How music is rewriting end-of-life care

Over the years, music has been used to express emotions for some while creating connections and memories for others. Listening to a certain song can take people back to a specific moment. Whether it elicits joy, pain, anger, or sadness, music has a different effect on each individual. 

Music stays with people throughout their lives, always bringing forth those emotions or memories. 

For those in end-of-life care, music can do the same. 

Music therapy has been used for centuries; The American Music Therapy Association states the profession dates back to and formally began in the 20th century. 

Music therapists worldwide use various interventions to address health care and educational goals, such as alleviating pain, managing stress and anxiety, improving communication, and more.

Today, hospitals and hospice centers are seeing an increase in the use of music therapy, specifically in end-of-life care. 

Katey Kooi, a music therapist of 16 years, supports patients who have serious illnesses or are at the ends of their lives along with families to ease suffering during the end-of-life process.

Kooi expressed how beneficial music therapy can be for end-of-life patients, as it releases dopamine and serotonin neurotransmitters, facilitates emotional processing through discussing lyrics, and supports life review and reflection. 

“Music innately is therapeutic because of the way it works in our brain and in our limbic system, so it releases serotonin and dopamine,” Kooi said. “When you hear your favorite song or something from your favorite artist, you initially get that dopamine hit. Then, the therapy portion usually comes in a context of more discussing some of the lyrics.” 

Kooi creates personalized playlists — ranging from Beyoncé to John Denver — for each patient to help them through challenging times, such as chemotherapy or radiation. The specific songs allow patients to transcend to a different place, which provides a mental escape from their current situation.

“You can use the lyrics of the song, but also you can do a guided relaxation where I would play guitar in the background and then lead them through kind of a mental script for them to focus on some breathing because you can match the tempo to where their breathing is, and then just bring it down,” Kooi said. 

Kooi hopes the use of music therapy will continue to grow.

“Hopefully, [music therapy] can continue to improve as we show the efficacy of music therapy for patients from NICU aged all the way up to older adults,” Kooi said. 

Head of the music therapy area and professor of music therapy at the University of Iowa, Abbey Dvorak, said music therapy uses evidence-based interventions to address various needs, such as motor, emotional, and cognitive goals. 

This form of therapy is also practiced in diverse settings, such as mental health facilities, hospitals, schools, rehabilitation centers, and community settings.

RELATED: DITV: Music Therapy at the UI Hospitals and Clinics

“Music therapists use a variety of music experiences, and we use a variety of instruments,” Dvorak said. “The music experiences might be things like composing music together to help express feelings; they might be listening and responding to music in different ways; they might be recreating preferred music of the client — especially if they have positive memories associated with them — and it might also be improvising, where we make up music in the moment, and sometimes that helps us express different things in our lives.” 

Dvorak shared the importance of music therapy for end-of-life care patients’ family members as well.

“[Music therapy] can help with connecting with other family members. If we have some songs that the family knows, we can sing those songs and then process and help family members reconnect or connect with the loved one,” Dvorak said. “Doing a life review, talking about important moments that they want to share with their loved ones, also processing some of that anticipatory grief that their loved ones might be experiencing.”

Maddison Smith, a recent graduate from the UI, discussed her experience as a new music therapist and how she uses treatment in end-of-life care. 

“Your focus is on the patient, but you also are incorporating the support system in any way that you can and trying to learn about their holistic experience with not only their illness, but who they are as a person and what their interests are,” Smith said. 

Smith echoed how beneficial music is when used to review and reminisce about one’s life. She shared that engaging in that technique can bring people together in the final moments. 

“Honestly, that was the part of my internship that I felt was the most impactful,” Smith said. “It was just really beautiful to be in those moments and to kind of provide a glimpse of light or a positive time in a very scary experience.”

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