Effects of music on depression and sleep quality in elderly people: A randomised controlled trial

Current scenario and potential of music therapy in the management of diseases

Over the preceding years, music therapy has gained tremendous attention due to new findings of music in management of various conditions like Alzheimer's, depression, anxiety, insomnia, etc. Music is a non-invasive, patient-friendly and pleasant form of therapy with minimal or no side effects. It activates the reward pathway of brain by influencing several processes such as dopamine release, reduction in cortisol levels, increase in estrogen and testosterone levels. This review article focuses on advantages and disadvantages of music therapy, mechanism of action of music in brain and its effective applications in the management of different diseases. The article covers history of music therapy in America, Egypt, and India with practice of music therapy. The advanced effects of music therapy in autism, cancer, post-operative pain, Parkinson's disease, selective mutism, stroke, heart problems, pregnancy, eating disorders, bone fractures and obsessive compulsive disorders are discussed. Also the effect of music therapy on the quality of sleep and brain waves has been discussed. This is an established profession in western countries like America, UK, Australia, and Canada, but not in low-income countries like India where it needs to be standardized.

Effects of different interventions on insomnia in adults: Systematic review and network meta-analysis

OBJECTIVE

Insomnia is a common sleep disorder. There are many clinical-intervention methods for treating this condition, but thus far, the most effective method has not been determined.

METHODS

We conducted a network meta-analysis by including random evidence of insomnia improvement in people over 18 years old, without other physical diseases. From January 1, 1990 to June 15, 2022, we searched multiple electronic databases for randomized controlled trials of different insomnia-related, clinical-intervention methods. R software was used to analyze 10 indices, in order to evaluate the effect of sleep improvement. Primary outcomes comprised Pittsburgh sleep quality-index (PSQI) scores and insomnia severity-index (ISI) scores.

RESULTS

Finally, 122 randomized controlled trials were included in our study. For the PSQI scores, we found the sequence of intervention measures by effect to be as follows: electroacupuncture, acupuncture, repetitive transcranial magnetic stimulation (rTMS), essential oils, herbal medicine, traditional Western medicine, Tai Chi and Baduanjin, music, supplements, cognitive behavioral therapy for insomnia (CBT-I), and exercise. The results for ISI were similar to those for PSQI, but with slight differences.

CONCLUSION

Our research results indicate that various measures have a certain effect on improving sleep, among which the effect of instruments is more prominent. The curative effect of placebo groups was better than that of blank control groups. There is essentially no statistical difference in detailed classification within the same intervention category.

The Effectiveness of a Multimodal Brain Empowerment Program in Mild Cognitive Impairment: A Single-Blind, Quasi-Randomized Experimental Study

The present study aimed to determine a multimodal brain empowerment (MBE) program to mitigate the modifiable risk factors in mild cognitive impairment (MCI), and its therapeutic effects are unknown. MBE encompassing (1) tDCS, light therapy, computerized cognitive therapy (TLC) and (2) robot-assisted gait training, music therapy, and core exercise (REM) interventions were randomly assigned to 20 healthy young adults and 20 older adults with MCI. The electroencephalography (EEG) power spectrum and topographic event-related synchronization (ERS) analysis were used to assess intervention-related changes in neural activity during the MBE program. Outcome: The EEG results demonstrated that both multimodal TLC and REM decreased delta waves and increased theta, alpha, and beta waves (p < 0.001). ERS showed increased neural activation in the frontal, temporal, and parietal lobes during TLC and REM. Such enhanced neural activity in the region of interest supports potential clinical benefits in empowering cognitive function in both young adults and older adults with MCI.

Effect of sleep ambient music on sleep quality and mental health in college students: a self-controlled study

To verify the effect of sleep ambient music intervention (SAMI) on sleep quality and mental status of college students, and to further explore the minimum effective duration of SAMI, this study was designed as a pre-and post-intervention self-controlled exploratory study. Participants were subjected to a one-week no-intervention test, then 4 weeks of music intervention followed. Subjective sleep quality data were collected using the Pittsburgh Sleep Quality Index (PSQI); objective sleep quality data were collected with Actigraphy; and mental status data were collected using the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory-II (BDI-II). Data were analyzed and processed using mixed-effects models and repeated measures. The results showed that compared with the no-intervention week, college students' subjective sleep quality, objective sleep onset latency (SOL), trait anxiety, and depression symptom were reduced at week 1; week 2; week 3; week 4 under SAMI; state anxiety of college students at week 3 and week 4 under SAMI were also reduced. And there were differences in sleep quality among college students of different genders too. Compared with females, males had worse sleep efficiency (SE), shorter total sleep time (TST), and more awaking times (AT). In addition, 3 days was the minimum effective length for SAMI to shorten objective SOL, and 2 days was the minimum effective length to shorten the subjective SOL of college students. The findings of this study suggest that SAMI can improve subjective sleep quality, shorten objective SOL, and reduce anxiety and depression in college students. Interventions for more than 3 days had a significant effect on shortening SOL and long-term effects seemed to emerge after 3 weeks.

Efficacy of hydrotherapy, spa therapy, and balneotherapy on sleep quality: a systematic review

The purpose of this article was to review and assess the results obtained from human studies on the effects of hydrotherapy, balneotherapy, and spa therapy on sleep disorders. In this study, databases such as Pubmed, Embase, Web of Science, Google Scholar, Cochrane, Scopus, and sciences direct database were searched from the beginning to September 2022. All human studies that examined the effect of hydrotherapy, balneotherapy, and spa therapy on sleep disorders were published in the form of a full article in English. In the end, only 18 of the 189 articles met the criteria for analysis. Most studies have shown that balneotherapy, spa therapy, and hydrotherapy may by affecting some hormones such as histamine, serotonin, sympathetic nerves, and regulating body temperature led to increased quality and quantity of sleep. Also, the results obtained from Downs and Black show that 3 studies were rated as very good, 7 studies as good, 7 studies as fair, and 1 study as weak. The results of studies also showed that hydrotherapy leads to an improvement in the PSQI score index. Nevertheless, more clinical trials are needed to determine the mechanism of action of hydrotherapy on sleep disorders.

Self-perception and anticipated efficacy of the anti-dementia multimodal program in 100 older adults with mild cognitive impairment

BACKGROUND

Effective and sustainable interventions are clearly needed for mild cognitive impairment (MCI) patients. Despite the clinical importance of the multimodal intervention approach, only one study using a multimodal approach demonstrated promising improvements in memory, attention, and executive functions, which also correlated with functional magnetic resonance imaging (MRI) blood oxygenation level dependent (BOLD) changes in cerebral activation in 50 MCI patients.

OBJECTIVE

To investigate the self-perception and anticipated efficacy of each element of the BRAIN-FIT multimodal intervention program (robotic-assisted gait training (RAGT), computerized cognitive therapy, music, light, transcranial direct current stimulation (tDCS), and diaphragmatic breathing exercises) and the correlation between memory, concentration, depression, and sleep in older adults with MCI.

METHODS

One hundred participants (mean±standard deviation: 8.63±78.4 years; 47 women) with MCI were recruited from a major university medical center and community dementia relief center. The survey questionnaire comprised four domains with 21 questions, including four pertaining to general demographic characteristics, eight related to exercise and activity, three related to sleep, and nine related to the BRAIN-FIT program. Chi-squared test was used to analyze the Likert scale data. The descriptive frequencies were calculated. Additionally, Spearman's rho statistics measure the rank-order association. The statistical significance was at P <  0.05.

RESULTS

A strong correlation was observed between memory and concentration (r = 0.850, P = 0.000), memory and depression (r = 0.540, P = 0.000), memory and sleep (r = 0.502, P = 0.000), concentration and depression (r = 0.602, P = 0.000), concentration and sleep (r = 0.529, P = 0.000) and sleep and depression (r = 0.497, P = 0.000). The correlation between medical services and sleep (r = 0.249, P = 0.012) was moderate. The chi-square test revealed a significant difference in memory and low-intensity duration of exercise (χ2[3,N = 100] = 11.69, P = 0.01), concentration and high-intensity exercise duration (χ2[3,N = 100] = 10.08, P = 0.02), concentration with low-intensity exercise duration (χ2[3,N = 100] = 21.11, P = 0.00), depression with high-intensity (χ2[3,N = 100] = 10.36, P = 0.02), high-intensity duration of exercise (χ2[3,N = 100] = 10.48, P = 0.02); low-intensity (χ2[3,N = 100] = 7.90, P = 0.48), and low-intensity duration of exercise (χ2[3,N = 100] = 9.69, P = 0.02). Additionally, significant differences were observed between sleep and high-intensity (χ2[3, N = 100] = 10.36, P = 0.02), low-intensity (χ2[3, N = 100] = 18.14, P = 0.00), and low-intensity duration of exercise (χ2[3, N = 100] = 18.30, P = 0.00). Among the participants 5% answered RAGT, and 20% responded that they had experienced computerized cognitive therapy. Music therapy (20 %), diaphragmatic breathing exercises (45 %), and light therapy (10 %) were used. No patient had experienced tDCS. Conversely, 11% of the participants answered RAGT for programs they wanted to experience and 21% responded to computerized cognitive therapy. 25% of music therapy, 22% of diaphragmatic breathing exercises, 5% of light therapy, and 16% of tDCS participants said they wanted to experience it. Finally, 63% of the participants wanted to participate in the BRAIN-FIT program.

CONCLUSION

The present study's results provide clinical evidence-based insights into the utilization of BRAIN-FIT in MCI to maximize cognitive score improvement of memory, concentration, depression, and sleep. Therefore, when designing the BRAIN-FIT, six intervention items were set in proportion to the preference based on the survey, to reduce participants' feeling of repulsion. The program was configured according to exercise intensity.

Domestic Violence From a Child Perspective: Impact of an Immersive Virtual Reality Experience on Men With a History of Intimate Partner Violent Behavior

Domestic violence has long-term negative consequences on children. In this study, men with a history of partner aggression and a control group of non-offenders were embodied in a child's body from a first-person perspective in virtual reality (VR). From this perspective, participants witnessed a scene of domestic violence where a male avatar assaulted a female avatar. We evaluated the impact of the experience on emotion recognition skills and heart rate deceleration responses. We found that the experience mainly impacted the recognition of angry facial expressions. The results also indicate that males with a history of partner aggression had larger physiological responses during an explicit violent event (when the virtual abuser threw a telephone) compared with controls, while their physiological reactions were less pronounced when the virtual abuser invaded the victim's personal space. We show that embodiment from a child's perspective during a conflict situation in VR impacts emotion recognition, physiological reactions, and attitudes towards violence. We provide initial evidence of the potential of VR in the rehabilitation and neuropsychological assessment of males with a history of domestic violence, especially in relation to children.

Tailored Music Listening in Persons With Dementia: A Feasibility Randomized Clinical Trial

Introduction: This study examined the feasibility, acceptability, and preliminary efficacy of tailored music listening intervention on sleep disturbances in older adults with dementia and their caregivers. Methods: We randomly assigned 33 older adults with dementia (mean age 71.7 [SD: 7.1], 72.7% female, 81.8% African American/Black) and their caregivers (mean age 58.4 [SD: 16.7], 72.7% female, 84.8% African American/Black) to a wait-list control or intervention group (NCT04157244). Results: The music intervention was feasible as evidenced by high study measure completion and retention rates (>90%). Recruitment was stopped prematurely due to the COVID-19 pandemic. We found mixed acceptability results from the survey and qualitative interviews with the participants. Both groups improved on objective sleep outcomes of sleep latency and wake sleep after onset. We found a small effect size for sleep duration post-intervention. Discussion: The findings provide preliminary evidence for the feasibility of a tailored music intervention and identified ways to improve its acceptability.

Listening to music for insomnia in adults

BACKGROUND

Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.

OBJECTIVES

To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.

SELECTION CRITERIA

Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.

AUTHORS' CONCLUSIONS

The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.

Comparative effects of music interventions on depression in older adults: A systematic review and network meta-analysis

BACKGROUND

The effect of different music interventions on depression in older adults is varied. We aimed to explore the comparative effect of different music intervention features on depression in older adults.

METHODS

We searched PubMed, EMBASE, CENTRAL, CINAHL, and ProQuest Dissertations&Theses from inception to October 2021 for randomized controlled trials (RCTs) of music interventions in participants aged ≥60 years. Music interventions were classified based on the TIP (theme, intensity, and provider/platform) framework. The theme was divided into: 1) active music therapy (ACT); 2) receptive music therapy (Recep); and 3) music medicine (MM). The intensity was classified as high (>60 minutes/week), and low (≤60 minutes/week). The provider was classified as a music therapist (MT) or a non-music therapist (NonMT). Summary standardized mean differences (SMD) of level of depression with 95% confidence interval (CI) were estimated using a frequentist framework with a random-effects model. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) approach. This study was registered with PROSPERO (CRD42021247165).

FINDINGS

Fifteen RCTs involving 1,144 older adults (mean age 67.9-86.6 years) were included. When compared with usual care, the most effective music intervention was active music therapy >60 minutes/week by music therapist (Act/High/MT) (SMD -3.00; 95%CI, -3.64,-2.35), followed by music medicine >60 minutes/week by non-music therapist (MM/High/NonMT) (SMD -2.06; 95%CI, -2.78,-1.35) with moderate and high certainty of evidence, respectively. Depression scores in older adults treated with ACT/High/MT was also significantly lower than all other interventions, except MM/High/NonMT. Low intensity music interventions other than Act/Low/MT had no impact on depression.

INTERPRETATION

Although active music therapy >60 minutes/week by music therapist is the most effective intervention to alleviate depression in older adults, music medicine by listening to music of older adult's own preference >60 minutes/week is an alternative approach in settings with limited resources.

FUNDING

None.

Why Sleep is Key: Poor Sleep Quality is a Mechanism for the Bidirectional Relationship between Major Depressive Disorder and Generalized Anxiety Disorder Across 18 Years

BACKGROUND

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) reliably precede and predict one another. However, there is insufficient data on mediators through which the longitudinal GAD-MDD association unfold. Based on insomnia theories, such as the hyperarousal model of sleep, we tested the degree to which poor global sleep quality functioned as a mediator of the prospective bidirectional anxiety-depression relationship.

METHOD

Participants were 3,294 community-dwelling adults who partook in three measurement waves nine years apart. The Composite International Diagnostic Interview-Short Form assessed GAD and MDD in-person at baseline (Time 1 [T1]), Time 2 (T2; nine years after T1), and 18 years later (T3). T2 global sleep quality was measured using the multiple-domain Pittsburgh Sleep Quality Index self-report at T2. We used longitudinal structural equation modeling mediation analyses.

RESULTS

Analyses showed that higher T1 MDD and GAD severity individually predicted lower T2 global sleep quality (Cohen's d = -0.561 to -0.480) and less T2 global sleep quality, thereby forecasted both higher T3 MDD and GAD (d = -0.275 to -0.190). Poorer T2 global sleep quality significantly mediated the T1 GAD-T3 MDD relation, explaining 41% of the association. Worse global sleep quality at T2 also significantly mediated the T1 MDD-T3 GAD association, mediating 11% of the T1 MDD-T3 GAD pathway. The results remained similar after controlling for multiple sociodemographic and clinical variables.

CONCLUSIONS

Findings offer evidence for transdiagnostic theories of sleep and insomnia. Theoretical and clinical implications, such as prioritizing sleep improvement in cognitive-behavioral therapies, are also discussed.

Music-based Intervention for Improving Sleep Quality of Adults without Sleep Disorder: A Systematic Review and Meta-analysis

BACKGROUND

Listening to music is often used as a self-help intervention to improve sleep quality, but its efficacy among individuals without sleep disorder remains unclear.

METHODS

A search was performed on five databases to identify for studies that examined the use of music-based intervention to improve sleep quality among individuals without sleep disorder. Random-effects meta-analysis was performed, and the certainty of evidence was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

RESULTS

Twenty-two articles which recruited 1,514 participants were included for review. Meta-analysis of six studies including 424 participants did not find an improvement in sleep quality among recipients of music-based intervention compared to those with standard care (mean difference: -0.80; 95% CI: -2.15 to 0.54, low-quality evidence). Subgroup analysis showed a clear improvement in sleep quality when interventions were administered for at least 3 weeks (-2.09; -3.84 to -0.34, n = 3). No difference in terms of sleep onset latency (standardized mean difference (SMD) -0.32; 95% CI -0.88 to 0.25, n = 4, very-low quality evidence) and sleep efficiency (SMD: -0.59; 95% CI -3.15 to 1.97, n = 2, very-low quality evidence) were observed. The effect of music-based intervention on anxiety, depression and quality of life were mixed with suggestions of possible benefits.

CONCLUSION

Music-based intervention in addition to standard care appears to be a promising strategy to improve sleep quality when delivered for 3 week or longer. However, effects are inconsistent across studies and larger randomized controlled studies reporting long-term outcomes are needed before it can be recommended for routine use.

PROSPERO REGISTRATION

CRD42018081193.

The Effect of Group Music Therapy with Physical Activities to Prevent Frailty in Older People Living in the Community

BACKGROUND

The frail elderly are prone to falls and fractures, which can result in dependency, disability, admission to institutions, and even death. They are at increased risk of frailty due to decreased physical activity, cognitive decline, and depression. Some evidence suggests that music therapy with physical activities may be particularly beneficial.

OBJECTIVE

This study aimed to investigate the intervention effect of music therapy with physical activities (MTPA) on frail elderly in the community.

METHODS

A quasi-experimental design was adopted. We selected 10 community care centers in southern Taiwan, in which elderly people over the age of 65 were assigned to a MTPA group and a comparison group after obtaining their informed consent. The MTPA group performed group music activities once a week for 120 min for 12 weeks, while the comparison group only continued with their daily activities. Instruments in this study included the Kihon Checklist, Senior Fitness Test (with Body Mass Index (BMI) and seven physical fitness items), Mini-Mental Status Examination (MMSE), and Geriatric Depression Scale Short Form (GDS-SF).

RESULTS

A total of 132 community elders agreed to participate in this study, and 122 completed both the pretest and posttest, with 62 in the music therapy group and 60 in the comparison group. The results of ANCOVA showed that after intervention, except for BMI, the Kihon frailty assessment, seven fitness scores individually and in total, MMSE, and depression showed significant improvements in the music therapy group relative to the comparison group (all p < 0.05).

CONCLUSION

MTPA can improve the frailty index, cognitive function, depression, and physical fitness index in the community elderly. The results of this study can be used as a reference for the design of activities for the community elderly, to provide them with appropriate activities, improve their physical functions, and improve or delay their disability.

Spectral content (colour) of noise exposure affects work efficiency

Introduction:

As part of an effort to enhance the efficiency of workers, experiments relating to three types of noise exposure were conducted. Previous studies have proved that pink noise can cause a brain wave to reach a lower potential. In this study, we utilized physical methods, in cognitive experiments, to understand the impacts that three colour noises have on working efficiency.

Subjects and Methods:

All 22 participants were exposed to a sound environment of quiet, red, pink and white noises respectively. After a laboratory experiment, details of psychomotor speed, continuous performance, executive function and working memory were recorded.

Results:

Red, pink and white noises were significantly positive in comparison with the quiet environment of the psychomotor speed test. As for the continuous performance test, pink noise gave the only significantly positive result. Red, pink and white noise resulted in a better executive function test. Red and pink noise showed significantly positive improvement, while white noise was significantly positive in comparison with the quiet environment of the working memory test. In addition, the results from the comfort questionnaires showed that red and pink noise increase the possibility of better judgment, implementation, and overall environment.

Conclusion:

At present time, it is considered that noise has negative effects on hearing and health. However, experimental results show that certain noise can enhance environmental comfort. It is feasible, in the future, to use knowledge of colour noises to improve productivity in a workplace with a healthy environment.

Effects of music interventions on sleep in older adults: A systematic review

Sleep disruption is common among older adults. Non-pharmacological interventions involving music has emerged as a promising approach to address sleep disruption. The purpose of this systematic review was to examine the effects of music interventions on sleep outcomes among older adults (age ≥ 50). We searched five databases through May 2020 and found 16 eligible studies focused on two types of music interventions: music listening (n = 11) and multi-component (n = 5). We found mixed evidence in the efficacy of music interventions to improve sleep outcomes in older adults, which included sleep quality, objective and subjective sleep characteristics. Music listening interventions contained relaxing music with research teams personalizing music choice based on participants' preferences. Multi-component interventions included listening to music in addition to one other approach, such as massage, tai chi, and nature scenes. Future higher-quality studies should provide a detailed description of music interventions and tailor music selections to older adults' preferences.

Evidenced-Based Review and Evaluation of Clinical Significance: Nonpharmacological and Pharmacological Treatment of Insomnia in the Elderly

Insomnia in the elderly is a prevalent condition that poses treatment challenges to practitioners across medical fields. There are many behavioral and other nonpharmacological therapies, 18 Food and Drug Administration-approved pharmacotherapies, and numerous off-label, over the counter and alternative treatments. Most reviews on this subject focus either on pharmacological treatments or behavioral treatments. The authors provide a combined review of available pharmacological and nonpharmacological treatments. The authors narratively reviewed each treatment from our literature search, tabled results with the highest level of available evidence on 5 major sleep outcomes and evaluated these results for clinical significance. The authors also evaluated the safety of pharmacotherapies within the context of the 2019 Beers Criteria for Potentially Inappropriate Medications in the Elderly. The authors found the most rigorous evidence supporting Cognitive Behavioral Therapy for Insomnia as a first-line treatment option, with longer lasting therapeutic effects than treatment with pharmacologic agents alone. The authors also found evidence of similar outcomes from other behavioral interventions, such as Brief Behavioral Therapy for Insomnia and relaxation training. The authors found 4 studies, 2 on relaxation training, 1 on sleep restriction, and 1 on stimulus control limited to the elderly with clinically significant results. The authors found no pharmacological studies limited to the elderly on treatments not contraindicated by Beers criteria with clinically significant results. The authors discussed the challenges of determining clinical significance in sleep studies, the lack of studies restricted to the elderly, and the role of placebo effect.

Use of music to enhance sleep and psychological outcomes in critically ill patients: a protocol for a systematic review and meta-analysis

INTRODUCTION

Music listening is used as a non-pharmacological intervention in various populations with positive results; however, evidence for its effect on sleep and psychological outcomes in critically ill patients remains unclear. It is essential to understand the impact of music listening for critically ill patients to optimise care and minimise the risk for harm. We will assess whether music listening improves sleep and psychological outcomes in critically ill patients.

METHODS AND ANALYSIS

We will systematically search scientific databases for relevant studies, including PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest, the Cochrane Central Register of Controlled Trials, China Biological Medicine Database, China National Knowledge Infrastructure Library, Wan fang databases, VIP Database for Chinese Technical Periodicals and the Chinese Clinical Trial Registry. Databases will be searched for articles published from inception to 10 June 2020. Music therapy journals and reference lists in some articles will be hand-searched. Grey literature will also be searched. We will include randomised and quasi-randomised controlled trials that used music listening to improve sleep and psychological outcomes in critically ill patients. The primary outcomes will be sleep-related outcomes, and secondary outcomes will be anxiety and depression scores and physiological outcomes. Two reviewers will independently verify study eligibility and methodological quality; disagreements will be resolved by a third reviewer or through discussion. The risk of bias will be independently determined using the Cochrane Risk of Bias Tool. The Consolidated Standards of Reporting Trials checklist will be used to examine the quality of included papers. Data will be extracted from eligible studies by two researchers. RevMan V.5.3 will be used for meta-analysis.

ETHICS AND DISSEMINATION

This work will review existing trial data and will not introduce new patient data or interventions; therefore, ethics committee approval is not required. We will disseminate this protocol in a related peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42019147202.

Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials

Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms.Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software.Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99-3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90-2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84-4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71-3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23-2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects.Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings.

Effects of music intervention on sleep quality of older adults: A systematic review and meta-analysis

BACKGROUND

Music interventions have several benefits for sleep quality. However, the effects of music interventions on sleep quality in older adults are controversial.

OBJECTIVE

To summarize and evaluate the efficacy of music interventions on sleep quality in older adults.

METHODS

The Cochrane Library, Embase, PubMed, Web of Science and Chinese National Knowledge Infrastructure (CNKI) were systematically retrieved until June 2020, updated on March 13, 2021. Both experimental and quasi-experimental studies were included if they evaluated the efficacy of music interventions on sleep outcomes in older adults. The methodological quality was assessed by the Cochrane RoB 2.0 and ROBINS-I Tool. The random effects models and effect measure (MD) were adopted, and sensitivity analysis by omitting each study was conducted to explore the source of heterogeneity.

RESULTS

A total of 489 participants from 9 studies met the inclusion criteria. 6 studies were included in meta-analysis and sensitivity analysis, and 3 studies were included in the qualitative analysis. Main concerns about risk of bias were lack of blinding participants and investigators, and confounding factors might exist in non-RCTs. The Post-hoc meta-analysis indicated that music interventions might have a positive effect on sleep quality [MD = -2.64, 95 % CI (-3.76, -1.53), p <  0.001; I² = 75.0 %]. Only one study evaluated adverse events and reported zero discomfort.

CONCLUSIONS

The results indicated that music interventions might be beneficial for improving sleep quality, especially in sleep latency, sleep duration, sleep efficiency and sleep of daytime dysfunction in elderly individuals.

Incorporating a Usual Care Comparator into a Study of Meditation and Music Listening for Older Adults with Subjective Cognitive Decline: A Randomized Feasibility Trial

BACKGROUND

Recent studies suggest meditation and music listening (ML) may improve cognitive and psychosocial outcomes in adults with subjective cognitive decline (SCD). However, lack of a usual care group has limited conclusions.

OBJECTIVE

To assess the: 1) feasibility of incorporating an enhanced usual care (EUC) comparator in a trial of Kirtan Kriya meditation (KK) and ML for adults experiencing SCD; and 2) preliminary effects of active treatment (KK/ML) versus an EUC program.

METHODS

Forty participants with SCD were randomized 1:1:2 to a 12-week KK, ML, or EUC program. KK and ML participants were asked to practice 12 minutes/day; EUC participants were given a comprehensive educational packet regarding healthy aging and strategies for improving/maintaining brain health and asked to record any activities or strategies used. Feasibility was assessed using measures of retention, adherence, treatment expectancies, and participant satisfaction, as well as information from exit questionnaires and daily practice/activity logs. Cognitive functioning, stress, mood, sleep-quality, and health-related quality of life (QOL) were measured pre- and post-intervention using well-validated instruments.

RESULTS

Thirty-two participants (80%) completed the 3-month study, with retention highest in the EUC group (p < 0.05). Active treatment participants averaged 6.0±0.4 practice sessions/week, and EUC participants, 7.5±0.6 brain health activities/week. Treatment expectancies were similar across groups. EUC participants indicated high satisfaction with the program and study. Despite limited study power, the active treatment group showed significantly greater gains in subjective memory functioning (ps≤0.025) and nonsignificant improvements in cognitive performance (TMT-B), perceived stress, QOL, and mood (ps≤0.08) compared to the EUC group.

CONCLUSION

Findings of this pilot feasibility trial suggest incorporation of an EUC program is feasible, and that participation in a simple 12-week relaxation program may be helpful for adults with SCD versus engagement in an EUC program.

Complementary and alternative treatments for insomnia/insomnia -depression-anxiety symptom cluster: Meta-analysis of English and Chinese literature

This study systematically reviewed randomized controlled trials (RCT), published in English or Chinese, investigating the effect of complementary and alternative medicines (CAM) on significant insomnia/poor sleep quality and accompanying depression and/or anxiety symptoms. A meta-analysis was completed by calculating within-group effect size (ES) of each CAM treatment on sleep, depression and/or anxiety measures. Moderating analyses of study quality, language, treatment duration and presence of physical diseases were conducted to evaluate their impact on ESs. Between-group ES of CAM (vs. non-specific/placebo controls) were computed among high-quality studies. From an initial pool of 5047 articles, a total of 72 studies were included in the meta-analysis (44 in English; 28 in Chinese). All CAM modalities yielded significant, moderate to large effect sizes on sleep, depression, and anxiety symptoms yet with high heterogeneity. Significant between-group differences on sleep measures were found only between mindfulness-based treatment and non-specific/placebo controls. Chinese literature are associated with larger ESs. Future study should examine the presence and nature of the active components in different CAM approaches.

Effect of executive music therapy on state and trait anxiety levels of patients in a psychiatric ward: A quasi-experimental study

AIM

This quasi-experimental study aimed to assess the effect of executive music therapy (EMT) on the state and trait anxiety levels of patients with psychiatric disorders.

DESIGN AND METHODS

The study sample consisted of 64 patients who were hospitalized in a psychiatric ward in Giresun, Turkey between January and April 2019.

FINDINGS

This study showed that EMT decreased the state anxiety levels of inpatients with psychiatric disorders (P < .05). However, the treatment caused no effect on trait anxiety levels (P > .05).

PRACTICE IMPLICATIONS

In line with these results, we recommend that EMT should be included in therapeutic nursing interventions in psychiatric ward.

Effects of music therapy on depression: A meta-analysis of randomized controlled trials

Background

We aimed to determine and compare the effects of music therapy and music medicine on depression, and explore the potential factors associated with the effect.

Methods

PubMed (MEDLINE), Ovid-Embase, the Cochrane Central Register of Controlled Trials, EMBASE, Web of Science, and Clinical Evidence were searched to identify studies evaluating the effectiveness of music-based intervention on depression from inception to May 2020. Standardized mean differences (SMDs) were estimated with random-effect model and fixed-effect model.

Results

A total of 55 RCTs were included in our meta-analysis. Music therapy exhibited a significant reduction in depressive symptom (SMD = −0.66; 95% CI = -0.86 to -0.46; P<0.001) compared with the control group; while, music medicine exhibited a stronger effect in reducing depressive symptom (SMD = −1.33; 95% CI = -1.96 to -0.70; P<0.001). Among the specific music therapy methods, recreative music therapy (SMD = -1.41; 95% CI = -2.63 to -0.20; P<0.001), guided imagery and music (SMD = -1.08; 95% CI = -1.72 to -0.43; P<0.001), music-assisted relaxation (SMD = -0.81; 95% CI = -1.24 to -0.38; P<0.001), music and imagery (SMD = -0.38; 95% CI = -0.81 to 0.06; P = 0.312), improvisational music therapy (SMD = -0.27; 95% CI = -0.49 to -0.05; P = 0.001), music and discuss (SMD = -0.26; 95% CI = -1.12 to 0.60; P = 0.225) exhibited a different effect respectively. Music therapy and music medicine both exhibited a stronger effects of short and medium length compared with long intervention periods.

Conclusions

A different effect of music therapy and music medicine on depression was observed in our present meta-analysis, and the effect might be affected by the therapy process.

Music on Prescription to Aid Sleep Quality: A Literature Review

Research on the efficacy of music for improving sleep quality has produced mixed results. We investigated whether the number of music dosages could be a reason for the lack of clarity. Six longitudinal music sleep studies using the Pittsburgh Sleep Quality Index (PSQI) over 3 weeks were identified. Music when compared to active (audiobooks or medication) or passive controls significantly improved (improvement is reflected by a lower score) PSQI within the first or second week of prescription. The improvement was an average mean difference of −1.15 (SD = 0.53) for each week. Music dosages continued to be associated with improved PSQI over a study that had a 3-month music intervention. One study with a low initial PSQI score resulted in poor sleepers (PSQI > 5) achieving healthy sleep (PSQI < 5) within 3 weeks of regular music intervention. For future studies, “prescribing” music beyond 3 weeks may lead to more instances of healthy sleep, particularly for those who have mild sleep problems. To explain the findings, we proposed that the relationship between weeks of music listening and improved PSQI are attributed to the truncation of poor bedtime habits linked to ruminative tendencies and consequent hyperarousal prior to the music intervention. Music listening at bedtime replaces those bad habits, we argue, by forming a new psychological link between bedtime and sleep through evaluative conditioning. The findings of the present study provide disarming evidence of the potential for prescription of music for treating mild sleep disorder.

Understanding the Effectiveness of Psychosocial Services for Anxiety and Depression in Chinese Older Adults: A Systematic Review and Meta-Analysis of Controlled Trials

BACKGROUND AND OBJECTIVES

There exists an imperative need to comprehensively evaluate the effectiveness of psychosocial interventions for Chinese geriatric populations' mental wellbeing. This study conducted a systematic review and meta-analysis of psychosocial services for Chinese older adults' depression and anxiety.

RESEARCH DESIGN AND METHODS

A search of nine electronic databases, five geriatric mental health journals, and reference lists was conducted for studies published between 1980 and April. 2018. Thirty-three studies (including totally 3,478 participants, 107 effect sizes) of true and quasiexperimental controlled trials were eligible and included for meta-analysis using robust variance estimation in meta-regression. Outcome indicators were geriatric depression and anxiety.

RESULTS

An overall significant treatment effect was identified for geriatric depression and anxiety (d = 0.577, 95% confidence interval [CI]: 0.288, 0.867, p < .001). Outcomes, geographic area, participants' marriage, service setting, and types of control group were moderators for treatment effects. Subgroup analysis observed statistically significant effect size among studies in Taiwan, used innovative service methods and small group interventions. Both in-person, home-based interventions and interventions provided by nurse practitioners and specially trained providers were statistically significant.

DISCUSSION AND IMPLICATIONS

Psychosocial services can benefit Chinese geriatric populations. Innovative and culturally relevant programs received strongest research supports. Future research should incorporate social interaction as an important component for serving Chinese older adults' mental wellbeing.

Music Therapy as a Potential Intervention for Sleep Improvement

Sleep deficiency is linked to chronic health problems, such as heart disease, kidney disease, high blood pressure, diabetes, stroke, obesity, and depression. Healthcare practitioners are increasingly paying close attention to sleep and its impact on health and wellness as a measure of critical vitality. Sleep's impact on neurologic function, and cognitive endurance affect capacity throughout the lifespan. This article will address recent findings related to the potential of music to induce sleep in illness and wellness. Music therapy research findings and its efficacy as a potent cost-effective intervention will be highlighted.

Possible Effect of Binaural Beat Combined With Autonomous Sensory Meridian Response for Inducing Sleep

Sleep is important to maintain physical and cognitive functions in everyday life. However, the prevalence of sleep disorders is on the rise. One existing solution to this problem is to induce sleep using an auditory stimulus. When we listen to acoustic beats of two tones in each ear simultaneously, a binaural beat is generated which induces brain signals at a specific desired frequency. However, this auditory stimulus is uncomfortable for users to listen to induce sleep. To overcome this difficulty, we can exploit the feelings of calmness and relaxation that are induced by the perceptual phenomenon of autonomous sensory meridian response (ASMR). In this study, we proposed a novel auditory stimulus for inducing sleep. Specifically, we used a 6 Hz binaural beat corresponding to the center of the theta band (4-8 Hz), which is the frequency at which brain activity is entrained during non-rapid eye movement (NREM) in sleep stage 1. In addition, the "ASMR triggers" that cause ASMR were presented from natural sound as the sensory stimuli. In session 1, we combined two auditory stimuli (the 6 Hz binaural beat and ASMR triggers) at three-decibel ratios to find the optimal combination ratio. As a result, we determined that the combination of a 30:60 dB ratio of binaural beat to ASMR trigger is most effective for inducing theta power and psychological stability. In session 2, the effects of these combined stimuli (CS) were compared with an only binaural beat, only the ASMR trigger, or a sham condition. The combination stimulus retained the advantages of the binaural beat and resolved its shortcomings with the ASMR triggers, including psychological self-reports. Our findings indicate that the proposed auditory stimulus could induce the brain signals required for sleep, while simultaneously keeping the user in a psychologically comfortable state. This technology provides an important opportunity to develop a novel method for increasing the quality of sleep.

How does music aid sleep? literature review

With the growth of interest in using music to treat insomnia, there is a need to collect and evaluate the literature. This paper reviews disparate literature and assesses the various kinds of assertions and hypotheses made by researchers about music's efficacy in assisting sleep. Six main researcher proposed reasons (RPR) for how music aids sleep were identified in the literature: (1) relaxation, where music encourages physiological or psychological relaxation; (2) distraction, where music acts as a focal point to distract from inner stressful thoughts; (3) entrainment, synchronization of biological rhythms to beat structures in music; (4) masking, obscuring noxious background noise with music; (5) enjoyment, listening to preferred, emotionally relatable or pleasant music; and (6) expectation, individuals cultural beliefs around music. We evaluated each RPR in terms of the evidence available in the extant literature. Masking RPR was identified as having support for improving sleep. Relaxation, distraction and enjoyment RPR had mixed levels of support. Expectation RPR had possible support. Entrainment had mixed possible support. The paper discusses interactions between RPRs, and a call is made to turn research attention to sequencing the RPRs and possible RPR mediators, with relaxation being a likely mediator of several RPRs.

Exposure to Patterned Auditory Stimuli during Acute Stress Prevents Despair-Like Behavior in Adult Mice That Were Previously Housed in an Enriched Environment in Combination with Auditory Stimuli

Several interventions have been shown to counteract the effects of stress that may be related to improved neuroplasticity and neuronal activation. In this sense, environmental enrichment (ENR) protects against acute stress and increases neuroplasticity. It has been suggested that the use of patterned auditory stimuli (PAS) may be beneficial in increasing the effectiveness of ENR on disorders related to stress, such as depression and anxiety. Examples of PAS are classical music compositions that have interesting effects at both clinical and preclinical levels. Thus, we analyzed the effects of the exposure to PAS, represented in this study by Mozart's compositions, during ENR housing for 35 days in adult male Balb/C mice to evaluate depression-associated behavior using the forced-swim test (FST) paradigm with an additional short exposure to PAS. We found that the ENR mice that were exposed to PAS during both housing and behavioral task (ENR + PAS/FST + PAS) show decreased immobility and the number of despair episodes within a higher latency to show the first bout of immobility. Additionally, we found increased neuronal activation evaluated by the identification of activity-regulated cytoskeleton-associated protein- (Arc-) labeled cells in the prefrontal cortex (PFC) in mice exposed to PAS during housing and in the absence or presence of PAS during FST. Moreover, we found increased neuronal activation in the auditory cortex (AuCx) of mice exposed to PAS during FST. Our study suggests that the exposure to PAS during an emotional challenge decreases despair-like behavior in rodents that were previously housed in an enriched environment in combination with auditory stimuli. Thus, our data indicate that the role of the exposure to PAS as an intervention or in combination with positive environment to aid in treating neuropsychiatric disorders is worth pursuing.

The effect of music therapy on depression and physiological parameters in elderly people living in a Turkish nursing home: a randomized-controlled trial

OBJECTIVE

This study was carried out in an effort to determine the effect of music therapy on depression and physiological parameters in elderly people who were living in a nursing home.

METHOD

The study was a randomized controlled trial. The study sample consisted of 64 elderly people who complied with the criteria of inclusion for the study. The data were collected using the 'Elderly Information Form' and 'Geriatric Depression Scale'. The music group listened to music three days in a week during 8 weeks. The depression levels were assessed at baseline (week 0) and follow-up in the eight week.

RESULTS

It was found that the difference between post-test depression scores of the two groups was found to be statistically significant (t = -2.86, p <.01). The mean scores of post-test systolic blood pressure in the music group were found to be significantly lower than those of the control group (t = -3.11, p < .05).

CONCLUSION

It was concluded that music therapy decreased the depression level and systolic blood pressure in elderly people. The study results implies that music therapy can be an effective practice for public health and home care nurses attempting to reduce depression and control physiological parameters of elderly people.

What works for wellbeing? A systematic review of wellbeing outcomes for music and singing in adults

Aims:

The role of arts and music in supporting subjective wellbeing (SWB) is increasingly recognised. Robust evidence is needed to support policy and practice. This article reports on the first of four reviews of Culture, Sport and Wellbeing (CSW) commissioned by the Economic and Social Research Council (ESRC)-funded What Works Centre for Wellbeing (https://whatworkswellbeing.org/).

Objective:

To identify SWB outcomes for music and singing in adults.

Methods:

Comprehensive literature searches were conducted in PsychInfo, Medline, ERIC, Arts and Humanities, Social Science and Science Citation Indexes, Scopus, PILOTS and CINAHL databases. From 5,397 records identified, 61 relevant records were assessed using GRADE and CERQual schema.

Results:

A wide range of wellbeing measures was used, with no consistency in how SWB was measured across the studies. A wide range of activities was reported, most commonly music listening and regular group singing. Music has been associated with reduced anxiety in young adults, enhanced mood and purpose in adults and mental wellbeing, quality of life, self-awareness and coping in people with diagnosed health conditions. Music and singing have been shown to be effective in enhancing morale and reducing risk of depression in older people. Few studies address SWB in people with dementia. While there are a few studies of music with marginalised communities, participants in community choirs tend to be female, white and relatively well educated. Research challenges include recruiting participants with baseline wellbeing scores that are low enough to record any significant or noteworthy change following a music or singing intervention.

Conclusions:

There is reliable evidence for positive effects of music and singing on wellbeing in adults. There remains a need for research with sub-groups who are at greater risk of lower levels of wellbeing, and on the processes by which wellbeing outcomes are, or are not, achieved.

Can music improve sleep quality in adults with primary insomnia? A systematic review and network meta-analysis

BACKGROUND

Primary insomnia is one of the most common issues for adults. However, whether to use music intervention as a non-pharmacological method of treatment, as well as which treatment should be preferred, is still a matter of controversy. Therefore, we aimed to compare and rank music interventions and no-music controls for primary insomnia patients.

METHODS

A network meta-analysis was used to identify evidence from relevant clinical trials. We searched PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure Library for publications up to May 2017, pertaining to music intervention for primary insomnia patients. The prespecified primary outcome was sleep quality (scored by the PSQI and overall), and the secondary outcomes were sleep onset latency and sleep efficiency. We did pairwise meta-analyses using the random-effects model, later completing the random-effects network meta-analyses. The study was registered with PROSPERO, number CRD42017064750.

RESULTS

We deemed 20 trials to be eligible, involving 1339 patients and 12 intervention arms. For PSQI scores, all intervention arms were statistically more effective than the usual care, with patients ranking listening to music as the best means of intervention (SMD: -0.61, 95%CrI: -1.01 to -0.20). For overall sleep quality, only music-associated relaxation was statistically more effective than the patients' usual care (-0.28, -0.48 to -0.08). In terms of sleep onset latency, music-associated relaxation and listening to music had significant advantages (-0.26, -0.64 to -0.09, and -0.28, -0.53 to -0.02); listening to music and music with exercise displayed a tendency to improve sleep efficiency.

CONCLUSIONS

When considering the efficacy, music intervention seemed to offer clear advantages for adults with primary insomnia. Listening to music and music-associated relaxation are probably the best options to consider in the application of music intervention.

Reviewing the Effectiveness of Music Interventions in Treating Depression

Depression is a very common mood disorder, resulting in a loss of social function, reduced quality of life and increased mortality. Music interventions have been shown to be a potential alternative for depression therapy but the number of up-to-date research literature is quite limited. We present a review of original research trials which utilize music or music therapy as intervention to treat participants with depressive symptoms. Our goal was to differentiate the impact of certain therapeutic uses of music used in the various experiments. Randomized controlled study designs were preferred but also longitudinal studies were chosen to be included. 28 studies with a total number of 1,810 participants met our inclusion criteria and were finally selected. We distinguished between passive listening to music (record from a CD or live music) (79%), and active singing, playing, or improvising with instruments (46%). Within certain boundaries of variance an analysis of similar studies was attempted. Critical parameters were for example length of trial, number of sessions, participants' age, kind of music, active or passive participation and single- or group setting. In 26 studies, a statistically significant reduction in depression levels was found over time in the experimental (music intervention) group compared to a control (n = 25) or comparison group (n = 2). In particular, elderly participants showed impressive improvements when they listened to music or participated in music therapy projects. Researchers used group settings more often than individual sessions and our results indicated a slightly better outcome for those cases. Additional questionnaires about participants confidence, self-esteem or motivation, confirmed further improvements after music treatment. Consequently, the present review offers an extensive set of comparable data, observations about the range of treatment options these papers addressed, and thus might represent a valuable aid for future projects for the use of music-based interventions to improve symptoms of depression.

Quality of Life and Its Factors in Korean Elderly With Mild Cognitive Impairment

Based on the secondary data analysis, this study aimed to identify quality of life and factors that affect quality of life among Korean elderly with mild cognitive impairment. Demographic characteristics, physical factors, and psychosocial factors as well as quality of life of the elderly with mild cognitive impairment were comprehensively measured. The research subjects consisted of 348 home-resident elderly and their quality of life scores were relatively high at 29.86. Their quality of life varied according to education and gender, and instrumental activities of daily living (actual, latent), somatic symptoms, sleep quality, depression, and social support affected their quality of life. Depression and social support were predictors of quality of life. The most powerful predictor was depression (β = −.583, p < .001). To improve the quality of life among elderly with mild cognitive impairment, nursing interventions to alleviate depression and to enhance social support from family, friends, and relevant neighbors are needed.

The Effect of Holy Qur'an Recitation on Depressive Symptoms in Hemodialysis Patients: A Randomized Clinical Trial

Patients with advanced renal failure often face considerable sociopsychological stress as a result of lifestyle changes due to the disease and its treatment. The aim of the present study is to examine the effect of the Holy Qur'an recitation on depressive symptoms in hemodialysis patients. In this clinical trial, 54 hemodialysis patients were randomized to either an experimental (n = 27) or a control (n = 27) group. Patients completed the Beck Depression Inventory-II (BDI-II) at baseline and at 1 month after the intervention. Participants in the experimental group listened to recitation of the Holy Qur'an, while those in the control group received no intervention. The mean BDI-II score at baseline was 33.6 (±6.7) for the experimental group and 29.3 (±9.0) for the control group; at the end of treatment, BDI-II scores in the experimental and control groups were 14.5 (±4.8) and 31.6 (±9.2), respectively. Results from the repeated-measures general linear model controlling for baseline differences indicated a significant treatment effect (F = 9.30, p = 0.004, Cohen's d = 0.85). Holy Qur'an recitation has a significant effect on lowering depressive symptoms in hemodialysis patients. Holy Qur'an recitation is an easy-to-implement and cost-effective strategy that may be used to supplement the treatment of depression in this setting in Iran.

A systematic review and meta-analysis of music therapy for the older adults with depression

OBJECTIVES

To determine the efficacy of music therapy in the management of depression in the elderly.

METHOD

We conducted a systematic review and meta-analysis of randomized controlled trials. Change in depressive symptoms was measured with various scales. Standardized mean differences were calculated for each therapy-control contrast.

RESULTS

A comprehensive search yielded 2,692 citations; 19 articles met inclusion criteria. Meta-analysis suggests that music therapy plus standard treatment has statistical significance in reducing depressive symptoms among older adults (standardized mean differences = 1.02; 95% CI = 0.87, 1.17).

CONCLUSIONS

This systematic review and meta-analysis suggests that music therapy has an effect on reducing depressive symptoms to some extent. However, high-quality trials evaluating the effects of music therapy on depression are required. Copyright © 2016 John Wiley & Sons, Ltd.

Effects of Resourcefulness on Sleep Disturbances, Anxiety, and Depressive symptoms in Family Members of Intensive Care Unit Patients

The study aimed to investigate the relationships among psychological distresses, resourcefulness, sleep disturbances, anxiety and depressive symptoms in family members of intensive care unit (ICU) patients. A cross-sectional, descriptive correlational design was employed. Using structural equation modeling (SEM) approach, relationships among factors, mediators, and outcomes were analyzed. The SEM explained 59% of the variances in depressive symptoms and 36% in anxiety. Family members with greater learned resourcefulness had fewer sleep disturbances, depressive and anxiety symptoms. Nursing professionals need to detect psychiatric disease of family members and must be especially vigilant with people who have low resourcefulness and sleep disturbances.

Pain management in patients with Parkinson's disease: challenges and solutions

This review focuses on the diagnosis and management of Parkinson-related pain which is one of the more frequently reported nonmotor symptoms in Parkinson’s disease (PD), which is the second most common neurodegenerative disease after Alzheimer’s disease. Pain is ranked high by patients as a troublesome symptom in all stages of the disease. In early-stage PD, pain is rated as the most bothersome symptom. Knowledge of the correct diagnosis of pain origin and possible methods of treatments for pain relief in PD is of great importance. The symptoms have a great negative impact on health-related quality of life. Separating PD-related pain from pain of other origins is an important challenge and can be characterized as “many syndromes under the same umbrella”. Among the different forms of PD-related pain, musculoskeletal pain is the most common form, accounting for 40%–90% of reported pain in PD patients. Augmentation by pathophysiological pathways other than those secondary to rigidity, tremor, or any of the other motor manifestations of the disease seems most probable. In PD, the basal ganglia process somatosensory information differently, and increased subjective pain sensitivity with lower electrical and heat-pain thresholds has been reported in PD patients. The mechanism is assumed to be diminished activity of the descending inhibitory control system of the basal ganglia. PD pain, like many of the nonmotor symptoms, remains underdiagnosed and, thus, poorly managed. A systematic collection of patient descriptions of type, quality, and duration of pain is, therefore, of utmost importance. Recent studies have validated new and more specific and dedicated pain scales for PD-related symptoms. Symptomatic treatments based on clinical pain classification include not only pharmacological but also nonpharmacological methods and, to some degree, invasive approaches. In the clinic, pharmacological and nonpharmacological interventions can be effective to varying degrees – as single therapies or in combination – and should be employed, because no therapeutic strategies have been validated to date for managing PD pain. Multimodal approaches should always be considered, dopamine replacement therapies should be adjusted, and analgesics and/or antidepressants should be considered, including the use of different forms of complementary therapies.

Symptom management strategies of Jordanian patients following coronary artery bypass grafting surgery

The aim of this study was to explore the symptom management strategies utilized by post coronary artery bypass graft (CABG) patients and its associations with demographic variables. A clear understanding of the use of symptom management strategies following CABG surgery may help nurses in developing educational program and interventions that help patients and their families during recovery period after discharge. A cross-sectional, descriptive design was utilized. A convenience sample of 100 Jordanian patients post CABG surgery selected from five hospitals was surveyed between November 2012 and June 2013 using the Cardiac Symptom Survey. Chi squared analyses were used to examine the associations between the symptoms management strategies and selected demographic variables. Frequency of symptom management strategies utilized by post CABG patients revealed that most frequently employed strategies were use of medications (79%), repositioning (54%) and the rest (45%). Symptom management strategies utilized for poor appetite, sleeping problem and fatigue had significant associations with demographic variables. By providing information about the symptoms expected after surgery and possible ways to manage them, will strengthen the patients psychologically and will make CABG experience within the realm of self-management and coping.

Effects of Meditation versus Music Listening on Perceived Stress, Mood, Sleep, and Quality of Life in Adults with Early Memory Loss: A Pilot Randomized Controlled Trial

BACKGROUND

Older adults with subjective cognitive decline (SCD) are at increased risk not only for Alzheimer's disease, but for poor mental health, impaired sleep, and diminished quality of life (QOL), which in turn, contribute to further cognitive decline, highlighting the need for early intervention.

OBJECTIVE

In this randomized controlled trial, we assessed the effects of two 12-week relaxation programs, Kirtan Kriya Meditation (KK) and music listening (ML), on perceived stress, sleep, mood, and health-related QOL in older adults with SCD.

METHODS

Sixty community-dwelling older adults with SCD were randomized to a KK or ML program and asked to practice 12 minutes daily for 12 weeks, then at their discretion for the following 3 months. At baseline, 12 weeks, and 26 weeks, perceived stress, mood, psychological well-being, sleep quality, and health-related QOL were measured using well-validated instruments.

RESULTS

Fifty-three participants (88%) completed the 6-month study. Participants in both groups showed significant improvement at 12 weeks in psychological well-being and in multiple domains of mood and sleep quality (p's≤0.05). Relative to ML, those assigned to KK showed greater gains in perceived stress, mood, psychological well-being, and QOL-Mental Health (p's≤0.09). Observed gains were sustained or improved at 6 months, with both groups showing marked and significant improvement in all outcomes. Changes were unrelated to treatment expectancies.

CONCLUSIONS

Findings suggest that practice of a simple meditation or ML program may improve stress, mood, well-being, sleep, and QOL in adults with SCD, with benefits sustained at 6 months and gains that were particularly pronounced in the KK group.

What affects the subjective sleep quality of hospitalized elderly patients?

AIM

The present study aimed to identify the factors affecting the subjective sleep quality in elderly inpatients.

METHODS

The participants were 290 older adults admitted in three general hospitals. Data were collected using a structured questionnaire consisting of scales for general characteristics, sleep quality, activities of daily living, instrumental activities of daily living and depression. Collected data were analyzed by descriptive statistics, t-test, one-way anova, Scheffé post-hoc, Pearson's correlation coefficient and stepwise multiple regression.

RESULTS

There were statistically significant differences in sleep quality according to age, education level, marital status, monthly income and number of cohabitants. The most powerful predictor of sleep quality was depression (P < 0.01, R²  = 0.30). Five variables, depression, perceived health status, diagnosis, number of cohabitants and duration of hospitalization; explained 43.0% of the total variance in sleep quality.

CONCLUSIONS

Elderly inpatients suffered from low sleep quality, and depression affected their sleep. We should develop and apply hospital-tailored sleep interventions considering older adults' depression, and then hospitalized older adults' sleep could improve. Furthermore, it is useful to identify other sleep-related factors. Geriatr Gerontol Int 2017; 17: 471-479.

Effects of relaxation interventions on depression and anxiety among older adults: a systematic review

OBJECTIVES

This systematic review examined empirical evidence of the effects of relaxation interventions on anxiety and depression among older adults.

METHOD

A comprehensive literature search identified studies that satisfied the pre-set inclusion and exclusion criteria. We focused on 15 published and non-published studies - 12 randomised controlled trials and three non-randomised controlled trials - undertaken in the past 20 years (1994-2014). Three reviewers selected studies, extracted data, and appraised the methodological quality. We then computed Hedges' effect sizes and used these to represent the effects of intervention.

RESULTS

Our findings suggested that older adults who received relaxation interventions experienced greater reductions in depression and anxiety than controls in most studies. Progressive muscle relaxation training, music intervention, and yoga had the strongest intervention effects on depression. Music intervention, yoga, and combined relaxation training most effectively reduced anxiety symptoms among older adults. Furthermore, the impact of some relaxation interventions remained in effect for between 14 and 24 weeks after the interventions.

CONCLUSION

This systematic review supported the positive effects of relaxation interventions on depression and anxiety among older adults. Health care providers may integrate relaxation interventions into standard care for older adults in community and hospital settings, taking into consideration the participant's preference and health care policy.

Comparing the Effects of Reflexology and Footbath on Sleep Quality in the Elderly: A Controlled Clinical Trial

BACKGROUND

Sleep disorders are common mental disorders reported among the elderly in all countries, and with nonpharmacological interventions, they could be helped to improve their sleep quality.

OBJECTIVES

The aim of this study was to compare the effects of two interventions, foot reflexology and foot bath, on sleep quality in elderly people.

PATIENTS AND METHODS

This three-group randomized clinical trial (two experimental groups and a control group) was conducted on 69 elderly men. The two experimental groups had reflexology (n = 23) and foot bath (n = 23) interventions for 6 weeks. The reflexology intervention was done in the mornings, once a week for ten minutes on each foot. The participants in the foot bath group were asked to soak their feet in 41°C to 42°C water one hour before sleeping. The pittsburgh sleep quality index (PSQI) was completed before and after the intervention through an interview process.

RESULTS

The results showed that the PSQI scores after intervention compared to before it in the reflexology and foot bath groups were statistically significant (P = 0.01 , P = 0.001); however, in the control group did not show a statistically significant difference (P = 0.14). In addition, the total score changes among the three groups were statistically significant (P = 0.01). Comparing the score changes of quality of sleep between the reflexology and foot bath groups showed that there was no significant difference in none of the components and the total score (P = 0.09). The two interventions had the same impact on the quality of sleep.

CONCLUSIONS

It is suggested that the training of nonpharmacological methods to improve sleep quality such as reflexology and foot bath be included in the elderly health programs. In addition, it is recommended that the impact of these interventions on subjective sleep quality using polysomnographic recordings be explored in future research.