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Table of contents

Rationale and aim

Search strategy

Critical appraisal

Synthesis

References

Appendix

Rationale and Aim of The Literature Review

Dementia patients suffer from various inabilities and reduced skills like memory loss, depression, mood swings, personality changes, mental confusion, jumbles speech, and many more (National Institute of Health and Care Excellence 2020). The pharmacological approaches have proved to be a little unsatisfactory in result outcomes. So, the use of music therapy as a non-pharmacological approach for dementia patients is studied and researched. It is found that music therapies help in reducing the behavioral and mental symptoms in dementia patients and also have others associated positive results like improved cognitive skills or reduced anxiety (Pedersen et al., 2017). This study aims to study the impacts of music therapy on dementia patients by conducting a systemic review of the published articles and critical analysis of them to get more insights about the topic.

Search Strategy of The Literature Review

The databases only in the English language that are only 10 years old are used for this study. The databases include PubMed, Cochrane, and NICE website. This study is structured in the form of a systematic literature review. The PICO question is – What is the efficacy of music therapy in dementia patients and how their cognitive and behavioral abilities are improved through music therapy? The keywords used for selection of the articles with Boolean operators are - music therapy AND dementia, dementia OR music therapy, cognitive skills AND music therapy, music therapy AND cognitive abilities. The study is using inclusive criteria.

Picture of Search Strategy of The Literature Review

The Critical Appraisal Of the Literature Review

According to Fusar-Poli et al. (2017), the authors conducted a meta-analysis to study the effects of music therapy on various skills and abilities of dementia patients. They stated that a decline in cognitive functions is one of the main issues in dementia and this problem is less likely to be managed with medications, so they studied the impacts of music therapy on dementia patients. They achieved their aim by conducting a meta-analysis and the search strategy was inclusion. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. In this study for each outcome, the meta-analysis was performed using standardized mean differences (SMD). The strengths were the use of a large sample size to reduce the risk of biases and the use of randomized controlled trials (RCTs) for the study. The large sample size provides smaller, the margin of errors identifies the outliners, and generate more accurate mean values. The results thus produced are more reliable. The use of randomized controlled trials (RCTs) facilitates the blinding of assessors and participants, thereby eliminating the bias in results produced by the studies. The limitations were - the reduced number of eligible studies because of the restrictions to randomized controlled trials. The efficacy of music therapy (MT) intervention was hampered due to the presence of clinical heterogeneity.

The changes that occurred between the start and end of music therapy interventions were not focused. The results showed that music therapy interventions show positive impacts on perceptual-motor skills, language skills, memory skills, learning abilities, executive function, and complex attention. It was also found that participants showed increased music activity involvements and the activity of the inferior frontal cortex was enhanced in such patients who were involved in the musical practice. The results also showed that music therapy resulted in increased volumetric changes in the parietal, temporal, and frontal cortex of the dementia participants. The verbal memory, auditory and visual skills are also improved on the patients using musical interventions. Moreover, it was found that music activated the limbic system and is associated with strong emotional feelings as well.

According to Zhang et al. (2017), the study aimed at studying the effects of music therapy on dementia patients. They conducted a meta-analysis and systematic review for the published articles in various databases to get insights about the impacts of music therapy interventions on the cognitive and behavioral functions in elderly dementia patients. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. The authors stated that cognitive and behavioral dysfunctions can be managed with pharmacological and non-pharmacological interventions as well. However, the outcomes of pharmacological interventions are less likely to be satisfactory than the outcomes of non-pharmacological interventions. The strengths were the use of randomized crossover trials, controlled clinical trials (CCTs), and randomized controlled trials (RCTs) for the study. The Critical Appraisal Skills Program (CASP) scale score and the Physiotherapy Evidence Database (PEDro) scale score were used by the authors to assess the quality of the included studies. All these approaches reduced the risk of errors in the results produced by the study. The use of randomized controlled trials (RCTs) facilitates the blinding of assessors and participants, thereby eliminating the bias in results produced by the studies.

Statistical analysis was also conducted for the data collected. The limitations include – the authors did not set any language and data restrictions. The negative results were not communicated but the positive results were more published. As the sample size of the included studies were small, this resulted in affecting the reliability of the results generated by the study as it leads to higher variability, that ends up in biased results. However, the aim of the study was achieved. The study had the following results –music therapy has positive impacts on quality of life, depression, behavioral functions, and cognitive functions. The participants were elderly dementia patients and they showed positive impacts on disruptive behavior and reduces anxiety. The authors showed music as an inexpensive, non-invasive, and non-pharmacological intervention with non-adverse reactions that can be delivered successfully and very easily in comparison to other pharmacological interventions.

According to Gómez-Romero et al. (2017), the study stated that the administration of drugs on dementia patients to manage their behavioral disorders result in adverse effects. So, non-pharmacological strategies are used to deal with these issues. The authors conducted a study by performing a systematic review of various databases retrieved from reliable sources to study the benefits of music therapy in dementia patients. The strengths are the use of a large sample size for data collection for the study and the study criteria were inclusive. The large sample size provides smaller, the margin of errors identifies the outliners, and generate more accurate mean values. The results thus produced are more reliable and the inclusive criteria provide minimal ethical concerns, lower costs, and improved feasibility. It also optimizes the internal and external validity of the study. The PEDro (Physiotherapy Evidence Database) 11 scale was used to measure the quality of the studies included. Moreover, the study had blinding of the assessor, blinding of therapists, and blinding of subjects as well. The limitations were fewer numbers of published studies available for data collection for the study and only a low number of controlled trials and clinical trials were used to analyze the effects of music therapy in dementia patients.

Moreover, another limitation was the study focused only on the outcomes during the start and at the end of the musical interventions, not after 1 month of using the musical interventions in dementia patients. The results showed that there was a decrease in verbally aggressive behaviors, verbally non-aggressive behaviors, a decrease in physically non-aggressive behaviors, decreased irritation, and reduced phobias. There was a decrease in delusional ideation, aggression, anxiety, and improvement in an emotional state with improved/better moods after interventions. Hallucinations, agitation, distress, and agony were found to be reduced. The results thereby showed that music therapy is beneficial for agitation, anxiety, and behavior disorders in dementia patients. Thus the authors achieved their aim to detect the benefits of music therapy in dementia patients.

According to Gallego and García (2017), the authors stated that agitation is a common problem in dementia patients. There are many medications to deal with this issue but the results are not effective. So, music therapy is used to reduce agitation in dementia. The authors conducted a meta-analysis of the articles retrieved from reliable databases to study the effect of music on dementia patients. They conducted statistical analysis for the data collected and they achieved their aim by conducting a meta-analysis. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. The search design was both inclusive and exclusive. They used randomized controlled trials with uncontrolled studies. They focused on the effects of both pre and post-interventions in dementia patients. The strengths were the use of a large sample size to reduce the risk of biases and the use of randomized controlled trials (RCTs) for the study. The large sample size provides smaller, the margin of errors identifies the outliners and generate more accurate mean values. The results thus produced are more reliable.

The use of randomized controlled trials (RCTs) facilitates the blinding of assessors and participants, thereby eliminating the bias in results produced by the studies. The limitations include the authors did not set any language and data restrictions as not many articles were published/available for data collection. Moreover, this meta-analysis did not differentiate between the degrees of severeness and the various types of dementia. The results showed by this study were – a significant decline in aggressive behavior between music and no music periods of interventions in dementia patients. Furthermore, the other impacts of music on dementia patients were decreased aggression, anxiety, depression, confusion, and improved quality of life. Music therapy was found to be successful in reducing stress and enhance non-verbal and verbal expressions in dementia patients that were having a musical therapy.

According to Tsoi et al. (2018), the authors stated that the use of drugs on dementia patients to treat their impaired functions/abilities resulted in adverse side-effects. The study aimed to evaluate the effects on behavior and cognitive functions between receptive and interactive music therapies on dementia patients. They conducted a meta-analysis for their systematic review study to achieve their aim. Cochrane Risk of Bias was used to evaluate the potential risks of bias of each included study. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. The strengths were the use of a large sample size to reduce the risk of biases. The large sample size provides smaller, the margin of errors identifies the outliners, and generate more accurate mean values. The results thus produced are more reliable. The limitations include - clinical heterogeneity in the studies that were not avoided, many articles were not available for studying the negative outcomes and some of the unpublished articles were also missed during data collections for this study. The results showed that neither receptive nor interactive music therapies were able to enhance the cognitive functions in elderly dementia patients.

The older patients who received casual care showed similar progress reports as showed by the patients receiving interactive music therapies, with significant differences in psychological and behavioral symptoms. However, a decline in agitation, anxiety, apathy, and behavioral dysfunction was observed in patients receiving interactive music therapies. This study has also compared the effects of both interactive and receptive music therapies on older patients. It showed that receptive music therapy has a better effect on behavioral problems, agitation, and alleviating anxiety than interactive music therapy. It concluded that receptive music therapies are easy to be conducted as they can be conducted without the help of professionals. It is less costly and better than interactive music therapies. It is more implementable and adopts a passive approach in comparison to interactive music therapies. The positive outcomes measured with the use of music therapies were the improved quality of life, reduced depression, reduced anxiety, improved cognitive functions, and better behavioral skills.

Synthesis of The Literature Review

Paper 1, is a meta-analysis systematic review and the authors have used randomized control trials in the study. This places this study in level 1 of evidence. They achieved their aim by conducting a meta-analysis and the search strategy was inclusion. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. It successfully showed that music does impact positively on cognitive and behavioral skills in dementia patients. It is also easy to practice that can be implemented in hospitals for health care centers for dementia patients as a non-pharmacological approach.

Paper 2, is a meta-analysis systematic review and the authors have used randomized control trials in the study. This places this study in level 1 of evidence. They achieved their aim by conducting a meta-analysis and the search strategy was inclusion. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. It is also easy to practice that can be implemented in hospitals for health care centers for dementia patients as a non-pharmacological approach because it has no side effects. The large sample size and CASP scale score are used to reduce the risk of biases.

Paper 3, is a systematic review and this places this study in level 1 of evidence. It is also easy to practice that can be implemented in hospitals for health care centers for dementia patients as a non-pharmacological approach because it has no side effects and also does not need any highly skilled professionals to implement it for the patients. The large sample size is used to reduce the risk of biases.

Paper 4, is a meta-analysis systematic review and the authors have used randomized control trials in the study. This places this study in level 1 of evidence. The use of randomized controlled trials (RCTs) facilitates the blinding of assessors and participants, thereby eliminating the bias in results produced by the studies. It is also easy to practice that can be implemented in hospitals for health care centers for dementia patients as a non-pharmacological approach because it has no side effects. The large sample size is used to reduce the risk of biases.

Paper 5, is a meta-analysis systematic review and this places this study in level 1 of evidence. They achieved their aim by conducting a meta-analysis and the search strategy was inclusion. The meta-analysis increases the statistical power to detect the effect as in this more amount of data is used, thereby providing better estimates for the results in the studies. It is also easy to practice that can be implemented in hospitals for health care centers for dementia patients as a non-pharmacological approach because it does not require a skilled professional to implement it for the patients. However, it has decreased impacts after 2 months of therapy. The large sample size is used to reduce the risk of biases.

References

Fusar-Poli, L., Bieleninik, Ł., Brondino, N., Chen, X. J., and Gold, C. 2017. The effect of music therapy on cognitive functions in patients with dementia: A systematic review and meta-analysis. Aging & Mental Health, pp. 1–10. DOI:10.1080/13607863.2017.1348474

Gallego, M. G. and García, J. G. 2017. Music therapy and Alzheimer's disease: Cognitive, psychological, and behavioural effects. Neurología, 32(5), pp. 300-308.

Gómez-Romero, M., Jiménez-Palomares, M., Rodríguez-Mansilla, J., Flores-Nieto, A., Garrido-Ardila, E. M., and González-López-Arza, M. V. 2017. Benefits of music therapy on behaviour disorders in subjects diagnosed with dementia: A systematic review. Neurología, 32, pp. 253–263. DOI:10.1016/j.nrleng.2014.11.003

National Institute of Health and Care Excellence (NICE). 2020. Dementia: Assessment, management and support for people living with dementia and their carers. [Online]. Available at: https://www.nice.org.uk/guidance/ng97 [Accessed on July 31, 2020].

Pedersen, S. K. A., Andersen, P. N., Lugo, R. G., Andreassen, M., and Sütterlin, S. 2017). Effects of music on agitation in dementia: A meta-analysis. Frontiers in Psychology, 8. DOI:10.3389/fpsyg.2017.00742

Tsoi, K. K. F., Chan, J. Y. C., Ng, Y. M., Lee, M. M. Y., Kwok, T. C. Y., and Wong, S. Y. S. 2018. Receptive music therapy is more effective than interactive music therapy to relieve behavioral and psychological symptoms of dementia: A systematic review and meta-analysis. Journal of the American Medical Directors Association, 19(7), pp. 568–576. DOI:10.1016/j.jamda.2017.12.009

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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