Music Therapy Increases Social and Emotional Well-Being in Persons With Dementia: A Randomized Clinical Crossover Trial Comparing Singing to Verbal Discussion

Abstract

The number of people living with Alzheimer’s disease and related dementias (ADRD) is growing proportional to our aging population. Although music-based interventions may offer meaningful support to these individuals, most music therapy research lacks well-matched comparison conditions and specific intervention focus, which limits evaluation of intervention effectiveness and possible mechanisms. Here, we report a randomized clinical crossover trial in which we examined the impact of a singing-based music therapy intervention on feelings, emotions, and social engagement in 32 care facility residents with ADRD (aged 65–97 years), relative to an analogous nonmusic condition (verbal discussion). Both conditions were informed by the Clinical Practice Model for Persons with Dementia and occurred in a small group format, three times per week for two weeks (six 25-minute sessions), with a two-week washout at crossover. We followed National Institutes of Health Behavior Change Consortium strategies to enhance methodological rigor. We predicted that music therapy would improve feelings, positive emotions, and social engagement, significantly more so than the comparison condition. We used a linear mixed model approach to analysis. In support of our hypotheses, the music therapy intervention yielded significant positive effects on feelings, emotions, and social engagement, particularly for those with moderate dementia. Our study contributes empirical support for the use of music therapy to improve psychosocial well-being in this population. Results also highlight the importance of considering patient characteristics in intervention design and offer practical implications for music selection and implementation within interventions for persons with ADRD.

Person-Centred, Culturally Appropriate Music Intervention to Improve Psychological Wellbeing of Residents with Advanced Dementia Living in Australian Rural Residential Aged Care Homes

“…Person-centred playlists not only enabled the reminiscence of family, places, love, and loss, but also became a means of encouragement for the residents to participate in physically and cognitively stimulating activities. We found, similar to other studies, an improvement in initiation and response of the RwADs, while the duration of the effectiveness varied among the studies [27,28,47]. While the effect of music is comparable with a low to medium effect size [46], the person-centred playlist based on each resident's preferences and cultural background and the residents' engagement by the musicians to the familiar songs and activities contributed to their connection to memory, reduced agitation, and functional improvements.…”

“…This study was about the effectiveness of person-centred music sessions and culturally appropriate group sessions in improving psychological wellbeing of RwADs of rural aged care homes in Australia. Music-based interventions were identified as a tool for improving person-centred care plans in rural aged care homes, in the Harmony in the Bush study, for RwADs who showed moderate to severe pain, aggression, agitation, anxiety, and depression as identified in the recent quantitative and qualitative studies [27][28][29]38,39]. The integration of person-centred music into care plans presented a high cognitive and executive functional capacity among the residents.…”

“…For example, exercise and music are identified as beneficial in reducing behaviours [25]. The literature indicates that evidence-based music activity has the potential, as a supplement to cognitive behavioural therapy and/or medication, to be an effective and safe compassionate intervention in behavioural change and is a meaningful interaction [26][27][28]. Rigorous systematic reviews and intervention studies reported the statistically significant effects of music interventions on reducing depression and anxiety, and led to a discontinuation of psychotic medication [11,24,28].…”

“…The literature indicates that evidence-based music activity has the potential, as a supplement to cognitive behavioural therapy and/or medication, to be an effective and safe compassionate intervention in behavioural change and is a meaningful interaction [26][27][28]. Rigorous systematic reviews and intervention studies reported the statistically significant effects of music interventions on reducing depression and anxiety, and led to a discontinuation of psychotic medication [11,24,28]. Studies reported that involving the residents with dementia in music activities, e.g., listening to music, playing instruments, movement, interaction, and singing together, decreased their agitation and depressive symptoms [28,29].…”

“…Rigorous systematic reviews and intervention studies reported the statistically significant effects of music interventions on reducing depression and anxiety, and led to a discontinuation of psychotic medication [11,24,28]. Studies reported that involving the residents with dementia in music activities, e.g., listening to music, playing instruments, movement, interaction, and singing together, decreased their agitation and depressive symptoms [28,29]. Music-based interventions have not been widely and systematically introduced for RwADs, especially in Australian rural residential aged care homes.…”