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2 - In Search of a Perfect Harmony: Music and Wellness in Later Life

Published online by Cambridge University Press:  07 October 2021

Scott F. Madey
Affiliation:
Shippensburg University of Pennsylvania
Dean D. VonDras
Affiliation:
University of Wisconsin, Green Bay

Summary

We discuss physical changes that are encountered in aging and how music may be a part of optimizing health outcomes and wellness. This chapter presents how music affects thinking, feeling, and acting. Other topics include effects of noise, biological theories of aging, physical changes with aging, longevity, mind-body interactions, music in a Utopian environment, and exercise. Finally, a discussion ensues on retirement centers that celebrate living, such as Casa Verdi, Triangle Partnership, and The George Center.

Type
Chapter
Information
Music, Wellness, and Aging
Defining, Directing, and Celebrating Life
, pp. 18 - 36
Publisher: Cambridge University Press
Print publication year: 2021

Music … takes us out of the actual and whispers to us dim secrets that startle our wonder as to who we are, and for what, whence, and whereto.

– Ralph Waldo Emerson

As Emerson intimates, music is a special conduit to explore the transcendent questions of who we are and where we will travel in the latter half of the life course.1 As the renowned existential philosopher and theologian Paul Tillich notes, concerns about our personhood, and our path in development, reflect universal and essential processes of meaning-making and are of central importance of people within all cultures, and across all historic settings.2 Therefore, recognizing the importance of interpreting and understanding one’s personal experiences of development and aging, in this chapter we discuss aspects of physical change, longevity, and wellness in later life. We also describe how various musical involvements may reveal as well as direct these processes and interpretations.

But before we go any further, we should ask how, as Emerson alludes, can music tell us about who and how we are? More broadly, how does music serve as a special conduit for exploring these aspects of living in later life? The first way of addressing these questions is to recognize music as a phenomenological expression of conscious and unconscious experiences that mirrors the deepest aspects, feelings, and concerns of the person. In that way, then, as philosopher Lewis Rowell notes, music is realized as a reflection of the archetypal myths that Jung suggests embody our deepest psychology and that are manifested in our behavior.3 Thus, music lays open to us an “indirect testimony … a gestalt … of related ideas, beliefs, and images” of the inner person and the world in which they live.4 In a similar manner, philosophers have proposed music to be “a secret language of the soul,”5 where, “aspiring to disclose the ineffable,” music offers insight into and a critique of the person and society.6 Thus, another way to resolve these questions is to recognize music as a universal expression, describing what words cannot. Indeed, as noted by the writer and amateur musician Ward Cannel and the composer and pianist Fred Marx, “every human society has a variety of musical compositions and instruments, and people from one part of the planet can learn to sing and play the music from another part. Thus, the ability to make music is part of human nature.”7 Therefore, whether as method of artistic or self-expression, a system of communication or social critique, an entertainment or hobby, therapy or vocation, music characterizes and points us toward the innermost dimensions of who we are and the dynamic world in which we live. For these reasons, then, as musicologist Michael Gallope has described, we understand music to be a semiotic expression of the person and their socio-cultural-environmental surround.8 That is, music symbolically portrays the person’s quest for and interpretations of life’s meaning and purpose, processes of challenge and adaptation, and of one’s relationship to others, the natural environment, and the cosmos. Therefore, in accordance with Emerson’s understanding, and as we will proclaim throughout this book, music represents a very unique lens of analysis, providing us insight into and understanding of various psychological aspects of the person, one’s development and aging, and one’s quest for adaptation and wellness in later life. How music may affect us and provide greater insight into the human condition, attracting universal appeal and an international audience of researchers, is discussed next.

The Power of Music to Affect Thinking, Feeling, and Acting

Music has long been identified in the areas of advertisement and marketing to powerfully influence consumer behavior.9 Indeed, music is used in media advertisements to manipulate the hedonic value and referential meaning associated with branded products, to evoke emotions that will set in motion consumer purchasing behavior, and has even been shown to influence older adults’ generosity when tipping.10 These powerful effects of music to alter our thinking, feeling, and acting lead us to consider how music may innervate mind–body relations and affect behavior. In later chapters, we will delve more deeply into how music may therapeutically aid older adults, but we should first recognize that there is rather credible evidence suggesting that music has a healing power, offering very positive benefits as an element of recovery and rehabilitative interventions.11 For instance, music listening and music making have both been found to aid older adults in recovery from neurological injuries caused by stroke.12 Similarly, other beneficial biophysiological effects are also suggested. For example, research from lab studies with rodents suggests that listening to music may optimize immunological responses against cancerous cells, as well as survival after heart transplantation.13 Further, considering psychiatric illnesses, music making has been indicated to improve and relieve depressive symptoms, as well as the maintenance of well-being in individuals with dementia.14 So how is it that music has a positive effect on our thinking, feeling, and action?

A review by British health researcher Daisy Fancourt and colleagues provides us some insight into this question. As noted by Fancourt and colleagues, listening to relaxing, slow tempo music, beyond the psychological effect of enhancing positive affect, may produce a switch from the “flight-or-fight” sympathetic nervous system response to the “rest-digest-recover” parasympathetic nervous system response.15 This switching to the “recovery mode” facilitates a lowering of blood pressure, heart rate, respiration, and galvanic skin conductance levels. These biophysiological changes denote the lowering of stress response and a more “relaxed” state, which aids healing. Beyond the modulation of sympathetic and parasympathetic response, however, there is also evidence that music listening and music making may also moderate a variety of neuro-endocrine and immunological responses. For example, listening to calming music is reported to lower beta-endorphin levels, an endogenous morphine-like chemical that is produced in response to stress or pain, thereby producing an overall more relaxed physical state.16 Similarly, other research also suggests music to modulate neuro-hormonal release. For example, research by Fancourt’s team involving cancer patients and their caregivers in an hour-long singing intervention noted reduction in cortisol, beta-endorphin, oxytocin production, and a general activation of cytokine molecules that mediate and regulate immunological function, inflammation, and blood cell production as a result of the singing intervention.17 Relatedly, a study by Japanese researcher Kaoru Okado and colleagues involving older adults with advanced dementia in a music therapy intervention reported that involvement in music therapy lowered adrenaline and noradrenaline levels, catecholamines that are produced when under stress.18 In addition to the music and catecholamine relationship, Okado’s team also found lower incidence of congestive heart failure events among those who received music therapy, suggesting that musical therapy may enhance parasympathetic tone and thereby improve coronary status in older individuals with congestive heart failure.

Allied research has indicated moderation of blood flow as well as activation of and response in limbic and paralimbic brain structures (neurological areas intimately involved with emotionality) when listening to joyful or sad music, as well as consonant and dissonant music.19 Adding to our understanding, a Canadian research team led by Valorie Salimpoor reports peak emotional responses while listening to music to also accompany enhanced dopamine release, a “feel good” hormone.20 Salimpoor and colleagues propose that it is this dopamine effect of music that makes it so universally valued. Similarly focusing on the universal effect music has on our emotions, cross-cultural research by American researcher Alan Cowen and colleagues suggests several distinct types of subjective feelings associated with various music samples across cultures.21 These feelings included conceptualizations such as amusing, angry, beautiful, dreamy, energizing, indignant, joyful, relaxing, sad, scary, and triumphant – thus again underscoring that music has a universal emotional appeal, stirring a broad spectrum of psychological processes, and evoking feelings within the person.

Other research has indicated that musical rhythms may coordinate and thus become synchronized with and drive electrical processes of the brain, producing an “entrainment” effect. Entrainment is noted to occur when changes in baseline alpha waves occur as a function of variations in musical pulse or tempo, which concomitantly also evoke and trigger social–emotive expression.22 These entrainment effects provide illumination into what it means when a person remarks, “The music makes me come ‘alive’!” or “I am really ‘feeling’ the music!” Indeed, research by Swiss investigators Patrick Gomez and Brigitta Danuser has indicated fast music tempo to be associated with higher physiological arousal (i.e., faster heart rate, respiration, skin conductance) and the expression of positive affect.23 Further, in examining various features of music, these same researchers note that greater emotionally positive arousal is produced by musical excerpts in the major mode and for downward melodic movement, while emotionally negative arousal is more often associated with musical excerpts in the minor mode and with increased harmonic complexity. Fittingly then, these entrainment and arousal effects suggest a whole new interpretive meaning to songs such as “I’ve Got the Music In Me,” composed by Bias Boshel and recorded by The Kiki Dee Band.24

Looking more closely at neurochemical production and hormonal secretions, some research has suggested dynamic gender and situational variation in their release while listening to music. For example, research by Hajime Fukui suggests that in certain situations music listening may inhibit secretion of testosterone in male college students while enhancing testosterone production in female college students.25 Other research has suggested that the relationship between music and testosterone production found in men may be enhanced if there is a dance partner present.26 It should be noted, however, that the association reported between music and neuro-hormonal chemical production is inconsistent from one study to the next.27 Therefore, as we seek to understand how music may make us feel happy or sad, excited or relaxed, it is not correct to just understand that music produces benign mind–health relationships and effects. We also need to understand the qualities of the musical sounds and their interactive relationship with various features of the person and the environment (e.g., gender characteristics of social actors, dynamic features of the social situation, high- versus low-stress environments). For example, experimental research exploring the effects of music exposure versus no music exposure while playing a violent video game indicated that exposure to music elevated subjects’ production of cortisol, suggesting that music may add to and further exacerbate stress levels in thrilling or exciting performance arenas.28

The Problem of Noise

Many of us have experienced discomfort from hearing loud music blare from an audio speaker. Indeed, the loudness of sounds can be painful and damaging to the cells of the inner ear.29 The sound threshold at which one feels discomfort is about 120 dB (e.g., the loudness level of being at a rock concert or near a chainsaw when operating), and the threshold at which pain is reported is about 140 dB (e.g., the loudness level of a nearby gunshot or standing close to the runway when a jet takes off).30 Similarly, like the unpleasant sounds produced by fingernails scratching a chalkboard, very low- or very high-frequency sound exposure may produce harmful effects. The human range of detectable sound extends from 20 to 20,000 Hertz (Hz) for young people, and, as we will discuss in Chapter 3, there is decline in the upper limit with advancing age.31 Yet, exposure to low-frequency sounds (20 to 100 Hz) and infrasound (i.e., very low-frequency sounds below 20 Hz) present in the roar and hum of boilers, railroad diesel engines, and natural sources such as windstorms and earthquakes, beyond just being annoying, may result in ear pain, balance disturbance, headache, and nausea; affect heart rate and breathing; and produce changes in the endocrine and central nervous systems.32 Exposure to ultrasound (i.e., inaudible very high-frequency sound about 20,000 Hz or higher) is suggested to produce similar ill effects, such as nausea and headache, as well as neurological injury.33 Thus, there are many deleterious effects of noise on hearing.34 Notwithstanding these immediate effects, however, it is also important to mention other ill-health effects due to chronic noise exposure.35 Research in this area suggests long-term exposure to noise increases blood pressure and release of stress hormones, and thereby also the elevation of risks for cancer,36 diabetes,37 and heart disease.38 Further, recognizing the potential ill effects of sound exposure, we should also be aware that loud and monotonous music has been used as a form of psychological warfare as well as torture.39

Understanding Aging and Development into Later Life

Before we go too much further, we should ask how we might explain aging and continued development into later life. In the next sections we discuss shifting perceptions of aging, how we might consider our story of development into the last chapters of life, and discuss biological processes that underlie physical changes that occur throughout the adult years.

Shifting Perceptions of Aging

Becoming an adult and maturing into later adulthood, in both a biological and psychological sense, are both affirmative experiences and a realization of our evolutionary potential.40 Yet, for most younger people, personal knowledge of these processes and the concerns of later life are not yet fathomable and thus perhaps not well understood. This lack of insight and understanding is not necessarily avoidable, either. As the philosopher and phenomenologist Maurice Merleau-Ponty posits, the body is our first point of reference and understanding.41 Thus, we perceive and construct knowledge about ourselves and the surrounding world from the point of view of our sensory–perceptual and emotional–cognitive experiences. Moreover, there is both a logical and valid truth expressed when we say, “I’m seeing it with my own eyes” or “I’m hearing it with my own ears.” This egocentric orientation has in many ways contributed to the tension, and at times discontent, expressed in the understanding of and relationship between younger and older generations.42 Further, conflict in generational points-of-view and parent–child detachment is recognized as a normative process in the young person’s identity development and process of becoming.43 Thus, as reflected in the rock song “My Generation” composed by Pete Townshend and recorded by the rock band The WHO in their same-named 1965 debut album, in our youth we seek out our own identity, free from the criticism of parents and authority.44

Indeed, the song “My Generation” celebrates a newly found sense of self-autonomy while also expressing the angst and insecurity of youth.45 However, as Pete Townshend has continued his career into his seventies, it might also be regarded as an anthem about finding your place in the world, as well as the younger person’s uncertainty about the next steps in development that lie beyond adolescence and the time of youth.46 Indeed, in his music and throughout his career, Townshend has characterized the struggles of forming and maintaining a mature identity, as well as other life challenges that occur throughout the life cycle.47 Thus, the song “My Generation” might, as the sociologist Lars Tornstam posits in his gerotranscendence theory, reflect the analytical lens of young adulthood, which often portrays aging merely as a pathological process.48 This “young” lens omits the recognition of aging and later life development as a natural and holistic process. Yet as Tornstam proposes, as we encounter physical changes and health challenges in later adulthood, we are likely to revise our understanding of the ups and downs we experienced at earlier times in development, what we consider as our most important accomplishments, and what living a “fulfilled life” means in old age.49 Thus, aging should not be thought of as simply a time of decline and decrement, but rather as a continuation of discovery and new awareness of life’s mysteries. Optimistically then, old age may best be understood as a time of fresh possibilities as life experiences unfold and new horizons come into view.

To help us see that aging is a natural and holistic process, we might characterize our development to be much like a literary work. That is, the process of aging is like a great novel, with many chapters that relate our life story – stories that have become interwoven and more elaborate as the person continues in their developmental journey into old age.50 Indeed, despite the various changes in physical and intellectual capacities that may occur, many older adults express a shift in how they perceive and understand their aging, which is revealed in statements like, “I am doing so much more now, and understanding things so much clearer than I did than when I was younger – even with the physical changes and unwelcomed health problems that make me feel like my hands are tied behind my back!” As a result, many older adults describe their life story, their hopes and goals, and their ability in overcoming life’s next challenges in a generative and empowered way.51 They convey a sense, irrespective of what they may have conceived old age to be like earlier in life, that they have more to contribute and more to do as they continue in their development.

Physical Changes in Later Life

Each person’s life story, undoubtedly, contains discussion of the physical changes that occur as we mature and the health concerns that arise as we age. Indeed, most of us will become keenly familiar with these changes and concerns as we mature and age. Key to our understanding, then, is recognition of the biological processes that underlie the physical changes that occur throughout the adult years. From the expression of growth hormones that innervate development throughout the earliest times in life, to the release of sex hormones and maturation of secondary sexual characteristics at the onset of puberty, to the time of menopause and andropause at midlife, we note a close rhythmic relationship between biological processes and physical changes that occur across the life span. These changes, however, especially as we move into the second half of the life span, are not necessarily embraced or accepted. Indeed, since ancient times there has been an interest in finding, as the Spanish explorer Ponce de Leon ventured, a “fountain of youth” that would extend life and prevent the declines of aging.52 Moreover, a noted and frequent topic of sacred music is the seeking and finding of “an elixir of new life.” Thus, both in Western and Eastern traditions, we also find reference to and a hope for a “fountain of life” that would resolve the existential crises associated with our physical decline and death, and provide us a life that would never end.53

To enlighten our understanding beyond the ancient yearning for “a life everlasting,” as biomedical scientist Kunlin Jin describes, biologists have offered theories of aging that point to genetic programming, as well as to damage or programming errors that may occur in the natural decline and degradation of the body’s physical systems.54 These programming theories suggest that aging follows a biological schedule of sorts. For example, the programmed longevity theory suggests that there is a predetermined switching on or off of genes that controls early pediatric growth, the onset of puberty and menopause, as well as when age-associated deficits and death of cells occur. Thus, from this theoretical perspective, processes of maturation, aging, and death are suggested to be an execution of our genetic programming. Another programming theory suggests that the neuro–endocrine system serves as an aging clock. The endocrine theory proposes that aging is hormonally regulated and that factors such as a healthy coping style and traumatic life stressors may respectively slow or speed up rates of aging. The physical changes (e.g., graying of hair, wrinkling of skin, increased risk for hypertension, stroke) we often observe when a person becomes President of the United States, with all the extreme mental stress of this job, provide some visual evidence suggesting the endocrine system as a moderator of biological aging.55 A third programming theory, immunological theory, suggests that there is a biologically planned immunological response, which invariably becomes less efficient and thereby increases our susceptibility to infections and disease as we mature through adulthood, and as a result causes aging and the occurrence of death.

In contrast, other biological accounts of aging include theories that highlight the accumulated wear and tear to biological systems over time. These theories emphasize damage and programming error, and the idea here is that like a piano, in due course and with continuous use, hammers and mechanical action parts become worn, strings corrode, and the soundboard cracks. Indeed, with advancing age, biological systems just wear down or go awry. One early theory of this type, put forth near the height of industrialization in 1882 by German biologist August Weisman, was aptly called the wear-and-tear theory.56 This theory suggests that the cells and structures of the body, much like other mechanical systems, as a result of the strain and stress of continued use, simply become exhausted and wear out. More recent wear-and-tear theories include cross-linking, free radical, and DNA damage theories. Cross-linking theory suggests that over time a gradual accumulation of cross-linked proteins within the cell occurs and that this cross-linking results in cellular changes and tissue damage, which slow bodily processes and cause aging. Free-radical theory also suggests modification of cellular processes, positing that unstable oxygen atoms are created through normal metabolic processes and are thrown off, causing oxidative stress or damage to the cell’s DNA and other structures. This oxidative damage accumulates over time, producing a decline of cell and organ function that causes aging. The DNA damage theory also focuses on the occurrence of damage to DNA within the cell and the inability of cellular repair mechanisms to keep up with the damage that occurs. This theory highlights the variation in the RNA-DNA transcription that results in genetic mutations. Over time, the accumulation of genetic mutations and associated damage causes cellular deterioration and malfunction that represents biological aging.

All of these theories provide scientific accounts for aging, whether it is the shortening of the telomeres during DNA replication that impacts the cells’ response to stress and continued growth, a cross-linking of proteins within cells that makes the cells of the body stiffer, free-radical production that causes damages to inner structures of the body’s cells, or a programmed cell death that implies that a self-destruct command may be part of the genetic program that controls cellular processes. As we look beyond the cell, then, and consider other systems of the body (musculoskeletal, endocrine, limbic, pulmonary, etc.), we realize that each of these systems also shows the basic effects of genetic programming and the wear and tear of aging. Thus, as we consider these various theories, both genetic and nongenetic processes can be recognized as causal factors influencing aging processes. Further, as we again think about how we understand aging, we realize that many of the physical changes we encounter often produce an associated psychological effect. For example, as we have grown from childhood into adulthood, we have experienced different feelings about our new “adult” physical characteristics and abilities. The thoughts and feelings we had about our development have often been positive, but at times we might have also felt a bit awkward about how we looked or the ways we felt about our bodies. Similarly, with development into midlife and old age, we continue to take notice of and consider other physical changes. For example, we experience wrinkling of skin and change in hair color and texture, as well as other physical capacities such as strength and stamina. In response, we may have undertaken a sort of psychological zero-sum calculation to understand how our physical abilities and limitations may impact upon ideal images of self, as well as our interpersonal and environmental interactions. The result of these calculations at midlife or in old age may be positive in that we believe we “still have it!” despite some apparent declines in physical abilities over the years or negative in that we feel we are “over the hill” a bit and headed toward more decline.

Longevity and Health

Living to a ripe old age is something many of us hope to do. But the question of how long one might live is often qualified by the choices we make and the ways in which we live. In casual conversation, many of us, with some unease, may remark that we do not hope to end up living and dying in a nursing home. In fact, having to live in a nursing home is a rather uncommon occurrence for most older adults. The US Bureau of the Census suggests that around 3 to 4 percent of adults age 65 or older lived in nursing homes in recent census counts.57 However, there is a caveat to recognize here, and it is that the rate of nursing home use increases with age: The number of older adults living in skilled nursing homes ranges from about 1 percent of adults 65 to 74 years of age, to 3.2 percent of those 75 to 84 years of age, to around 10 percent of those 85 to 94 years of age, and to nearly 25 percent of those ages 95 and older. Nonetheless, it is still unlikely that most of us will breathe our last breath in a nursing home. In fact, in western societies, most people die at home or in hospice care.58

As we consider the physical challenges and existential concerns of later life, it is important to note that with advancing age comes an increased risk for illness and death. Thus, as a matter of fact and without illusion, we recognize that illnesses will occur throughout the adult years, and each ailment and sickness represents an increase in risk of death. Indeed, as suggested in Tornstam’s gerotranscendence theory, like the shadow we cast as we walk along in the afternoon sunlight, illness and death are part of an increasing personal awareness of the physical limitations that we experience in later life.59 These limitations both inform and offer us a new awareness of our relation to life processes and the joining of our personal sense of being with the perils of illness and disease. Thus, at midlife, there is an existential resetting of our “life clock” from the early reference point of youth and “all the physical ways I’ve grown up and all the things I’ve accomplished and experienced since I was born or my last birthday” to a time of a mature awareness and a consideration of “all the things I still might hope to do before I die.”60

Uneasily, some of us might be asking now, “But what types of illnesses and causes of death are we talking about?” In research that considered the top 5 causes of death of men and women in the United States, it is reported that about 20 percent, or 1 in 5 people, die of ischemic heart disease (or coronary artery/heart disease), followed by dementia of the Alzheimer’s type (8.3 percent and 12.7 percent for men and women, respectively), lung cancer (7.4 percent and 6.7 percent for men and women, respectively), chronic obstructive pulmonary disease (almost 6 percent for both men and women), and cerebrovascular diseases (5 percent and 7.3 percent for men and women, respectively).61 Rounding out the top 10 causes, this same research notes various forms of cancers (prostate, 2.8 percent; breast, 3.4 percent; colorectal, 2.6 percent for men and 2.5 percent for women), lower respiratory infections (roughly 3 percent for both men and women), diabetes (almost 3 percent for both men and women), and chronic kidney disease (almost 3 percent for both men and women) as causing death. Collectively, these causes of death are also suggested to be linked to a wide range of risk factors that go beyond genetic predisposition and include lifestyle factors such as poor dietary habits (high-fat and high-calorie foods), use of or exposure to tobacco smoke, use of alcohol and drugs, obesity, low physical activity, and working in hazardous environments.

So, what are the secrets to a long life? We often hear the health-associated exhortations to exercise, eat right, refrain from tobacco products, or drink in moderation. Is that enough? Our risk for disease and the causes for our death strongly relate to the lifestyle choices we make and our ability to eat healthy foods, exercise, limit our use of alcohol and tobacco products, and practice safe sex and healthy mental hygiene. Further, physical activity is recognized as an essential healthy lifestyle practice that prevents risk of disease and aids the management of chronic illness. Indeed, as reported in research by mobility and balance scientist Stephanie Studenski and colleagues, physical activity is an important dimension of health. They note that at age 75, walking-gait speed predicts 10-year survival for both men and women.62 Moreover, these researchers suggest that walking speed is as important a predictor of mortality risk as are age, chronic health conditions, use of mobility aids, and other predictive factors such as smoking history, blood pressure, body mass index, and hospitalization history.

Should we join a marching band then? Well, maybe – if that is a way for you to find fulfillment in your living. Indeed, in reviewing a longitudinal study ongoing since 1921 that followed children into later life, health psychologists Howard Friedman and Leslie Martin report that all of the commonly prescribed health practices, such as getting more exercise, improving dietary habits, a moderate use of alcohol, and abstaining from tobacco, are secondary to living a fulfilled life.63 What these researchers indicate is that the “real” secret to a long life is to have a sense of living a purposeful and meaningful life!

Music and Mind–Body Interaction in Later Life

When we consider the ways in which we may live in later life, we are reminded of the older adults we have observed. For example, one author relates a concert he attended in the 1980s by the Spanish classical guitarist Andres Segovia, who performed well into his nineties.64 Then at eighty-eight years of age, Maestro Segovia, with careful and slow steps, was escorted to his chair on the stage and once seated performed in a way that was wonderfully animated and full of passion. In that hour or so of his performance, he was again youthful and agile, alive with the energy and effervescent spirit of the music he performed.  In this example there is something of importance to recognize – something much deeper than just the activity of playing music to acknowledge. It is that in our playing of a musical instrument, singing, attending a concert, or just listening to a recording, we are involved in a ritual of sorts – a musical ritual that activates our memory and connects with our emotions that lends new insight into our current living and life experiences. Thus, whether performing or just listening to music, we become immersed in a mind–body interaction, one that reflects an ancient practice calling us to life.65 Moreover, like many other creative activities, music may connect us to the deepest moments and points of reference in our life journey. So the benefit of music is not just in the physical activity, but also in the way music may psychologically buoy us and be a navigational guide as we quest for deeper meaning in our living.

As Candace Pert, neuroscientist and leader in the discovery of the opioid receptor, has proposed, wellness and illness have a psychosomatic component.66 According to Pert, every system of the body is coordinated and run via the “molecules of emotion” (e.g., acetylcholine, dopamine, norepinephrine, testosterone, estrogen, oxytocin). Our thoughts and actions affect the production and uptake of neurotransmitters and vice versa. Thus, our emotional experiences and expressions affect the balance of the neuropeptide–receptor relationship throughout our body and, resultantly, our immunological system response and healing.67 These neurochemical processes underlie cognitive-to-physiological relationships and the mind–body interaction.68 Further, there is a wide array of cognitive and behavioral therapies that both induce and demonstrate mind–body interactions such as the relaxation response and that serve as alternate therapies or adjutants for traditional medical therapies.69

Therefore, in accord with the mind–body interactions of playing or listening to music, other health-associated benefits (psychological, emotional, social, and spiritual) are to be recognized. Research exploring the connection of music to the quality of life in older adults reports that musical activities such as listening to and making music influence how older adults may characterize and express enjoyment about their lives.70 Further, research by music psychologist Stefan Koelsch and neuropsychologist Lutz Jäncke reports that in contrast to listening to tranquilizing music, listening to exciting music increases heart and respiration rates and affects regional activity of the heart as measured by electrocardiogram.71 Moreover, these same researchers suggest that in contrast to silence, listening to pleasant, unpleasant, or simple isochronous sound pulses (i.e., sounds without melody, rhythm, or harmonies) was found to increase heart and respiration rates as well as reduce heart rate variability, again suggesting the powerful effect of the “musical beat” to play an important role in the autonomic nervous system responses to music. Other research has indicated that musical activities such as playing the piano may boost the level of general bodily activity (e.g., increases in blood flow and heart rate, and blood pressure proportional to exercise intensity) similar to that of taking a brisk walk.72

With regard to the health benefits of singing, research by the health and music research team of Stephen Clift and Grenville Hancox reports that members of a university choir self-reported that their participation enhanced mood and reduced stress, as well as improved lung function, breathing and posture, and feeling of being more energized.73 Other longitudinal research following almost 13,000 adults in Sweden suggested that, after controlling for other risk and confounding variables, attendance at cultural events, reading, and singing in a choir were associated with lower mortality risk.74 Furthermore, as geriatric psychiatrist Gene Cohen noted, involvement in music has a beneficial general health effect.75 For example, in a 30-week intervention study where ambulatory and healthy enough to participate older adults were assigned to sing in a choral group or to a similar social activity control group, at the 12-month follow-up survey, the choral group self-reported higher rates of physical health and lower rates of doctor visits, use of medication, instances of falling, and health problems compared to the control group,76 thus suggesting that music is more than a mere pastime experience that reflects significant life experiences and our celebration of our living, but also a way of maintaining wellness!

Music and Exercise

Getting started and staying with an exercise routine is problematic for many older adults, especially during rehabilitation following an injury. Research using music therapy as part of a rehabilitation program, however, suggests that listening to instrumental and vocal music spurred older adults’ compliance to the physical exercise program.77 Thus, special aspects of music may play a key role in motivating and directing individuals in their exercise routine. For example, a particular piece of music’s rhythm, its melodiousness, and its cultural impact and association all have been noted to affect psychophysiological processes, with rhythm being the most important.78 Further, exercising to music that highlights its vibrant rhythmic flow is suggested to increase participants’ fun and enjoyment and thus their intrinsic motivation to exercise.79 Moreover, similar to what is noted in young athletes, for older adults who are athletes or exercise regularly, music may serve to enhance mood and allow for dissociation from unpleasant feelings such as pain or fatigue, affect pre-event activation or relaxation, reduce perceptions of exertion during aerobic training and increase attainment of flow states, and extend work output and the acquisition of motor skills via the synchronizing of movement with music.80

When reduced strength or disability prevents individuals from participating in traditional aerobic types of exercise programs, activity programming that incorporates the movements of the orchestra conductor may provide another opportunity for physical exertion and benefit. For example, Conductorcise, a program that is oriented around listening to music and conducting the orchestra, created by conductor, clarinetist, and educator David Dworkin, pairs the physical movements of the conductor with the expressive themes of recorded orchestral music. Research examining the benefits of Conductorcise suggests it to be a viable technique to enhance mental and physical activity levels, and thus improve healthfulness, even for frail older adults.81 Hence, as the research suggests, we see a rather substantial and wide influence of music as a component of physical exercise routines. In the next section and throughout the book, we will continue to explore ways musical activities may define and direct our everyday living and what we may do to improve our health and well-being, and age in a celebratory way.

Music as a Condition for Utopian Living: Environment–Behavior Relationships

As we found in the area of exercise, music may serve as a guide and motivator for physical activity and optimal athletic performance. Indeed, music transports us to a “different place.” In many ways, then, as Sir Thomas More’s Utopia describes,82 we recognize music as an essential aspect of the “ideal” living conditions for older adults. What is more, music has been recognized as a key element of the idyllic environment throughout the Utopian literature. For example, from the Epic of Gilgamesh,83 where there is no illness, no old age, and no mourning, to the place of Elysium noted in Homer’s Odyssey,84 with its “permanent background music provided by nightingales,”85 to Edward Bellamy’s Looking Backward: 2000–1887,86 where having orchestral music piped into every home effectively creates a paradise in which the limits of human felicity are realized, we find music distinguished as one of life’s great tonics and essential dimensions of the ideal environment.

In More’s story of Utopia, he envisions a society where respect for and the privileges of old age are celebrated, and living is pleasurable. Focusing on pleasurable living, More posits that “we’re impelled by reason as well as an instinct to enjoy ourselves in any natural way which does not hurt other people, interfere with greater pleasures, or cause unpleasant after-effects.”87 In his description of “pleasure,” More further suggests it to be characterized in various physical–sensory experiences, as well as the deeper mental processes of learning and understanding, and via our reflective contemplation and seeking of “truth.”

There is, however, a distinction of how physical–sensory pleasures may be characterized. As More discerns, we should distinguish physical–sensory pleasures directed by organic needs, such as the quenching of our thirst, in the satisfaction of eating food, relief of bowel or bladder tensions, or the discharge of sexual energies, from other sensory pleasures that are not directed by organic needs. This latter type of pleasure, experienced via the sating of bodily requirements, powerfully occupies our senses and emotions and “is the pleasure of music.”88 Thus, similar to what we find in the area of physical performance, music, from deeply cerebral orchestral works to foot-tapping folk songs, occupies our thinking and feeling, and compels our behaviors through its affordance of pleasure. Further, in our enjoyment of music and what it reveals about us, we again become aware of deeper aspects of our human nature.

Each of the utopian stories briefly noted, those of Gilgamesh, Homer, Bellamy, and More, focus on human happiness and how we might better arrange physical and social environments so that everyone experiences acceptance, honor, and joy in their living. However, when we look closely at the lives of older adults throughout the world, we recognize the very difficult and challenging conditions many endure, and the hardship and suffering they experience. Yet, we can imagine a place like Utopia and hope of its discovery. We can also realize it is yet within our ability to create such an environment. But how might we go about creating a “utopian-like” environment, where we can experience the best living conditions and fulfill our life potentials? This is a concern that seemingly interests and involves us all, not only as a desire that everyone may live in a place that provides safety and security, but also as a hope of how we can help each other be healthy and find remedy for life challenges.

The utopian notion of an ideal environment that, when created acts to bring forth the superior nature of the person and community, in many ways is reflective of the mind–body, yin–yang dialecticism found in Eastern philosophy. That is, much like the harmonic consonance and dissonance of tonal relations found within music, there is a wholeness and harmony revealed in the unity and interdependence among opposing elements. This philosophical perspective is one that has been appreciated and expressed in the psychological writings offered by Carl Jung and Carl Rogers,89 has had a growing influence within Western and global psychology,90 and is thus signified by the notion of “dynamic equilibrium,”91 the “yin-yang of wellbeing,”92 and the “mind-body monism” of alternative medicines.93 Eminent in describing this dialecticism between life forces is the Tao Te Ching,94 which inspires axiomatic expressions such as “the bass and the treble complement one another,” “the subjective experience and the aural surround share the same moment,” and “music’s melodic form and its emotional content arise from one another.”

With regard to factors that influence processes of aging, similar reciprocal relations involving social–environmental, psychological, and biological systems have been proposed as interacting forces that dynamically mediate physical changes and declines throughout adulthood.95 Thus, to move closer to the creation and realization of utopian living, an embrace of contextualism – the perspective that recognizes interdependent relations between behavior and environment – is prescriptive. Indeed, a guiding principle of modern psychology is that to best understand people’s needs and their behaviors and to improve their emotional and physical wellness, we must also understand and have knowledge of the sociocultural and physical context in which they live.96

Music as an Aspect of Utopia: Reprised

If music is a source of pleasure, how might we use it to enhance the living environment for older adults, including those who are still very independently living within the broader community? One way, as Bellamy alludes, is to arrange for music to be available during certain times of the day in retirement centers, assisted-living residences, nursing homes, as well as homes of community-dwelling older adults, so as to offer opportunity to find enjoyment and enhancement of human felicity.97 Indeed, having the choice of participating in musical activities (e.g., attending a concert, background listening, performing) is one way for older adults to maintain feelings of competency and personal control.98 In this regard we find a rich use of musical activities by older adults to discover and find deeper meaning and joyfulness in living. For example, interviews conducted by music educator Terrence Hays with adults in Australia ranging from sixty to seventy years of age who were casual music listeners as well as amateur and professional musicians documented the importance of music in the lives of older adults.99 As participants noted in Hays’ research, music affords an opportunity to express one’s individuality and inner self, and to enjoy psychologically elevating experiences. Indeed, participants reported that music affects their whole being – physical, mental, and spiritual. Further, in support of the utopian positions offered earlier that music is a source of pleasure and a way to enhance and to find the highest boundary of our “human felicity,” many participants noted that music provides a source of pleasure that is psychologically uplifting.100 Other research participants interviewed by Hays emphasized how music impacted their general well-being and alluded that much like a massage, music produces a soothing and calming effect.101 In addition, similar to what we noted in the area of exercise and athletic performance, listening to music was also reported to help in structuring the daily routines, in feeling competent and in control, in completing mundane chores such as housework, or in making going for a walk more enjoyable.102 Perhaps most remarkable were reports that, like the background music of “nightingales singing” suggested in Homer’s utopian world, music filled an “emptiness” in their life after work or careers have ended or spouses and friends have passed on.103

Furthermore, the influences of music on the lives of older adults are widespread and reported within many different cultural communities. For example, qualitative research by Darina Petrovsky and colleagues, exploring how older adults from predominantly African American community choirs perceive their involvement, report that participants’ characterize their singing as doing something they love, where they benefit from having a joyful time together and the exhilaration of performing for others.104 In a related manner, recognizing community singing as a potential intervention to enhance quality of life, experimental research by Julene Johnson and collaborators involving community-dwelling older adults from diverse backgrounds reports involvement in the community choir to reduce loneliness and increase interest in life.105 Similarly, research by Jane Southcott and Rohan Nethsinghe, exploring the phenomenological experiences of elderly Russian immigrant members of a community choir in Australia, suggests that singing may enhance the individual’s sense of autonomy and resiliency, communal connection, and access to inner resources that aid in meeting life’s challenges.106 Other research by Southcott and Sicong Li, exploring older Chinese adults’ involvement in a weekly singing class, suggested community singing provides a way to enhance emotional, physical, and psychological well-being.107 As these studies collectively suggest, music helps to coordinate and in a positive way accentuate the lives of many older adults. Moreover, considering deeper psychological influences, music may broaden access to engaging social and communal experiences, and make aware psychological resources that gird up and improve the quality of life.

At the Center of Life’s Celebration

We will take up more specific discussion of quality of life and how music may enhance well-being and produce healing in later chapters. But let us end this chapter by describing a few places where music serves as a catalyst for the celebration of living. One place of special note is Casa di Riposo per Musicisti, a retirement home for musicians in Milan, Italy.108 Founded in 1896 by the composer Giuseppe Verdi, and thus simply known as Casa Verdi, is a residence where both young and older retired musicians live. It is a place where music is always heard and performed, and where older musicians continue to teach and learn from younger musicians. Much like the operatic masterpieces Otello, and Falstaff, which Verdi composed during his seventies and respectively premiered at ages seventy-four and seventy-nine,109 Casa Verdi is a place of vibrant living. It offers an abundance of care, respect, and support, and where, for both young and old, there is opportunity to discover deeper meaning and purpose in living. Thus, Casa Verdi is one example of a “utopia”– a place where we find younger and older generations living in harmony and working together, with music at the center of life’s celebration.

Another reflection of the utopian ideal is the Triangel Partnerschaften, or Triangle Partnership, in Braunschweig, Germany.110 This project brings together gifted high school and university students with nursing home residents to sing and play music together. Like Casa Verdi, this partnership hopes to provide benefits for everyone involved: For older adults it is the opportunity to continue to be involved with younger people, to remain intellectually stimulated, and to be active in the expression of their musical talents, as well as to explore and find new meaning in their living. For high school students, it is the opportunity to perform their music outside the school and to learn from their social interaction with the older adults. For university students, it is the opportunity to learn about the critical application of music therapy with older adults. Thus, as it is aptly named, this collaborative partnership offers and promotes intellectual, social, and personal enrichment for both younger and older musicians.

A similar intergenerational program is offered at The George Center,111 an American music therapy center near Atlanta, Georgia. Incorporating music throughout all its care programs, The George Center brings preschoolers and assisted-living residents together to sing, dance, and play, and combines high school and college students with older adults in an intergenerational rock band. The George Center also offers a wide array of music therapy programs that include interventions to improve memory and neurocognitive functioning, and to promote a healing experience in end-of-life care. The reported positive outcomes of The George Center’s hospice, hospital, and neonatal care music therapy programming has been reduction in the length of stay and use of certain types of drugs, along with lower overall cost of treatments.112 Thus, like the aim of Casa Verdi and the Triangle Partnership, the programs at The George Center are intended to be educational and inspirational for all involved, and to herald a celebration of living.

As Ralph Waldo Emerson alludes, music innervates connections between mind-body-spirit, stirring our emotions and influencing the expression of our living. Indeed, music inspires our most complex feelings, thoughts, and actions – and as an essential aspect of our experience, provides us comfort and a place where we can feel we belong and celebrate our living. In Chapter 3 we will further consider how music may be a source of enjoyment and connection with others, as well as its effects in sensory and neuro–cognitive processes.

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