Article Summary by Kathryn Trujillo
According to the authors, and the World Health Organization (WHO), more than 55 million people live with dementia worldwide. Dementia causes deterioration in cognitive functioning, and “negatively affects memory, thinking, orientation, understanding, calculation, ability to learn, language, and judgment” (Dahms, p.13). There are three stages of dementia: early, middle, and late. Depending on the characteristics and symptoms expressed by individuals living with dementia, Common symptoms of dementia, from early to late progression, are forgetfulness, losing track of time, becoming lost in familiar places, forgetful of recent events or people’s names, behavioral changes, repeating questions, an increasing need for assisted self-care, and behavior changes that can escalate to include aggression (WHO, 2021, p. 1). The study by Dahms, Eicher, and colleagues titled “Influence of Music Therapy and Music-Based Interventions on Dementia: A Pilot Study,” though conducted in Germany, has results which should be considered in the care of those living with dementia here in the United States. Dahms and colleagues implemented music by following guidelines set by the National Dementia Plan. According to Dahms, nursing homes in “other countries of the world (such as Australia and the United States)” also act according to the National Dementia Plan (p.14). This study provides evidence that when Music Therapy (MT) and technology music-based interventions (TMBI) that are a part of a patient’s daily routine, decrease agitation and apathy of those living with dementia in nursing homes.
Dahms and colleagues focused on the influence of individual MT, group MT, listening to background music, group music with movement, and presence of a music program in the common room on disruptive behaviors of those living with dementia in 3 separate nursing homes across Germany. Terms used synonymously to describe behavioral symptoms being observed were “disruptive behavior” (e.g agitation) and “social behavior” (e.g. apathy) (Dahms, p. 18). The primary research question was, “what was the frequency of use and acceptance of the different music interventions (MT and TBMI) offered to people with dementia in nursing homes” (Dahms, p.15)? The purpose of the study was to evaluate the use, acceptance, and interaction of music on people with dementia living in nursing homes across Germany (Dahms, 2021). Three nursing homes, two in Berlin and one in Stuttgart, Germany were included in the study. 30 people between the ages of 65 and 97 years, and diagnosed with dementia, were included in the study. Considering that those with dementia were dependent on full time caregivers, the related caregivers (RPs) answered questionnaires on behalf of the included residents before, during, and after the study took place. All questionnaires “included questions on the following topics: instrumental activities of daily life that influence the behavior of people with dementia (e.g disruptive behavior), depression, quality of life...and about expectations of MT and TBMI” (Dahms, 2021, p. 17).
The goal of each MT and TMBI intervention was to investigate their usage by people with dementia over time. MT is unique, in that board-certified music therapists (MT-BCs) individualize each intervention to the preferences and likings of each study participant. The use of music is purposeful and intentional. Interventions were presented under 6 different conditions: group MT, individual MT, background music during meals, background music during exercise, CD in the common room, and individual listening time with a radio. Group MT was conducted once a week for 45-minutes, with 5 study participants, but when other nursing home residents stepped in, the group size varied (Dahms, p.19). The interventions presented were live, improvised, facilitated by an MT-BC on guitar or accordion, and singing bowls and percussion instruments were given to participating group members. Individual MT was provided bi-weekly for 30-minutes, and facilitated by an MT-BC on guitar. Background technology based music (TBMI), was played by caregivers on a daily basis during meals for all study participants for 4-minutes with a CD player (Dahms, p. 19). Music was played on a television (TV) for a group music class with movements. Group music with movement was provided every two weeks for 60-minutes with a certified fitness trainer for physical activation. A music program in the common room was available to each participant for 6 hours through a TV and accompanied by lyrics and visuals, daily. Individual radio time was provided twice a day for 30 minutes in each resident’s room and individualized to meet their personal needs (e.g volume, playing speed, genre).
Data was primarily collected through physical questionnaires filled out by the related caregivers, and then turned into digital data using Microsoft Excel. Researchers used IBM’s SPSS Statistics 27 program to evaluate data from the questionnaires. The study was separated into four test phases and questionnaires were filled out at each phase. Data was then analyzed at timepoints “T2 and T3, using bivariate and multivariable analysis. For example, one variable, the “frequency of use on MT and TBMI” was split into two sub variables to distinguish the sample between “residents with high usage” and “residents with low usage” (Dahms, p20). Researchers used nonparametric Mann-Whitney U-tests on scores for agitation, apathy, and depression, independent sample t-tests were used for quality of life, and a Friedman test was used to further evaluate the influence of MT and TBMI on agitation (Dahms, p.21).
There were three primary limitations to Dahms’ and colleagues’ study. The first limitation was that all participants relied on caregivers due to late stage dementia, and their declining health made it impossible for participants to provide self-assessments on the questionnaires. The second limitation was that acceptance of the use of technology was not assessed. Participants relied on related caregivers to physically set up and start the music using technology. The third limitation was that the study’s “eight-week intervention phase was not sufficient enough to detect long-term effects in people with dementia with respect to the parameters studied” (Dahms, p.32). Though there were limitations to this study, the design, implementation, and results are supported by previous research.
Results of Dahms’ and colleagues' study stated that 83% of participants with dementia did listen to music regularly, that some residents still handled this activity independently, while the majority of people with dementia were dependent on the support of their caregivers for it (Dahms, p.e21). According to the responses from RPs on the questionnaires, the reasons for nonuse of MT or TBMI was due to health problems of the residents, loss of memory about the existence of the music interventions, their tendency to retreat, and motor restlessness. On p.22 it states that “the frequency of use of the TBMI, for example, karaoke and biography-specific favorite music, was lower than the frequency of use of the personnel-guided music interventions.” A majority of the residents with dementia preferred the individualized active music therapy sessions with an MT-BC. Group MT was rated the best, followed by group music with movements, and individual MT. Overall, this study suggests that individualized MT and group MT, provided by an MT-BC, can reduce agitation and apathy of inpatient nursing home residents living with dementia.
-Kathryn Trujillo, Music Therapy Intern
Reference:
Dahms, R., Eicher, C., Haesner, M., & Mueller-Werden, U. (2021). Influence of music therapy and music-based interventions on dementia: A pilot study. Journal of Music Therapy, 58(3), e12-e36. doi:10.1093/jmt/thab005
World Health Organization. (2021, September 2). https://www.who.int/news-room/fact-sheets/detail/dementia