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The Impact of Music Therapy on Dementia Patients

Title

The study is a systematic review with qualitative analysis to get insights into the use of music therapies on dementia patients and its impact on them.

Abstract on Nonpharmacological Interventions in Dementia

The systematic literature review is a qualitative review done on the impact of music therapy on dementia patients and the effectiveness of music therapy in improving the anxiety, depression, behavioral, and other problems of the patients. Music therapy is a form of a non-pharmacological approach to treating patients (Vink et al. 2012). For this purpose, many studies were searched on various databases like ScienceDirect, MEDLINE, and CINAHL. The eligibility criteria for the selection of studies were that they should not be older than 10 years and should be relevant containing information about music therapy and its impact on dementia patients. The participants in the studies were dementia patients, dementia residents in nursing care, and their families. Music can treat many health problems. Therefore, after reviewing nearly 8 articles it was found that music has effectively proved to improve the health, behavior, psychosocial and social aspects of the patients. Moreover, it can be suggested that before applying the non-pharmaceutical approaches to the patient, the nurse should know the mechanism of action and treatment (Burgener et al. 2015).

Introduction to Nonpharmacological Interventions in Dementia

Rationale

The effects of patient-centered care and non-pharmacological approaches have either nearly similar or high impact than drug therapy. Therapy of music is one of the non-pharmacological approaches. In music therapy, there is the use of various factors like mode and tempo to relax and activate and to stimulate emotional and social well-being and decrease the level of stress or anxiety in older patients who suffer from dementia. The use of music therapy on dementia decreases the depression and agitation symptoms, decreases agitation in patients with dementia, significantly lower the depression scores, and decreases depressive symptoms (Mileski et al. 2019). The use of music therapies can not only reduce depression or stress but it can also reduce anxiety, behaviors, and reliance on antipsychotic medications. The use of music therapies also improves language abilities (Burgener et al. 2015). This study conducts a systematic literature review on various published articles to understand the impact of music therapies in improving dementia patient’s health.

Aim

This study aims to study the positive impacts of using non-pharmacological approaches like music therapy for dementia patients to improve their health and well-being along to observe the effectiveness to get positive outcomes both physically and mentally in nursing facilities. 

Methodology of Nonpharmacological Interventions in Dementia

Eligibility criteria

Only those studies that are available in the English language have been considered for the systematic review. The studies between the period of 2010 to 2020 has been selected for the study. This time slot has been considered for eligibility of literature so that only recent information can be included in the systematic review. Only those articles are selected from the academic journals that are reliable.

Information sources

The selection of the appropriate database is a very important factor because it ensures that only high quality and reliable evidence are retrieved for the research analysis (Wright, Golder, and Lewis-Light 2015). The databases which have been selected for the given systematic review include ScienceDirect, MEDLINE, and CINAHL.

The MEDLINE contains approximately >2400 journal articles related to biomedicine, oncology, nursing, pharmacy, and other related fields (Kaste 2015).

IN CINAHL approximately 4,000 peer-reviewed journal articles are present which are related to healthcare, biomedicine, nursing, allied health, oncology, and medicines (Wright et al. 2015).

Search

Various processes can be adopted for searching for literature. The method which has been employed for this systematic review is the use of keywords and Boolean operators (Grewal et al. 2016). The keywords help in easy identification of literature as they act as the keys for unlocking the locks and filter out the desired material from full-body text (Grewal et al. 2016). The various keywords which have been used for a given study are as follows:

Dementia therapy, music therapy, music, mental health, behavior, cognitive, health status

Boolean operators are also an effective strategy that can help in using the keywords in combination so that the literature in which the keywords with context are present can be retrieved from the database (Grewal et al. 2016). The variety of Boolean operators which has been used for the study are :

AND, OR.

Dementia therapy AND music therapy, music OR mental health, behavior AND music, health status AND music, cognitive OR music

Study selection

The studies were selected using key terms. The eligibility for selecting the studies was that they should not be older than 15 years, should be in the English language, and should be qualitative studies only. The rest of the searched papers that did not meet the criteria were excluded out. 

Articles Assessments and Their Critical Appraisal

Paper 1 – The statistical analyses were used to analyze the data and hence the aim was also achieved. The strength of this study constitutes the use of a randomized controlled design with a large number of patients involving assessments and sessions. Moreover, the nurses who were also responsible for guiding the residents to the music therapy room or the activity room were kept not aware of the study's aim, this stopped them from being biased for the music therapy. Thereby, the study provided no guarantee for complete blinding, this might act as a risk for the business (Vink et al. 2012).

Paper 2 – the authors collected data by conducting interviews of the patients and their family members. They also audio recorded their interviews and conducted the long-table approach and the general inductive approach. The aim was achieved to know about the meaning of music from the perspective of dementia patients. The risk of business includes that the interviews and the focus groups were conducted and analyzed with only a particular aim to develop a measure for music therapy output qualitatively for people suffering from either moderate or severe dementia. Therefore, there are chances that some aspects of the music into the lives of dementia patients were not chosen up during the collection of the data (McDermott et al. 2014).

Paper 3 – the authors reviewed the high need for using non-pharmacological therapies or evidence-based therapies for individuals suffering from dementia. The assessments included evidence of gradings and mechanisms of action that helped to achieve the aim of the article. Moreover, there was no risk of biases in this study because it reviewed many different non- pharmacological therapies with their assessments to get reliable and true results. The study also gave information about each therapy’s treatment plans that further helps in achieving the aim (Burgener et al. 2015).

Paper 4 –the authors used both exclusion and inclusion criteria to collect and analyze the data. The results obtained after viewing articles were tabulated in different columns under different categories to get information about the positive outcomes of using music thereby enabling the authors to achieve their results. The study was at one risk that it considered many articles that considered different age groups in the adult category but did not specify which adult of which age group is in what category resulting in biased results (Mileski et al. 2019).

Paper 5 – the authors conducted a literature search by collecting data from various online databases. A prespecified protocol was used to analyze the data. With the help of Egger’s test and Begg’s tests were used to reduce the risk of biases. The meta-analysis was performed for the data collected to get results, thereby enabling the authors to achieve their goals. Moreover, a comprehensive search strategy was used to reduce the risk of biases (Zhang et al. 2017).

Paper 6 – the authors have a bias study because there was no blinding of the proxy respondents and treatment allocation. They conducted a statistical analysis and achieved their aim they also did a descriptive analysis. They achieved their aim and found that agitation disruptiveness decreased due to music therapy (Ridder et al. 2013).

Paper 7 – the authors chose randomized controlled trials to reduce biased results and also provided a detailed description of various alternatives and their criteria for assessments as well. The authors found many alternatives for non-pharmaceutical interventions (Cohen-Mansfield et al. 2014).

Paper 8 – the authors used repeated measurements for their experimental study. The authors chose 104 participants and 100 subjects completed this study The sample size included more females than males that might result in a biased study. The authors achieved their aim by conducting descriptive statistics using t-test and the Mann–Whitney U-test. Moreover, a large sample size enables the authors to get reliable and better results. This paper discussed the effect of music therapy on verbal and physical behavior (Lin et al. 2010).

Results of Nonpharmacological Interventions in Dementia

PAPERS

1

2

3

4

5

YEAR

2012

2014

2015

2019

2017

AUTHOR

Vink et al.

McDermott et al.

Burgener et al.

Mileski et al.

Zhang et al.

COUNTRY

India

United Kingdom

United States

New Zealand

India

TITLE

The effect of music therapy compared with general recreational activities in reducing agitation in people with dementia: a randomized controlled trial

The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff, and music therapist

Mechanism of action for non-pharmacological therapies for individuals with dementia

Positive physical and mental outcomes for residents in nursing facilities using music: a systematic review

Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis

AIM

To aimed to compare the music therapy effects with that of the general recreational day activities effects in decreasing agitation in dementia patients

To explore the value of music from the dementia patient

To addresses the need for non-pharmacological therapies and increased use of evidence-based for individuals with dementia

To investigate the effectiveness and the applicability of using music for positive mental and physical outcomes in nursing facilities.

To analyze the impacts of music therapy in dementia patients

DESIGN

It used a randomized controlled design.

The study conducted interviews with qualitative data analysis

It used a randomized controlled trial design, quasi-experimental design, and controlled study designs.

The authors conducted a systematic review of articles using key-words and Boolean characters. Also used both inclusive and exclusive criteria for the study.

The authors used different trial designs and meta-analysis was excluded from the study.

SAMPLING and SIZE

94 residents with dementia were chosen that were allocated to either recreational activities or music therapy

69 residents with dementia were chosen and interviewed along with their families.

Various non-pharmaceutical therapies were reviewed.

30 articles were chosen for the study

743 studies were chosen from different databases and many were excluded resulting in only 32 final studies for analysis.

RESULTS or FINDINGS

It was found that the agitation behavior was less in music therapy residents than in recreational activities therapy residents.

The results showed that music can support the social psychology and the personal psychology of dementia residents.

The findings showed each non-pharmaceutical therapy with its effectiveness and mechanism of action should be known before applying to the patient.

Music therapy resulted in reduced depression (12%), increased communication (18%), and improved physical health (11%)

The results showed that music can treat disruptive anxiety and depression, this ultimately resulted in a good quality of life.

 

PAPERS

6

7

8

YEAR

2013

2014

2010

AUTHOR

Ridder et al.

Cohen-Mansfield et al.

Lin et al.

COUNTRY

United Kingdom

Netherland

United States

TITLE

Individual music therapy for agitation in dementia: an exploratory randomized controlled trial

Expanded Review Criteria: The case of non-pharmacological interventions in dementia

Effectiveness of group music intervention against agitated behavior in elderly persons with dementia

AIM

To study the effect of music on dementia patients living in nursing homes.

To explore alternatives for non-pharmacological interventions.

To explore the effectiveness of music to cure agitation in dementia patients.

DESIGN

two-armed, randomized controlled, exploratory study

randomized controlled study design

pretest-posttest control group design

SAMPLING or SIZE

42 participants with dementia were chosen as the sample size

The authors used a sample size of 27 reviews

104 participants were recruited and 100 subjects completed this study

RESULTS or FINDINGS

Agitation disruptiveness decreased due to music therapy

The authors found many alternatives for non-pharmaceutical interventions

The study showed that music decreased aggressive behavior both physically and verbally.

Discussion on Nonpharmacological Interventions in Dementia

This study aims to review the literature and explore the impacts of music therapy that can improve various psychological aspects and other health problems of dementia patients. The paper 1 discussed about recreational activity impacts as well, paper 7 discussed alternatives, and this generated argument among papers because although every paper discussed about the impact of music on health but they chose different health issues to talk about. Therefore, the argument came up because of their different approaches but similar objectives about music therapy impact as shown below:

Paper 1

Paper 2

Paper 3

Paper 4

Paper 5

Paper 6

Paper 7

Paper 8

This paper discussed additionally about the impact on dementia by both music and recreational activities. It also explored that agitation was found to be reduced thus linking with paper 6.

This paper discussed and explored the psychological aspects of dementia patients, but did not discussed about agitation and depression behavior

This paper explored dementia-related neuropathology and aging-related neuropathology, neurological regeneration theories to deal with dementia

This paper discussed and explored that depression, anxiety, mental and physical well being are improved with music therapies. It discussed physical health linking with that in paper 8

This is the only paper that explores and explored the effect of music on quality of life. It also showed the efficacy of music therapy for cognitive function. Its discussion on reduced depression was linked with that in paper 4

This paper explored and discussed the impact of music on meditation and other care facilities. It also included a case study referencing that was not in other article papers. It discussed about agitation which was linked to paper 1.

This is the only article that explored the alternatives for non-pharmacological interventions in dementia patients that were not discussed in other papers. The discussion of improved physical health in this paper is linked with that in paper 8

This paper discussed the effect of music therapy on verbal and physical behavior, these were not explored by other papers.

Conclusion on Nonpharmacological Interventions in Dementia

It was found that music therapy does help in treating dementia patients and such interventions should be involved in the general-normal practice of health care services. This review showed that music resulted in positive outcomes of using non-pharmacological interventions for improved behavior and cognitive functions. Music therapy helps in reducing agitation. It was found that music and physical health have positive relationships. The positive effects include better physical health, increased socialization, improved mood, and communication. This study has reviewed many articles and found that there are many alternatives also for non-pharmacological interventions in dementia patients. Music therapy can help in treating depression, anxiety and nursing home services should start implementing such non-pharmacological approaches for treatment of dementia patients or dementia residents.

References for Nonpharmacological Interventions in Dementia

Burgener, S. C., Jao, Y. L., Anderson, J. G., and Bossen, A. L. 2015. Mechanism of action for nonpharmacological therapies for individuals with dementia: Implications for practice and research. Research in Gerontological Nursing, 8(5), pp. 240–259. DOI:10.3928/19404921-20150429-02 

Cohen-Mansfield, J., Buckwalter, K., Beattie, E., Rose, K., Neville, C., and Kolanowski, A. 2014. Expanded review criteria: The case of nonpharmacological interventions in dementia. Journal of Alzheimer’s Disease, 41(1), pp. 15–28. DOI:10.3233/jad-132357 

Grewal, A., Kataria, H., and Dhawan, I.2016. Literature search for research planning and identification of research problem. Indian Journal of Anaesthesia60(9). DOI: 10.4103/0019-5049.190618

Kaste, A. 2015. Medline complete. Journal of the Medical Library Association: JMLA103(1). DOI: 10.3163/1536-5050.103.1.018

Lin, Y., Chu, H., Yang, C. Y., Chen, C. H., Chen, S. G., Chang, H. J., and Chou, K. R. 2010. Effectiveness of group music intervention against agitated behavior in elderly persons with dementia. International Journal of Geriatric Psychiatry, 26(7), pp. 670–678. DOI:10.1002/gps.2580 

McDermott, O., Orrell, M., and Ridder, H. M. 2014. The importance of music for people with dementia: the perspectives of people with dementia, family carers, staff and music therapists. Aging & Mental Health, 18(6), pp. 706–716. DOI:10.1080/13607863.2013.875124 

Mileski, M., Brooks, M., Kirsch, A., Lee, F., LeVieux, A., and Ruiz, A. 2019. Positive physical and mental outcomes for residents in nursing facilities using music: A systematic review. Clinical Interventions in Aging,  14, pp. 301–319. DOI:10.2147/cia.s189486 

Ridder, H. M. O., Stige, B., Qvale, L. G., and Gold, C. 2013. Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging & Mental Health, 17(6), pp. 667–678. DOI:10.1080/13607863.2013.790926 

Wright, K., Golder, S., and Lewis-Light, K. 2015. What value is the CINAHL database when searching for systematic reviews of qualitative studies?. Systematic Reviews4(1). DOI : 10.1186/s13643-015-0069-4

Zhang, Y., Cai, J., An, L., Hui, F., Ren, T., Ma, H., and Zhao, Q. 2017. Does music therapy enhance behavioral and cognitive function in elderly dementia patients? A systematic review and meta-analysis. Ageing Research Reviews, 35, pp. 1–11. DOI:10.1016/j.arr.2016.12.003 

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