Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

Abstract

Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

The effectiveness of interventions to improve the care and management of people with dementia in general hospitals: A systematic review

“…All interventions were delivered on the ward, other than one study where the training was delivered online for staff to access at home . The majority (13/24, 54%) of studies evaluated multicomponent staff educational interventions aiming to improve dementia care on the ward (medical model of dementia, approaches to communication and behaviour, dementia‐friendly care, connecting with the carer, communicating with patients, dementia‐related behaviour, wandering and falls, managing BPSD, nutrition and hydration, importance of activities, falls management, and end‐of‐life care), followed by person‐centred care (3/24), specialist geriatric medical ward, improving communication and relationship (using experiential learning therapy with actors trained to portray patients living with dementia) between staff and family carers, and creative music therapy . One technology‐based intervention was a humanoid robot for psychomotor therapy.…”

“…Music therapy: One before‐and‐after study evaluated this therapy. It reported a statistically significant difference in levels of pleasure and alertness (The Lawton Observed Emotion Rating Scale; OERS).…”

“…Music therapy: One before-and-after study 29 Robot-assisted therapy: One before-and-after tudy 33 evaluated this therapy. It did not report a statistically significant difference in levels of immediate well-being and quality of life (Instant Assessment of Wellbeing Tool; EVIBE).…”

Non-pharmacological Treatment of Intensive Care Unit Delirium

“…In addition, therapy is used to reduce anxiety and promote relaxation among these patients. The impacts of musical therapy were further demonstrated in a systematic review by Abraha et al [28] although further studies are required to ascertain this literature.…”

“…Non-pharmacological interventions for managing Delirium are dependent on patient factors and the healthcare providers' selection. In the systematic review by Abraha et al [28] in using the non-pharmacological management for patients above 60 years, it was revealed that multicomponent approach is essential in preventing the condition and that the interventions are profound when administered to the patient at high risk of developing the condition. This review further revealed that for the single component management approaches, only the reorientation protocol, staff education, and Geriatric Risk Assessment Med Guide had significant outcomes in reducing the condition severity.…”