In this study, the kinds of sounds recollected by elderly people with dementia were investigated as a first step towards improving their sound environment. Onomatopoeias were presented to elderly people as keys to recollecting sounds, and they told what they imagined from each onomatopoeia. The results are summarized as follows.
(1) Generally speaking, sounds from nature, such as the songs of birds and the sound of rain were recollected easily from onomatopoeias, regardless of gender.
(2) Sounds of kitchen work were recollected by women only.
(3) Sounds from old routines were recollected clearly.
(4) Sounds that elicited feelings of nostalgia were also recollected intensely from onomatopoeias.
These results show that elderly people suffering from dementia are able to recollect the sounds that had once occupied very important parts of their lives. However, these sounds in themselves are not unusual sounds in their daily lives. This suggests the importance of soundscape design in daily life.
Keywords: sound environment, dementia, life history, onomatopoeias, soundscape design
|How to cite this article:|
Nagahata K, Fukushima T, Ishibashi N, Takahashi Y, Moriyama M. A soundscape study : What kinds of sounds can elderly people affected by dementia recollect?. Noise Health 2004;6:63-73
|How to cite this URL:|
Nagahata K, Fukushima T, Ishibashi N, Takahashi Y, Moriyama M. A soundscape study : What kinds of sounds can elderly people affected by dementia recollect?. Noise Health [serial online] 2004 [cited 2020 May 31];6:63-73. Available from: http://www.noiseandhealth.org/text.asp?2004/6/24/63/31654
| Introduction|| |
The sound environment is an important element of our living environment, and it must be the same for the elderly affected by dementia. Therefore, when we discuss improving the living environments for people affected by dementia, we must not ignore soundscape design.
Here is an example. According to a note written by a woman affected by dementia (Borden, 1997), it was very difficult for her to know what a sound actually was when she heard it, and it often took some time to process it. She also wrote that sounds were very unfamiliar, strange, and stressful for her until she realized what they were.
Takahashi and Ishibashi (1996) pointed out that problematic behavior of elderly people affected by dementia are caused by fears due to forgetfulness. They also report that if the fears are removed, problematic behaviour decreases. Kuraho (1999) referred to the fact that nursing care which tries to remove elderly peoples' stress has been spreading.
These suggest that if certain sounds cannot be recalled easily by elderly people with dementia, the elimination of these sounds would produce a better acoustic environment for them. To eliminate these kinds of sounds, it is necessary to establish what kinds of sounds are recollected easily.
In this study, the kinds of sounds that are recollected easily by subjects are investigated from the viewpoint of soundscape design as a first step towards improving their sound environment.
| Subjects and Methods|| |
The subjects in this study were fourteen elderly people with dementia who were members of a day-care facility in Izumo City, "Oyama-noouchi". Group psychotherapy was offered in "Oyama-no-ouchi" daily for regular attendants (Takahashi & Ishibashi, 1996, Ishikura, 1999). The elderly people suffered from moderate to advanced degrees of dementia. According to the American Psychiatric Association Practice Guideline (American Psychiatric Association, 1997), the degree of severity of any dementia is described by the level of functional impairment. Elderly people with moderate impairment have difficulties with simple food preparation, household cleaning, and yard work and may require assistance with some aspects of self-care. With regard to memory loss, memory for recent events or names is affected first, and then remote memories are lost (Edwards, 1994, Kertesz & Mohs, 1999). Patients at the moderate stage are very forgetful of recent events. Their memories for the distant past generally seem better, but some details may be forgotten or confused (Borden, 1997). With regard to language deterioration, word finding difficulties and circumlocutions are detectable in the early stage of dementia (Kertesz & Mohs, 1999). Circumlocutions are more frequent among people with moderate impairment: they have difficulty finding even ordinary words such as "pencil" and "kitchen knife" (Ozawa, 2003).
The investigation was carried out as part of a course on group care at "Oyama-no-ouchi" on February 23, 2001. The outline of our investigation is shown below.
The subjects and care staff sat in a room as they liked, but faced a care leader. The care leader showed them a large card on which an onomatopoetic word was written. The subjects and care staff read the onomatopoeia aloud several times to help the subjects imagine what kind of sound the onomatopoeia indicated. Sometimes subjects talked with neighbors to help each other recollect what the onomatopoeia signified. Subjects then described what they imagined and answered individually or in groups, as they saw fit. The care leader and other staff responded to subjects' descriptions to further stimulate their recollections.
One hundred onomatopoeias were prepared for this study. These onomatopoeias covered many types of sound events including natural sounds like the songs of birds and the sound of a waterfall, the sounds of kitchen work, the sounds of traditional customs, and so on. The onomatopoeias used for our investigation are listed in [Table - 1]. They were selected from the prepared onomatopoeias by the deputy-care leader in the investigation in consideration of the elderly people's responses. To be more precise, these onomatopoeias were basically selected randomly, but those onomatopoeias to which it was thought many of the subjects could respond, considering daily conversation at the day-care facility, were inserted. From the viewpoint of group care, all subjects were expected to make some response, and no one was allowed remain silent.
A questionnaire survey to the elderly peoples' families about the relationships between the subjects and sounds was also conducted. The questionnaire consisted of three questions as shown in [Table - 2].
| Reasons for Using Onomatopoeias|| |
Onomatopoeias were employed for two main reasons.
The first is that each onomatopoeia, as Osaka (1999) suggests, expresses a certain realistic soundscape image with a strong connection between each onomatopoeia and a particular sound. Therefore, if a person can recall a certain sound from an onomatopoeia, it means that they have a lasting memory of the sound.
The second reason is that an actual sound (or a recorded sound) often differs from the sound in seniors' memories. In fact, some subjects pointed out differences between some actual sounds and the sounds in their memories when they listened to recorded sounds in our pre-investigation. However, the connection between onomatopoeias and sounds does not seem to change, unless the subjects had entirely forgotten a certain onomatopoeia, because the features of language deterioration of dementia patients are word-finding difficulties and circumlocutions. Connections between onomatopoeias and actually remembered sounds were very clear.
| Results|| |
Subjects' responses for each onomatopoeia are shown in [Table 3 in pdf], in which M1-M3 indicate responses from male subjects, F1-F6 indicate responses from female subjects, and S1-S3 indicate responses from care staff. In this table, responses directly to a care leader or those reported to all participants by care staff are shown. As mentioned above, subjects sometimes talked with neighbors including care staff during the investigation, but responses in such a situation are not shown in this table.
In [Table 3 in pdf], the durations of dialog about each onomatopoeia are also shown. There is no simple relationship between the duration and the number of respondents for each onomatopoeia and neither is there any simple relationship between the duration and variety of content about each onomatopoeia.
In the cases of some onomatopoeias, such as "piyo-piyo" and "moe", replies were made much more quickly and more intensively than replies to other onomatopoeias. In other cases, such as "kasha", the contents of responses diverged from the shown onomatopoeia. And in the case of "kachi-kochi", subjects could recall nothing, even though care staff gave hints to help them recollect. These differences in responding are the reason for the lack of a simple relationship as mentioned above.
The features of subjects' behaviors observed in this investigation are described as follows. Focusing on the number of subjects who reacted to each onomatopoeia including responses to the care leader, talk with neighbors, and reactions by making various gestures, there are some onomatopoeias to which many subjects react and some to which only a few subjects do. More concretely, most of the subjects, regardless of gender, reacted by talking with neighbors or making various gestures besides the responses in [Table 3 in pdf] to "zah-zah", "piyo-piyo", "moe", and "boon". In contrast, almost no subjects reacted to "kachi" and "kachi-kochi". In the case of "kasha" described in more detail later, many female subjects reacted to this onomatopoeia, while male subjects tended not to react.
Consequently, subjects' responses to each onomatopoeia are described by the kinds of sounds indicated by the onomatopoeias.
| Responses to Onomatopoeias based on Sounds in Nature|| |
As mentioned above, many subjects, regardless of gender, reacted by making various gestures or talking more often with neighbors about "zahzah", "piyo-piyo", "moe", and "boon". Moreover, replies to these onomatopoeias were made comparatively quickly compared with replies to others.
In Japanese, the above onomatopoeias indicate the sounds of nature: "zah-zah" represents the sound of a waterfall or rain, "piyo-piyo" represents the chirping of chicks, "moe" represents the sound of a cow and "boon" represents the buzzing of bees or mosquitoes. These results show that the sounds of nature were recollected easily.
Izumo City, located in the western part of Japan along the Sea of Japan, has not been highly urbanized. So Izumo City and towns near this city have always been surrounded by natural beauty, and residents seemed to be very familiar with the sounds of nature. Living in such an environment for a long time seems to be one of the reasons why the subjects could recall these sounds easily.
| Responses to Onomatopoeias Associated with Kitchen Work|| |
In this investigation, "kasha" and "pachi-pachi" were recognized as the sounds of kitchen work.
In the case of "kasha", one woman (F2 in [Table 3 in pdf]) mentioned that this onomatopoeia indicated the clashing of pots and pans. Some women nodded their heads at this answer, and other women talked with neighbors afterwards. However the men did not react to this onomatopoeia, although one man said that to men, this kind of sound just represented "noise".
In the case of "pachi-pachi", one woman (F5 in [Table 3 in pdf]) said "pachi-pachi" indicated a popping sound, and another woman (F4 in [Table 3 in pdf]) said that it indicated the sound of burning firewood, charcoal or similar substances.
With regard to "kasha", there were several responses from women in the questionnaires to the families, that subjects had disliked the clashing sound of tableware, pots or pans even before they were affected by dementia. The following serves as a notable example: "When I (the daughter-in-law of a female subject) dropped a pot lid or something similar, she always scolded me even if she was in another room." These responses suggest that seniors, at least those living in this district, generally dislike this kind of sound. Moreover this kind of sound seems to be considered as a noise that one ought not to make. Therefore, it is considered that people who did kitchen work were careful not to make these kinds of sounds. In Japan, housework had long been thought of as women's work, and seldom done by men. This custom had persisted, especially in rural districts, until fairly recently. Among the subjects in this study, the female subjects had always done kitchen work, while the male subjects had seldom done any. This means that the women had to be careful not to make these kinds of sounds while the men only disliked these kinds of sounds. This must be the reason why only women reacted strongly to this onomatopoeia.
Similarly, the fact that in general only females did housework, gives a good reason why only female subjects responded to "pachi-pachi" as sounds of kitchen work.
Thus, the sounds of kitchen work, which are very familiar to women but unfamiliar to men, were recollected only by the female subjects.
| Responses to Onomatopoeias Associated with Old Customs|| |
Next, the case of "kachi-kachi" is described. First, a man (M1 in [Table 3 in pdf]) pointed out that "kachi-kachi" indicated the sounds of flintstones. Then, a woman (F1 in [Table 3 in pdf]) explained with gestures that it was an old custom to strike flintstones when someone went to work. Another man (M2 in [Table 3 in pdf]) then continued, saying that this custom originally meant "to go to work without mishap" and/or "to come back unhurt". Thus, this onomatopoeia recalled not only what this indicated but various clear and relevant memories.
This suggests that onomatopoeias of sounds from the subjects' long-established customs can result in recall not only of what these indicate but also of various relevant memories.
| Responses to Onomatopoeias of Nostalgic Sounds|| |
Each of the subjects responded to onomatopoeias of nostalgic sounds on account of a relationship to his/her life history. Subjects often responded to this kind of onomatopoeia, not only with explanations of what the onomatopoeia indicated, but also with their own comments on the sounds or memories of the sounds.
For example, a man (M3 in [Table 3 in pdf]), who showed an acute interest in the sound of temple bells in our pre-investigation, said that "kashakasha" is a bad sound because it is a kind of noise. Then he mentioned continuously that "when it comes to sounds, I think they should resound like a temple gong. Solemn sounds are quite good."
A woman (F6 in [Table 3 in pdf]) who, according to the questionnaires to the families loved the sound of festivals, replied that "pee-hyala" was the sound of a festival flute, and started singing a children's song named "the village festival", in which "don-don-hyalala" occurs in the lyrics. In "dondon-hyalala", "don" indicates the sound of drums and "hyalala" indicates the sound of a festival flute.
The sound of Flintstones, mentioned above, was also classified in this type of reply.
The results described above show that seniors with dementia can easily recollect sounds which had been once very familiar to them.
| Response Patterns to Onomatopoeias|| |
As mentioned above, subjects responded to sounds with which they had once been very familiar. Therefore, most of subjects were individually able to respond to limited sorts of onomatopoeias.
In contrast, the most frequent respondent (M1 in [Table 3 in pdf]) replied to various kinds of onomatopoeias. Moreover, his responses tended to include analytical comments. For example, he pointed out the difference between the timbre of a temple gong and that of a gong on a family Buddhist altar, and offered two onomatopoeia; "Kaaan" indicates the timbre of a temple gong, and "cheen" or "keen" indicates that of a gong on a family Buddhist altar. This type of fine distinction did not occur with subjects who only responded to a limited number of onomatopoeias.
According to the questionnaires to the families, the family of the man wrote:
"As he says, he is oversensitive, he dislikes all loud sounds and is very often alarmed by them. It seems that loud voices or sounds remind him of enemy attacks."
During World War II, this subject seems to have been sensitive to sounds, discriminating between the sound of an enemy attack and other sounds in order to defend himself. So he seems to have established the habit of listening to sounds around him very carefully and analytically. His analytical comments to onomatopoeias originated from his own experiences in wartime.
This means that his response patterns to onomatopoeias also reflected his life history. He also responded to the sounds that had been very familiar to him.
| Discussion|| |
As mentioned above, the subjects responded to sounds that had once been very familiar to them. In other words they could recollect and describe sounds that once occupied important parts of their lives. This suggests that any soundscape design for people affected by dementia must consider individual life histories.
However, not all sounds recollected were peculiar to their individual daily lives. Many of these sounds are rather common. This suggests that soundscape designs reflecting individual life histories require common daily sounds, not unusual sounds. This also suggests that an important point of the soundscape design reflecting the individual's life history is how to set up the sounds heard in the senior's old daily life in a present day sound environment. For the example of the kitchen, using classical cooking equipment instead of modern ones can make this possible.
Moreover, it must be clear that common sounds for people who have been living in the same area around the same time, are very similar. It suggests that less stressful soundscape designs for facilities for seniors can be made by considering how to set up the sounds heard in the seniors' daily lives in a present day sound environment. Recently in rural districts, there are some group homes for senile elderly people which have small farming areas for the elderly people in the yards, and elderly people in there work as they are able with the assistance of the care workers. These attempts may lead to a solution to the problem of creating a better sound environment for rural seniors.
From another point of view, we can say that the sounds which each senior can recollect are the sounds which each senior has listened to attentively in his/her past daily life. Especially, responses from the person who answered most frequently (M1 in [Table 3 in pdf]) strongly suggest this. This means that whether or not one can recollect a certain sound even after dementia, depends on whether he/her had listened to the sound attentively. Furthermore, it is likely that the number of sounds which one can recollect even after dementia depends on how attentively he/she had listened to the sounds in his/her daily life. This supports the importance of listening to the sounds about us with greater critical attention, as advocated by R. Murray Schafer, and also suggests the necessity of "A Sound Education" (Schafer 1992).
Finally, the results of this study show that the sound environment of each senior's past daily life has a considerable effect on what kinds of sounds each senior can recollect. This means that the sounds around us will have a great effect on what kinds of sounds we can recollect if we are subsequently affected by dementia. Thus, we must not forget this when we design our soundscapes.
| Conclusion|| |
The results of our investigation are summarized as follows.
(1) Generally speaking, nature sounds, like the songs of birds and the sound of rain are recollected easily from onomatopoeias regardless of gender.
(2) Sounds of kitchen work are recollected by women only.
(3) Sounds from old routines are recollected clearly.
(4) Nostalgic sounds are recollected intensely. These results show that seniors suffering from dementia are able to recollect sounds that once occupied very important parts of their lives.
This suggests the importance of soundscape design in our daily lives.
| Acknowledgments|| |
The authors express their sincere appreciation to the seniors and their families for their cooperation in this survey. This work was supported by a JSPS.KAKENHI (12670385).
| References|| |
|1.||American Psychiatric Association (1997) Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias of Late Life, American |
|2.||Psychiatric Association, Washington, D.C. |
|3.||Borden. C. (1997) Who will I be when I die?, Harper Collins Religious, Australia |
|4.||Edwards. A. J. (1994) When Memory Fails: helping the Alzheimer's and dementia patient, Plenum Press, New York, pp.141-148 |
|5.||Ishikura. y., ed., The care of the elderly with dementia in the formative period, Kitaouji Shobo, Kyoto (in Japanese) |
|6.||Kertesz. A., Mohs. R. C. (1999) Cognition, Clinical Diagnosis and Management of Alzheimer's Disease, Second Edition, Gauthier. S., ed. Martin Duntz, London, pp.179-189 |
|7.||Kuraho. K. (1999) Defects caused by dementia and ministering to seniors with dementia. The care of elders with dementia in the formative period, Ishikura. Y., ed. |
|8.||Kitaouji Shobo, Kyoto, pp.233-239 (in Japanese) |
|9.||Osaka. N., ed. (1999) Studying Sensibility Words, Shinyo-sha, Tokyo (in Japanese) |
|10.||Ozawa. I. (2003) Living with dementia, Iwanami Shoten, Tokyo (in Japanese) |
|11.||Schafer. R. M. (1992) A Sound Education, Arcana Edition, Ontario |
|12.||Takahashi. Y., Ishibashi. N. (1996) Seniors affected by dementia and their day care, The Nursing Home That We Think Ideal, Eiwa. Y., ed. Chu-o Houki Shuppan, Tokyo, pp.89-134 (in Japanese) |
Fukushima University, Kanayagawa 1, Fukushima City, Fukushima-960-1296
Source of Support: None, Conflict of Interest: None
[Table - 1], [Table - 2]