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Keywords:

  • music therapy;
  • elderly;
  • dementia;
  • agitated behavior

Abstract

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References

Objectives

This study explored the effectiveness of group music intervention against agitated behavior in elderly persons with dementia.

Methods

This was an experimental study using repeated measurements. Subjects were elderly persons who suffered from dementia and resided in nursing facilities. In total, 104 participants were recruited by permuted block randomization and of the 100 subjects who completed this study, 49 were in the experimental group and 51 were in the control group. The experimental group received a total of twelve 30-min group music intervention sessions, conducted twice a week for six consecutive weeks, while the control group participated in normal daily activities. In order to measure the effectiveness of the therapeutic sessions, assessments were conducted before the intervention, at the 6th and 12th group sessions, and at 1 month after cessation of the intervention. Longitudinal effects were analyzed by means of generalized estimating equations (GEEs).

Results

After the group music therapy intervention, the experimental group showed better performance at the 6th and 12th sessions, and at 1 month after cessation of the intervention based on reductions in agitated behavior in general, physically non-aggressive behavior, verbally non-aggressive behavior, and physically aggressive behavior, while a reduction in verbally aggressive behavior was shown only at the 6th session.

Conclusions

Group music intervention alleviated agitated behavior in elderly persons with dementia. We suggest that nursing facilities for demented elderly persons incorporate group music intervention in routine activities in order to enhance emotional relaxation, create inter-personal interactions, and reduce future agitated behaviors. Copyright © 2010 John Wiley & Sons, Ltd.


Introduction

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References

By 2008, the total number of patients with dementia was estimated to be 30 million worldwide. That number is projected to reach 35.6 million by 2010, 65.7 million by 2030, and 115.4 million by 2050 (Alzheimer's Disease International, 2009). In Taiwan, the population aged ≥65 years was 2.4 million by the end of 2008, or 10.4% of the total population. The prevalence of dementia among this age group was estimated to be 1.9–4.4% (around 2.5%) (Liu, 2006), and the total number of patients with dementia exceeds 150 000 (Department of Health Executive Yuan Taiwan, 2008).

According to several studies, agitated behavior in the elderly with dementia is the most troubling problem and primary source of pressure for the family and nursing staff (Smith, 2004; Gwendolen and Heidi, 2007). In the search for methods to alleviate such problems, increasing attention has been paid to non-medicinal interventions, among which music therapy is one of the most frequently recommended. Not only does it avoid the side effects of traditional medicinal and physical management methods, but it also reduces the frequency of troubled behaviors by customization according to the patient's physical, emotional, and social needs (Gerdner, 2000; Ragneskog et al., 2001; Goodall and Etters, 2005; Gwendolen and Heidi, 2007).

Music intervention has been proven effective in alleviating agitated behavior in elderly patients with dementia. According to previous studies, music intervention for aged dementia patients generally involves four to 16 sessions, conducted individually or in groups, involving listening to music (passive methods) and musical activities (active methods). The evaluation scales used include the Cohen-Mansfield Agitation Inventory (CMAI), Observational Checklist for Aggressive Behaviors, Multidimensional Observed Aggressive Behaviors, Facial Action Coding System (FACS), and Observation Scale for Elderly Subjects (MOSES), and Momentary Time Sampling (MTS). Ledger and Baker (2007) conducted group music therapy by certified music therapists and found that the verbal aggressive behavior instead of verbal non-aggressive, physical non-aggressive, and physical aggressive behavior was significantly less in the music therapy group than the control group (p < 0.05). Suzuki et al. (2004) also performed group music therapy by music therapists and assessed its long-term effect by MOSES. The results revealed a significant reduction in dementia patients' irritability (p < 0.05). Previous research also has found the effects of music intervention conducted by a health care profession who is not a music therapist (Ragneskog et al., 2001; Remington, 2002; Sung et al., 2006; Garland et al., 2007). Remington (2002) reported a significant suppression of agitated behaviors, the average CMAI score dropped from 22.0 to 3.8; physically non-aggressive behavior was reduced in the music group (p < 0.05). In Hicks-Moore's study (2005), the average CMAI decreased from 10.0–7.3 to 4.6–3.4. For those subjects who participated in active group music intervention conducted with a trained nurse, the average CMAI score dropped from 5.1 to 3.4 (p < 0.001) (Sung et al., 2006). According to Garland et al. (2007) and Brotons and Marti (2003), active group music intervention, conducted by a trained psychologist, was able to reduce the average CMAI from 6.2 to 2.3, and to 4.3 at the 2-month follow-up (p < 0.05); physically aggressive behavior significantly reduced more in music group than usual care group (p < 0.05); verbally aggressive behavior significantly reduced more in music group than the placebo group (p < 0.05). Through video recording, FACS was able to detect a significant reduction in agitated behavior with individualized music when compared to ordinary music or no music at all (Ragneskog et al., 2001). The MTS method uses an observer to record the effects of background music on the behavior of elderly patients with dementia, and it showed a significant increase in positive behaviors, such as physical touching, laughter, smiling, calmness, humming, singing, and rhythmic movements of the hands, feet, and body, and a significant decrease in negative behaviors such as agitation (Ziv et al., 2007).

The majority of investigations of group music intervention were conducted in Western countries (Bradley et al., 1995; Clark et al., 1998; Cohen-Mansfield et al., 1989; Gerdner and Buckwalter, 1999; Gerdner and Swanson, 1993; Sweeney-Calciano et al., 2003). Little is known about how differences in the group music intervention influence patients' agitated behavior in Eastern cultures. In Taiwan, psychiatric medication and physical restraints continue to be the primary management strategy for agitated behavior in patients with dementia. There are limited studies on the use of group music intervention in patients with dementia in Taiwan. In light of the scarcity of studies of patients with dementia domestically, this study explored the effects of group music intervention on dementia patients' agitated behavior.

Methods

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References

This was an experimental study that evaluated the efficacy of group music intervention as an intervention to alleviate agitated behavior in elderly patients with dementia using a pretest–posttest control group design. Subjects consisted of a total of 104 elderly persons who were randomly assigned to the experimental (n = 52) or control group (n = 52) by permuted block randomization. Subjects in the experimental group were given a total of 12 sessions of group music intervention (two 30-min sessions per week for 6 weeks) at the same location. The subjects in the control group continued to perform their usual daily activities. In order to measure the efficacy of group music intervention, agitated behaviors were assessed in both the experimental and control groups at the 6th and 12th sessions, and at 1 month after cessation of the intervention, using the CMAI. This includes four sub-classifications: physically non-aggressive behaviors, physically aggressive behaviors, verbally non-aggressive behaviors, and verbally aggressive behaviors.

Subjects

In this study, subjects were elderly patients with dementia aged ≥65 years, recruited from three nursing home facilities in Taiwan. The enrollment criteria were as follows: (a) the patient had been diagnosed by a physician as having dementia, using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition Text Revision (DSM-IV-TR), (b) the patient was ≥65 years, and (c) the patient spoke Mandarin and/or Taiwanese. The required sample size was estimated to be 102 by the program, G-Power, with an α of 0.05, a power of 0.80, and an effective size of 0.5.

Tools

Background information form

This form recorded the subjects' demographic variables, including background information and disease characteristics, including the number of chronic disease and dementia rating.

Interest in music evaluation form

This form included subjects' fondness for music, the frequency and type of music-related activities in which the subjects were involved, and preference in music genres before the onset of dementia.

Mini-Mental State Examination (MMSE)

The MMSE includes 11 questions with a maximum total score of 30. A higher score indicates better cognitive function (Folstein et al., 1975). The cutoff point of MMSE scores was 23. A score of <24 (0–23) is indicative of dementia, while a score >24 is normal (DePaulo and Folstein, 1978). The test/retest reliability of the MMSE over a 24-h period on the same subjects was 0.89, whereas the inter-rater reliability was 0.82. For elderly demented subjects, the retest reliability at 28 days was shown to be 0.98. A positive correlation between subjects' MMSE scores and their Wechsler Adult Intelligent Scale scores (0.78 and 0.66 for verbal and performance sections, respectively) demonstrated good validity for the MMSE (Folstein et al., 1975). The C-MMSE was constructed and validated by Guo et al. (1988, 1989), where the cutoff score was set to 15 for subjects with a lower educational status, and to 23 for those with higher educational levels (Guo et al., 1988, 1989). Subjects' severity of dementia was categorized according to their MMSE score as mild (19–23), moderate (10–18), severe (1–9), and very severe (0) (Tiraboschi et al., 2000).

Chinese Version of the Cohen-Mansfield Agitation Inventory (C-CMAI)

The C-CMAI was translated by Lin et al. (2007) from the original version of the CMAI, designed by Cohen-Mansfield in 1989. The instrument rates a subject's agitated behavior and its frequency over the previous 2 weeks. The C-CMAI includes 29 items, each rated on a 7-point scale (1–7) ranging from never (1 point) to several times an hour (7 points), with a total score of 29 (minimum) to 203 (maximum). The four categories of behavior rated by the CMAI are physically non-aggressive, physically aggressive, verbally non-aggressive, and verbally aggressive behaviors. The split-half reliabilities of the C-CMAI and CMAI were shown to be 0.69 and 0.74, respectively. The content validity index of the C-CMAI was 0.99, whereas its test–retest reliability ranged 0.63–0.86 (Lin et al., 2007), indicating that the C-CMAI has good reliability and validity. The C-CMAI was used with the original authors' consent.

Research procedures

This study was conducted at three nursing facilities for elderly patients with dementia in Taiwan between August 2008 and January 2009. Subjects were initially screened after the patients' background information was collected and the purposes of the research were explained to their relatives. After consent forms were acquired, the subjects were randomly assigned to either the experimental or the control group, using a permuted block randomization computer-based program. Prior to the music intervention, one-on-one interviews were conducted to evaluate subjects' interest and fondness for music. The music intervention was modified from the protocol developed by Clair and Bernstein (1990). The main topics for each therapy session included: (1) rhythmical music and slow-tempo instrumental activities-I, (2) rhythmical music and slow-tempo instrumental activities-II, (3) therapeutic singing-I, (4) therapeutic singing-II, (5) listening to specially selected music-I, (6) listening to specially selected music-II, (7) glockenspiel-I, (8) glockenspiel-II, (9) musical activities and traditional holidays-I, (10) musical activities and traditional holidays-II, (11) music creator-I, and (12) music creator-II. All sessions were performed at the same location in each nursing facility. The subjects in the control group continued to engage in their normal daily activities. In order to conduct music intervention effectively, the researcher completed a series of music therapy courses in two university music therapy programs that included (1) music theory, perception and skills in clinical situations; (2) initial assessment and treatment planning; and (3) treatment implementation and termination. She also applied various ways to use music as intervention to help elderly patients with dementia at a nursing facility for years. Therapist adherence was monitored by two external senior music therapists who were independent of the therapy component of the system. The system rated compliance with the fundamental principles of music therapy and adherence to one or more modules and interventions specified in the treatment manual.

Data analysis

Data were analyzed with SPSS 15.0 for Windows. Descriptive statistics utilized χ2, t-test, and the Mann–Whitney U-test. Inferential statistics on repeated measures were conducted using generalized estimating equations (GEEs) to examine the effectiveness of music therapy in improving agitated behavior, when differences in and chronological trends of C-CMAI scores between the two groups were examined.

Ethical considerations

Patients who met the enrollment criteria received information about this study, including its aims, duration, and the use of data. They were also assured that the study would not interfere with the outcome of their medical treatment. The study was performed with the consent of the patients or their legal guardians. Throughout the research period, subjects were able to discontinue their participation at any time upon request, and this would not affect existing treatment and healthcare. The subjects' background information was kept strictly confidential and used only for research purposes.

Results

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References

Subjects' background information

In total, 104 subjects were recruited for this study, with 52 each in the experimental and control groups. Three patients dropped out of the experimental group with a dropout rate of 5.7%. One subject dropped out of the control group for a dropout rate of 1.9%. An analysis of their reasons for discontinuing showed that three subjects were hospitalized for worsening illness, one subjects quit this study due to physical discomfort. As a result, 100 patients completed the study, 49 were in the experimental group and 51 were in the control group. The average age of subjects was 82 years (SD, 6.80; range, 65–97). There were slightly more females than males (female/male of 53: 47). Most subjects (62%) had dementia of moderate severity. The average length of stay in their current facility was 37 months. (Table 1). With regard to medications for dementia (such as antipsychotics, sedatives, and drugs for Alzheimer's disease (AD)), 76 subjects were receiving at least one medication. Most subjects were taking one drug, among which antipsychotics were the most common (58 patients, 75.3%), followed by sedatives (41 subjects, 53.2%), and drugs for AD (13 subjects, 17.3%). There was no significant difference between the two groups in any of the above-mentioned variables.

Table 1. Description of subject demographic characteristics—categorical data (n = 100)
VariableExperimental group (n = 49)Control group (n = 51)p valuea
No. of subjectsPercentageNo. of subjectsPercentage
  • MMSE, Mini-Mental State Examination. Higher scores represent better cognitive abilities.

  • C-CMAI, the Chinese version of the Cohen-Mansfield Agitation Inventory. Higher scores represent more-agitated behavior.

  • M, mean; SD, standard deviation.

  • a

    Fisher's exact test.

  • b

    t-test.

  • c

    Mann–Whitney U-test.

Gender    1.000
 Male2346.942447.06 
 Female2653.062752.94 
Marital status    0.750
 Single612.2435.88 
 Married1632.651733.33 
 Widowed2448.982854.90 
 Divorced36.1235.88 
Education    0.537
 Illiterate1530.611019.61 
 Elementary school1530.611733.33 
 Junior high school48.16713.73 
 Senior high/professional school510.20917.65 
 College1020.41815.69 
Severity of dementia    0.409
 Mild612.241121.57 
 Moderate3163.273160.78 
 Severe1224.49917.65 
 MSDMSD 
Age (years)81.467.3482.156.280.617b
Length of stay in the institution (months)43.2448.5631.0025.990.637c
MMSE12.806.1513.805.300.381b
No. of chronic diseases2.771.432.691.460.808b

Descriptive statistics on patients' agitated behavior

The mean value of agitated behavior (C-CMAI) and its four categories (physically non-aggressive, physically aggressive, verbally non-aggressive, and verbally aggressive behavior) in four waves of data collection were shown in Table 2. The Mann–Whitney U-test revealed little difference between the two groups in average C-CMAI values, physically non-aggressive, verbally non-aggressive, and verbally aggressive behavior before the intervention.

Table 2. Mean value of agitated behavior and its four categories (n = 100)
VariablesBaselineZ valuep-valuea6th session12th sessionOne month after cessation
Experimental groupControl groupExperimental groupControl groupExperimental groupControl groupExperimental groupControl group
MSDMSDMSDMSDMSDMSDMSDMSD
  • C-CMAI, the Chinese version of the Cohen-Mansfield Agitation Inventory. Higher scores represent more-agitated behavior.

  • Baseline, measured 1 week prior to music therapy intervention (pretest); 3rd week, measured in the third week of music therapy (at the 6th session); 6th week, measured in the 6th week of music therapy (posttest); 1 month after cessation, measured 1 month after cessation of the music therapy intervention (follow-up).

  • M, mean; SD, standard deviation.

  • a

    Mann–Whitney U-test, *p < 0.05.

C-CMAI43.1216.3237.7811.04−1.540.12435.898.5338.2510.8536.3710.6438.5510.2735.699.9937.759.70
Physically non-aggressive behavior14.947.5213.204.70−1.160.24712.874.6114.065.7413.335.6614.306.0012.173.5513.775.60
Physically aggressive behavior14.946.3912.514.06−2.570.01012.673.0912.423.4912.562.7712.112.3412.864.1212.253.01
Verbally non-aggressive behavior10.296.229.044.61−0.750.4527.823.168.714.228.003.849.094.277.983.698.773.88
Verbally aggressive behavior2.961.683.042.08−0.490.6272.531.253.062.062.491.083.051.842.691.372.951.77

Three follow assessments were performed at the 6th and 12th group music sessions and at 1 month after cessation of the intervention. Lower C-CMAI scores were observed in the experimental group (average scores of 35.89, 36.37, and 35.69 points, respectively), while little change was observed in the control group (average scores of 38.25, 38.55, and 37.75 points, respectively) (Table 2).

Evaluation of the effects on agitated behavior

Changes in average scores of agitated behavior

After adjusting for time, group, and gender, relationships between the average scores in agitated behavior and variables such as time, group, and time–group interaction were explored. The results showed a statistically significant decrease in agitated behavior scores in the experimental group at three time-point comparisons: at the 6th session versus the pretest, when the average score of the experimental group was 0.47 points lower (p < 0.001); at the 12th session versus the pretest, when the average score of the experimental group was 0.44 points lower (p < 0.001); and at 1 month after cessation of the intervention versus the pretest, when the average score of the experimental group was 0.47 points lower (p < 0.001) (Table 3, Figure 1).

Table 3. GEE analysis on Cohen-Mansfield Agitation Inventory
VariableBSEWald χ2p-value
  • EXP, experimental group; CON: control group.

  • a

    Reference group, control group.

  • b

    Reference group, time (1st).

  • c

    Reference group, group (CON) × time (1st).

  • ***

    p < 0.001.

Group (EXP)a0.380.203.670.055
Time (2nd)b0.020.070.060.810
Time (3rd)b0.010.070.030.864
Time (4th)b−0.040.070.030.616
Interactions
 Group (EXP) × Time (2nd)c−0.470.1411.70<0.001***
 Group (EXP) × Time (3rd)c−0.440.1213.54<0.001***
 Group (EXP) × Time (4th)c−0.470.1410.44<0.001***
thumbnail image

Figure 1. Trends in average scores for agitated behavior.

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Changes in physically non-aggressive behaviors

As shown in Table 4, the results revealed a statistically significant decrease in physically non-aggressive behaviors in the experimental group at three time-point comparisons: at the 6th session versus the pretest, when the average score of the experimental group was 0.31 points lower (p = 0.004), at the 12th session versus the pretest, when the average score of the experimental group was 0.26 points lower (p = 0.015), and at 1 month after cessation of the intervention versus the pretest, when the average score of the experimental group was 0.34 points lower (p = 0.006).

Table 4. GEE analysis of agitated behavior in four categories
VariableBSEWald χ2p-value
  • EXP, experimental group; CON, control group.

  • a

    Reference group, control group.

  • b

    Reference group, time (1st).

  • c

    Reference group, group (CON) × time (1st).

  • *

    p < 0.05, **p < 0.01.

Physically non-aggressive behavior
 Group (EXP)a0.190.151.650.198
 Time (2nd)b0.090.053.090.079
 Time (3rd)b0.080.052.990.084
 Time (4th)b0.030.060.190.662
 Interactions    
  Group (EXP) × time (2nd)c−0.310.118.350.004**
  Group (EXP) × time (3rd)c−0.260.115.870.015*
  Group (EXP) × time (4th)c−0.340.127.640.006**
Physically aggressive behavior
 Group (EXP)a0.290.125.860.015*
 Time (2nd)b−0.010.050.060.813
 Time (3rd)b−0.050.060.780.378
 Time (4th)b−0.030.050.400.527
 Interactions    
  Group (EXP) × time (2nd)c−0.230.114.800.028*
  Group (EXP) × time (3rd)c−0.200.095.040.025*
  Group (EXP) × time (4th)c−0.210.095.560.018*
Verbally non-aggressive behavior
 Group (EXP)a0.160.151.090.296
 Time (2nd)b−0.060.080.570.451
 Time (3rd)b0.0040.080.0030.959
 Time (4th)b−0.030.090.160.691
 Interactions    
  Group (EXP) × time (2nd)c−0.220.114.120.042*
  Group (EXP) × time (3rd)c−0.280.116.630.010**
  Group (EXP) × time (4th)c−0.260.124.370.037*
Verbally aggressive behavior
 Group (EXP)a−0.010.090.010.944
 Time (2nd)b0.0010.030.0020.963
 Time (3rd)b−0.010.030.170.679
 Time (4th)b−0.030.050.440.505
 Interactions    
  Group (EXP) × time (2nd)c−0.110.055.350.021*
  Group (EXP) × time (3rd)c−0.090.052.650.104
  Group (EXP) × time (4th)c−0.020.070.090.764
Changes in physically aggressive behaviors

As shown in Table 4, the results revealed a statistically significant decrease in physically aggressive behaviors in the experimental group at three time-point comparisons: at the 6th session versus the pretest, when the average score of the experimental group was 0.23 points lower (p = 0.028), at the 12th session versus the pretest, when the average score of the experimental group was 0.20 points lower (p = 0.025), and at 1 month after cessation of the intervention versus the pretest, when the average score of the experimental group was 0.21 points lower (p = 0.018).

Changes in verbally non-aggressive behaviors

The results revealed a statistically significant decrease in verbally non-aggressive behaviors in the experimental group at three time-point comparisons: at the 6th session versus the pretest, when the average score of the experimental group was 0.22 points lower (p = 0.042), at the 12th session versus the pretest, when the average score of the experimental group was 0.28 points lower (p = 0.010), and at 1 month after cessation of the intervention versus the pretest, when the average score of the experimental group was 0.26 points lower (p = 0.037) (Table 4).

Changes in verbally aggressive behaviors

As shown in Table 4, the results revealed a statistically significant decrease in verbally aggressive behaviors in the experimental group at the 6th session versus the pretest, when the average score of the experimental group was 0.11 points lower (p = 0.021). However, the difference did not reach statistical significance at the 12th session versus the pretest, when the average score of the experimental group was 0.09 points lower (p = 0.104), or at 1 month after cessation of the intervention versus the pretest, when the average score of the experimental group was 0.02 points lower (p = 0.764).

Discussion

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References

Subjects recruited for this study were elderly patients with dementia, aged 82 years on average. Most of them had dementia of moderate severity along with one or two other chronic diseases. Nonetheless, this study had a low total dropout rate and high attendance at the group music therapy sessions. Physically and verbally non-aggressive behaviors were the most common agitated behaviors among subjects. At the 6th and 12th group intervention sessions, and at 1 month after cessation of the intervention, decreases were observed in the experimental group in several aspects, including agitated behaviors in general, physically and verbally non-aggressive behaviors, and physically aggressive behaviors. Reduced verbally aggressive behavior in the group was only noted after the 6th intervention.

This study revealed that group music intervention is effective in alleviating agitated behavior in elderly patients with dementia. This is in line with studies by Ledger and Baker (2007), Sung et al. (2006), Suzuki et al. (2004), Garland et al. (2007), and Ziv et al. (2007). The results of this study support the hypothesis that for elderly patients with dementia, there is less agitated behavior in those who receive group music intervention than in those who do not. Some possible reasons are as follows. First, the number of patients recruited was large enough for extrapolation. The general age and background of the patients should also be considered when deciding what types of music to make available. Second, 12 group music therapy sessions were conducted in a warm and comfortable environment. In practice, the theme and goal of each therapy session were very explicit. A music intervention should help the patient attain a state of calmness and relaxation, and further alleviate agitated behaviors. Third, before the therapy sessions, a subject's fondness for music was evaluated through an interview, and the musical activities in the group sessions were arranged according to the interview findings. Providing the subjects with a selection of Chinese/Taiwanese music that the majority were familiar with and liked might have fostered a greater degree of relaxation. The fourth reason was the design of group music therapy activities. Chinese people tend to suppress and hide their feelings and express them differently than do Westerners. Perhaps this type of group music therapy can help patient sooth their emotions and agitated behavior.

The group music intervention provided live or recorded music for patients to listen to, and direct involvement of patients though singing or playing an instrument. Passively listening to music relieves agitated behavior because of the emotional and evocative elements of music, and helps to elicit repressed feelings. Rhythmical music with slow tempos can be relaxing. Pitch acts on the autonomic nervous system, with a low pitch promoting relaxation. The results support positive effects being generated by familiar and pleasing music and in those who appreciate it. Familiar and pleasing sounds possibly remind patients of the normalcy of life beyond the nursing facility. Musical stimulation can activate several areas of the cerebral cortex, and this may be beneficial both emotionally and behaviorally. Instrumental playing, group singing, and listening to music together are morale-building social experiences for patients, who may derive strength and support from the group.

Incorporating music into the therapeutic milieu is helpful. Therefore, group music therapy can be used as an intervention in conjunction with pharmacological therapy without inducing contraindications, and it can maximize the effect of decreasing agitated behavior of patients. Group music is an intervention with relatively untapped potential for making significant contributions to patients with dementia.

Conclusions

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References

The results showed that after group music intervention, the experimental group presented fewer agitated behaviors at the 6th and 12th sessions and at 1 month after cessation of the intervention. This study confirms that patients with dementia benefit from participating in music interventions. The representativeness and extrapolation of this study may be limited because the subjects were recruited from three nursing facilities for the elderly with dementia in Taipei. We suggest that future studies recruit subjects from a broader geographic area. In addition, a broader sample source could come from demented elderly persons in the community, daycare centers, and hospitals, in order to understand the applicability of group music intervention in those settings. In light of our findings, we recommend that nursing facilities for patients with dementia adopt group music intervention as a routine institutional activity. In addition, due to the relatively short-term effects of music group sessions, such activities should be long-term and sustainable, so that complete care can be provided for demented elderly persons. As our study found that group music intervention can improve symptoms in demented elderly persons, we recommend that music intervention be incorporated with standardized methods to measure different physiological indices in future studies.

Key points

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References
  • After the group music therapy intervention, the elderly persons with dementia showed better performance based on reductions in agitated behavior in general, physically non-aggressive behavior, verbally non-aggressive behavior, and physically aggressive behavior.

  • Reduced verbally aggressive behavior in the group was only noted after the 6th group music therapy intervention.

  • Group music intervention alleviated agitated behavior in elderly persons with dementia.

References

  1. Top of page
  2. Abstract
  3. Introduction
  4. Methods
  5. Results
  6. Discussion
  7. Conclusions
  8. Key points
  9. Conflict of interest
  10. References
  • Alzheimer's Disease International. 2009. Statistics, available at: http://www.alz.co.uk/research/statistics.html
  • Bradley L, Siddique CM, Dufton B. 1995. Reducing the use of physical restraints in long-term care facilities. J Gerontol Nurs 21: 2134.
  • Brotons M, Marti P. 2003. Music therapy with Alzheimer's patients and their family caregivers: a pilot project. J Music Ther 40: 138150.
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