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Learning to play a musical instrument provides a peaceful retreat from the pressures of daily life. Therapeutic outcomes of playing music include better communication skills, improved emotional release, and decreased anxiety and agitation.1 Musical training promotes cognitive function, mental health, and a connection to others.2,3
Depression
Impacting 14.8 million people, depression is the most prevalent mental health issue for adults aged ≥ 55 years and accounts for 10% of all medical disability in the U.S. and Canada.4-6 About half the people diagnosed with depression also have an anxiety disorder, which can lead to smoking, drinking alcohol, overeating, and complicated health care issues.5 By 2020, depression is predicted to be the second most common disease in the world and cost employers about $23 billion in absenteeism.4
Hays and Minichiello found that learning to read music and play the piano might enhance mood and certain aspects of the quality of living indicators in older adults. Those aged ≥ 65 years who participated in playing music reported improved self-esteem, greater independence, and fewer feelings of isolation. In addition, playing music created a temporary escape from the stress of daily life.7 Seinfield and colleagues compared a piano training group with a control group (nonplaying) and found that those who played piano experienced a decrease in psychological distress, depression, and fatigue.8 Playing an instrument can positively impact the well-being of older adults throughout life by promoting empowerment, autonomy, and social cohesion.7-11Manalai and colleagues found that a single episode of playing the piano was beneficial for a 91-year-old female patient who previously played when she was young and who was currently experiencing psychotic and depressive symptoms. Following playing, the patient’s vocabulary and insight temporarily improved. For the first time since her admission, the patient provided many details about her past mental and physical health. Even though the patient never played again, due to her delusional disorder, the improvement in mood and cognition were sustained for several months.12 The researchers noted that the patient’s temporary improvement may have been attributed to other factors.12
Another study measured levels of anxiety, depression, and loneliness in senior citizens. Study participants who regularly participated in a keyboard class were less anxious, depressed, and lonely compared with the control group.13 Other studies support the idea that music can modulate emotional responses and enhance cognitive performance.14,15
Mind Stimulation
As people age, they will experience progressive physiologic losses in function, such as auditory, cognition, memory, and motor control.16,17 Affect or mood can also be impacted.8 Consequently, there is a focus on promoting nonpharmacologic solutions that protect against age-related health issues. For example, musical training for adults that involves sensorimotor practice produces greater changes in the auditory cortex than does the equivalent experience involving only auditory training.18 Research indicates that age-related auditory decline can be mitigated by musical training.19 Evidence also supports cognitive stimulation, which may help reduce the likelihood of cognitive impairments in advanced age.16,17
The brain works on a principle of “use it or lose it.” Therefore, exercising the brain is important, and musical training may fill that need. Learning a skill such as playing an instrument reorganizes the brain’s neural pathways.2,16 Brain plasticity is the ability of the brain to change its structure, and engaging older adults in sensory, cognitive, and motor activities creates positive outcomes.16,17 Research also indicates active participation in music lessons creates larger plasticity effects than does passively listening to music.16 Musical training provides a multisensory activity that requires integrating signals from different sensory modalities with motor responses.16 Verghese and colleagues found that individuals who played a musical instrument were less likely to experience dementia than were those whose leisure activities consisted of reading, writing, and working crossword puzzles.20 Verghese suggested that 6 months of piano lessons in older adults improved the brain’s executive functioning (regulates abilities and behaviors) and working memory (ie, keeping track of information).20 Balbag and colleagues who conducted a study of twins found that “playing an instrument in older adulthood is significantly associated with reduced likelihood of dementia and cognitive impairment.”21 Musical training is also associated with improved visual memory and the ability to divide the individual’s attention between several activities. This ability is crucial for activities such as driving and is useful for navigating crowded areas, such as a mall.22,23
Dexterity
Musical training also has been found to be beneficial for stroke survivors, because this type of training elicits a change in the reorganization of the sensorimotor cortex that results in improved movement quality.24 Piano playing can lead to meaningful improvements in manual dexterity, finger movement coordination, and functional use of upper extremities.25
Zelazny studied the effects of keyboard playing on 4 older adults with osteoarthritis who over 4 weeks had 30-minute sessions of electronic keyboard playing 4 days per week.26 The researcher found that participants reported decreased arthritic pain, increased dexterity, and increased finger strength. Playing the piano requires both eye and hand coordination, which is essential as a person ages. Improved dexterity of fine motor skills can assist individuals with the activities of daily living, such as buttoning a shirt and using a remote control.26
Stress Reduction
Life is filled with stressors, and anyone can have difficulty coping with daily stress. According to Toyoshima and colleagues, playing the piano can lower cortisol levels and decrease a person’s anxiety level.27 These researchers compared the activities of piano playing, calligraphy, and clay molding and found that playing the piano was significantly more effective at lowering stress levels when measuring salivary C-reactive protein levels and State-Trait Anxiety Inventory (STAI) scores.
Another study found stress reduction was significant for participants who played the keyboard compared with participants who relaxed, read magazines, or solved puzzles.28 Stress has a negative impact on the immune system, which can increase an individual’s risk of disease. According to Mohd “emotional stress is a major contributing factor to the 6 leading causes of death in the U.S.: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver, and suicide.”29
PTSD and Guitars for Vets Program
Guitars for Vets is a nonprofit organization with 25 chapters that uses music to assist veterans with physical and mental health injuries.30 The program provides free guitars and weekly music lessons taught by volunteers. The weekly music lessons create a forum for veterans to socialize and share personal experiences, thus contributing to their healing process.30 A randomized, controlled pilot study was conducted with veterans diagnosed with posttraumatic stress disorder (PTSD) who may have physical and mental changes such as self-isolation from others, night sweats, flashbacks, and depression.31
The study participants had weekly private guitar lessons for 1 hour and a group learning session. The results showed positive outcomes in both PTSD and depression symptoms after 6 weeks of guitar lessons.30 One veteran with PTSD who participated in the Guitar for Vets Program stated, “I came here with some real serious anger issues; this takes my mind off everything.” This veteran noted that as he practiced, a peaceful feeling enveloped him and the memories of trauma faded.32
Personal Experience
Following the completion of my PhD, I started piano lessons as a hobby. I also found engaging in playing music helped me to psychologically cope with the overwhelming stress of having a parent with a debilitating disease.
My dad was diagnosed with Parkinson disease, making it difficult for him to view life positively. Piano lessons helped him to mentally deal with his disease. Dad genuinely looked forward to his music lessons and was able to focus on practicing the piano rather than on his disease. I believe playing the piano prevented him from becoming depressed and kept him engaged, because he was accomplishing something.
Dad’s Parkinson disease has progressed; he is now in a nursing home. My gift to Dad is playing the piano for him. I sincerely believe it helps him cope with his disease or at least temporarily forget about it. His mood changes, and he becomes more animated. In his more lucid moments, we play music together. Playing music has a magical way of creating peace within the mind. Plato is often attributed with the quote, “Music gives a soul to the universe, wings to the mind, flight to the imagination, and life to everything.”
Conclusions
A healthful lifestyle includes holistically addressing issues pertaining to mental and physical well-being. Learning how to play a musical instrument is a workout for the brain, just as physical exercise is a workout for the body; both are necessary for optimal health. Evidence exists to support the hypothesis that playing an instrument elicits brain changes that positively influence cognitive functioning and decreases stress. Despite the lifelong benefits of playing an instrument, only about 8% of adults aged > 18 years play a musical instrument.33
Playing a musical instrument provides health benefits without the adverse effects that accompany pharmacologic therapy. It also can help improve social skills and provide individuals with a sense of achievement. Group music lessons provide an opportunity for people to build bonds and positively affect lifestyle choices.
In addition, engaging individuals in learning to play music may decrease the cost of health care when considering treatments for depression, PTSD, and substance abuse. Playing an instrument may help decrease the need for antidepressants and provide a healthy recreational activity. Based on its physical and mental benefits, learning to play a musical instrument should be explored as complementary alternative medicine. Compared with filling prescription medications over an individual’s lifetime, the cost of a portable keyboard is substantially less.
Given the benefits of increased coordination, social involvement, neural responses, and ability to focus along with improving fine motor skills and reducing stress, including music lessons as part of a veteran’s health care makes sense and is well worth further investigation and research.
Acknowledgements
The author would like to thank Jack Hooten, MHA, MSN, RN, and Jennifer Hammond, MS, for their help in preparing this manuscript.
1. Music for Veterans. Program results. Music for Veterans Website. http://www.music4veterans.org/program-results-1.html. Published 2014. Accessed January 11, 2016.
2. Miendlarzewska E, Trost W. How musical training affects cognitive development: rhythm, reward and other modulating variables. Front Neurosci. 2014;7:1-18.
3. Bergland C. Musical training optimizes brain function. Psychology Today. November 2013. https://www.psychologytoday.com/blog/the-athletes-way/201311/musical-training-optimizes-brain-function. Accessed January 22, 2016.
4. Witters D, Liu D, Agrawal S. Depression costs U.S. workplaces $23 billion in absenteeism. Galllup Website. http://www.gallup.com/poll/163619/depression-costs-workplaces-billion-absenteeism.aspx. Published July 24, 2013. Accessed January 11, 2016.
5. Anxiety and Depression Association of America. Facts and statistics. Anxiety and Depression Association of America Website. http://www.adaa.org/about-adaa/press-room/facts-statistics. Updated September 2014. Accessed January 11, 2016.
6. World Health Organization. The global burden of disease: 2004 update. The World Health Organization Website. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Published 2008. Accessed January 11, 2016. 7. Hays T, Minichiello V. The contribution of music to quality of life in older people: an Australian qualitative study. Aging Soc. 2005;25(2):261-278.
8. Seinfield S, Figueroa H, Ortiz-Gill J, Sanchez-Vives MV. Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults. Front Psychol. 2013;4:1-13.
9. Coffman DD, Adamek MS. The contribution of wind band participation to quality of life of senior adults. Music Ther Perspect. 1999;17(1):27-31.
10. Creech A, Hallam S, McQueen H, Varvarigou M. The power of music in the lives of older adults. Res Studies Music Educ. 2013;35(1):83-98.
11. Park A-La. Can musical activities promote healthy ageing? Int J Emerg Ment Health. 2015;17(1):258-261.
12. Manalai G, Manalai P, Dutta R, Fegan G, Scrofani P. Rapid improvement of depressive symptoms and cognition in an elderly patient with a single session of piano playing: a clinical treatment report. Aging Clin Exp Res. 2012;24(3):278-280.
13. Koga M, Tims F. Music making and wellness project. Music Teachers National Association Website. www.mtna.org/media/4686/2001AOY.pdf. Published 2001. Accessed January 29, 2016.
14. Becker J. Anthropological perspectives on music and emotion. In: Juslin PN, Sloboda JA, eds. Music and Emotion: Theory and Research. New York, New York: Oxford University Press; 2001:135-160.
15. Witvliet CV, Vrana SR. Play it again Sam: repeated exposure to emotionally evocative music polarizes, liking and smiling responses, and influences other affective reports, facial EMG, and heart rate. Cogn Emot. 2003;21:3-25.
16. Dawson WJ. Benefits of music training are widespread and lifelong: a bibliographic review of their non-musical effects. Med Probl Perform Art. 2014;29(2):57-63.
17. Mahncke HW, Connor BB, Appelman J, et al. Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci USA. 2006;103(33):12523-12528.
18. Lappe C, Herholz SC, Trainor LJ, Pantev C. Cortical plasticity induced by short-term unimodal and multimodal musical training. J Neurosci. 2008;28(39):9632-9639.
19. Parbery-Clark A, Strait DL, Anderson S, Hittner E, Kraus N. Musical experience and the aging auditory system: implications for cognitive abilities and hearing speech in noise. PloS ONE. 2011;6(5):e18082.
20. Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med. 2003;348(25):2508-2516.
21. Balbag M, Pedersen N, Garz M. Playing a musical instrument as a protective factor against dementia and cognitive impairment: a population-based twin study. Int J Alzheimers Dis. 2014;2014:1-6.
22. Oechslin MS, Van De Ville D, Lazeyras F, Hauert CA, James CE. Degree of musical expertise modulates higher order brain functioning. Cereb Cortex. 2013;23(9):2213-2224.
23. Patston LL. Balanced brains: an investigation of visuospatial ability and lateralization in musicians. Pyschmusicol. 2012;22(2):187.
24. Rodriguez-Fornells A, Rojo N, Amengual JL, Ripollés P, Altenmüller E, Münte TF. The involvement of audio-motor coupling in the music-supported therapy applied to stroke patients. Ann NY Acad Sci. 2012;1252(1):282-293.
25. Villeneuve M, Lamontagne A. Playing piano can improve upper extremity function after stroke: case studies. Stroke Res Treat. 2013;2013:1-5.
26. Zelazny CM. Therapeutic instrumental music playing in hand rehabilitation for older adults with osteoarthritis: four case studies. J Music Ther. 2001;38(2):97-113.
27. Toyoshima K, Fukui H, Kuda K. Piano playing reduces stress more than other creative activities. Intl J Music Educ. 2011;29(3):257-263.
28. Bittman B, Berk L, Shannon M, et al. Recreational music-making modulates the human stress response: a preliminary individualized gene expression study. Med Sci Monit. 2005;11(2):BR31-BR40.
29. Mohd RS. Life event, stress and illness. Malays J Med Sci. 2008;15(4):9-18.
30. U.S Department of Veterans Affairs. PPO 10-075–HSR&D study. U.S Department of Veterans Affairs Website. http://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141700403. Updated March 24, 2014. Accessed January 20, 2016.
31. Hooten J, Shipman D, Osting V. Posttraumatic stress disorder in veterans: inpatient assessment and management. Fed Pract. 2008;25(1):27-37.
32. WJLA. Music therapy program helps veterans with PTSD. WJLA Website. http://wjla.com/news/nation-world/music-therapy-program-helps-veterans-with-ptsd-98564. Published December 26, 2013. Accessed January 20, 2016.
33. U.S. Census Bureau, Statistical Abstract of the United States: 2011. Arts, recreation and travel section 26. U.S. Census Bureau Website. https://www.census.gov/prod/2011pubs/11statab/arts.pdf. Published 2011. Accessed January 11, 2016.
Learning to play a musical instrument provides a peaceful retreat from the pressures of daily life. Therapeutic outcomes of playing music include better communication skills, improved emotional release, and decreased anxiety and agitation.1 Musical training promotes cognitive function, mental health, and a connection to others.2,3
Depression
Impacting 14.8 million people, depression is the most prevalent mental health issue for adults aged ≥ 55 years and accounts for 10% of all medical disability in the U.S. and Canada.4-6 About half the people diagnosed with depression also have an anxiety disorder, which can lead to smoking, drinking alcohol, overeating, and complicated health care issues.5 By 2020, depression is predicted to be the second most common disease in the world and cost employers about $23 billion in absenteeism.4
Hays and Minichiello found that learning to read music and play the piano might enhance mood and certain aspects of the quality of living indicators in older adults. Those aged ≥ 65 years who participated in playing music reported improved self-esteem, greater independence, and fewer feelings of isolation. In addition, playing music created a temporary escape from the stress of daily life.7 Seinfield and colleagues compared a piano training group with a control group (nonplaying) and found that those who played piano experienced a decrease in psychological distress, depression, and fatigue.8 Playing an instrument can positively impact the well-being of older adults throughout life by promoting empowerment, autonomy, and social cohesion.7-11Manalai and colleagues found that a single episode of playing the piano was beneficial for a 91-year-old female patient who previously played when she was young and who was currently experiencing psychotic and depressive symptoms. Following playing, the patient’s vocabulary and insight temporarily improved. For the first time since her admission, the patient provided many details about her past mental and physical health. Even though the patient never played again, due to her delusional disorder, the improvement in mood and cognition were sustained for several months.12 The researchers noted that the patient’s temporary improvement may have been attributed to other factors.12
Another study measured levels of anxiety, depression, and loneliness in senior citizens. Study participants who regularly participated in a keyboard class were less anxious, depressed, and lonely compared with the control group.13 Other studies support the idea that music can modulate emotional responses and enhance cognitive performance.14,15
Mind Stimulation
As people age, they will experience progressive physiologic losses in function, such as auditory, cognition, memory, and motor control.16,17 Affect or mood can also be impacted.8 Consequently, there is a focus on promoting nonpharmacologic solutions that protect against age-related health issues. For example, musical training for adults that involves sensorimotor practice produces greater changes in the auditory cortex than does the equivalent experience involving only auditory training.18 Research indicates that age-related auditory decline can be mitigated by musical training.19 Evidence also supports cognitive stimulation, which may help reduce the likelihood of cognitive impairments in advanced age.16,17
The brain works on a principle of “use it or lose it.” Therefore, exercising the brain is important, and musical training may fill that need. Learning a skill such as playing an instrument reorganizes the brain’s neural pathways.2,16 Brain plasticity is the ability of the brain to change its structure, and engaging older adults in sensory, cognitive, and motor activities creates positive outcomes.16,17 Research also indicates active participation in music lessons creates larger plasticity effects than does passively listening to music.16 Musical training provides a multisensory activity that requires integrating signals from different sensory modalities with motor responses.16 Verghese and colleagues found that individuals who played a musical instrument were less likely to experience dementia than were those whose leisure activities consisted of reading, writing, and working crossword puzzles.20 Verghese suggested that 6 months of piano lessons in older adults improved the brain’s executive functioning (regulates abilities and behaviors) and working memory (ie, keeping track of information).20 Balbag and colleagues who conducted a study of twins found that “playing an instrument in older adulthood is significantly associated with reduced likelihood of dementia and cognitive impairment.”21 Musical training is also associated with improved visual memory and the ability to divide the individual’s attention between several activities. This ability is crucial for activities such as driving and is useful for navigating crowded areas, such as a mall.22,23
Dexterity
Musical training also has been found to be beneficial for stroke survivors, because this type of training elicits a change in the reorganization of the sensorimotor cortex that results in improved movement quality.24 Piano playing can lead to meaningful improvements in manual dexterity, finger movement coordination, and functional use of upper extremities.25
Zelazny studied the effects of keyboard playing on 4 older adults with osteoarthritis who over 4 weeks had 30-minute sessions of electronic keyboard playing 4 days per week.26 The researcher found that participants reported decreased arthritic pain, increased dexterity, and increased finger strength. Playing the piano requires both eye and hand coordination, which is essential as a person ages. Improved dexterity of fine motor skills can assist individuals with the activities of daily living, such as buttoning a shirt and using a remote control.26
Stress Reduction
Life is filled with stressors, and anyone can have difficulty coping with daily stress. According to Toyoshima and colleagues, playing the piano can lower cortisol levels and decrease a person’s anxiety level.27 These researchers compared the activities of piano playing, calligraphy, and clay molding and found that playing the piano was significantly more effective at lowering stress levels when measuring salivary C-reactive protein levels and State-Trait Anxiety Inventory (STAI) scores.
Another study found stress reduction was significant for participants who played the keyboard compared with participants who relaxed, read magazines, or solved puzzles.28 Stress has a negative impact on the immune system, which can increase an individual’s risk of disease. According to Mohd “emotional stress is a major contributing factor to the 6 leading causes of death in the U.S.: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver, and suicide.”29
PTSD and Guitars for Vets Program
Guitars for Vets is a nonprofit organization with 25 chapters that uses music to assist veterans with physical and mental health injuries.30 The program provides free guitars and weekly music lessons taught by volunteers. The weekly music lessons create a forum for veterans to socialize and share personal experiences, thus contributing to their healing process.30 A randomized, controlled pilot study was conducted with veterans diagnosed with posttraumatic stress disorder (PTSD) who may have physical and mental changes such as self-isolation from others, night sweats, flashbacks, and depression.31
The study participants had weekly private guitar lessons for 1 hour and a group learning session. The results showed positive outcomes in both PTSD and depression symptoms after 6 weeks of guitar lessons.30 One veteran with PTSD who participated in the Guitar for Vets Program stated, “I came here with some real serious anger issues; this takes my mind off everything.” This veteran noted that as he practiced, a peaceful feeling enveloped him and the memories of trauma faded.32
Personal Experience
Following the completion of my PhD, I started piano lessons as a hobby. I also found engaging in playing music helped me to psychologically cope with the overwhelming stress of having a parent with a debilitating disease.
My dad was diagnosed with Parkinson disease, making it difficult for him to view life positively. Piano lessons helped him to mentally deal with his disease. Dad genuinely looked forward to his music lessons and was able to focus on practicing the piano rather than on his disease. I believe playing the piano prevented him from becoming depressed and kept him engaged, because he was accomplishing something.
Dad’s Parkinson disease has progressed; he is now in a nursing home. My gift to Dad is playing the piano for him. I sincerely believe it helps him cope with his disease or at least temporarily forget about it. His mood changes, and he becomes more animated. In his more lucid moments, we play music together. Playing music has a magical way of creating peace within the mind. Plato is often attributed with the quote, “Music gives a soul to the universe, wings to the mind, flight to the imagination, and life to everything.”
Conclusions
A healthful lifestyle includes holistically addressing issues pertaining to mental and physical well-being. Learning how to play a musical instrument is a workout for the brain, just as physical exercise is a workout for the body; both are necessary for optimal health. Evidence exists to support the hypothesis that playing an instrument elicits brain changes that positively influence cognitive functioning and decreases stress. Despite the lifelong benefits of playing an instrument, only about 8% of adults aged > 18 years play a musical instrument.33
Playing a musical instrument provides health benefits without the adverse effects that accompany pharmacologic therapy. It also can help improve social skills and provide individuals with a sense of achievement. Group music lessons provide an opportunity for people to build bonds and positively affect lifestyle choices.
In addition, engaging individuals in learning to play music may decrease the cost of health care when considering treatments for depression, PTSD, and substance abuse. Playing an instrument may help decrease the need for antidepressants and provide a healthy recreational activity. Based on its physical and mental benefits, learning to play a musical instrument should be explored as complementary alternative medicine. Compared with filling prescription medications over an individual’s lifetime, the cost of a portable keyboard is substantially less.
Given the benefits of increased coordination, social involvement, neural responses, and ability to focus along with improving fine motor skills and reducing stress, including music lessons as part of a veteran’s health care makes sense and is well worth further investigation and research.
Acknowledgements
The author would like to thank Jack Hooten, MHA, MSN, RN, and Jennifer Hammond, MS, for their help in preparing this manuscript.
Learning to play a musical instrument provides a peaceful retreat from the pressures of daily life. Therapeutic outcomes of playing music include better communication skills, improved emotional release, and decreased anxiety and agitation.1 Musical training promotes cognitive function, mental health, and a connection to others.2,3
Depression
Impacting 14.8 million people, depression is the most prevalent mental health issue for adults aged ≥ 55 years and accounts for 10% of all medical disability in the U.S. and Canada.4-6 About half the people diagnosed with depression also have an anxiety disorder, which can lead to smoking, drinking alcohol, overeating, and complicated health care issues.5 By 2020, depression is predicted to be the second most common disease in the world and cost employers about $23 billion in absenteeism.4
Hays and Minichiello found that learning to read music and play the piano might enhance mood and certain aspects of the quality of living indicators in older adults. Those aged ≥ 65 years who participated in playing music reported improved self-esteem, greater independence, and fewer feelings of isolation. In addition, playing music created a temporary escape from the stress of daily life.7 Seinfield and colleagues compared a piano training group with a control group (nonplaying) and found that those who played piano experienced a decrease in psychological distress, depression, and fatigue.8 Playing an instrument can positively impact the well-being of older adults throughout life by promoting empowerment, autonomy, and social cohesion.7-11Manalai and colleagues found that a single episode of playing the piano was beneficial for a 91-year-old female patient who previously played when she was young and who was currently experiencing psychotic and depressive symptoms. Following playing, the patient’s vocabulary and insight temporarily improved. For the first time since her admission, the patient provided many details about her past mental and physical health. Even though the patient never played again, due to her delusional disorder, the improvement in mood and cognition were sustained for several months.12 The researchers noted that the patient’s temporary improvement may have been attributed to other factors.12
Another study measured levels of anxiety, depression, and loneliness in senior citizens. Study participants who regularly participated in a keyboard class were less anxious, depressed, and lonely compared with the control group.13 Other studies support the idea that music can modulate emotional responses and enhance cognitive performance.14,15
Mind Stimulation
As people age, they will experience progressive physiologic losses in function, such as auditory, cognition, memory, and motor control.16,17 Affect or mood can also be impacted.8 Consequently, there is a focus on promoting nonpharmacologic solutions that protect against age-related health issues. For example, musical training for adults that involves sensorimotor practice produces greater changes in the auditory cortex than does the equivalent experience involving only auditory training.18 Research indicates that age-related auditory decline can be mitigated by musical training.19 Evidence also supports cognitive stimulation, which may help reduce the likelihood of cognitive impairments in advanced age.16,17
The brain works on a principle of “use it or lose it.” Therefore, exercising the brain is important, and musical training may fill that need. Learning a skill such as playing an instrument reorganizes the brain’s neural pathways.2,16 Brain plasticity is the ability of the brain to change its structure, and engaging older adults in sensory, cognitive, and motor activities creates positive outcomes.16,17 Research also indicates active participation in music lessons creates larger plasticity effects than does passively listening to music.16 Musical training provides a multisensory activity that requires integrating signals from different sensory modalities with motor responses.16 Verghese and colleagues found that individuals who played a musical instrument were less likely to experience dementia than were those whose leisure activities consisted of reading, writing, and working crossword puzzles.20 Verghese suggested that 6 months of piano lessons in older adults improved the brain’s executive functioning (regulates abilities and behaviors) and working memory (ie, keeping track of information).20 Balbag and colleagues who conducted a study of twins found that “playing an instrument in older adulthood is significantly associated with reduced likelihood of dementia and cognitive impairment.”21 Musical training is also associated with improved visual memory and the ability to divide the individual’s attention between several activities. This ability is crucial for activities such as driving and is useful for navigating crowded areas, such as a mall.22,23
Dexterity
Musical training also has been found to be beneficial for stroke survivors, because this type of training elicits a change in the reorganization of the sensorimotor cortex that results in improved movement quality.24 Piano playing can lead to meaningful improvements in manual dexterity, finger movement coordination, and functional use of upper extremities.25
Zelazny studied the effects of keyboard playing on 4 older adults with osteoarthritis who over 4 weeks had 30-minute sessions of electronic keyboard playing 4 days per week.26 The researcher found that participants reported decreased arthritic pain, increased dexterity, and increased finger strength. Playing the piano requires both eye and hand coordination, which is essential as a person ages. Improved dexterity of fine motor skills can assist individuals with the activities of daily living, such as buttoning a shirt and using a remote control.26
Stress Reduction
Life is filled with stressors, and anyone can have difficulty coping with daily stress. According to Toyoshima and colleagues, playing the piano can lower cortisol levels and decrease a person’s anxiety level.27 These researchers compared the activities of piano playing, calligraphy, and clay molding and found that playing the piano was significantly more effective at lowering stress levels when measuring salivary C-reactive protein levels and State-Trait Anxiety Inventory (STAI) scores.
Another study found stress reduction was significant for participants who played the keyboard compared with participants who relaxed, read magazines, or solved puzzles.28 Stress has a negative impact on the immune system, which can increase an individual’s risk of disease. According to Mohd “emotional stress is a major contributing factor to the 6 leading causes of death in the U.S.: cancer, coronary heart disease, accidental injuries, respiratory disorders, cirrhosis of the liver, and suicide.”29
PTSD and Guitars for Vets Program
Guitars for Vets is a nonprofit organization with 25 chapters that uses music to assist veterans with physical and mental health injuries.30 The program provides free guitars and weekly music lessons taught by volunteers. The weekly music lessons create a forum for veterans to socialize and share personal experiences, thus contributing to their healing process.30 A randomized, controlled pilot study was conducted with veterans diagnosed with posttraumatic stress disorder (PTSD) who may have physical and mental changes such as self-isolation from others, night sweats, flashbacks, and depression.31
The study participants had weekly private guitar lessons for 1 hour and a group learning session. The results showed positive outcomes in both PTSD and depression symptoms after 6 weeks of guitar lessons.30 One veteran with PTSD who participated in the Guitar for Vets Program stated, “I came here with some real serious anger issues; this takes my mind off everything.” This veteran noted that as he practiced, a peaceful feeling enveloped him and the memories of trauma faded.32
Personal Experience
Following the completion of my PhD, I started piano lessons as a hobby. I also found engaging in playing music helped me to psychologically cope with the overwhelming stress of having a parent with a debilitating disease.
My dad was diagnosed with Parkinson disease, making it difficult for him to view life positively. Piano lessons helped him to mentally deal with his disease. Dad genuinely looked forward to his music lessons and was able to focus on practicing the piano rather than on his disease. I believe playing the piano prevented him from becoming depressed and kept him engaged, because he was accomplishing something.
Dad’s Parkinson disease has progressed; he is now in a nursing home. My gift to Dad is playing the piano for him. I sincerely believe it helps him cope with his disease or at least temporarily forget about it. His mood changes, and he becomes more animated. In his more lucid moments, we play music together. Playing music has a magical way of creating peace within the mind. Plato is often attributed with the quote, “Music gives a soul to the universe, wings to the mind, flight to the imagination, and life to everything.”
Conclusions
A healthful lifestyle includes holistically addressing issues pertaining to mental and physical well-being. Learning how to play a musical instrument is a workout for the brain, just as physical exercise is a workout for the body; both are necessary for optimal health. Evidence exists to support the hypothesis that playing an instrument elicits brain changes that positively influence cognitive functioning and decreases stress. Despite the lifelong benefits of playing an instrument, only about 8% of adults aged > 18 years play a musical instrument.33
Playing a musical instrument provides health benefits without the adverse effects that accompany pharmacologic therapy. It also can help improve social skills and provide individuals with a sense of achievement. Group music lessons provide an opportunity for people to build bonds and positively affect lifestyle choices.
In addition, engaging individuals in learning to play music may decrease the cost of health care when considering treatments for depression, PTSD, and substance abuse. Playing an instrument may help decrease the need for antidepressants and provide a healthy recreational activity. Based on its physical and mental benefits, learning to play a musical instrument should be explored as complementary alternative medicine. Compared with filling prescription medications over an individual’s lifetime, the cost of a portable keyboard is substantially less.
Given the benefits of increased coordination, social involvement, neural responses, and ability to focus along with improving fine motor skills and reducing stress, including music lessons as part of a veteran’s health care makes sense and is well worth further investigation and research.
Acknowledgements
The author would like to thank Jack Hooten, MHA, MSN, RN, and Jennifer Hammond, MS, for their help in preparing this manuscript.
1. Music for Veterans. Program results. Music for Veterans Website. http://www.music4veterans.org/program-results-1.html. Published 2014. Accessed January 11, 2016.
2. Miendlarzewska E, Trost W. How musical training affects cognitive development: rhythm, reward and other modulating variables. Front Neurosci. 2014;7:1-18.
3. Bergland C. Musical training optimizes brain function. Psychology Today. November 2013. https://www.psychologytoday.com/blog/the-athletes-way/201311/musical-training-optimizes-brain-function. Accessed January 22, 2016.
4. Witters D, Liu D, Agrawal S. Depression costs U.S. workplaces $23 billion in absenteeism. Galllup Website. http://www.gallup.com/poll/163619/depression-costs-workplaces-billion-absenteeism.aspx. Published July 24, 2013. Accessed January 11, 2016.
5. Anxiety and Depression Association of America. Facts and statistics. Anxiety and Depression Association of America Website. http://www.adaa.org/about-adaa/press-room/facts-statistics. Updated September 2014. Accessed January 11, 2016.
6. World Health Organization. The global burden of disease: 2004 update. The World Health Organization Website. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Published 2008. Accessed January 11, 2016. 7. Hays T, Minichiello V. The contribution of music to quality of life in older people: an Australian qualitative study. Aging Soc. 2005;25(2):261-278.
8. Seinfield S, Figueroa H, Ortiz-Gill J, Sanchez-Vives MV. Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults. Front Psychol. 2013;4:1-13.
9. Coffman DD, Adamek MS. The contribution of wind band participation to quality of life of senior adults. Music Ther Perspect. 1999;17(1):27-31.
10. Creech A, Hallam S, McQueen H, Varvarigou M. The power of music in the lives of older adults. Res Studies Music Educ. 2013;35(1):83-98.
11. Park A-La. Can musical activities promote healthy ageing? Int J Emerg Ment Health. 2015;17(1):258-261.
12. Manalai G, Manalai P, Dutta R, Fegan G, Scrofani P. Rapid improvement of depressive symptoms and cognition in an elderly patient with a single session of piano playing: a clinical treatment report. Aging Clin Exp Res. 2012;24(3):278-280.
13. Koga M, Tims F. Music making and wellness project. Music Teachers National Association Website. www.mtna.org/media/4686/2001AOY.pdf. Published 2001. Accessed January 29, 2016.
14. Becker J. Anthropological perspectives on music and emotion. In: Juslin PN, Sloboda JA, eds. Music and Emotion: Theory and Research. New York, New York: Oxford University Press; 2001:135-160.
15. Witvliet CV, Vrana SR. Play it again Sam: repeated exposure to emotionally evocative music polarizes, liking and smiling responses, and influences other affective reports, facial EMG, and heart rate. Cogn Emot. 2003;21:3-25.
16. Dawson WJ. Benefits of music training are widespread and lifelong: a bibliographic review of their non-musical effects. Med Probl Perform Art. 2014;29(2):57-63.
17. Mahncke HW, Connor BB, Appelman J, et al. Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci USA. 2006;103(33):12523-12528.
18. Lappe C, Herholz SC, Trainor LJ, Pantev C. Cortical plasticity induced by short-term unimodal and multimodal musical training. J Neurosci. 2008;28(39):9632-9639.
19. Parbery-Clark A, Strait DL, Anderson S, Hittner E, Kraus N. Musical experience and the aging auditory system: implications for cognitive abilities and hearing speech in noise. PloS ONE. 2011;6(5):e18082.
20. Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med. 2003;348(25):2508-2516.
21. Balbag M, Pedersen N, Garz M. Playing a musical instrument as a protective factor against dementia and cognitive impairment: a population-based twin study. Int J Alzheimers Dis. 2014;2014:1-6.
22. Oechslin MS, Van De Ville D, Lazeyras F, Hauert CA, James CE. Degree of musical expertise modulates higher order brain functioning. Cereb Cortex. 2013;23(9):2213-2224.
23. Patston LL. Balanced brains: an investigation of visuospatial ability and lateralization in musicians. Pyschmusicol. 2012;22(2):187.
24. Rodriguez-Fornells A, Rojo N, Amengual JL, Ripollés P, Altenmüller E, Münte TF. The involvement of audio-motor coupling in the music-supported therapy applied to stroke patients. Ann NY Acad Sci. 2012;1252(1):282-293.
25. Villeneuve M, Lamontagne A. Playing piano can improve upper extremity function after stroke: case studies. Stroke Res Treat. 2013;2013:1-5.
26. Zelazny CM. Therapeutic instrumental music playing in hand rehabilitation for older adults with osteoarthritis: four case studies. J Music Ther. 2001;38(2):97-113.
27. Toyoshima K, Fukui H, Kuda K. Piano playing reduces stress more than other creative activities. Intl J Music Educ. 2011;29(3):257-263.
28. Bittman B, Berk L, Shannon M, et al. Recreational music-making modulates the human stress response: a preliminary individualized gene expression study. Med Sci Monit. 2005;11(2):BR31-BR40.
29. Mohd RS. Life event, stress and illness. Malays J Med Sci. 2008;15(4):9-18.
30. U.S Department of Veterans Affairs. PPO 10-075–HSR&D study. U.S Department of Veterans Affairs Website. http://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141700403. Updated March 24, 2014. Accessed January 20, 2016.
31. Hooten J, Shipman D, Osting V. Posttraumatic stress disorder in veterans: inpatient assessment and management. Fed Pract. 2008;25(1):27-37.
32. WJLA. Music therapy program helps veterans with PTSD. WJLA Website. http://wjla.com/news/nation-world/music-therapy-program-helps-veterans-with-ptsd-98564. Published December 26, 2013. Accessed January 20, 2016.
33. U.S. Census Bureau, Statistical Abstract of the United States: 2011. Arts, recreation and travel section 26. U.S. Census Bureau Website. https://www.census.gov/prod/2011pubs/11statab/arts.pdf. Published 2011. Accessed January 11, 2016.
1. Music for Veterans. Program results. Music for Veterans Website. http://www.music4veterans.org/program-results-1.html. Published 2014. Accessed January 11, 2016.
2. Miendlarzewska E, Trost W. How musical training affects cognitive development: rhythm, reward and other modulating variables. Front Neurosci. 2014;7:1-18.
3. Bergland C. Musical training optimizes brain function. Psychology Today. November 2013. https://www.psychologytoday.com/blog/the-athletes-way/201311/musical-training-optimizes-brain-function. Accessed January 22, 2016.
4. Witters D, Liu D, Agrawal S. Depression costs U.S. workplaces $23 billion in absenteeism. Galllup Website. http://www.gallup.com/poll/163619/depression-costs-workplaces-billion-absenteeism.aspx. Published July 24, 2013. Accessed January 11, 2016.
5. Anxiety and Depression Association of America. Facts and statistics. Anxiety and Depression Association of America Website. http://www.adaa.org/about-adaa/press-room/facts-statistics. Updated September 2014. Accessed January 11, 2016.
6. World Health Organization. The global burden of disease: 2004 update. The World Health Organization Website. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf. Published 2008. Accessed January 11, 2016. 7. Hays T, Minichiello V. The contribution of music to quality of life in older people: an Australian qualitative study. Aging Soc. 2005;25(2):261-278.
8. Seinfield S, Figueroa H, Ortiz-Gill J, Sanchez-Vives MV. Effects of music learning and piano practice on cognitive function, mood and quality of life in older adults. Front Psychol. 2013;4:1-13.
9. Coffman DD, Adamek MS. The contribution of wind band participation to quality of life of senior adults. Music Ther Perspect. 1999;17(1):27-31.
10. Creech A, Hallam S, McQueen H, Varvarigou M. The power of music in the lives of older adults. Res Studies Music Educ. 2013;35(1):83-98.
11. Park A-La. Can musical activities promote healthy ageing? Int J Emerg Ment Health. 2015;17(1):258-261.
12. Manalai G, Manalai P, Dutta R, Fegan G, Scrofani P. Rapid improvement of depressive symptoms and cognition in an elderly patient with a single session of piano playing: a clinical treatment report. Aging Clin Exp Res. 2012;24(3):278-280.
13. Koga M, Tims F. Music making and wellness project. Music Teachers National Association Website. www.mtna.org/media/4686/2001AOY.pdf. Published 2001. Accessed January 29, 2016.
14. Becker J. Anthropological perspectives on music and emotion. In: Juslin PN, Sloboda JA, eds. Music and Emotion: Theory and Research. New York, New York: Oxford University Press; 2001:135-160.
15. Witvliet CV, Vrana SR. Play it again Sam: repeated exposure to emotionally evocative music polarizes, liking and smiling responses, and influences other affective reports, facial EMG, and heart rate. Cogn Emot. 2003;21:3-25.
16. Dawson WJ. Benefits of music training are widespread and lifelong: a bibliographic review of their non-musical effects. Med Probl Perform Art. 2014;29(2):57-63.
17. Mahncke HW, Connor BB, Appelman J, et al. Memory enhancement in healthy older adults using a brain plasticity-based training program: a randomized, controlled study. Proc Natl Acad Sci USA. 2006;103(33):12523-12528.
18. Lappe C, Herholz SC, Trainor LJ, Pantev C. Cortical plasticity induced by short-term unimodal and multimodal musical training. J Neurosci. 2008;28(39):9632-9639.
19. Parbery-Clark A, Strait DL, Anderson S, Hittner E, Kraus N. Musical experience and the aging auditory system: implications for cognitive abilities and hearing speech in noise. PloS ONE. 2011;6(5):e18082.
20. Verghese J, Lipton RB, Katz MJ, et al. Leisure activities and the risk of dementia in the elderly. N Engl J Med. 2003;348(25):2508-2516.
21. Balbag M, Pedersen N, Garz M. Playing a musical instrument as a protective factor against dementia and cognitive impairment: a population-based twin study. Int J Alzheimers Dis. 2014;2014:1-6.
22. Oechslin MS, Van De Ville D, Lazeyras F, Hauert CA, James CE. Degree of musical expertise modulates higher order brain functioning. Cereb Cortex. 2013;23(9):2213-2224.
23. Patston LL. Balanced brains: an investigation of visuospatial ability and lateralization in musicians. Pyschmusicol. 2012;22(2):187.
24. Rodriguez-Fornells A, Rojo N, Amengual JL, Ripollés P, Altenmüller E, Münte TF. The involvement of audio-motor coupling in the music-supported therapy applied to stroke patients. Ann NY Acad Sci. 2012;1252(1):282-293.
25. Villeneuve M, Lamontagne A. Playing piano can improve upper extremity function after stroke: case studies. Stroke Res Treat. 2013;2013:1-5.
26. Zelazny CM. Therapeutic instrumental music playing in hand rehabilitation for older adults with osteoarthritis: four case studies. J Music Ther. 2001;38(2):97-113.
27. Toyoshima K, Fukui H, Kuda K. Piano playing reduces stress more than other creative activities. Intl J Music Educ. 2011;29(3):257-263.
28. Bittman B, Berk L, Shannon M, et al. Recreational music-making modulates the human stress response: a preliminary individualized gene expression study. Med Sci Monit. 2005;11(2):BR31-BR40.
29. Mohd RS. Life event, stress and illness. Malays J Med Sci. 2008;15(4):9-18.
30. U.S Department of Veterans Affairs. PPO 10-075–HSR&D study. U.S Department of Veterans Affairs Website. http://www.hsrd.research.va.gov/research/abstracts.cfm?Project_ID=2141700403. Updated March 24, 2014. Accessed January 20, 2016.
31. Hooten J, Shipman D, Osting V. Posttraumatic stress disorder in veterans: inpatient assessment and management. Fed Pract. 2008;25(1):27-37.
32. WJLA. Music therapy program helps veterans with PTSD. WJLA Website. http://wjla.com/news/nation-world/music-therapy-program-helps-veterans-with-ptsd-98564. Published December 26, 2013. Accessed January 20, 2016.
33. U.S. Census Bureau, Statistical Abstract of the United States: 2011. Arts, recreation and travel section 26. U.S. Census Bureau Website. https://www.census.gov/prod/2011pubs/11statab/arts.pdf. Published 2011. Accessed January 11, 2016.