Music, Nostalgia, and Wellness in the Care of Older Adults
By John Moulder
By 2050, approximately 394.7 million people will be 80 or older. By comparison, in 1950, only 14.5 million adults were over 80. There has, indeed, been a “significant rise in life expectancy in almost all regions of the world, contributing to an increasingly older population” (Bergman et al. 2013, p. 61). As a result of this demographic trend, there will be an increase in the need for older adult services, including the need to meaningfully attend to this burgeoning population during the end of life period.
We see in Erik Erikson’s (1963) developmental theory that as people age their final stage of psychosocial development revolves around a life review, wherein they reflect upon their lives and take inventory of them. In Erikson’s eighth stage, the developmental task is to attain deeper integrity rather than despair. In order for integrity to prevail, one must come to a self-understanding of one’s life fortified with a sense of its meaning and purpose. He writes, “only in him who in some way has taken care of things and people and has adapted himself to the triumphs and disappointments adherent to being, the originator of others or the generator of products and ideas—only in him may gradually ripen the fruit of these seven [prior] stages. I know no better word for it than integrity” (p. 268). In other words, the quest for integrity requires a making sense of one’s past and life path.
Here we might recognize a human proclivity for order and meaning, but a proclivity that may well require assistance, focus, and effort in order for integrity to deepen and to achieve what Erikson calls wisdom and equanimity at the prospect of death. Achieving greater cohesion and integration is precisely what is required to cultivate greater peace and wellbeing during this critical developmental stage (Rogers, 2016).
In my experience of facilitating groups of adults, music and nostalgia have been powerful partners in the service of self-expression and personal integration. This paper proposes the use of music in group settings to help older adults in Erikson’s eighth stage. I have seen how music can stimulate the positive effects of nostalgia and has thus validated my sense that Erikson (1963) was correct in his insistence on the struggle older adults undergo in the search for meaning and cohesion as they process important life events and relationships in order to better attend to the end of their life. I argue that nostalgia can be effectively employed in the process of reviewing one’s life. Indeed, the power of music to stimulate nostalgia, and nostalgia’s powerful role in the process of life review, and its potential to lead to personal integration, positive affect, meaning and self-continuity warrants a deepened understanding of its potential and expanded use in clinical settings. The spiritual advantages that music provides such as enhanced meaning and reverence for one’s life seem to hold the power to make powerful contributions for older adults achieving integrity, and perhaps gracefully, navigating the final chapters of life.
There has been a slow evolution, spanning the course of the last three centuries, in how nostalgia is understood. While widely seen as an illness between the 17th and 19th centuries, more recently it has evolved into a more esteemed mental process. Numerous contemporary studies support the idea that nostalgia is a powerful inner resource that not only can propel us toward social connectedness, self-continuity, and spiritual wellness, but might prove to be a trustworthy ally in prompting us toward the construction of a renewed self and society (Routledge, Sedikides, Wildschut & Juhl, 2013).
For example, Constantine Sedikides and Tim Wildschut (2018) have conducted extensive research that focuses on the relationship between nostalgia and a number of variables important for the well-being of older persons. These include a sense of belonging, personal meaning and selfacceptance. Sedikides and Wildschut assert that empirical findings over the last 15 years suggest that indeed, far from being a medical disease or a psychiatric disorder, nostalgia is in fact an invigorating psychological resource that engenders hope and meaning in individuals. They have found, across numerous studies, that the act of nostalgizing, they argue, is indicative of those who find meaning in their lives and a sense of value in the key episodes of their existence. This active cultivation of nostalgia generates a memory form that “pertains to momentous or cultural-lifescript occurrences. These occurrences are textured and self-defining. They depict the individual as having a key, if not central, place in a sequence of germane and ritualistic episodes that are enriched by the presence and roles of close others” (p. 49). By increasing social connectedness and self-continuity, and that by “enriching people’s lives with meaning, nostalgia contributes to motivated goal pursuit, psychological equanimity, and psychological or even physical health” (p. 57).
In addition to retrieving the past and its potential meaning, nostalgia also assists in inventing the future. As Jill Bradbury (2012) writes, “narratives of the past may provide resources for articulating future possibilities” and that nostalgia stems not from a longing for the way things were as from futures that never were realized, from possibilities that were foreclosed in the unraveling events within one’s life. Her work underscores the ways in which nostalgic retrieval of the past offers resources for future possibilities. Nostalgia “is the desire not to be who we once were, but to be, once again, our potential future selves” (p. 1).
From Music to Nostalgia in Senior Care
Music has been shown to be an effective means of evoking nostalgia because it has the capacity to transport the listener to past times and places of their life, as well as to awaken associated emotions which are otherwise inaccessible. Andrea Creech, Hilary McQueen, Susan Hallam and Maria Varvarigou (2013) summarize a formidable body of research that demonstrates that music offers older adults a powerful potential for enhanced social cohesion, personal development and growth. They cite growing evidence that social networks focusing on participation in music reduce levels of depression and isolation, and increase well-being and social connectedness and conclude that “music offers a medium through which older people can re-connect with their youth, experience vitality and feel empowered” (p. 92).
Emelia Michels-Ratliff and Michael Ennis (2016) conducted a study that explored the relationship between nostalgia, memory, and music. Consistent with previous research, their study found that participants’ experience of nostalgia was primarily a “positive experience” however much it might be interlaced “with negative affect.” Furthermore, they found a significant correlation between nostalgic recollection and meaning, such that “even though nostalgia is often tinged with sadness, it is usually an experience people want to have. Because the negative affect is experienced as meaningful, it is not entirely unwanted” (p. 383).
Cultural sociologist Lauren Istvandity (2017) performed a systematic review of research (1996-2016) that focused upon music and reminiscence therapy, involving review and reflection upon one’s life and the use of life histories in the service of well-being. Through her systematic review, she found growing evidence that four out of the five studies examined confirmed that elderly participants experienced positive effects from music and reminiscence therapy. Furthermore, she explains that, “the overlap of the use of music and reminiscence between these two therapies is rather germane. Studies across the domains of psychology and sociology demonstrate that music can effectively trigger autobiographical memories with strong emotional content and that an individual’s personal memories of music are closely tied to their self-identity and life story” (p. 19). She concludes that the review of existing research demonstrates the positive effects of such therapies upon the stress, anxiety, and depression levels and mental well-being of participants.
Clinical studies have shown the benefits of listening to music for older adults. Christopher Kaufman, Lori Montross-Thomas, and Sean Griser (2018) recognized that this connection had not been examined in a national, representative, population-based sample. In response, they compiled data on 5,797 participants from the 2012 Health and Retirement Study and the 2013 Consumption and Activities Mail Survey. Participants reported the prevalence of certain health conditions, the number of hours they listened to music each week, as well as social, cognitive, physical, and spiritual activities. Those who consistently listened to music reported fewer health problems and significantly higher engagement in cognitive, social, spiritual, and physical activities.
The aforementioned research underscores the power of music to evoke nostalgia for the purpose of accessing significant memories and emotions constitutive of a person’s life. The retrieval of meaningful life material becomes a catalyst for personal renewal. Nostalgia offers tremendous potential in its ability to place a person’s emotionally laden autobiographical memories at the service of building a hopeful future. Nostalgia evoked from music is a meaning making tool for the clinical social worker to use in helping older adults to find meaning in their past, to renew and reclaim their present, and to create a desired future.
Music Nostalgia and Wellness Sessions
The wellness sessions proposed in this paper are conceived of as weekly sessions for 90 minutes, with an overall duration of six to eight weeks. The purpose of this Music Nostalgia and Wellness Program is to provide a platform for elders to use music and nostalgia in a group setting to strengthen the sense of integrity they take from their understanding of their lives. Each session should begin with the social worker articulating for the group the importance of confidentiality, listening (i.e. no side conversations), and respect for the differences within the group. Together with the social worker facilitating, participants discuss the musical soundtrack of their lives and work out how these selections and memories—acts of nostalgizing—relate to their values. By highlighting significant experiences, they work to knit together their lives. This sense of connection gives them greater coherence, purpose, and meaning. The goals of the using music and nostalgia within a group session are thus twofold. The first goal of the group is to increase the members’ feeling of social connectedness and mutual support. Through playing music for the sake of nostalgia, and interpersonal sharing, the second goal is to increase participants’ self-reflection, self-acceptance and sense of personal meaning, in regard to the important events and experiences within their lives.
Small, closed groups of seven to ten adults work well. They are brought together to listen to self-selected passages of music and share the importance of these passages for them. This approach differs from traditional music therapy because the participants select the music that is played and direct the process. This is not to suggest that there is no merit or value to music therapy and the way it is practiced. However, it is significant that music therapy proceeds differently. Contemporary music therapy views its enterprise as “a clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship” (American Music Therapy Association, 2018). Music therapists design music sessions for individuals and groups depending on an assessment of their needs. Participants in traditional music therapy are subject to musical interventions and are often involved in activities such as music improvisation, music and imagery sessions, and music performance. The Music Nostalgia and Wellness Program, conversely, is radically client-centered. There are no predetermined treatment plans or calculated musical interventions. Contrary to being a therapy group these wellness sessions are designed for support. Pelech, Basso, Lee, and Gandarilla (2016)
explain this distinction this way:
support groups are different from interpersonal counseling or therapy groups. The purpose of a support group is to assist members to restabilize through compassionate and concerned interactions in the group. Support groups reinforce strengths, reframe problems as opportunities for change and provide the space for group members to disclose issues related to common problems. (p. 56)
This approach offers a new inroad to working with older adults to mutually support one another and explore the developmental tasks of deepened integrity and self-continuity as well as the spiritual quest for deeper unity, peace, transcendence, and meaning near the end of life.
The Structure of Sessions
I propose that facilitators use a semi-structured agenda determined in advance but recommend that this structure be combined with a good measure of flexibility to allow for spontaneity. Because the group will engage members by inviting them to introduce and play musical pieces that have importance to them, I ask members who wish to share music at the next meeting to think about their selections and share them with me three days in advance of when the group is scheduled to meet. This will assist in preparing for the meetings and making sure that selected music is prepared and cued up to be played at the following meeting. In this way, the basic structure of the meeting is determined by both myself and group members.
Each session begins with articulating for the group the importance of differences between the musical selections, the value of them for each individual, and the importance of their presence within our group. Creating and maintaining a safe environment for diversity to be expressed is a chief aim of one’s work as a facilitator. This is instilled by modeling openness, accepting diversity and encouraging group members to conduct themselves in a similar manner. It will demand that the clinician relate to and include those who might be in a minority or a socially oppressed group with equal respect and consideration.
Music serves to empower members of oppressed minorities, subcultures, and countercultures. Often enough, music is a vehicle that connects individuals. Therefore, honoring the music that powerfully connects with participants’ life narratives and their struggles and joys is of central importance to the process of Music, Nostalgia, and Wellness, and demands continued vigilance. The goal of the group is to uphold inclusivity that is open to diversity. The beauty of music is that it can touch and unite people who are quite diverse (e.g. with different outlooks, ethnicities, sexual orientations, and socioeconomic classes) and who otherwise might not perceive common ground between themselves.
Sessions typically begin with a check-in that allows group members to briefly disclose how they are doing. Time will be allotted to address any of the themes or issues that have arisen in the group from the previous meeting and to provide an outline and plan for the meeting, even as there is permission to depart from that plan if it is important for the group. The musical selections provide content that will be the basis for individual reflection and group discussion throughout most of the meeting.
Group members will choose a song to play for the group, have the opportunity to introduce it, talk about its personal meaning for them as well as share any important events or people that it might call to mind. There is also time for group sharing and feedback related to what the music evokes in all participants. Finally, five to ten minutes will be devoted at the end of the meeting to summarizing the material, emotions, and group experience and bringing the meeting to a close.
In summary, the clinical social worker overseeing the session must be attuned to the meaning that the music has for a participant and to reflect its importance back to the participant through the course of the session. Second, the social worker should invite group feedback that can help participants integrate the content of their life narrative. In this way, the social worker allows group participants to support each other as they engage their respective memories and aid one another. Finally, the social worker must be sensitive to the ways in which music and conversation can have different impacts on various members of the group and to the dialogue that ensues.
Older adults can suffer from isolation and are at a developmental stage where they are prone to review their life and seek to integrate important experiences into a cohesive narrative. Music is a formidable ally and nostalgia a meaning-making tool that has tremendous potential to assist older adults with integrating their experiences during this developmental stage within the final chapters of their life (Routledge, Sedikides, Wildschut and Juhl, 2013). The purpose of the Music, Nostalgia, and Wellness Group is to increase participants’ level of self-acceptance, personal integration, social connectedness, and perceived meaning (of one’s life) through music, nostalgia and group process.
However, additional research is required. Kaufman, Montross-Thomas, and Griser (2018) suggest that future studies might examine music as a public health initiative for older adults. One goal of future research should be to discern individuals and groups that might not benefit from nostalgia. For example, those who have experienced significant trauma might be triggered by nostalgic music to recall painful memories. Other individuals with certain conditions or life experience might not respond favorably to music and nostalgia. As with all forms of healing, caution, discernment, and research are indispensable allies that guide clinical practice. Nevertheless, based on current evidence, nostalgia has shown promise in redeeming the past and creating a revitalized future.
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JOHN MOULDER is a Chicago jazz guitarist and composer that has released several recordings. He is an adjunct faculty member at the Bienen School of Music at Northwestern University and the Chicago College for the Performing Arts at Roosevelt University. He is also finishing his graduate work in clinical social work at the University of Chicago and serves as a psychotherapist at the Replogle Center for Counseling and Well-Being.