Sounds of Difference: A Typology of Reactions of People With Dementia to Individualized Music in the Presence of a Monitoring Person.

Background And Objectives: Despite promising effects of individualized music listening (IML) for people with dementia, the individualized nature and heterogeneity of reactions to IML remain underexplored. We aimed to develop an empirically derived typology of directly observed reactions of people with dementia to IML and propose recommendations for tailoring the intervention to the respective types.

Research Design And Methods: An ideal-type analysis was conducted on 108 video recordings of 45 people with mainly severe dementia (78% female, mean age of 83.02 years, all White participants) listening to recorded individualized music. Dimensions were identified for capturing similarities and differences between types.

Results: The analysis yielded 10 types of reactions ("expressing and sharing joy," "self-disclosure stimulated by music," "concentrated, absorbed listening," "blissful enjoyment," "experience of the music as bittersweet," "sharing memories," "releasing tension," "tensing up and rejecting," "predominant search for social exchange," "no interpretable reaction") and 3 dimensions ("valence" from negative to positive, "arousal" from calm to activated, "communicative activity" from defensive/resistant to proactive), resulting in a three-dimensional coordinate system, providing a holistic representation and facilitating a systematic contrast of identified reaction types to IML.

Discussion And Implications: Reactions to IML were influenced by the interaction with the project staff, who monitored the sessions. Based on these observations, we propose recommendations for tailoring both the behavior of the monitoring person (e.g., engaging in synchronous activities like clapping along) and the setup of the intervention (e.g., communal vs individual listening) to each type, which may improve the effects of IML.