Multisensory Stimulation and Individualized Music Sessions on Older Adults with Severe Dementia: Effects on Mood, Behavior, and Biomedical Parameters

Motivation and music interventions in adults: A systematic review

ABSTRACTMusic is increasingly used in a wide array of settings, from clinical recovery to sports or well-being interventions. Motivation related to music is often considered as a possible working mechanism for music to facilitate these processes, however this has not previously been systematically evaluated. The current systematic review considered studies that involved music (therapy) interventions, together with motivation-related measures such as wanting to practise, liking the musical activities, or patient adherence to an intervention. Our objective was to examine whether music is related to increased motivation in task performance and/or rehabilitation settings, and whether this is in turn related to better clinical or training outcomes. Seventy-nine studies met the inclusion criteria, the majority of which (85%) indicated an increased level of motivation with music as compared to without. Moreover, in those studies where motivation was increased, clinical or other outcomes were improved in most cases (90%). These results support the notion of motivation as an underlying mechanism of music-based interventions, but more robust evidence is needed to ascertain which mechanisms are crucial in increasing motivation from a behavioural, cognitive, and neurobiological point of view, as well as how motivational mechanisms relate to other factors of effectiveness in music-based paradigms.

Effects of multisensory environment/stimulation therapy on adults with cognitive impairment and/or special needs: A systematic review and meta-analysis

AIM

This review aimed to evaluate the effects of multisensory environments/stimulation (MSE/MSS) therapy, on the behavior and psychological symptoms in adults with cognitive impairment and/or special needs.

METHODS

Online database searches were performed to identify studies reporting on the effects of MSS/MSE therapy in adults (>18 years). Data were extracted for the following investigated outcomes including anxiety, depression, mood, behavioral attributes, biomedical parameters, cognition, motor skills, quality of life (QoL), pain, and end of life quality. Two reciprocally blinded investigators extracted the data. Inter-investigator reliability (𝝹) was calculated. A meta-analysis and a qualitative analysis were performed on the information extracted.

RESULTS

Thirty-six studies were included for data extraction and analysis. Meta-analysis of the included studies revealed a significant improvement with the MSE/MSS therapy, for agitation (p = .018), anxiety (p = .023), cognition (p < .001), and depression (p < .001). MSS/MSE therapy demonstrated a tendency for the improvement of the QoL in adults (p = .05).

CONCLUSION

MSE/MSS therapies are beneficial in cognitively impaired adults and improve their anxiety, depression, cognitive and other behavioral attributes such as agitative behaviors. Promoting these therapies in geriatric care may help to improve/reduce the challenging/care-resistant behaviors in adults and facilitate effective provision of the necessary care.

Smellscape as a healing factor in institutional gardens to enhance health and well-being for older people with dementia: A scoping review

BACKGROUND

There is mounting evidence for the health benefits of aromatic scents for the older people with dementia. However, existing research has focused on indoor aromatherapy using essential oils. It is necessary to explore the health benefits of smellscapes in the outdoor environment for older people with dementia.

AIMS AND OBJECTIVES

This scoping review aims to examine existing evidence for smellscape as a healing factor in institutional garden for older people with dementia, try to bridge the knowledge gaps between outdoor sensory garden scents and aromatherapy to develop green care techniques that incorporate outdoor activities.

METHODS

Seven databases (Scopus, PubMed, PsycINFO, CINAHL, MEDLINE, Embase and Web of Science) were searched with English language articles published between 1990 and 2022. The PRISMA-ScR Checklist was used.

RESULTS

Out of 1013 articles, 11 meet the inclusion criteria. The comprehensive health outcomes include five aspects: mental health; physical health; reduced agitation behaviour; improved cognitive function; and well-being. These aspects are part of the rehabilitation model comprising the person (older people with dementia), environment (garden smellscapes) and outdoor activities (active or passive interventions or a combination).

CONCLUSIONS

The smellscape, as a healing factor in the garden, not only benefits from evidence on indoor aromatherapy but also creates a sensory environment for older people with dementia by compensating for functional impairment, activity support and environmental creation, thereby promoting enhanced health and well-being.

RELEVANCE TO CLINICAL PRACTICE

The research on the healing effects of smellscapes presented in this review offers a novel environmental intervention technique for transferring evidence on essential oils to outdoor sensory gardens. This green care technique is suggested to assist in the creation of healing environments and interventions for people with dementia who cannot be cured.

NO PATIENT OR PUBLIC CONTRIBUTION

This scoping review did not directly involve patient or public contributions to the manuscript.

Usability, Appeal, and Relevance of Music and Wellbeing Training for Carers of People with Dementia: A Think-Aloud Study

Background

Personalized music listening can be highly effective in supporting people experiencing changes in mood and behavior due to Alzheimer's disease and other conditions causing dementia. However, a lack of staff education can be a barrier to effective use of music in residential aged care.

Objective

This study investigates the usability, appeal and relevance of an online training course designed to help care staff develop personalized music programs for people living with dementia in their care.

Methods

A mixed methods approach was taken in which 13 participants took part in a think-aloud session while using the training. Qualitative data from the think-aloud session and interviews were triangulated with results of a survey evaluation of the training.

Results

Themes relating to Engagement, Usability and Appeal, Pedagogical Design and Content, and Transfer, Impact and Barriers to Uptake were discussed. Results indicated that participants regarded the virtual environment and pedagogical design as of high quality, although some minor issues in navigability were identified. Participants also found the training to be highly relevant to their roles as caregivers and reported ways they would incorporate key concepts into care practices. However, ongoing barriers to implementation of such training were identified including systemic issues that contribute to a culture of focus on physical care.

Conclusions

Consistency of navigation and clear instructions for interacting with content are important in training of time-poor care staff. Linking training to industry standards can provide important motivation for implementation of training, although systemic barriers can impede real-world change.

Inconsistent Music-Based Intervention Reporting in Dementia Studies: A Systematic Mapping Review

Background

Recent research has shown beneficial results for music-based interventions (MBIs) for persons living with Alzheimer's disease and related dementias (AD/ADRD), but reports often lack sufficient detail about the MBI methodology, which reduces replicability. A detailed checklist for best practices in how to report MBIs was created in 2011 by Robb and colleagues to remedy the lack of detail in MBI descriptions. The implementation of the checklist specifically in AD/ADRD research has not been established. Given the complexity of music and the variety of uses for research and health, specific MBI descriptions are necessary for rigorous replication and validation of study results.

Objective

This systematic mapping review utilized the "Checklist for Reporting Music-Based Interventions" to evaluate the current state of MBI descriptive specificity in AD/ADRD research.

Methods

Research articles testing MBIs and reviews of MBI efficacy published between January 2015 and August 2023 were scored using the checklist and the results were summarized.

Results

Forty-eight studies were screened, and reporting was inconsistent across the 11 checklist criteria. Ten out of 48 studies fully reported more than 5 of the 11 criteria. Only one of the 11 scoring criteria was at least partially reported across 47 of 48 studies.

Conclusions

Thorough reporting of intervention detail for MBIs remains limited in AD/ADRD MBI research. This impedes study validation, replication, and slows the progress of research and potential application of music in practice. Greater implementation of the reporting guidelines provided by Robb and colleagues would move the field of MBI research for AD/ADRD forward more quickly and efficiently.

Does music intervention relieve depression or anxiety in people living with dementia? A systematic review and meta-analysis

BACKGROUND

This study aimed to summarize the available evidence on music intervention alleviating depression or anxiety in dementia.

METHODS

A comprehensive literature search was performed to analyze the effects of music intervention on depression or anxiety. Subgroups were created to explore the effect of intervention period, duration, and frequency on efficacy. The effect size was reported as a mean standardized difference (SMD) with 95% confidence interval (CI).

RESULTS

The analysis included 19 articles involving 614 samples. Thirteen studies for relieving depression revealed that, with an increase in intervention period, the efficacy decreased and then increased, whereas with an increase of intervention duration, the effect became better. A weekly intervention is ideal. Seven studies verifying the impact on anxiety relief revealed that the effect of intervention within 12 wk is significant; with an increase of intervention duration, the effect became better. A weekly intervention is ideal. Collaborative analysis showed that long low-frequency interventions are more efficient than short high-frequency interventions.

CONCLUSIONS

Music intervention can relieve depression or anxiety in people living with dementia. Weekly short interventions of more than 45 min are effective for emotional regulation. Future research should concentrate on severe dementia and follow-up impact.

A novel music-based therapeutic approach: the Therapeutic Music Listening

The therapeutic use of music is frequently based on active interventions that directly involve the patient through a sonorous-music interaction with the music therapist. In contrast, approaches based on musical listening are characterized by a relationship aimed at promoting an introspective work and processing of one's emotional experiences. Increasingly, the scientific literature has shown how even listening to music related to the patient's personal tastes (preferred music listening) and by-passing the direct relationship with the patient, can produce therapeutic effects in different clinical settings. However, in many cases, a clear therapeutic rationale and specific application protocols are still lacking. The paper introduces a novel approach based on music listening: the Therapeutic Music Listening. This approach integrates the subjective component of listening (patient's musical tastes) and structural and parametric characteristics of the music in relation to the therapeutic aims. The article defines theoretical-applicative bases as well as therapeutic and research perspectives of this music listening-based intervention.

Music Therapy in the Treatment of Dementia: A Review Article

The etiology of depression is the degeneration of the brain cells involved in cognitive function before the other brain cells. It is characterized by a neurological condition that causes a reduction in terms of physical, social, and cognitive impairment and has no cure presently. These nonpharmacological approaches, such as music therapy, enhance living outcomes for those dealing with dementia and also reduce behavioral incidence. Among these strategies is music therapy, and individual or gap-time psychological and educational counseling. Many scientists believe in the advantages of music for the brain. The brain is affected by music function and enhances some cognitive abilities, including the mechanism of speech, alteration, memory, and learning. Music can activate the limbic system, subcortical circuits, and emotionally related systems, inducing the sensation of well-being. The music itself is quite effective at increasing cerebral plasticity. Music therapy has powerful stimulation for neuroplastic alterations in the adult and developing brain. Dementia can be cured by music therapy and music-based intervention (nonpharmacological intervention) rather than by medication. This study highlights dementia therapy utilizing the music therapy method.

Exploring the factors influencing meaningful engagement of persons living with advanced dementia through the Namaste Care Program: a qualitative descriptive study

Background:

Meaningful engagement has been described as active participation based on a person’s interests, preferences, personhood, or perceived value. It has many benefits for persons living with dementia in long-term care (LTC) homes, including improvement in physical and cognitive function, and mental health. People with advanced dementia continue to need and benefit from inclusion and social contact in LTC, yet there is not a well-developed understanding of how to support this. A tailored intervention called Namaste Care has been shown to be an effective approach to meaningfully engage residents in LTC, decrease behavioral symptoms, and improve their comfort and quality of life. There is a need to consider how best to deliver this intervention.

Objective:

The aim of this study was to describe environmental, social, and sensory factors influencing meaningful engagement of persons with advanced dementia during Namaste Care implementation in LTC.

Methods:

In this qualitative descriptive study, focus groups and interviews were conducted with families, volunteers, staff, and managers at two LTC homes. Directed content analysis was conducted. The Comprehensive Process Model of Engagement was used as a coding framework.

Results:

With respect to environmental attributes, participants emphasized that a designated quiet space and a small group format were helpful for engagement. In terms of social attributes, participants emphasized Namaste Care staff capacity to deliver individualized care. Regarding sensorial factors, familiarity with the activities delivered in the program was emphasized.

Conclusion:

Findings reveal the need to offer small group programs that include adapted recreational and stimulating activities, such as Namaste Care, for residents at the end of life in LTC. Such programs facilitate meaningful engagement for persons with dementia as they focus on individual preferences, comfort, and inclusion while recognizing changing needs and abilities of residents.

Responses to stimuli in the 'snoezelen' room in unresponsive wakefulness or in minimally responsive state

BACKGROUND

Sensory stimulation in Snoezelen room increased responsiveness after brain injury and dementia.

OBJECTIVE

To explore the physiological and clinical effects of Snoezelen stimulation in persons with unresponsive wakefulness syndrome or minimally conscious state (UWS or MCS).

DESIGN

A comparative prospective observational cohort study.

METHODS

Ten patients with UWS and 25 in MCS were exposed to consecutive stimuli involving the 5 senses in a Snoezelen room. Heart rate (HR) and cerebral blood flow velocity (CBFV), and scores of the Loewenstein communication scale (LCS) were obtained before and during or after the stimuli.

RESULTS

The stimuli increased HR values and decreased left hemisphere CBFV values in patients with MCS (p < 0.05). Stimulation increased LCS scores (from 28.48 ± 6.55 to 31.13 ± 7.14; p < 0.001) in patients with MCS, but not in the UWS group. LCS gain correlated with HR and right hemisphere CBFV gains in patients with MCS (r = 0.439 and 0.636 respectively, p < 0.05).

CONCLUSIONS

Snoezelen stimulation induced immediate improvement in communication and physiological changes in patients with MSC, and had a minor physiological effect in patients with UWS. If additional studies support these findings, it will be possible to suggest that Snoezelen stimulation can affect arousal, and possibly improve functioning.

Estimating the cost of an individualised music intervention for aged care residents with dementia

BACKGROUND

Individualised music listening has been shown to reduce agitation and improve mood in people with dementia. However, there is a paucity of research describing the cost of implementing such interventions in residential care settings for older people.

AIM

To determine the cost of implementing an individualised music intervention for older people with dementia in residential aged care in Australia.

METHOD

A simple cost analysis was undertaken to determine the cost of delivering the individualised music intervention to 32 older people with dementia at two residential aged care facilities in New South Wales. The analysis took into consideration the operating, training and delivery costs, as well as the costs of purchasing the music equipment and downloads.

RESULTS

The cost of delivering the individualised music intervention was found to be AU$6,623.76 per year - or AU$3.98 per resident per week, at 2017 values. At 2022 values, this equates to an annual cost of AU$7,130.07 (£4,031.85) for 32 residents and a weekly cost of AU$4.28 (£2.42) per resident per week.

CONCLUSION

The cost of implementing the individualised music intervention was relatively low compared with the overall cost of residential aged care for older people with dementia.

Nursing Home Residents' Positive Behavioral Responses to Individualized Music Predict Improvements in Sundowning Symptoms After Music Listening

Objective: The goal of this exploratory study was to predict which long-term care residents with dementia would experience improvements in their sundowning symptoms after listening to personalized music playlists. Methods: We studied 101 residents with moderate to severe dementia from 15 long-term care facilities across 8 months. We observed residents' behavioral responses to individualized music while they listened and recorded sundowning symptoms both before and after each listening session. Results: As hypothesized, residents who exhibited a greater number of positive reactive behaviors while listening to music also evidenced more improvements in their confusion, disengagement, unresponsiveness, and restlessness after their music-listening session. Discussion: Our results reveal that observing behavioral responses during music listening is an effective way to determine when nursing home residents are benefiting from personalized music playlists. These findings inform music programs in long-term care settings by identifying residents whose sundowning symptoms are most amenable to music intervention.

Use of multisensory stimulation in institutionalized older adults with moderate or severe dementia

The Multisensory Stimulation Program can help manage behavioral and psychological symptoms of dementia.

Effectiveness of Physical Activity Interventions on Cognition, Neuropsychiatric Symptoms, and Quality of Life of Alzheimer’s Disease: An Update of a Systematic Review and Meta-Analysis

The topic of physical activity interventions for the treatment of Alzheimer’s disease (AD) has been discussed for decades, but there are still inconsistent views on the effect of its intervention in different studies. With the increase in randomized controlled trials (RCTs), it is necessary to update newly published studies and systematically evaluate the effects of physical activity interventions. Scientific citation databases (e.g., PubMed, EMBASE, etc.) and registration databases (e.g., ISRCTN, CHICTR, etc.) were checked to screen RCTs and systematic reviews of physical activity interventions in AD. Then extract and review the intervention methods and their evaluation results in the included studies. Spearman correlation method was used to test the association between the mean difference (MD) of intervention results and activity time. The Hedges’g method was used to combine continuous data to analyze the standard MD (SMD) of different intervention types or time subgroups. The overall results show that physical activity intervention can improve the cognition, neuropsychiatric symptoms and quality of life (Qol) of AD patients, but the duration of the intervention significantly affected the outcome of the assessment. Subgroup analysis results showed that an intervention duration of 2–5 months had a significant advantage: cognitive function (Minimum Mental State Examination: SMD = 0.47, 95% CI = 0.33 ∼ 0.61, P &lt; 0.01), neuropsychiatric symptoms (Neuropsychiatric Inventory: SMD = −0.48, 95% CI = −0.85 ∼−0.11, P &lt; 0.01), and quality of life (Qol-AD: SMD = 0.47, 95% CI = 0.23 ∼ 0.71, P &lt; 0.01). The systematic review and analysis results of updated RCTs suggested that short-term (2–5 months) physical activity interventions were more beneficial in improving cognitive function, neuropsychiatric symptoms and Qol in patients with AD. And there was no evidence of differences in the effectiveness of different physical activity interventions.

A scoping review: Sensory interventions for older adults living with dementia

This scoping review focused on the existing scholarly literature exploring sensory interventions and immersive environments developed for, and used by, older adults living with dementia. The purpose of the scoping review is 1) to understand the various sensory interventions that have been developed, used, and have provided data to show how such interventions are expected to impact the lives of individuals living with dementia; and 2) to understand how the field is moving forward. We chose to map the literature to understand the types of interventions, the types of outcomes measured, and the contexts of their implementation. Our search was constrained to references from 1990 to 1 June 2019 in the following databases: Academic Search Complete, CINAHL Complete, MEDLINE, PsycINFO databases, and Summon Search discovery layer. We screened 2305 articles based on their titles and abstracts, and 465 were sent to full text review, of which 170 were included in our full text extraction. Once the data were extracted, we created emic categories, which emerged from the data, for data that were amenable to categorization (e.g., study setting, intervention type, and outcome type). We developed ten different categories of interventions: art, aromatics, light, multi-component interventions, multisensory rooms, multisensory, music, nature, touch, and taste. Sensory interventions are a standard psychosocial approach to managing the personal expressions commonly experienced by people living with dementia. Our findings can help providers, caregivers, and researchers better design interventions for those living with dementia, to help them selectively choose interventions for particular outcomes and settings. Two areas emerging in the field are nature interventions (replacing traditional "multisensory rooms" with natural environments that are inherently multisensory and engaging) and multi-component interventions (where cognitive training programs are enhanced by adding sensory components).

Comparison of behaviors characteristic of autism spectrum disorder behaviors and behavioral and psychiatric symptoms of dementia

BACKGROUND

Similarities exist in behavioral expression of autism spectrum disorder (ASD) and Alzheimer's disease and related dementias (ADRD). The purpose of this study was to assess presence of behavioral and psychiatric symptoms of dementia (BPSD) and ASD-like behaviors in adults with ADRD.

METHODS

Using a cross-sectional design, data from University of Kentucky Alzheimer's Disease Center participant cohort were used. Hierarchical linear regression was used to assess (1) the relationship between ASD-like behaviors (measured by the Gilliam Autism Rating Scale-Second Edition, GARS-2) and BPSD measured by the Neuropsychiatric Inventory (NPI), and (2) the relationship between ASD-like behaviors and dementia severity (measured by the Clinical Dementia Rating [CDR] sum of boxes), when controlling for BPSD.

RESULTS

Complete data were available for 142 participants. Using α of 0.05, analyses identified ASD behaviors were significantly associated with BPSD severity ratings (r = 0.47; p < 0.001) and dementia severity (r = 0.46; p < 0.001). GARS-2 explained 6.1% (p < 0.001) of variance in CDR sum of boxes when controlling for NPI and other covariates.

DISCUSSION

There is significant overlap in behaviors characteristic of ASD and BPSD as assessed by the NPI and GARS-2, despite the use of these instruments in disparate developmental vs. aging settings. ASD behaviors appear to not be solely present in early childhood as a manifestation of ASD but are also present in older adults with neurodegenerative cognitive impairment. Such associations warrant additional research into causation, assessment, and behavioral interventions to further enable new therapeutic approaches targeting ASD behaviors across the lifespan.

The Rationale and Design of Behavioral Interventions for Management of Agitation in Dementia in a Multi-Site Clinical Trial

BACKGROUND

Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings.

OBJECTIVE

To describe the rationale and design of structured behavioral interventions in the StaN study.

METHODS

Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility.

RESULTS

The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and to integrate them with pharmacotherapy.

CONCLUSION

Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.

Music, Mind, Mood, and Mingling in Alzheimer's Disease and Related Dementias: A Scoping Review

BACKGROUND

Music-based interventions may help to alleviate neuropsychiatric symptoms of dementia and promote prosocial interactions between individuals living with dementia and their caregivers. However, current literature does not combine these evidence bases toward explanation of how music-based interventions may alleviate symptoms and promote prosocial interactions.

OBJECTIVE

We conducted a scoping review to address the following question: what do the evidence bases suggest toward how music therapy or music-based therapeutic interventions might promote prosocial interactions between individuals living with dementia and their caregivers?

METHODS

In this review we focused on: 1) quantitative and qualitative evidence of music-based therapies promoting prosocial behaviors in individuals living with dementia, and 2) potential neurobehavioral mechanisms associated with the processes involved with how music may promote prosocial interactions. Databases included PubMed, EBSCOhost's CINAHL and PsycINFO, Cochrane Library (sub-search conducted using ALOIS, the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group), Web of Science, clinicaltrials.gov, ProQuest's Biological Science Collection, the Journal of Music Therapy, Nordic Journal of Music Therapy, and Google Scholar.

RESULTS

Sixteen original research studies were included for evidence synthesis. This scoping review reveals the need to define and clarify mechanisms of prosocial interactions between individuals living with dementia and their caregivers considering biological and social factors. These mechanisms may include dynamic interactions between preserved brain regions associated with music-evoked autobiographical memory recall and shifts from negative to positive mood states.

CONCLUSION

Defining and clarifying how and to what extent music may promote prosocial behaviors using well-designed and well-controlled mixed-methods studies may positively influence the design of interventions to promote prosocial interactions with caregivers.

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.

Bright Light Therapy in Older Adults with Moderate to Very Severe Dementia: Immediate Effects on Behavior, Mood, and Physiological Parameters

Bright light therapy (BLT) has demonstrated positive short- and long-term effects in people with cognitive impairment or dementia; however, the immediate impact of BLT sessions has been scarcely investigated. In this study, we aimed to explore the immediate effects of BLT on behavior, mood, and physiological parameters (oxygen saturation/heart rate) in a sample of institutionalized older adults with moderate to very severe dementia, with a median age of 85.0 (interquartile range, IQR, 82.0–90.0), being higher in men (87.0 years, IQR 80.0–94.0) than in women (84.5 years, IQR 82.0–89.5). The BLT protocol consisted of 30-min morning sessions of 10,000 lux, Monday through Friday, for 4 weeks. The physiological parameters were recorded immediately before and after each session by pulse oximetry. Mood and behavior were assessed before, after, and during the sessions using the Interact scale. Post-session Interact scores showed a significant decrease in the items Tearful/sad and Talked spontaneously, and a significant increase in the items Enjoying self, active or alert, and Relaxed, content or sleeping appropriately. Interact scores during the sessions reflected a significant decrease in the speech-related items. Both physiological parameters changed positively from before to after sessions. Our results suggest that BLT provides immediate positive effects on mood, stimulation level, and physiological parameters, as well as a trend toward decreased speech. More robust research is needed to further explore the immediate impact of BLT. This study is registered with Clinicaltrials.gov (NCT04949984).

Individualised music for people living with dementia and the experiences and perceptions of residential aged care staff: A qualitative study

OBJECTIVE

To explore the experiences and perceptions of staff regarding the use of individualised music for people with dementia living in residential aged care.

METHODS

A qualitative descriptive methodology was used. Methods included a focus group and face-to-face interviews, open-ended responses to a pre-post survey and relevant clinical notes about older participants' responses. Qualitative content analysis was used to analyse data.

RESULTS

There were four themes: (1) transcendental reminiscing, the calm, the joy and the elation; (2) optimism, excitement and the snowball effect; (3) pitching in for older person, it is not rocket science and the hurdles; and (4) music beyond the intervention.

CONCLUSIONS

Overall, the individualised music was a generally positive experience. While some older participants reported discomfort with the use of headphones, staff concerns related to care and accessibility of music equipment.

The Effects of Individualized Music Listening on Affective, Behavioral, Cognitive, and Sundowning Symptoms of Dementia in Long-Term Care Residents

OBJECTIVES

This study aimed to replicate music's positive effects on dementia-related symptoms, determine whether a 6-month intervention would lead to greater positive outcomes than typical 3- to 4-month interventions, and examine changes in sundowning symptoms after music listening.

METHODS

282 nursing home residents with dementia listened to personalized music playlists 1-3 times weekly for 30 minutes across 6 months. Standardized assessments of affect, behavior, and cognition and direct observations of sundowning symptoms comprised the outcomes.

RESULTS

Results documented significant improvements in residents' general neuropsychiatric symptoms, agitation, and depression across the first 3 months, but no additional improvements across the subsequent 3 months. Seven sundowning symptoms significantly improved following music listening, with some (e.g., disengagement) being more amenable to music than others (e.g., aggression).

DISCUSSION

Results support short-term individualized music listening as an effective non-pharmacological approach for improving dementia-related symptoms in nursing home residents and suggest new applications of music-related interventions.

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.

Sensory Stimulation for Nursing-Home Residents: Systematic Review and Meta-Analysis of Its Effects on Sleep Quality and Rest-Activity Rhythm in Dementia

INTRODUCTION

Disrupted sleep-wake cycles might be associated with an exacerbation of behavioural disturbances and accelerate disease progression in dementia. The effect of sensory stimulation for improving sleep quality is unclear.

METHODS

A systematic literature search was performed and all studies examining the effects of a sensory stimulation intervention (i.e. bright light, massage, acupuncture, animal-assisted interventions) on rest-activity rhythm (RAR) and/or nocturnal restlessness in nursing-home residents with dementia were included.

RESULTS

Sensory stimulation was shown to improve nocturnal behavioural restlessness as well as sleep duration and continuation, but the effect on the number of awakenings, RAR, and daytime sleep was negligible. Notable was the high heterogeneity between studies regarding treatments and patients' characteristics and sleep parameters.

CONCLUSION

Sleep quality and nocturnal restlessness in nursing-home residents with dementia may benefit from sensory stimulation. An environment with sensory stimulation may prevent or improve sleep disturbances in nursing homes, and thereby contribute to a better quality of life for their patients.

Personalized treatment interventions: nonpharmacological and natural treatment strategies in Alzheimer's disease

Introduction: Alzheimer's disease (AD) is a slow, irreversible, progressive, complex, and fatal neurodegenerative disorder. Available pharmacological treatment, known for almost two decades, does not cure the disease, but only alleviates the symptoms, with various efficacy and different side effects. Therefore, there is an unmet need to find other person-centered or personalized approaches to treat AD.Areas covered: This article describes the application of precision medicine-like approaches utilizing nonpharmacological treatment strategies and the use of natural products in personalized care for patients with AD.Expert opinion: Due to the heterogeneity of disease symptoms, somatic conditions, and patient preferences, there is definitely no "one size fits all" intervention. Therefore, individualized treatment choice is based on dementia stage, medical and psychiatric comorbidity, leading symptoms, patient preferences, and remaining capacity of the patient. In the absence of disease-modifying agents, a patient-centered, multidisciplinary team approach appears to be the best option to alleviate the heavy symptomatic burden in this unfortunate population. Hence, appropriate interventions can be offered along the AD continuum, while a better understanding of personal characteristics might help in establishing optimal individualized treatment, as well as its duration and intensity, to deliver interventions in the most effective ways.

Immediate physiological effects of listening to music before physical exercise in institutionalized older people with dementia

ABSTRACT The evolution of dementia is strongly related to cognitive, motor, and functional changes and to the presence of cardiovascular diseases. Disturbances vary according to phase of dementia and can limit instrumental and basic activities of daily living. The aim of this study was to analyze the immediate physiological effects of listening to music before physical exercise in institutionalized older people with moderate to advanced dementia. A randomized trial was conducted with 18 institutionalized older people with dementia (mean age was 79 years old, 52.6% were female), who were divided into a Training with Music Group (TWMG) and a Training without Music Group (TWtMG). The evaluation included heart rate (HR), blood pressure (BP) and HR variability (HRV). The assessment was conducted in a closed environment or in places with minimal visual and auditory stimulation. The TWMG was submitted to stimuli with music for 15 minutes and physical exercises for 30 minutes to improve/maintain their global mobility. The TWtMG performed the same physical exercises, however without music before physical exercise. The interventions lasted 12 weeks, and were performed individually once a week. In the TWMG, we observe a decrease in diastolic BP in the third session. In the sixth week, the HR increased after the session in both groups. TWMG improved HRV in the third session, with a difference between groups only after the session. After the sixth session, HRV values improved in both groups. In conclusion, listening to music before physical exercise is associated with positive effects in people with dementia, as it tends to maintain and improve physiological factors.

Sensory stimulation programs in dementia: a systematic review of methods and effectiveness

INTRODUCTION

Dementia is characterized by the presence of cognitive decline and can lead to sensory-perceptual alterations, compromising the functionality in activities of daily living. The main objective of this work is to review the characteristics of sensory stimulation programs in dementia and its effectiveness.

AREAS COVERED

Studies were identified through a literature search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Cochrane Collaboration Guidelines. Twenty studies were included in this review. The studies used multisensory stimulation at different stages of dementia. The results show a lack of consensus regarding frequency, duration, and number of sessions, as well as the duration of the interventions and assessment instruments used to evaluate the results. Multisensory stimulation, particularly Snoezelen, was the most widely used approach. Vision, hearing, touch, and smell were the most frequently stimulated senses. Most studies comprised pre- and post-intervention assessment, but few studies performed follow-up assessment. The interventions that revealed positive results in dementia were Snoezelen, multisensory environment other than Snoezelen, and Multi-sensory Behavior Therapy.

EXPERT OPINION

This review weakly supports sensory stimulation in dementia, providing useful information for rehabilitation and future investigations.

Effects of Music Therapy on Patients with Dementia-A Systematic Review

Dementia is an increasingly common syndrome and while pharmacotherapy is available, its potential benefit is limited, especially in non-cognitive outcomes. Non-pharmacotherapy such as music therapy is potentially associated with improved outcomes. We assessed the effects of music therapy on patients with dementia to evaluate its potential benefits on dementia. Two independent reviewers searched MEDLINE, EMBASE, CINAHL, CENTRAL, and ClinicalTrials.gov databases for clinical trials, using the keywords "music therapy" and "dementia". Study outcomes included cognitive function, behavioral and psychological symptoms of dementia (BPSD), and quality of life. A total of 82 studies were included, of which 43 were interventional clinical trials, and 39 were systematic reviews or meta-analyses. Significant improvements in verbal fluency occurred after music therapy, with significant reductions in anxiety, depression, and apathy. There were no significant improvements in cognition or daily functioning, and the results on quality of life and agitation were ambiguous. Limitations of studies included low patient numbers, lack of standardized music therapy, and high heterogeneity in outcomes. More large-scale clinical trials would allow for clearer conclusions on the benefits of music therapy in patients with dementia.

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

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

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

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

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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.

What is the evidence for the activities of Namaste Care? A rapid assessment review

Objectives

To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia.

Design

Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale.

Results

The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia.

Conclusions

There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.

Impact of individualised music listening intervention on persons with dementia: A systematic review of randomised controlled trials

OBJECTIVE

To summarise the evidence regarding the impact of individualised music listening on persons with dementia.

METHODS

Six electronic databases (CINAHL, Medline, ProQuest, PsycINFO, Music Periodicals and Cochrane) were searched up to July 2018 for randomised controlled trials (RCTs) evaluating the efficacy of individualised music listening compared to other music and non-music-based interventions.

RESULTS

Four studies were included. Results showed evidence of a positive impact of individualised music listening on behavioural and psychological symptoms of dementia (BPSDs) including agitation, anxiety and depression and physiological outcomes. Evidence for other outcomes such as cognitive function and quality of life was limited.

CONCLUSIONS

The limited evidence suggests individualised music listening has comparable efficacy to more resource-intensive interventions. However, there was a small number of RCTs and some outcomes were evaluated by a single study. This limits the conclusions drawn, warranting more RCTs evaluating other outcomes beyond the BPSDs.