Written with AI-assistance.
When Pixar’s Coco swept audiences into tears in 2017, many assumed it was simply a beautiful story about family and Mexican culture. But at its heart, Coco is a film about music itself—its power to heal, to harm, to connect, and to transform lives across generations.
The film’s central tension revolves around music: young Miguel dreams of becoming a musician, but his family has banned music for generations. This prohibition stems from trauma—Miguel’s great-great-grandmother Imelda banished music from the family after her husband, a musician, abandoned her and their daughter Coco to pursue his dreams. For the Rivera family, music represents abandonment, betrayal, and pain. It’s a wound that has festered for nearly a century, passed down through generations who never even knew the original story.
Yet nested within this narrative about music’s capacity to cause trauma lies something even more profound: a demonstration of music’s irreplaceable role in dementia care, palliative care, and end-of-life comfort. Coco doesn’t just tell us that music matters—it shows us, in deeply moving scenes, exactly how and why music remains essential even when words fail, memory fades, and life draws to a close.
Two Pivotal Scenes: Music as Connection
The film offers two powerful portrayals of music’s role in care. Early in the story, we witness Héctor singing to Chicharrón, a forgotten soul fading into his final death in the Land of the Dead. As Chicharrón disappears, Héctor’s song provides comfort, dignity, and companionship in his last moments—a scene that mirrors the work of music therapists in hospice care every day.
Later, the film’s emotional climax centers on Miguel singing “Remember Me” to his great-grandmother Coco, who is living with advanced dementia. As the familiar melody reaches her, something remarkable happens: Coco awakens. She completes the lyrics, remembers her father, and reconnects with a past that seemed lost forever.
For anyone who has witnessed the power of music with dementia patients or at the end of life, these scenes don’t feel like movie magic—they feel like documentary.
The Science Behind the Story
What Coco captures so beautifully is supported by decades of research in music therapy and neuroscience. Music activates multiple areas of the brain simultaneously, including regions involved in emotion, movement, and memory. Critically, musical memory is often preserved even when other cognitive functions decline.
Research using high-field functional MRI has identified that brain regions encoding long-term musical memory—particularly the caudal anterior cingulate and ventral presupplementary motor area—correspond to areas showing minimal cortical atrophy and minimal disruption of glucose metabolism in Alzheimer’s patients compared to the rest of the brain (Jacobsen et al., 2015). This neurobiological preservation may explain why Coco can sing along to her father’s song even when she cannot remember him otherwise.
Recent systematic reviews of randomized controlled trials have demonstrated that music therapy shows improvement in cognitive functions in Alzheimer’s disease patients, with greater effects observed when patients actively participate in music-making rather than passive listening (Moreno-Morales et al., 2020). The phenomenon has been documented countless times in clinical settings: patients who can no longer recognize their own children will suddenly sing every word to a song from their wedding day. Those who haven’t spoken in months will hum along to a favorite hymn.
Music Therapy in End-of-Life Care
Coco‘s portrayal of Héctor comforting Chicharrón resonates deeply with the growing recognition of music therapy as a vital component of palliative and hospice care. Elisabeth Kubler-Ross recognized the value of music therapy in helping dying patients who are withdrawn become more engaged with others, and theoretical frameworks have been developed specifically for the use of music therapy for people nearing the end of their life (Hilliard, 2005).
In randomized controlled trials, music therapy interventions have been shown to be more effective than control treatments at promoting relaxation and well-being in palliative care patients, with significantly greater improvements in self-rated relaxation scores and heart rate variability (Warth et al., 2015).
Certified music therapists work with patients at the end of life to:
- Reduce anxiety and agitation through calming music and familiar melodies
- Facilitate communication when words become difficult or impossible
- Provide comfort through songs connected to spiritual or cultural identity
- Support reminiscence and life review, helping patients process their experiences
- Strengthen family bonds by creating shared musical moments
Both scenes in Coco demonstrate these elements. The songs are personal, culturally meaningful, emotionally resonant, and create moments of genuine connection between people.
The Deeper Message: Memory as Love
But Coco goes beyond simply showing music’s therapeutic effects. The film’s central philosophy—that the dead are truly gone only when they are forgotten—transforms music from a clinical intervention into something more profound: an act of love.
When Miguel sings to Coco, he isn’t just triggering a neurological response. He is honoring her, her father, and the chain of memory that connects them. When Héctor sings to Chicharrón, he ensures that his friend’s last moments are not spent alone, but accompanied by music and remembered with dignity. These are acts that say, through music, “You matter. Your story matters. You are not forgotten.”
This reframes what happens in nursing homes and hospice facilities every day when music therapists and family members sing with those nearing the end of life. These aren’t just therapeutic interventions—they are profound human moments of witness, connection, and dignity.
Practical Lessons from Coco
For families caring for loved ones with dementia or at the end of life, Coco offers gentle guidance:
Create personalized playlists. Songs from their youth, their wedding, their children’s childhoods—music tied to meaningful life events has the strongest effect. Research shows that music therapy interventions must meet a person’s needs in the moment and be supported within the wider care environment to reduce distress and improve well-being for people with advanced dementia (Thompson et al., 2024). Studies have also found that individualized music interventions based on patients’ personal preferences are more effective than generic music selections (Gaviola et al., 2020).
Don’t just play music—share it. Sing together, even if they can’t sing back. Hold hands. Make eye contact. The human connection amplifies music’s power.
Pay attention to their responses. Not every song will work. Watch for signs of engagement, comfort, or distress, and adjust accordingly.
Music isn’t about perfect recall. Coco doesn’t remember everything when she hears the song—but she remembers what matters. That’s enough.
Preserve musical memories. Record yourself singing family songs. Document what music mattered to your loved one. Like the photo on Coco’s ofrenda, these preserve something essential.
Remember music can comfort even when unresponsive. Hearing is thought to be the last active sense to lapse before death, and music therapy may be quite appropriate for unresponsive patients (Hilliard, 2005). Just as Héctor’s song accompanied Chicharrón’s final moments, music can provide comfort even when a patient cannot respond.
The Gift of the Film
Coco reminds us that in our final chapters, when so much may be lost, music remains. It is a bridge across the river of forgetting, a way to say “I see you” when words fail, and a testament to the enduring power of love and memory.
As Miguel sings to Coco in that quiet room, and as Héctor sings to Chicharrón in his final moments, they offer us—and their loved ones—a profound gift: the reminder that we are more than our failing bodies or fading minds. We are the songs we’ve sung, the memories we’ve shared, and the love that outlasts even death itself.
Remember me, though I have to say goodbye / Remember me, don’t let it make you cry.
In the end, perhaps that’s what music therapy at end of life is really about: not preventing grief, but ensuring that when our loved ones pass, they pass remembered, honored, and connected to the love that has always sustained them.
References
- Jacobsen, J.H., Stelzer, J., Fritz, T.H., Chételat, G., La Joie, R., & Turner, R. (2015). Why musical memory can be preserved in advanced Alzheimer’s disease. Brain, 138(8), 2438-2450.
- Thompson, N., Odell-Miller, H., Underwood, B.R., et al. (2024). How and why music therapy reduces distress and improves well-being in advanced dementia care: a realist review. Nature Mental Health, 2, 1532-1542.
- Prick, A.J.C., Zuidema, S.U., van Domburg, P., Verboon, P., Vink, A.C., Schols, J.M.G.A., & van Hooren, S. (2024). Effects of a music therapy and music listening intervention for nursing home residents with dementia: a randomized controlled trial. Frontiers in Medicine, 11, 1304349.
- Moreno-Morales, C., Calero, R., Moreno-Morales, P., & Pintado, C. (2020). Music therapy in the treatment of dementia: A systematic review and meta-analysis. Frontiers in Medicine, 7, 160.
- Warth, M., Kessler, J., Hillecke, T.K., & Bardenheuer, H.J. (2015). Music therapy in palliative care: A randomized controlled trial to evaluate effects on relaxation. Deutsches Ärzteblatt International, 112(46), 788-794.
- Hilliard, R.E. (2005). Music therapy in hospice and palliative care: A review of the empirical data. Evidence-Based Complementary and Alternative Medicine, 2(2), 173-178.
- Gaviola, M.A., Inder, K.J., Dilworth, S., Holliday, E.G., & Higgins, I. (2020). Impact of individualized music listening intervention on persons with dementia: A systematic review of randomized controlled trials. Journal of Advanced Nursing, 76(6), 1356-1372.
- Clark, C.N., & Warren, J.D. (2015). Music, memory and mechanisms in Alzheimer’s disease. Brain, 138(8), 2122-2125.
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