in an e-mail.

"When we hear familiar and preferred music, we mentally follow it," she said. "It seems that whereas general memory deteriorates in dementia, memory for music remains relatively intact."

Familiar or preferred music evokes memories and influences mood, which is perhaps the underlying reason for these results, Ziv said.

Catherine Shmerling appreciates the effect that certain musical events have had on her father, Dr. Sanford A. Shmerling, 85. The elder Shmerling used to be the medical director of the William Breman Jewish Home in Atlanta; now, he lives there. He has Alzheimer's, and most of his speech is not comprehensible, his daughter said.

On a recent weekend, a swing band performed at the nursing home. At first the former medical director sat in his wheelchair staring into space, but soon his daughter noticed him clapping his feet. She started swinging his arm with the music, and after a few minutes he gave her "a cute little smile."

"It's gratifying," Catherine Shmerling said. "There is something about — I don't know, the music or the auditory or something — that does seem to get past whatever it is that's blocking their normal communication, and somehow it gets in there."

Science may not have all the answers, but Shmerling savors these small signs that her father is listening.