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Soundscape Support for People with Dementia: A
Systematic Literature Review
Zehang Cheng1, Kamal Sabran2
{chengzehang5@gmail.com1, kamalsabran@gmail.com2}
Universiti Sains Malaysia, 11800 Gelugor, Penang1,2
Abstract. As the global ageing trend intensifies, new technologies to provide support for
people with dementia have become a research hotspot in related fields. Studies have shown
that listening to music or sound effects has a specific impact on the recovery of people with
dementia. At the same time, the supportive effect of soundscape on the environment can
also positively impact patients' health and well-being. The supporting role of soundscapes
for people with dementia is getting more and more attention in practice. This article uses
a systematic literature review method to review the current worldwide research on
providing supportive soundscapes for patients with dementia and analyse how they use
soundscapes. The purpose of this review is to find techniques and methods that can offer
soundscapes to people with dementia. Finally, the future development direction of using
new technology to help people with dementia is proposed. This review hopes to improve
people's well-being and behaviour with dementia in terms of treatment and life.
Keywords: Dementia, Soundscapes, Music, Technology, Improve Health, Quality of Life.
1 Introduction
According to a report from the World Health Organisation (WHO), the number of cases of
dementia continues to increase at a rate of 10 million cases per year. Currently, there are
approximately 50 million people with dementia in the world.[1] By 2050, the number of cases
of dementia will be more than three times the current number, but dementia is largely ignored.
Many family members believe that dementia is an inevitable phenomenon of human ageing.
Dementia is a chronic or progressive syndrome caused by various brain diseases that affect
memory, thinking, behaviour, and ability to perform daily activities. Alzheimer's disease is the
most common cause of dementia and is likely to cause up to 70% of dementia cases. Although
people with dementia live in all countries, more than half (58%) live in low- and middle-income
countries. By 2050, this proportion will rise to more than 70%.[2]
Dementia is usually a chronic brain disorder caused by a brain disease. It will affect the
thinking of the elderly, make people's judgment ability difficult, memory decline, middle and
late patients will have difficulties in self-care. As the disease progresses, patients with dementia
will increasingly need caring from other people.[1] Moreover, dementia is irreversible. Shekhar
Saxena, the head of the WHO mental health department, said no drug could cure dementia.[3]
With the deepening of research, non-drug treatment methods have become new due to the
advantages of common side effects and relatively low cost.[4]
Among non-pharmacological treatment methods, many studies believe that art can provide
DESIGN-DECODED 2021, August 24-25, Kedah, Malaysia
Copyright © 2022 EAI
DOI 10.4108/eai.24-8-2021.2315262
support for patients with dementia.[5] Hearing impairment is not usually considered the main
feature of dementia,[6] so some researchers in related fields have begun to design soundscapes
for patients with dementia. Soundscape refers to the human perception of the auditory
environment in context. Canadian musician, Murray Schafer, first promoted the concept of the
soundscape. There are sounds of positive value in the background, such as natural sounds and
cultural sounds. Studies have shown that these positive voices have a positive impact on
health.[7] Soundscape has also been introduced into the hospital environment to alleviate the
suffering of patients and improve their healthcare experience. At the same time, music medical
methods have also been widely studied and used in stroke, mental illness, and post-operative
rehabilitation.[8]
This article will conduct a systematic literature review of the current soundscape support
for patients with dementia, aiming to determine the recent research progress in this field and
understand the methods and results achieved by soundscapes designed for dementia patients.
This literature review will summarise the previous research and aim to help related research in
the future.
2 Methods
This review focuses on the soundscape-related research literature supporting patients with
dementia and mainly refers to Keele's systematic literature review guidelines.[9] This review
method is divided into three stages.
2.1 Plan review
The concept of soundscape is broad, including natural sounds and human-created sounds, and
these sounds are diverse. Different groups of people have different perceptions of the
soundscape. According to the purpose of this review, the question of this literature review is
raised. The results of this SLR will provide practical help in providing supportive soundscapes
for patients with dementia and provide useful starting information for future research. This
review intends to solve the following research questions:
RQ1: What types of soundscapes does the research provide for people with dementia?
RQ2: What kind of support do different soundscapes provide for patients with dementia?
After determining the research questions, the selection criteria for this review can be
proposed based on the two research questions. First, determine the keywords and subject areas
to be searched. The soundscape is defined as auditory scenery, including natural and artificial
sounds, including music and sound effects.[10] Alzheimer is the primary disease of dementia,
so it should also be included in the search category. The search keywords are determined:
dementia, Alzheimer's disease, soundscape, sound, sound effect, and environmental sound.
Many studies have confirmed the method of music intervention in the treatment of dementia.
This review mainly provides soundscapes for dementia patients daily, including music as a
soundscape to support dementia patients, but music therapy is performed in hospitals. Related
research is not included in the scope of this review.
2.2 Search process
The search was conducted on May 6, 2021. First, search the ACM, SPRINGER, and PMC
databases. Then, check the questions one by one and delete duplicates. Search the titles and
abstracts of the documents in the database based on the keywords that have been determined,
and create filters based on the research selection criteria from different database search methods
to filter out the documents for analysis and reporting. After a preliminary search, it was found
that the number of related studies that provided soundscape support for patients with dementia
was relatively small. Then, a reverse search was started, and the investigation was carried out
based on the references of the searched documents to increase the number of records in this
review.
2.3 Conduct review
Judgment is done on whether the searched literature is related to the research question
through the title and abstract. Then, read the content of the documents that meet the requirements
one by one to determine the relevance to this review. (1) The research must be designed for
supportive soundscapes for patients with dementia. (2) The test results of the soundscape should
be explained in the literature. (3) It must be an experiment in which patients with dementia
participate in the test. Use this as a standard to screen out documents that can be included in this
review. Table 1 summarises the results of each electronic database.
Table 1. Summary of Search Result
Electronic Database
Search Results
ACM
22
PMC
68
Scopus
34
Total
124
2.4 Report results
After deleting duplicates, 15 articles were finally included in the scope of this review. The
two research questions identified in the preparation phase are the focus of this review. A
thematic analysis of the literature was conducted to determine in detail what soundscapes are
provided for patients with dementia in the study and what support dementia patients receive?
After screening, evaluate the paper and read the full text. Figure 1 uses the PRISMA flow
diagram to illustrate the process of this systematic literature review. The literature of this review
will be summarised in the third section.
Figure 1. Process of review using a PRISMA flow diagram.
3 Results
In this search, a total of 203 related documents were searched in four electronic databases.
After screening, 15 documents met the criteria of this review. The search results show that in
the research to provide help for patients with dementia, the research on soundscape is relatively
lacking. In the research in healthcare, most researchers regard soundscape as a means of
reducing noise. [11][12] Improving the soundscape can relieve stress for patients, increase
patience and work enthusiasm for medical staff, and enhance the comfort of the hospital
environment.[13] Some studies have proved that soundscape as a non-pharmacological
intervention can positively affect people suffering from diseases in recent years. Providing a
natural soundscape can reduce pain for patients, and music therapy has also been proven to
improve the mental state of patients.[14] After studying the 19 documents included in this
review, the documents are summarised in Table 2 according to the research questions.
Table 2. Summary of review results.
Numbering
Research purposes
Sample size &
demographics
Soundscape provided
Research results &
soundscape support
[15]
Use music to aid the
memory of Alzheimer's
patients
10 people with
dementia
Provide each person
with Alzheimer's disease
with songs they are
familiar with.
Nine patients
awakened their
memories through
familiar music.
[16]
Explore the influence of
music on the mood and
cognition of women with
dementia
25 people with
dementia in two
groups
Playing music while
people with dementia are
exercising
The cognitive ability
of the exercise group
has been significantly
improved.
[17]
Explore the soundscapes
that can evoke the
memories of people with
dementia
14 elderly people with
dementia
Design life
onomatopoeia for people
with dementia
The subject will
respond to sounds that
were once familiar.
[18]
This research aims to
explore the influence of
emotional music
stimulation on
autobiographical memory
information retrieval
25 Alzheimer's
patients
The soundscape
provided includes happy,
sad, unemotional sounds
and ambient sounds.
Sad music is the most
effective way for
patients to recall the
past.
[19]
Explore why music is good
for the health of people
with dementia
12 people with
dementia, 15 family
caregivers, 14 nursing
home staff, and 8
music therapists
To provide different
music according to the
nursing home
environment, including
classical music,
nostalgic music, etc.
Music can alleviate
behavioural and
psychological
symptoms, and music
can help improve the
nursing home
environment.
[20]
Use soundscapes to
improve the quality of life
of people with dementia
and to improve the
experience of patients and
medical staff
People and staff with
dementia living in 5
nursing homes
Monitor the noise
intensity, soundscape
composition and
response of patients with
dementia in the living
rooms of five nursing
homes.
Several soundscape
quality attributes and
the perception of
sound source types are
significantly different.
There is a moderately
positive correlation
between voice level
and the number of
people.
[21]
Use the soundscape
method to improve the
quality of life of patients
with dementia and reduce
the behaviour and
psychological symptoms
of patients with dementia
People and staff with
dementia living in 5
nursing homes
Observe the living
rooms of five nursing
homes in Belgium and
collect soundscape data
Daily patterns and
time-varying acoustic
landscape strategies
can manage the
acoustic environment
of nursing homes to
improve the overall
experience of
residents.
[22]
Describe, explain, and
verify the potential of
sound art in people with
Alzheimer's disease
30 people with
dementia, 6
paramedics, and 4
doctors
To study specially
designed sounds, the
prototype includes three
types: natural
soundscape, musical
instrument soundscape
and abstract soundscape.
The patient's response
to the natural
soundscape is active
and comfortable. The
patient is happy and
dedicated to the
soundscape of the
musical instrument.
The patient is calm
and tired with the
abstract soundscape.
[23]
Provide soundscapes for
dementia care centres to
improve the well-being of
patients and staff
Dementia patients and
staff living in 5
nursing homes
Natural soundscape,
restaurant soundscape
The soundscape can
stimulate the
behaviour of residents
at the right sound
level.
[24]
Provide health-based
interventions for patients
with dementia by
designing soundscape
triggering devices.
11 early to mid-stage
dementia patients
Dementia soundboards
that provide soundscapes
for people with
dementia, mainly based
on natural environment
soundscapes.
Soundscape can
trigger personal
associations of people
with dementia,
stimulate memories,
and increase personal
confidence. It also
relieves stress for
nursing staff.
[25]
Provides a convenient
pillow sound player Vita
for patients with dementia
and proposes the design
significance of everyday
sounds in dementia care
19 people with
Alzheimer's disease
The daily life
soundscape can be
provided based on the
personal experience of
the dementia patient.
Everyday sounds
played by Vita can
evoke associations for
people with dementia
[26]
Use soundscapes to create
an atmosphere to improve
people's quality of life.
17 people with
dementia
A custom database is
composed of natural
sounds, environmental
sounds, and music. The
control panel can be
used to provide patients
with personalised
soundscapes.
Soundscape has a
positive effect on
patients' anxiety, pain,
night sleep, stress, and
life treatment
[27]
Provide a soundscape
adapted to the environment
for people with dementia,
and detect the response of
people with dementia to
the soundscape.
14 Alzheimer's
patients
Provide patients with
corresponding
soundscapes according
to the environment,
including natural
sounds, human society
sounds, animal sounds,
etc.
A soundscape adapted
to the environment can
provide support for
people with dementia.
[28]
Provide interactive
background music
playback function for the
elderly in the dementia
care centre.
8-10 people with
dementia
Provide background
music for patients and
observe their behaviour
and emotions
The creative
interaction of many
people with dementia
is achieved through
music. Music can
evoke memories.
[29]
Use songs for people with
dementia and caregivers to
reduce the burden and
improve the quality of life.
24 dementia patients
and 22 family
members responsible
for caring for the
patients
Provide patients with
various types of songs
Most patients'
emotions are positive,
which can improve
concentration, and
songs they do not like
will trigger a negative
association
The soundscape is the human perception of the sound environment in the context. People
will experience the auditory experience from the sound environment in life, and the resulting
perception of the sound environment can become a soundscape.[30][31] A popular research
believes that soundscapes can evoke different responses from individuals. Since the two
problems planned in 2.1 are mutually progressive, the following will classify the soundscapes
in the study and explain the support that soundscapes provide to patients with dementia.
3.1 Natural soundscape
The natural soundscape positively impacts the therapeutic environment and can help the
patient's mental health recovery and other broader well-being. In this review, a total of seven
studies provide natural soundscapes for patients with dementia. In a study by Dr Kamal Sabran,
researchers designed three types of soundscapes for 30 patients with dementia in two nursing
facilities. In the design, psychoacoustic theory, sound perception theory, and good therapy
theory are applied to soundscape creation, and the research adopts the methods of case study
and qualitative research. The data gathered found that natural soundscapes can calm people with
dementia and reduce anxiety.[22]
After testing the soundscapes in the living room in five nursing homes in Belgium, the
researchers continued the research and sampled the created soundscapes in a 24-hour loop
playback in the nursing homes. The soundscape played contains natural sounds, the sounds of
birds singing, and leaves blowing in the wind. The volume was adjusted to an appropriate level.
Most of the sounds are in the low-frequency range. By detecting the patient's heartbeat and
observing feedback, it is found that the patient is happy and the heartbeat is stable. In turn, it
produces a positive response to medical activities.[23]
A study in 2019 provided dementia patients with a dementia soundboard that can trigger
the soundscape. The soundscape provided includes two soundscapes: beach and forest. The
experimental results show that the soundboard evokes the personal thoughts and emotional
responses of dementia patients by creating sound scenes. The patients can associate the sound
of the beach with their previous travel experiences.[24]
In addition, a 2020 study provided people with dementia with soundscapes from the natural
world, such as the sound of rain, bonfires, and singing crickets. Observing residents' verbal and
non-verbal responses found that natural voices have more positive feedback than artificial
voices.[27] Many studies have proved that natural soundscapes have a therapeutic effect on
patients with dementia. Natural soundscapes are generally believed to make patients feel happy
and calm, and some studies believe that they can bring memories of dementia patients. However,
there are many kinds of sounds in nature, and which sounds may cause uncomfortable responses
to patients with dementia need to be further verified.
3.2 Daily soundscapes and other soundscapes in human society
In a study in Osaka, Japan, researchers designed 100 familiar voices in life for people with
dementia. The test results show that people with dementia can produce clear memories through
sounds in life. The role of soundscapes varies from person to person. Women are more sensitive
to the soundscape of the kitchen, and men are more susceptible to the sound of war.[17]
Francesco Aletta conducted two studies in five nursing homes in Belgium to monitor the
noise intensity and soundscape composition in the living room of nursing homes at different
times of the week and observe the impact of different soundscapes on patients with dementia. It
is found that the composition of the soundscape in the nursing home is complicated, including
electronic sounds, human sounds, pet sounds, installation sounds, and environmental noise.
They measured the intensities of different sounds, and the results showed that the soundscapes
in the living room of the nursing home were different every day. Still, the overall power of the
sound levels they produced during a week was the same.[20]
It shows that regular practice changes in the sound environment provide auditory safety for
patients with dementia, and patients will not feel discomfort. A research suggests that the
soundscape of the dementia patient care centre has a wide variety of sound sources, and
quietness is not necessarily the first choice for the soundscape.[21]
Three studies[18][23][27] used the soundscape of the restaurant, including the ambient
soundscape of the cafe and the soundscape of the restaurant. People with dementia will have an
appetite after hearing a similar soundscape and increase their food intake. In a study in 2021,
researchers set up soundscapes for different areas of the dementia centre. They set up outdoor
natural soundscapes near the windows according to the time, soundscapes of kitchen utensils in
the dining area, soundscapes of waterfalls and birds in the rest area, and relaxing night
soundscapes in the bedroom. These provided a full range of soundscape enjoyment for the care
of dementia patients. The results show that the atmosphere formed by the soundscape is accepted
by most dementia patients, including the nursing staff. A soothing and elegant soundscape can
elicit a positive response from the patient more than a fast-paced sound.[27]
3.3 Music soundscape
The most supportive soundscape provided for patients with dementia is music. In a study
by Carol A. Prickett, researchers tried to help ten Alzheimer's patients recall the past by playing
previous songs. They played music familiar to the elderly and new music. The results indicate
that Alzheimer's patients can stimulate reactive participation by using familiar music. Elderly
people with mild illness can improve the joy of life by learning, listening to, or humming new
music.[15]
A randomised controlled trial was used in one study. Music for a group of patients during
rehabilitation was provided. The types include accordion, country, folk, and other soothing
music. Compared with another group of dementia patients who did not listen to music, it was
found that music-based rehabilitation had positive support for cognitive recovery.[16]
In another study, researchers provided different types of music to elderly people in an
Alzheimer's care centre in Spain. These elderly people are older than 60 years old, and they all
maintain communication and hearing skills. In the experiment, happy music, sad music, and
ambient sound in cafes were played for the elderly. The results showed that the memory
performance of the subjects was significantly different with or without voice. Emotion-inducing
music is conducive to the retrieval of memories. Sad music can be used as a clear and specific
recall route.[18]
In a 2014 study, researchers conducted qualitative research, hoping to gain insights into the
music experience of dementia patients and explore the meaning of music for dementia patients
and caregivers. Patients and staff from two dementia care institutions and music therapists
participated in the study. Music helps improve the nursing home environment, improve patients'
quality of life with dementia, and effectively help patients with dementia relieve anxiety. This
is because everyone has different music preferences, and music is of little importance to caring
for patients.[19]
Music as a soundscape is sufficient to support dementia patients. Many documents believe
that music soundscape is beneficial to dementia patients' memory, effectively relieves patients'
anxiety, and improves patients' mood. The sound of the instrument also supports the recovery
of cognition. At the same time, the literature also pointed out that it is necessary to fully consider
the patient's experience and music preferences when designing a music soundscape.
4 Discussion
Dementia is now the most common cause of disability in the elderly in the world. Although
some drugs can help patients with dementia reduce their symptoms, the help of drug therapy is
limited. Therefore, art therapy is becoming an essential method of dementia care.[5] Designing
soundscape to support patients with dementia is multi-faceted support that focuses on patients'
physical health, mental health, and quality of life.[32]
According to the types of soundscapes in the review, the most commonly used natural
soundscapes are insects and birds, the sound of gentle waves, the sound of forests, and the sound
of rain. Based on the research results, the beautiful natural environment music can relieve stress,
reduce anxiety, focus and help sleep, and other aspects of support for patients with dementia.[7]
The research results also show that playing soundscapes in the courtyard or front of the windows
of nursing homes is better. That is, soundscapes can be combined with scenery to achieve better
results.[33][24]
In the research on the soundscape of human society, the sounds of restaurants and kitchens
and the sounds of people and pets have achieved remarkable results. In this type of research, it
is found that the soundscape of human society helps people with dementia to find lost
memories.[6] People with dementia can recall events in the scene based on their sounds,
including short-term and long-term memories. Therefore, this kind of sound setting needs to
communicate with the patient and the patient’s relatives in advance, and understand the patient’s
personal experience to make a personalised soundscape setting.[27]
The research on music intervention therapy is sufficient. Music can improve the mood and
quality of life of patients with dementia. It also has the effects of recalling memories and
soothing emotions. However, the choice of music should be cautious.[34] Based on the literature
reviewed in this review, we find that the music therapy used for dementia patients is mainly
soothing and elegant music. Some studies have shown that people with dementia may not
remember all the lyrics in music, but they can usually understand the emotions in music.[15]
All soundscapes reviewed this time have clear signs that the appropriate soundscapes have
significant support for the treatment and life of dementia patients. However, many of the studies
in this review have limitations. At the same time, the supporting research on soundscapes for
patients with dementia is also limited, which requires extensive attention from society.
Soundscape's support for patients with dementia requires the cooperation of experts in multiple
fields. Only when the caregivers of patients with dementia, sound artists, and medical experts
cooperate, can they draw practical research conclusions.
The technology for providing soundscapes for patients with dementia has been improving.
The early designs were mainly traditional audio playback devices. Recently, wearable devices
and designs have gradually appeared on dementia patients, such as smart application interfaces.
Appearance can help people with dementia interact with their mobile phones and can choose
the soundscape they need.[35]
In the current situation of the global pandemic of new coronary pneumonia, this review also
found that a website called "Music for Dementia" provides support for patients with dementia
who are isolated at home, as well as other interactive network activities and conferences for
patients with dementia who are isolated at home.[36] These studies emphasise the social well-
being of people with dementia, but the study's results still need to be further observed.
This search also found a diverse ways to provide soundscapes for patients with dementia.
A study designed a pillow, Vita, that can play various soundscapes for patients with dementia,
allowing patients to choose the soundscape they need and provide. To interact with the patient,
the patient and the nursing staff can explore the role of the soundscape together and increase the
patient's sense of social belonging.[25] Another study provided a soundboard (namely the
dementia soundboard) for patients with dementia. Different soundscapes can be selected
through the control panel. It also provides the function of interacting with new technologies for
patients with dementia. The test found the cognitive ability of patients with dementia see an
increase.[24]
5 Conclusion
This article aims to explore the support of soundscape for patients with dementia and
explore how soundscape can improve the care environment for patients with dementia. The
review results show that soundscape supports dementia patients, mainly in three aspects:
soothing emotions, improving cognition, and awakening memory. Another study believes that
providing soundscapes for dementia patients in a specific environment can enhance the function
of the environment, such as eating meals. Providing relevant soundscapes in places can increase
the patient's food intake. Another thing to note is that many studies have shown that soundscapes
need to be designed according to the personal life experiences of patients with dementia, and
the sensitivity of patients to soundscapes varies from person to person. At the same time, the
volume setting also needs to be consulted with the caregiver in advance to confirm the hearing
ability of the dementia patient.
In general, research on soundscape supporting dementia patients is increasing year by year,
reflecting that with the ageing trend and the increasing incidence of dementia, paying attention
to the social well-being of dementia patients has become one of the current research focuses in
the world. Future research should pay more attention to the needs of dementia patients living at
home and provide support to families with dementia patients. In terms of soundscape equipment,
diversified product designs can be carried out to integrate soundscape into the lives of patients
with dementia and improve the quality of life of patients with dementia. Artificial intelligence
(AI) has been widely used in the field of healthcare. AI-based algorithms and in-depth learning
functions can provide personalised soundscapes for patients with dementia.[37] The future
development of the AI field will bring better well-being to patients with dementia.
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