Music therapy in dementia and end-of-life care: A report from Italy

Abstract

This report outlines the fundamental phases and factors that have contributed to the development of music therapy in Italy, from 1970s up to the present day, paying particular attention to the context of dementia and end-of-life care. Drawing on knowledge and experience of the Italian music therapy schools and professional associations, the paper explores the development of music therapy in dementia care, from the first interventions in the 1980s in residential care homes across the country to the several qualitative and quantitative research projects available today. Another focus is about the growth of the hospice movement in Italy and the inclusion of professional music therapists in multidisciplinary teams involved in palliative care and pain management. Music therapy started to be used sporadically in hospices from the end of the 1990s and since 2000 many Italian studies of music therapy in end-of-life care are annually presented in national and international conferences. Finally, the reports looks at the future and explores the various music therapy projects that have been increasing and developing in different contexts.

Full text

Approaches: An Interdisciplinary Journal of Music Therapy
12 (2) 2020
ISSN: 2459-3338 | www.approaches.gr
261
REPORT
Special Feature | Music therapy in dementia and end-of-life care: Mediterranean perspectives
Music therapy in dementia and end-of-life care:
A report from Italy
Mariagrazia Baroni
Madonna dell’Uliveto Foundation, Italy
ABSTRACT
This report outlines the fundamental phases and factors that have contributed
to the development of music therapy in Italy, from 1970s up to the present day,
paying particular attention to the context of dementia and end-of-life care.
Drawing on knowledge and experience of the Italian music therapy schools and
professional associations, the paper explores the development of music
therapy in dementia care, from the first interventions in the 1980s in residential
care homes across the country to the several qualitative and quantitative
research projects available today. Another focus is about the growth of the
hospice movement in Italy and the inclusion of professional music therapists in
multidisciplinary teams involved in palliative care and pain management. Music
therapy started to be used sporadically in hospices from the end of the 1990s
and since 2000 many Italian studies of music therapy in end-of-life care are
annually presented in national and international conferences. Finally, the
reports looks at the future and explores the various music therapy projects that
have been increasing and developing in different contexts.
KEYWORDS
music therapy,
Italy,
dementia,
end-of-life care
Publication history:
Submitted 3 May 2019
Accepted 18 Apr 2020
First published 20 Jun 2020
AUTHOR BIOGRAPHY
Mariagrazia Baroni is a board-certified music therapist and classical pianist. She graduated in piano at the Conservatory (Reggio Emilia),
obtained a MA in Musicology (Parma University) and a MA in Music Therapy at the University of the West of England (UK). Since 2001 she
has worked in dementia care and in palliative care with terminally ill patients in one of the first hospices of Italy. She has presented papers
about her work in various national and international conferences. She teaches several palliative care courses for music therapists, nurses
and doctors, with lectures about music and music therapy. She has been President of the Italian Association of Professional Music therapists
(AIM) since 2016. [mariagrazia.baroni@icloud.com]
MUSIC THERAPY IN ITALY
Professional associations
Music therapy was introduced for the first time in Italy midway through the 1970s, more specifically
at the National Bologna Conference in 1973. The Italian Association of Music Therapy Studies
(A.I.S.Mt) [Associazione Italiana Studi di Musicoterapia] was then formed in 1975 and, a few years

Approaches: An Interdisciplinary Journal of Music Therapy Baroni
262
later in 1981, after several experts began to structure and define music therapy, the first training course
was founded in Assisi. Subsequently, many different Associations and training courses arose and the
Italian Confederation of Music Therapy Associations and Courses (CONF.I.A.M) [Confederazione
Italiana Associazioni e Scuole di Musicoterapia] was founded in 1994.
Numerous factors contributed to the development of music therapy both as an area of practice
and as an area of knowledge. Around the 1980s and throughout the 2000s, it was essential to draw on
the knowledge and theories of key European and American academics who were active in the music
therapy field. Therefore, many publications, including those translated into Italian, were made
available. Lectures and supervision were organised involving prominent music therapists such as
Juliette Alvin, Rolando Benenzon, Kenneth Bruscia, Leslie Bunt, Edith Lecourt, Paul Nordoff, Clive
Robbins, Mary Priestley, and Tony Wigram. Some of these music therapists visited Italy during this
time (Scarlata, 2015).
A growing number of trained professionals began to use music therapy in new contexts and
increased awareness amongst other professional fields. The collaboration between music therapists
and other professionals provided an opportunity to disseminate more knowledge about music therapy
and its application in different areas, allowing them to learn from each other and their practice and
experience. “Music therapy gradually became a recognized and accredited practice spread throughout
the country, and music therapists are now present and appreciated within the various social-
educational, rehabilitative and therapeutic teams” (European Music Therapy Confederation [EMTC],
2020).
At the end of the 1990s four professional associations for music therapists were formed:
Federazione Italiana Musicoterapeuti (FIM) [Italian Federation of Music Therapy] in 1998,
Associazione Italiana Professionisti della Musicoterapia (AIM) [Italian Association of Professional
Music Therapists] in 2002, Associazione Italiana Registro Musicoterapia (AIReM) [Italian Association
of Register of Music Therapists] in 2003, and the Associazione Punto di Svolta [Turning Point
Association] in 2004. These organisations act as a reference for music therapists, providing
information regarding music therapy practice, training and events.
Moreover, to guarantee the continuing professional development of their music therapists, the
Italian professional associations regularly organise continuing professional development courses,
congresses and workshops, involving foreign colleagues such as Leslie Bunt, Jos De Backer, Cheryl
Dileo, Amelia Oldfield, Hanne Mette Ridder and Tonius Timmerman. Additionally, based on my
observations, the participation of Italian music therapists, and in particular AIM members, at
international music therapy congresses has increased in the past seven years.
Training programmes
One of the fundamental tasks and aspects that the professional associations have been working on
is the definition of educational criteria. The associations have been promoting local undergraduate
training courses as well as some postgraduate training courses throughout Italy.
National coordination and monitoring of the courses have identified fundamental criteria for
organising educational programs and enabled some standardisation across the courses. The
educational programme is divided into the following areas: music therapy, music, psychology,

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263
medicine, practical placement and tutoring (Manarolo & Di Franco, 1999).
The publication of the Norma UNI 11592, by Ente Italiano di Normazione Italiana (UNI) [Italian
Institution of Regulation] (UNI, 2015), created an agreement about music therapy training among the
different music therapy associations and schools, with the following criteria: length of training courses
in music therapy at least two years (120 credits); entrance criteria an undergraduate degree and
excellent knowledge and skills in the area of music, certified by a Conservatory or gained through a
non-formal education, as established by the European Qualifications Framework (EQF). In this last
case the admission is subject to the evaluation by the public or private school of music therapy.
In the first half of the 1990s, a music therapy course was established in Bologna by Barbara
Zanchi and Leslie Bunt which offered Italian music therapists the opportunity to study abroad, initially
at the University of Bristol and later at the University of the West of England (Manarolo & Di Franco
1999; Music Space Italy, 2018). Currently, in Italy there are around 30 music therapists who have
studied at European universities and obtained a MA in Music Therapy.
In Italy there has been an increase in collaboration between private training courses, music
conservatories and universities over the last 15 years. The aim has been to improve the quality of
courses and to avoid the danger of self-referencing, which may be present in privately managed
courses.
In the last decade, the training in music therapy offered by the conservatories has been very
diverse, with regard to structure, level of study and the total amount of hours of instruction. Currently
in Italy there are courses of study that issue a Bachelor in music therapy (EQF 6). Moreover, in
conservatories and universities, some two-year specialisation courses in Music Therapy (EQF 7) have
been started. They are either of first or second level, with different lengths and number of credits
issued. These programmes are implemented in several Italian conservatories which also actively
collaborate with universities for the instruction of medical and psychological topics as well as with
local institutions regarding practical placements and internships. Some courses, even private ones,
offer a specific training for a particular context. Fondazione Edo e Elvo Tempia [Edo and Elvo Tempia
Foundation], for example, established a training course regarding music therapy in palliative care,
while the University of Ferrara and the University of Pavia established courses with a specific focus
on music therapy and neurology.
Professional recognition
In Italy the recognition of music therapy as a profession is regulated by Law 4/2013, approved by the
Italian government in January 2013 (Gazzetta Ufficiale, 2013). This law recognises the existence of
new professions and establishes the characteristics of the professional associations that are
constituted in order to enhance the competences of their members and to guarantee and monitor their
continuing professional development. The law also establishes that the professional associations
must have a clear code of conduct, which includes: transparency in activities and institutions;
observation of professional ethics; an appropriate organisational structure and a qualified scientific
committee within the Association; clear access to an information point for the clients (Gazzetta
Ufficiale, 2013).

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After the law’s ratification, a UNI working group of professional associations of arts therapies
was created. AIM and FIM participated in the working group for the definition of the UNI standard, a
technical regulation that defines the specific knowledge, skills and competences that professional arts
therapists, including music therapists, must have.
At the moment, the best way to be recognised as professional music therapists in Italy is through
membership to a professional association and/or by being appropriately qualified and holding a
specific certification in music therapy in accordance with the technical regulation 11592 issued in
October 2015 by UNI and approved by Accredia, the Italian Institution of Accreditation.
Currently, one of the most widespread definitions of music therapy in Italy focuses on aspects
of research, practice, education, and clinical training that “are based on professional standards
according to cultural, social, and political contexts” (Kern, 2011). There are also specific definitions
adopted by professionals and by training schools that, depending on the reference model used
(Cremaschi-Trovesi, 2001, 2013; Cremaschi-Trovesi & Scardovelli, 2005; Centro Musicoterapia
Benenzon Italia, 2014; D’Ulisse & Polcaro, 2000; Lorenzetti & Suvini, 2001; Manarolo, 2012), refer to
particular aspects of music therapy rather than the profession in general.
In the past 15 years, the practice of music therapy has increased nationwide in various areas.
Currently there are around 480 music therapists registered in one of the four professional associations
(AIM; AIReM; FIM; Punto di Svolta); however, it is hard to calculate the exact number of music
therapists who work, as allowed by the current law, but who are not members of a professional
Association.
Alongside an increase in the number of professional music therapists, the contexts in which they
work and the projects that they undertake, the work of professional associations has become more
and more important and necessary. Professional associations work to maintain high professional
standards that will guarantee high quality music therapy interventions and follow developments in the
European environment which would impact delivery of music therapy services in Italy.
MUSIC THERAPY IN DEMENTIA CARE
In Italy, music therapy in dementia care began in the 1980s in residential care homes across the
country. The first publications (Lorenzetti & Piatti, 1984; Delicati, 1995, 1997; Downie, 1996) reported
some music therapy interventions with patients with Alzheimer’s disease and suggested observations
and reflections aimed to define music therapy as a discipline with specific clinical applications.
As in other music therapy contexts, in the early years in Italy it was essential to differentiate
music therapy interventions from simple musical activities, such as musical entertainment or musical
listening, already present in many facilities. Therefore, it was necessary to define theoretical
frameworks and methodological aspects of music therapy, as well as appropriate methods for the
analysis of results collected during music therapy interventions with this group of patients (Lorenzetti
& Piatti, 1984; Delicati, 1995, 1997; Downie, 1996).
In that first phase supporting literature was sourced from international studies (Raglio et al.,
2001b). From the research of international colleagues it was possible to learn about the effects of
music therapy on psychological and behavioural disorders (Brotons & Pickett Cooper, 1996; Clark et
al., 1998), cognitive abilities, relational and social competences (Brotons et al., 1997), depression and

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overall quality of life for elderly patients with dementia (Smith & Lipe, 1991).
At the end of the 1990s in Florence, a group of 16 music therapists from different Italian cities
formed a group to study the impact of music therapy on elderly people with Alzheimer’s (Scardovelli,
2003). They analysed their clinical notes to define and further deepen some aspects of their work.
From the group’s reflections and discussions, several initiatives were created, such as: a conference
dedicated to music therapy and Alzheimer’s disease, held in Florence in 2000, a volume on music
therapy with patients with Alzheimer’s disease (AAVV, 2003), a cultural association named Progetto
Anziani Musicoterapia (PAM) [Music Therapy for Elderly People] and one of the first websites
specifically for music therapy in this context (http://web.tiscali.it/pamonline/). The aim was to spread
information and provide music therapists working with elderly patients some insights into the Italian
context as well as both the national and international studies about music therapy in dementia.
During this period, many topics were addressed and discussed regarding music therapy in
dementia: the possibility to open up communication and emotional expression channels through
music therapy (Delicati, 1997); the value of memories, the effectiveness of singing, the functionality of
narration (Delicati, 1995, 1997; Downie, 1996); the role of sound to stimulate, affecting indirectly the
cognitive functions, the organisational aspects and structuring of the setting (in relation to timing,
spaces and intervention methods), the intervention methods in the cases of patients with a severe
dementia diagnosis, the necessity to define observation protocols and evaluation instruments (Raglio
et al., 2001a); the possibility to support communication of a relative with his/her family member in
order to recover an affective-relational dimension that could not be achieved otherwise (Delicati, 2000).
At the same time, in different Italian areas, the request for music therapy intervention in
residential care homes increased: knowledge about the discipline started to spread and many
experiences of Italian music therapists were published (Bonanomi & Gerosa, 2001; Delicati, 2000,
2010; Varagnolo et al., 2004). In this phase, investments from several public institutions involved with
elderly people were a strong incentive for spreading the use of music therapy in dementia care. In order
to validate music therapy as a non-pharmacological therapeutic or rehabilitative resource for dementia
or Alzheimer patients, the first clinical studies and researches on the impact and effects of music
therapy were conducted (Raglio et al., 2001a).
Qualitative and quantitative studies and research
In Cremona at the Fondazione Sospiro, the first results of the clinical use of music therapy with
dementia encouraged research projects to begin, employing only a qualitative perspective at first and
then a quantitative perspective as well. Many of the studies were achieved through the collaboration
of public and private institutions (Raglio et al., 2003). Gradually, the research focused on an approach
that integrated both a qualitative and quantitative point of view, also organising multi-centre studies
that demonstrated the effectiveness of music therapy on psychiatric and behavioural disorders in
dementia (Raglio et al., 2008).
Between 2009 and 2010, the care home for the elderly of Fondazione Centro Assistenza Fermo
Sisto Zerbato led a multi-centre, single-blind, randomised controlled trial that involved 51 elderly people
with dementia. It was an experimental study that evaluated the effects of the STAM© protocol
(Ceccato et al., 2006, 2009) as an additional intervention in six residential care homes across Veneto

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and Tuscany. The research included standardised and observational evaluation instruments, both
qualitative and quantitative methods and were used to evaluate the cognitive, behavioural and
emotional responses to the intervention (Ceccato et al., 2012). Studies and research have been
published in international journals and have been presented at medical and music therapy
conferences, both national and international (Ceccato et al., 2006, 2009, 2012; Raglio, 2013, 2014;
Raglio et al., 2013).
In the same period in Italy, several literature reviews concerning the use of music and music
therapy with dementia were undertaken, focusing mainly on behavioural and psychiatric disorders and
the recommendations of the Italian Psychogeriatric Association (Raglio et al., 2012b). In 2017,
different studies led by Enrico Ceccato (Ceccato et al., 2012) and Alfredo Raglio (Raglio et al., 2008,
2010a, 2010b, 2012a) were included in a systematic review and meta-analysis (Fusar-Poli et al., 2018)
and in the Cochrane review (van der Steen et al., 2017).
In recent years, additional research work involved Ceccato and Raglio (initially as managers for
the Italian research site and subsequently as advisors) in the multinational cluster-randomised trial
MIDDEL (Music Interventions for Dementia and Depression in Elderly care) carried out by Gold et al.
(2019). To the present day, the daily activities carried out by many music therapists in several Italian
care homes for the elderly provide strong evidence for the efficacy and inclusion of music therapy as
a complementary resource in dementia care, as suggested in the “Manuale di Competenza in Geriatria
– Item 4” published by Italian Geriatric and Gerontology Society (SIGG, n.d.).
MUSIC THERAPY IN END-OF-LIFE CARE
The origins of palliative care and the hospice movement are relatively recent, going back to England in
the early 1960s when Cicely Saunders had the idea for what would become St Christopher’s Hospice;
the first institution specifically designed to help terminally ill people. Right from the start there were
guidelines regarding the aims of the hospice: to offer personalised treatment plans and manage
symptoms of illness, to offer psychosocial and spiritual support, and help to relieve the total pain which
is so often presented in the final stage of life (Du Boulay, 1993).
In Italy, the hospice movement is very recent. More particularly it was promoted by Fondazione
Floriani, founded in Milan in 1977, which contributed to the creation of Società Italiana di Cure
Palliative (SICP) [Italian Society of Palliative Care] in 1986. Fondazione Floriani also promoted the
European Association for Palliative Care (1988) organising the first European congress about palliative
care and by establishing the European doctors’ network for pain management and palliative care.
The first two Italian hospices opened at the end of the 1980s in Brescia and Milan, but since the
2000s their number has increased rapidly and there are currently 246 hospices across Italy. In 2010
law 38/2010 (Provisions to guarantee access to palliative care and pain management) established the
minimum criteria and the required organisational structure that a facility needs to have in order to be
accredited as a hospice, as well as specifying the level of professional training that hospice staff must
have (Gazzetta Ufficiale, 2010).
The construction of purpose-built hospices and the passing of laws about the right to palliative
care was only a first step. From the time the first hospices opened, nursing staff and other professional
figures sought to increase people’s understanding of palliative care, hand in hand with providing

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medical attention, relief and support to patients and their families (Federazione Cure Palliative, 2013).
Even today, the general public have little understanding of the philosophy behind palliative care,
both from a practical point of view (e.g. how to gain access to palliative care or be admitted to a
hospice, or the services that are offered at home) or with regard to ethical issues such as pain
management or the patient’s rights in the final stages of life (Hospice Casa Madonna dell’Uliveto, 2017,
2018). In order to increase the public’s awareness of the reality of palliative care, the Ministry of Health
launched a campaign in May 2013 on national television and using information leaflets in hospitals
(Ministero della Salute, 2013).
Music therapy in Italian hospices
Music therapy started to be used sporadically in hospices from the end of the 1990s. Music therapists
were asked to use their skills to meet the needs of patients and their families, and quickly many
hospices began to integrate a music therapist into their multidisciplinary team (Bagnus, 2002;
Scardovelli & Ghiozzi, 2003). However, only few articles have been published on this topic in Italy
(Bagnus, 2002; Caneva et al., 2003; Scardovelli & Ghiozzi, 2003). As such, in the past 18 years, it was
necessary to refer to literature from other countries in order to give a scientific basis to music therapy
in this context. Some studies highlighted the clinical effects of music therapy in palliative care
(Gallagher et al., 2006; Horne-Thompson et al., 2007), on pain (Krout, 2001) and anxiety (Horne-
Thompson & Grocke, 2008), and on quality of life (Hilliard, 2003) and spirituality (Wlodarczyk, 2007).
Other studies focus on the themes which emerge from therapy sessions and research the themes of
grief and loss. David Aldridge (1999) also published a collage of clinical stories written by several
European and Australian music therapists, demonstrating a variety of music therapy approaches in
palliative care settings and highlighting goals such as creativity, communication, relationship,
environment, personal expressiveness and meeting the client in music. These were also very popular
in Italy.
Since the beginning of the spread and development of the hospice movement in Italy, music
therapy has been suggested to: recover important positive aspects of one’s life; improve self-esteem;
improve mood; enhance communication and relationships with relatives and caregivers; help the
patient to connect with his/her situation and needs, including spiritual ones (Baroni, 2009). Currently,
music therapists have to consider several important topics: the definition of criteria to send terminally
ill patients to music therapy; the personalisation and quality of care in a bio-psycho-social perspective
(that involves a music therapy approach, which is necessarily individual because focused on the
patient and his/her family); integrated working within teams and inter-professional communication
(Baroni, 2015).
Since 2000, many Italian studies of music therapy in end-of-life care are annually presented in
national conferences organised by the Italian Society of Palliative Care (Baroni, 2017; Calanchi, 2017,
2019; Catuogno, 2017; Fucili & Mancini, 2019; Marchi et al., 2019; Menegoni et al., 2019; Parente,
2018a, 2018b; Patzak, 2018; Romito et al., 2018).
One of the most complex topics for music therapists who work in end-of-life situations alongside
terminally ill patients concerns the methods used to carry out research and studies in this context.
From 2002 to the present day, the Italian scientific literature does not include many articles concerning

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the use of music therapy in end-of-life care. Often these publications are qualitative studies and
present case studies (Gamba, 2017), working methods and the integration of music therapy in the
multidisciplinary team (Rossi & Capolsini, 2013).
Conferences and events
Over the last 20 years, an increasing number of music therapists work in hospices allowing music
therapy to spread in this context and creating important opportunities for dialogue with other
professionals such as nurses, doctors and psychologists (Trevor-Briscoe et al., 2018).
In September 2012, the first National Congress of Music Therapy and Oncology was held in Biella
and was organised by Fondazione Edo e Elvo Tempia. Many of the reports presented in the conference
have been published in Musica & Terapia (Baroni, 2012; Laurentaci & Cifarelli, 2012; Malfatti et al.,
2012); a volume entirely dedicated to the application of music therapy in oncology and palliative care.
In 2013, in Biella, the first specialisation course for Music Therapy in Oncology and Palliative
Care was introduced by Fondazione Edo e Elvo Tempia and was aimed specifically at professional
music therapists who wanted to further deepen their education in this context. In 2015 the first Italian
volume entirely dedicated to music therapy and oncology was published (Cerlati & Crivelli, 2015). It
presented some music therapy activities in oncology and end-of-life care, conducted by both Italian
and foreign professionals.
In October 2016, AIM organised the congress Musicoterapia in oncologia e cure palliative: Struttura
e processo di lavoro tra clinica e ricerca [Music therapy in oncology and palliative care: Structure and
work process among clinic and research] and invited Clare O’Callaghan to attend and give two keynote
lectures (AIM Congress, 2016). The aim of the congress was to further explore the topics of research
and the close connections between practice and research in music therapy with oncological patients,
terminally ill and their relatives (O’Callaghan, 2009a, 2009b). On the occasion of the conference, the
Association AIM promoted the creation of a study group, Musicoterapia in oncologia e cure palliative
[Music therapy in oncology and palliative care], which was joined by 20 music therapists from different
Italian cities. The group has been operating for three years and it organises training and study days
for its members. Cheryl Dileo was invited in 2018 and held a two-day workshop about music therapy
entrainment. The group is currently working on the evaluation and dissemination of the results
gathered and documented by the music therapists who work in oncology and palliative care; the data
collected concern the past three years of the members’ work (Trevor-Briscoe et al., 2018).
LOOKING FORWARD
The Italian professional associations are working on different important topics, particularly the
communication about the proper practice of music therapy in Italy. Without a doubt, the spirit of
collaboration activated between the main professional music therapy associations constitutes a very
important foundation for the development of music therapy in Italy. In particular, the associations are
continuing the work with the Italian Ministry of Economic Development and Ministry of Health to
recognise music therapy at a national level.

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With reference to clinical and research areas it is important to point out how far music therapy
practice is spreading and how this increase coincides with a significant improvement in quality. This
is supported by the significant presence of research projects which consider, among their main aims,
the advancement and improvement of clinical practice and the application of music therapy. In fact,
in the past ten years music therapy projects have been increasing and developing in different contexts:
prison (Rosa, 2014); drug addiction (Navone, 2018); neonatal rehabilitation in the Neonatal Intensive
Care Unit – NICU (Cerri, 2015); neurological rehabilitation (Meschini, 2015; Meschini et al., 2017);
paediatric oncology (Zanchi, 2015; Zanchi et al., 2018).
Many conferences, study days, and workshops have been organised to focus on the application
of music therapy in these contexts. The most recent studies, mentioned above, demonstrate the
quality of research being undertaken in Italy. There are two further studies in paediatric oncology and
neurological rehabilitation which are worthy of note and are outlined below.
In 2015, at the Istituto Santo Stefano of Porto Potenza Picena, the Music Therapy Observational
Tool (MuTOT) was developed (Meschini et al., 2017). Its main aim is to improve music therapy
intervention and provide important information for interdisciplinary assessment and treatment of the
people in low awareness.
Five years ago, at the paediatric-oncology unit of Bari Hospital, research on the impact of music
therapy on anxiety in children undergoing painful procedures was launched. The primary objective of
the study was to evaluate the influence of music therapy as a complementary/non-pharmacological
intervention to reduce preoperative anxiety and to promote more compliant behaviours during
anaesthesia induction. A lower preoperative anxiety score (m-YPAS) was observed in the music
therapy group compared with the standard care group. Results support the potential effectiveness of
integrating music therapy with a pharmacological approach to reduce preoperative anxiety in painful
procedures. More than 90% of medical staff were also very satisfied about the ability of music therapy
to distract the patient and support the staff (Giordano et al., 2019).
CONCLUSIONS
To conclude, some considerations on music therapy in dementia and end-of-life care are motivating
for the future. In the past six years (since the law on palliative care was approved), a discussion has
been developing in Italy about the possibility of offering palliative care to elderly people of 80 years
old and over. It is likely that facilities for elderly people will increasingly become providers of palliative
care, and that the terminal suffering experienced by elderly patients affected by dementia will compel
facilities to examine their role in palliative care. When discussing end-of-life care, it is also necessary
to consider the physical, psychological and spiritual dimensions, as established by the study group of
Società Italiana di Gerontologia e Geriatria (SIGG) [Italian Geriatric and Gerontology Society]. In my
opinion, while continuing to implement music therapy in dementia settings, it will also be important to
develop new music therapy methods and to examine the role of music therapists in end-of-life
contexts.
A further complex topic relates to the potential involvement of music therapists in the ‘living will’
of patients; Disposizioni Anticipate di Trattamento (DAT) [Advance Healthcare Directive]. It is
regulated by a Law 219/2017, recently passed and effective from 31st January 2018, that establishes

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the possibility for every individual to express their own intentions regarding medical treatments at the
end of life (Gazzetta Ufficiale, 2017). In my experience, some topics often surface during music therapy
sessions and help the patient, both young and old, to express his/her own will: the patient’s subjective
perception of his/her condition, sense of identity, the need for completion, and existential questions
about the last days (Baroni, 2009, 2017). It is important to question what specific contribution music
therapy can make in this case, helping to enhance the quality of care in a multi-disciplinary team. A
challenge for professional associations is to offer Italian music therapists continual professional
refresher courses in order to support their daily work in constant contact with these realities.
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Ελληνική περίληψη | Greek abstract
Η μουσικοθεραπεία στην άνοια και τη φροντίδα στο τέλος της
ζωής: Μία αναφορά από την Ιταλία
Mariagrazia Baroni
ΠΕΡΙΛΗΨΗ
Αυτή η αναφορά συνοψίζει τις βασικές φάσεις και τους παράγοντες που έχουν συνεισφέρει στην ανάπτυξη
της μουσικοθεραπείας στην Ιταλία, από τη δεκαετία του 1970 έως και σήμερα, εστιάζοντας ειδικότερα στο
χώρο της άνοιας και της φροντίδας στο τέλος της ζωής. Αντλώντας από τη γνώση και την εμπειρία των
Ιταλικών εκπαιδευτικών ιδρυμάτων και των επαγγελματικών συλλόγων μουσικοθεραπείας, το κείμενο
διερευνά την εξέλιξη της μουσικοθεραπείας στη φροντίδα της άνοιας, από τις πρώτες παρεμβάσεις κατά τη
δεκαετία του 1980 σε γηροκομεία σε όλη τη χώρα έως τις διάφορες ποιοτικές και ποσοτικές ερευνητικές
μελέτες που είναι διαθέσιμες σήμερα. Ένα άλλο θέμα διερεύνησης αφορά την ανάπτυξη του κινήματος των
ξενώνων ανακουφιστικής φροντίδας [hospice movement] στην Ιταλία και την συμπερίληψη επαγγελματιών
μουσικοθεραπευτών στις διεπιστημονικές ομάδες σχετικά με την ανακουφιστική φροντίδα και τη διαχείριση
πόνου. Η μουσικοθεραπεία άρχισε να χρησιμοποιείται σποραδικά σε ξενώνες ανακουφιστικής φροντίδας
[hospices] από τα τέλη της δεκαετίας του 1990, και από το 2000 πολλές ιταλικές έρευνες σχετικά με τη
μουσικοθεραπεία στη φροντίδα στο τέλος της ζωής παρουσιάζονται ετησίως σε εθνικά και διεθνή συνέδρια.
Τέλος, η αναφορά αυτή εξετάζει τις μελλοντικές προοπτικές και εξερευνά διάφορα μουσικοθεραπευτικά
προγράμματα τα οποία αυξάνονται και αναπτύσσονται σε διάφορα πλαίσια.
ΛΕΞΕΙΣ ΚΛΕΙΔΙΑ
μουσικοθεραπεία, Ιταλία, άνοια, φροντίδα στο τέλος της ζωής [end-of-life care]