An Individualized Music-Based Intervention for Acute Neuropsychiatric Symptoms in Hospitalized Older Adults With Cognitive Impairment: A Prospective, Controlled, Nonrandomized Trial

Examining pain, function, behavioral symptoms and associations with engagement in meaningful activity for residents with dementia in assisted living

OBJECTIVES

The purpose of this study was to examine factors associated with engagement in meaningful activity among residents with dementia in assisted living. We hypothesized that greater functional independence, less pain, and lower behavioral and psychological symptom severity would be associated with higher engagement in meaningful activity after controlling for residents' age, gender, comorbidities, and cognition. Understanding factors associated with engagement in meaningful activity can help to inform strategies for optimizing engagement among residents with dementia in assisted living.

METHOD

This descriptive study used baseline data from a randomized controlled trial, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). Linear regression was used to examine factors associated with engagement in meaningful activity.

RESULTS

A total of 71 residents from 5 assisted living settings were included in the sample. Most participants were female (n = 52, 73%), White (n = 62, 87%), and mean age was 85 years old (SD = 8.2). Controlling for age, gender, comorbidities, and cognition, pain was significantly associated with engagement in meaningful activity (b= -2.09, p < 0.05). There were no associations found between function and behavioral symptoms with engagement in meaningful activity.

CONCLUSION

Findings from this study show that pain is a significant factor that is negatively associated with residents' engagement in meaningful activity. Ongoing research is needed to help improve pain management for residents with dementia in assisted living and support their engagement in meaningful activity.

Is it possible to prevent the progression of mild cognitive impairment through non-pharmacological treatments?

INTRODUCTION

Mild cognitive impairment produces slight cognitive and motor disturbances without affecting daily life during aging, however, if this symptomatology is not controlled, the speed of deterioration can increase, and even some cases of dementia can appear in the elderly population.

OBJECTIVE

To describe non-pharmacological therapies that seek to prevent, control and reduce the symptoms of mild cognitive impairment.

METHODS

An initial search was carried out in the databases of PubMed, Lilacs, EBSCO, ScienceDirect, Taylor & Francis and ProQuest. The results found were filtered through the PRISMA system and biases evaluated using the Cochrane Handbook for Systematic Reviews of Interventions.

RESULTS

Four categories of non-pharmacological therapies were created, using 50 articles found in the search, which contribute to controlling and improving cognitive and motor areas, in order to reduce the symptoms presented by mild cognitive impairment. The treatments have different methods, instruments and objectives, so that no meta-analysis of the studies could be performed. In addition, limitations related to the sample, the effectiveness of the results and the methodological quality were found.

CONCLUSIONS

It was found that non-pharmacological therapies prevent, improve and control the symptoms caused by mild cognitive impairment, however, it is necessary to carry out more studies with better methodologies to corroborate these results.

Individualized Music Interventions for Dementia-Related Behavior Management

ABSTRACT

Dementia presents many challenges for the person diagnosed, as well as for caregivers. The use of psychotropic medications for dementia-related behaviors has been linked to adverse reactions and increased mortality. Alternative approaches such as the use of personalized music playlists and musically-related spiritual care have had promising results including improved quality of life for persons with dementia and reduced stress for caregivers. Implementing an individualized music program is relatively simple and avoids deleterious side effects that may accompany medication use.

Can a personalised music listening intervention decrease agitation in hospitalised patients with dementia? A feasibility trial

Introduction

Agitation is a common manifestation of the behavioural and psychological symptoms of dementia (BPSD). Pharmacotherapy is not the first-line management because of its potential harms, particularly in the elderly. Music as a non-pharmacological intervention for agitation has been explored in residential aged-care facilities, but few studies have been situated in hospitals. This pilot aims to evaluate the feasibility of a personalised music listening intervention for reducing agitation in hospitalised patients with dementia in a metropolitan Geriatric Evaluation and Management (GEM) unit.

Methods

Two-arm randomised control feasibility trial. Eligible patients were assigned to the music intervention or control group, with the intervention group receiving music daily between 15:00-16:00, and agitation levels measured in both groups hourly based on the Pittsburgh Agitation Score (PAS) over 5 days of hospitalisation. Post-trial semi-structured interviews assessed feasibility of the intervention.

Results

Twenty-one patients were recruited over 8 months. Interviews with staff involved indicated that the music intervention was manageable to deliver, assisted engagement with patients which increased efficiency of some clinical tasks, and challenged staff mindset around using psychotropic medication to address agitation. PAS results were inconclusive, because of underpowered numbers in this pilot study.

Conclusion

It is feasible for nursing staff to deliver a personalised music listening intervention to patients with dementia in a geriatric unit of a tertiary hospital, without compromising on usual clinical care.

Music-based interventions for people living with dementia, targeting behavioral and psychological symptoms: A scoping review

INTRODUCTION

Dementia care is a major public health issue worldwide. The management of behavioral and psychological symptoms (BPSD) is one of the hardest challenges in this context. Non-pharmacological strategies, like music-based interventions (Mbi), seem promising options, being considered low-risk, widely available and inclusive. This scoping review aimed at mapping all Mbi used in dementia care, targeting BPSD, and debriefing its components, structure and rationale. Music therapy and other therapeutic music activities were included.

METHODS

The Arksey and O'Malley framework, Cochrane recommendations and PRISMA checklist were followed. Embase, PubMed, PsycINFO, ASSIA and Humanities Index were searched from first records until the 31^st of March 2020. Snowballing process and screening of relevant journals were also undertaken. A panel of experts critically guided the evidence synthesis.

RESULTS

Overall, 103 studies (34 RCT; 12 NRT; 40 Before/After studies and 17 Case Studies) met inclusion criteria. Basic elements of the Mbi, the rationale supporting its development and hypothesis tested were mostly underreported, thus hampering cross-study comparisons and generalizations. Despite this, available evidence indicates that: it is feasible to deliver Mbi to PwD at very different stages and in different settings - from community to the acute setting - even for non-music therapists; positive or neutral effects in BPSD are often reported but not without exception; individualization seems a critical factor mediating Mbi effects.

CONCLUSIONS

Detailed intervention and research reporting are essential to interpretation, replication and translation into practice. Ten years after the publication of specific reporting guidelines, this goal is not yet fully achieved in music in dementia care.

Music Compared with Auditory Books: A Randomized Controlled Study Among Long-Term Care Residents with Alzheimer's Disease or Related Dementia

BACKGROUND

Over 5 million Americans age 65 years and older were diagnosed with Alzheimer's disease and/or related dementia (ADRD), a majority of whom exhibit behavioral and psychological symptoms leading to placement in long-term care settings. These facilities need nonmedical interventions, and music-based programs have received supportive evidence.

SETTING

Thirteen long-term care facilities were among a wave of facilities that volunteered to be trained and to administer a music-based intervention. The residents within were randomized into intervention or control groups (intervention/music, n = 103; control/audiobook, n = 55).

DESIGN

This team used a pragmatic trial to randomly embed music and control (audiobooks) into 13 long-term care facilities to compare the effects on agitation in people with ADRD.

METHODS

Measures included a demographic survey; the Mini-Mental Status Examination, used to assess cognitive status; and the Cohen-Mansfield Agitation Inventory with 4 subscales, used to measure agitation. These measures were implemented at baseline and every 2 weeks for 8 weeks. Mixed-effects models were used to evaluate change in agitation measures while addressing dependencies of scores within participants and facility.

RESULTS

Decreases in agitation were attributable to both music and audiobooks in 3 of 4 agitation subscales. In the fourth, physical agitation, which was not directed toward staff, initially, it decreased given music, and increased thereafter; and generally, it increased with the audiobooks.

CONCLUSION AND IMPLICATIONS

Both music and control audiobooks delivered by headphones after personalized selection reduced some aspects of agitation in residents diagnosed with ADRD. The effects of music were greater initially then diminished.

Music-based interventions in the acute setting for patients with dementia: a systematic review

PURPOSE

The utilization of non-pharmacological interventions is increasingly recommended in dementia care. Among them, Music-based interventions seem promising options, according with numerous positive studies conducted in long-term care institutions. In this review, we aim to investigate its administration to patients with dementia in a less-researched setting-the acute hospital.

METHODS

A systematic review (PROSPERO registration: 81698), according to PRISMA recommendations, was performed. Embase, PubMed, PsycINFO, ASSIA and Humanities Index were searched from first records to June 2019 and the search was updated in June 2020. Manual screening of journals, trial registries and grey literature was undertaken. Risk of bias was assessed with the Downs and Black (1998) checklist.

RESULTS

345 records were initially retrieved and nine complied with the inclusion criteria. Data on 246 acute inpatients (224 PwD), with a mean age (reported only in 4 studies) varying from 74.1 to 86.5 was presented. Interventions varied significantly and practical details of their administration and development were poorly reported. Overall, quantitative results indicate a trend towards a positive effect in well-being, mood, engagement/relationship and global cognitive function, as well as a reduction in BPSD, resistive care, utilization of pro re nata medication and one-on-one care. Qualitative data also demonstrates acceptability and positive effects of music-based interventions.

CONCLUSION

Despite the lack of robust, adequately powered and controlled trials, identified studies suggest it is feasible to deliver music-based interventions, in the acute setting, to patients with dementia and there is a trend towards positive effects.

Effects of non-facilitated meaningful activities for people with dementia in long-term care facilities: A systematic review

•

Most activity interventions for people with dementia in long-term care are facilitated.

•

Non-facilitated meaningful activities included music/stimulated family presence, animal-like social robot, lifelike dolls.

•

Some beneficial effects for agitation, emotional wellbeing, feelings of pleasure, engagement and sleep quality.

•

Future research into the potential benefits of non-facilitated meaningful activities is needed in rigorously designed RCTs.

This systematic review sought to evaluate the effectiveness of non-facilitated meaningful activities for older people with dementia in long-term care facilities. Searches were conducted in PubMed; CINAHL; EMBASE; Web of science; PsycINFO; Cochrane; ProQuest; and ClinicalTrials.gov to identify articles published between January 2004 and October 2019. A total of six studies were included. Results implied that current randomised controlled trials or controlled trials about non-facilitated meaningful activities for people with living dementia in long-term care facilitates are limited, but those included in this review were of adequate methodological quality. Meaningful non-facilitated activities, such as music, stimulated family presence, animal-like social robot PARO/plush toy and lifelike dolls, may have beneficial effects on agitation, emotional well-being, feelings of pleasure, engagement, and sleep quality. However, there remains a lack of conclusive and robust evidence to support these psychological and physiological effects of non-facilitated meaningful activities for older people with dementia living in long-term care facilities by care staff.

The Roth Project - Music and Memory: A Community Agency Initiated Individualized Music Intervention for People with Dementia

INTRODUCTION

"The Roth Project - Music and Memory" is a music-based intervention program, implemented by the Alzheimer's Association of Central and Western Kansas, which provides a non-pharmacological means for addressing neuropsychiatric symptoms in individuals with dementia.

METHODS

Participants were individuals with dementia who were enrolled in The Roth Project - Music and Memory. Post-intervention surveys were distributed to caregivers of participants which assessed caregiver satisfaction with the program as well as caregiver perception of the impact of individualized music on mood and behavioral symptoms.

RESULTS

Of returned surveys (n = 79), 99% of caregivers indicated they were satisfied or very satisfied with the program and 94% of caregivers perceived participants to like or very much like listening to the music. While a substantial number of participants required assistance with iPod use (95%), the majority of participants were observed to listen to the music with stable or increased frequency over time. Personalized music was observed to improve mood in 78% of cases, with the most frequent benefits being improved overall happiness, decreased anxiety, increased positive emotional expression, and decreased depression.

CONCLUSIONS

The Roth Project - Music and Memory was well received by caregivers and was perceived to benefit mood of individuals with dementia. These results provided ongoing support for individualized music-based interventions and demonstrated that such interventions, when implemented by community agencies, can be well received by those who use them.