Development of the Music Therapy in Transition to Long-Term Care Model

Transition to long-term care can be a challenging period for older adults, with high risk for negative outcomes, including depression, anxiety, and fear. However, music therapy has the potential to enhance related protective factors because it emphasizes individual strengths by leveraging culture-specific resources, facilitates relationships and a sense of belonging through joint music-making, and provides opportunities to process and make sense of one's experiences in the "new normal" through sharing of music-related emotions. The purpose of this study was to explore the perspectives of older adult long-term care residents, their care team staff, and their music therapists to develop a conceptual framework for the role of music therapy in older adults' transition and adjustment to long-term care. A grounded theory approach was used to conceptualize this process. Interviews with 17 participants were transcribed and analyzed using open, axial, and selective coding. The resulting theoretical model describes a progression of qualities and benefits of music therapy that leads to residents "feeling their best self." Related categories include: Music therapy is accessible and engaging; Music therapy is personal and meaningful; Music therapy acts as a bridge to other resources; Music therapy facilitates transformation; and Music therapy facilitates community integration. This initial theoretical model provides a foundation for clinical assessment and interventions. Future research is needed for continued testing and refining this theory.

Effects of a Personalized Music Intervention for Persons with Dementia and their Caregivers

Background: Given the challenges of developing disease-modifying treatments for Alzheimer’s disease and related disorders, non-pharmacological interventions represent an increasingly promising approach in long-term care settings. Music-based interventions have been effective in improving the quality of life by influencing biopsychosocial factors that play a role in the progression of illnesses such as depression and anxiety. However, approaches have tended to focus exclusively on the person with dementia rather than integrating caregivers. Objective: This study aimed to determine the impact of a music-based intervention on the quality of life of persons with dementia and their caregivers. Methods: A mixed-methods study was conducted with seven dyads consisting of residents (aged 76–92) with diagnoses of dementia and their caregivers (aged 53–84) at a skilled nursing facility in Pennsylvania. Eight music intervention sessions were completed in the presence of the resident and caregiver using personalized playlists created for the dyad. Pre- and post-intervention questionnaires were administered during each session, and observational data for both residents and caregivers were collected. Results: Caregivers reported feeling less overwhelmed after the intervention with a mean difference of –0.24±0.14, p = 0.016. Mean difference in the other 5 responses showed that listening to music had a beneficial impact for resident/caregiver dyads. Observations of interpersonal behavior supported the benefit of the intervention for these dyads. Conclusion: Quantitative analysis of a personalized music intervention for residents/caregivers showed positive trends in increasing personal connection, and qualitative data identified greater appreciation of the relationship and increased bonding.

Feasibility of a Music System Intervention to Affect Mental Stress and Strain of Employees in Inpatient Dementia Care

OBJECTIVES

If family caregivers participate with people with dementia in group music therapies, their mental stress can be reduced. The interventions investigated this context are often limited to active music therapies in groups, which do not consider the inclusion of formal caregivers. In the presented study, a music system was implemented in the routine nursing care of a dementia residential community. Aiming to investigate the use and the effects of the music system on employees' mental stress and strain, hypotheses were derived, which, for the first time, qualitatively describe this connection.

METHODS

A controlled feasibility study with pretests and posttests was conducted. Two residential areas of an inpatient care facility for people with dementia participated as an intervention and control groups-these included 28 residents and 18 employees. In the intervention phase, the employees of the intervention group used the music systems during nursing activities and the operations were saved in log files. Mental stress and strain were recorded six times using the BGWmiab questionnaire. In the questionnaire part on mental stress, typical stress factors were assessed, while the part on mental strain records the extent of seven typical symptoms of overstrain.

RESULTS

The music systems were used 1.6 (±1.3) times per day and per resident, dependent on the residents (P < 0.05, n = 13). Changes in total mental stress and strain scores could not be determined. Regarding the strain symptoms, scores of work motivation, fatigue, and aversions decreased. Seventy-one percent of the employees stated an improved daily work routine. The strain changes in employees of the intervention group correlated significantly with their work experience (r = 0.73, P = 0.04, n = 8).

CONCLUSIONS

Eight hypotheses on the usage and effect of music systems were generated. These did not represent an additional stress factor and affected single strain symptoms. In addition, the study highlighted a positive impact that the music systems had on the employees' perception of stress. This is the first time that the positive effects of receptive music interventions on mental stress and strain of formal caregivers are described. Further investigations with an increased frequency of use of the music systems should validate and specify the findings and hypotheses.

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

Objectives

The objective of this study was to investigate the applicability and effectiveness of the use of music in providing for positive physical and mental outcomes in nursing facilities.

Problem

Lack of quality of life (QOL) has been a significant issue within nursing facilities. With the rise in census due to Baby Boomers, it has become imperative to find ways to increase overall QOL.

Methods

The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate to collect data regarding the use of music to provide for positive physical and mental outcomes in nursing facilities.

Results

The most common facilitator mentioned was increased socialization or communication (18%), followed by reduced depression (12%), improved physical health (11%), and reduced agitation or behavior problems (9%). The most common barriers were as follows: cannot isolate effects of music (26%), cost prohibitive (11%), difficult to implement (11%), and no significant improvements in QOL or well-being (11%).

Conclusion

The use of music showed positive outcomes for residents in nursing facilities and should be considered for implementation as part of the normal culture within such facilities.

Effect of music care on depression and behavioral problems in elderly people with dementia in Taiwan: a quasi-experimental, longitudinal study

OBJECTIVES

The purpose was to examine the effectiveness of music care on cognitive function, depression, and behavioral problems among elderly people with dementia in long-term care facilities in Taiwan.

METHODS

The study had a quasi-experimental, longitudinal research design and used two groups of subjects. Subjects were not randomly assigned to experimental group (n = 90) or comparison group (n = 56). Based on Bandura's social cognition theory, subjects in the experimental group received Kagayashiki music care (KMC) twice per week for 24 weeks. Subjects in the comparison group were provided with activities as usual.

RESULTS

Results found, using the control score of the Clifton Assessment Procedures for the Elderly Behavior Rating Scale (baseline) and time of attending KMC activities as a covariate, the two groups of subjects had statistically significant differences in the mini-mental state examination (MMSE). Results also showed that, using the control score of the Cornell Scale for Depression in Dementia (baseline) and MMSE (baseline) as a covariate, the two groups of subjects had statistically significant differences in the Clifton Assessment Procedures for the Elderly Behavior Rating Scale.

CONCLUSION

These findings provide information for staff caregivers in long-term care facilities to develop a non-invasive care model for elderly people with dementia to deal with depression, anxiety, and behavioral problems.

Effects of viewing a preferred nature image and hearing preferred music on engagement, agitation, and mental status in persons with dementia

Background:

The purpose of the described exploratory study was to test proactive strategies for enhancing engagement and cognitive ability while diminishing dementia-related disordered behaviors of those diagnosed with Alzheimer’s disease and other dementias. Study participants resided in an Memory Care unit of an assisted living community.

Method:

The researchers measured the effects of exposure to music and nature images on engagement using the Individualized Dementia Engagement and Activities Scale tool, on cognitive ability using the Montreal Cognitive Assessment, and on agitation using the Cohen-Mansfield Agitation Inventory.

Result:

The within-subject study design revealed that use of both music and nature images hold promise for reducing undesirable behaviors and improving engagement of residents.

Conclusion:

The authors suggest caregivers for those with Alzheimer’s disease and other dementias can effectively use nature images and music to improve engagement and reduce disordered behaviors, thus potentially enhancing quality of life for the care recipient as well as the caregiver while possibly reducing the costs of medications used to control dementia-related undesirable behaviors.