The Role of Sound in Residential Facilities for People With Profound Intellectual and Multiple Disabilities

Music-based interventions for people with profound and multiple learning disabilities: A systematic review of the literature

Music is motivational, accessible and engaging for individuals with learning disabilities. Several systematic reviews have addressed the effects of music activity on people with learning disabilities; however, none has specifically reviewed the use of musical activity with people with profound and multiple learning disabilities.This review aimed to: 1. identify peer-reviewed studies and describe the characteristics of evidence-based musical activity used with people with profound and multiple learning disabilities and 2. evaluate and analyse the effectiveness of these music-based interventions and identify gaps within current research. A systematic search was conducted in April 2021 identifying seven peer-reviewed studies which included music-based interventions with at least one person with profound and multiple learning disabilities.Findings reveal the interventions varied in their frequency, duration and content. The outcome of most (n=6) interventions documented the development of the participants' social skillset. Interventions were predominantly (n=6) implemented by facilitators with musical expertise. The diverse and novel nature of the reviewed studies highlights a need to expand and enhance research with this population.

The Influence of Everyday Acoustic Environments on the Challenging Behavior in Dementia: A Participatory Observation Study in Nursing Homes

Challenging behavior (CB) is a group of behaviors, reactions and symptoms due to dementia, which can be challenging for the caregivers. The study aims to research the influence of acoustics on CB in people with dementia (PwD). An ethnographic method was used to study the daily life of PwD in their nursing homes with a specific focus on how people react to everyday environmental sounds. Thirty-five residents were included in the sample based on purposeful, homogeneous group characteristics and sampling. Empirical data were collected using 24/7 participatory observations. The collected data were analyzed using a phenomenological-hermeneutical method: a naïve understanding, a structural analysis and a comprehensive understanding. The result shows that the onset of CB depends on whether the resident feels safe and is triggered by an excess or lack of stimuli. The excess or shortage of stimuli and whether and when it affects a person is personal. It depends on various factors, the person's state and the time of day, the nature of the stimuli, familiarity, or strangeness is also a determining factor for the onset and progression of CB. The results can form an essential basis for developing soundscapes to make the PwD feel safe and reduce CB.

Soundscape Optimization in Nursing Homes Through Raising Awareness in Nursing Staff With MoSART

Introduction

Soundscapes in nursing homes are often suboptimal for residents. This can cause them feeling anxious and unsafe, or develop behavioral and psychological problems. Residents with dementia cannot adapt nursing home environments to their needs due to cognitive and physical limitations. It is up to the staff of psycho-geriatric wards to improve the soundscape. We evaluated the effect of the sound awareness intervention Mobile Soundscape Appraisal and Recording Technology (MoSART+) on soundscapes in nursing homes.

Methods

The MoSART+ intervention was carried out in four nursing homes and took three months in each home. The MoSART+ intervention involved training ambassadors, assessing the soundscape with the MoSART application by the nursing staff to raise their sound awareness on random time points, discussing the measurements, and implementing micro-interventions. Soundscapes were assessed from 0 to 100 on four attributes: pleasantness, eventfulness, complexity, and range of affordances. Based on these scores, soundscapes were classified in four dimensions: calm, lively, boring, and chaotic. Nursing staff graded the environment on a scale of 0 to 10. T-test and Z-tests were used to analyze data.

Results

Staff recorded 1882 measurements with the MoSART app. "People," "music, TV, and radio," and "machines and appliances" were the most prevalent sound sources before and after the implementation of micro-interventions. Post-implementation of micro-interventions, soundscapes were pleasant (median 69.0; IQR 54.0-81.0), of low complexity (33.0; 18.0-47.0), uneventful (27.0; 14.0-46.5), and gave moderate affordances (50.0; 35.0-67.0). Changes in attributes were statistically significant (p < 0.01). The proportion of the dimension calm increased (z = 12.7, p < 0.01), the proportion of chaotic decreased (z = 15.0, p < 0.01), and the proportion of lively decreased not statically significant (z = 0.68, p = 0.79). The proportion of boring was unchanged. The proportion of grades ≥6 increased after implementation of the micro-interventions (z = 15.3, p < 0.01). The micro-interventions focused on removing or reducing disturbing sounds and were unique for each nursing home.

Discussion

The MoSART+ intervention resulted in a statistically significantly improvement of soundscapes, and more favorable evaluations of the nursing staff. The intervention empowered staff to adapt soundscapes. Nursing homes can improve soundscapes by raising sound awareness among staff.

Trial Registration

Netherlands National Trial Register (NL6831).

Sounds in nursing homes and their effect on health in dementia: a systematic review

OBJECTIVES

Nursing home residents with dementia are sensitive to detrimental auditory environments. This paper presents the first literature review of empirical research investigating (1) the (perceived) intensity and sources of sounds in nursing homes, and (2) the influence of sounds on health of residents with dementia and staff.

DESIGN

A systematic review was conducted in PubMed, Web of Science and Scopus. Study quality was assessed with the Mixed Methods Appraisal Tool. We used a narrative approach to present the results.

RESULTS

We included 35 studies. Nine studies investigated sound intensity and reported high noise intensity with an average of 55-68 dB(A) (during daytime). In four studies about sound sources, human voices and electronic devices were the most dominant sources. Five cross-sectional studies focused on music interventions and reported positives effects on agitated behaviors. Four randomized controlled trials tested noise reduction as part of an intervention. In two studies, high-intensity sounds were associated with decreased nighttime sleep and increased agitation. The third study found an association between music and less agitation compared to other stimuli. The fourth study did not find an effect of noise on agitation. Two studies reported that a noisy environment had negative effects on staff.

CONCLUSIONS

The need for appropriate auditory environments that are responsive to residents' cognitive abilities and functioning is not yet recognized widely. Future research needs to place greater emphasis on intervention-based and longitudinal study design.

The Perspectives of Professional Caregivers on Implementing Audio-Based Technology in Residential Dementia Care

Music and familiar everyday sounds can be meaningful for people with dementia by providing benefits such as evoking memories and emotions or prompting social interactions with caregivers or relatives. Motivated by this potential, researchers and designers are investigating how to leverage these beneficial effects of sound in care environments through audio-based technology. However, there is a gap in the knowledge of how audio-based technology can be successfully implemented within everyday care practice. In this paper, we present the outcome of three participatory workshops with 18 professional caregivers to explore how audio-based technology can add value to existing care processes and activities in residential dementia care. During the participatory workshops, professional caregivers (1) mapped existing care activities; (2) linked findings in research with practice, and (3) designed scenarios for the Vita sound cushion. Care professionals indicate how audio-based technology can support existing care practice by influencing the mood of residents and by supporting social interaction during moments of care, daytime activities, or situational sessions. This study bridges research findings with insights from practice, contributing to a shared understanding of opportunities for embedding audio-based technology in dementia care. These opportunities motivate future research to implement and evaluate audio-based technology in residential dementia care.

Designing Supportive Soundscapes for Nursing Home Residents with Dementia

Sound and its resulting soundscape is a major appraisal component of the living environment. Where environmental sounds (e.g., outdoor traffic sounds) are often perceived as negative, a soundscape (e.g., containing natural sounds) can also have a positive effect on health and well-being. This supportive effect of a soundscape is getting increasing attention for use in practice. This paper addresses the design of a supportive sonic environment for persons with dementia in nursing homes. Starting from a review of key mechanisms related to sonic perception, cognitive deficits and related behavior, a framework is derived for the composition of a sonic environment for persons with dementia. The proposed framework is centered around using acoustic stimuli for influencing mood, stimulating the feeling of safety and triggering a response in a person. These stimuli are intended to be deployed as added sounds in a nursing home to improve the well-being and behavior of the residents.

Participation of adults with visual and severe or profound intellectual disabilities: Analysis of individual support plans

BACKGROUND

The extent of participation of adults with visual and severe or profound intellectual disabilities (VSPID) is unclear.

AIMS

To explore participation of adults with VSPID and the association between occurrence and importance of aspects of participation.

METHODS

Individual support plans (ISPs) of 40 adults with VSPID were analyzed: selected text fragments were categorized according to 125 previously operationalized statements that had different levels of importance and were divided into seven participation clusters.

RESULTS

The ISPs contained 2791 text fragments that related to a statement. All clusters were covered: the clusters 'Experience and discover' (91.7%), 'Involvement' (90%), and 'Social relations' (87.5%) were well covered. 'Inclusion' (53.6%) and 'Leisure and recreation' (57.1%) were mentioned less often. Among the 36 high-importance statements, two related to 'Inclusion', 'Involvement' and 'Social Relations' each, three to 'Communication and being understood', and five to 'Self-management and autonomy' had at least 30 text fragments.

CONCLUSIONS

The participation domains 'Experience and discover', 'Involvement', and 'Social relations' are well-documented, suggesting that adults with VSPID participate in those areas. However, domains such as 'inclusion in society' and 'leisure in society' were not documented. This overview of participation offers residential facilities the opportunity to determine in which areas participation can be improved.