Background: Music and singing are considered to have a strong impact on human emotions. Such an effect has been demonstrated in caregiving contexts with dementia patients.

Objectives: The aim of the study was to illuminate vocally expressed emotions and moods in the communication between caregivers and persons with severe dementia during morning care sessions.

Design: Three types of caring sessions were compared: the "usual" way, with no music; with background music playing; and with the caregiver singing to and/or with the patient.

Participants and setting: Nine persons with severe dementia living in a nursing home in Sweden and five professional caregivers participated in this study.

Methods: Qualitative content analysis was used to examine videotaped recordings of morning care sessions, with a focus on vocally expressed emotions and moods during verbal communication.

Results: Compared to no music, the presence of background music and caregiver singing improved the mutuality of the communication between caregiver and patient, creating a joint sense of vitality. Positive emotions were enhanced, and aggressiveness was diminished. Whereas background music increased the sense of playfulness, caregiver singing enhanced the sense of sincerity and intimacy in the interaction.

Conclusion: Caregiver singing and background music can help the caregiver improve the patient's ability to express positive emotions and moods, and to elicit a sense of vitality on the part of the person with severe dementia. The results further support the value of caregiver singing as a method to improve the quality of dementia care.