As mentioned in recent Music Therapy Research Blog (MTRB) post, there has been an heightened focus on research for older adult populations, in part due to the impending increase in the number of older adults. In this MTRB mash-up we will take a look at current research in music therapy for agitation in older adults with dementia.

Agitation is a major concern for older adults with dementia due to the behaviors exhibited due to agitation.  Agitated behaviors may include nonverbal agitation (i.e., pacing, wandering), verbal agitation (i.e., repeatedly asking questions or making demands), or verbal/physical aggression. These behaviors can be difficult to deal with and music intervention has been one way of trying to decrease agitation.

Lin et al. (2010) studied the use of a 2x-weekly 30-minute music therapy interventions that were based on Clair and Bernstein’s 1990 protocol.  This was a Randomized Control Trial with 49 in the treatment group and 51 in the control group. Between group results indicated that the treatment group had a decrease in agitated behaviors (measured by Cohen-Mansfield Agitation Inventory) compared to baseline at session 6, 12, and 1 month following treatment. Verbal aggression only decreased after the 6th session. This study included a basic sketch of what they implemented, but not enough to replicate the protocol. Also, this study was completed by a non-MT researcher who took courses in music therapy and who was supervised by music therapists.

Another RCT study found similar results. Raglio et al (2008) investigated the effect of MT on behaviors associated with dementia (Mini Mental State Examination, Barthel Index and Neuropsychiatry Inventory) over 16-weeks of MT treatment (30 sessions). There were significant reductions in agitation, as measured by the Neuropsychiatry Inventory.

More positive results were found by Choi et al (2009), who completed a study that involved three 50-minute interventions for five weeks, provided by a professional music therapist. This study was with 20 participants and found that participants who received the music therapy intervention decreased agitation according to the Neuropsychiatric Inventory. The music intervention included playing instruments, song writing, singing, making instruments, and song painting. The biggest issue with this study is that the participants were not randomly assigned to the groups, leaving the possibility for bias in participant assignment. The music therapy interventions were not defined beyond the descriptions above, which were not clear to me (song painting?).

As it often goes in research, another study found contradictory results; music had no effect on agitation in older adults with dementia. Cooke et al (2010), also used live music therapy sessions (40 minutes) for adults with dementia, using a randomized cross-over design with 47 persons with dementia. This study was for eight weeks, with interventions three times a week. The results indicated that music intervention had no significant effect on agitated behaviors (Cohen-Mansfield Agitation Inventory and the Rating Anxiety in Dementia Scale), which the authors state may have been attributed to factors such as cognitive impairment.

Why the different results?  There are a lot of variables in research that may affect the outcomes. Just to name a few – testing measures utilized, length of study, the music therapy protocol/intervention (this is why it is so important that this is clear), living situation, level of dementia, etc….  The qualifications of the researchers can also affect the results. One of these studies was completed by a non-MT – although they may have been well-meaning, they did not have the qualifications to implement “music therapy” interventions.

All of these variables make interpreting research for the clinic very difficult, since you can read two studies back-to-back and come to a different conclusion. One way to help verify results is to replicate research (replication research can make a great thesis project) – if many researchers find the same results given similar variables, then there is more “power” to the results.

What can you do as a clinician:

• Evidence-based practice is not only informed by research, but also draws on your experience; you have to determine if any of these results (both supporting and not supporting) are generalizable to your situation with the clients you serve.
• You can ask if the researcher(s) did something in the study/protocol that might change the way you currently provide services.
• You can ask if the research is supporting the way you practice music therapy.
• You can ask if the research is consistently finding that something you usually do in music therapy doesn’t work.

Based on this information you can reflect on your practice and change how you provide services in accordance with your experience and the evidence.

References:

Choi, A.N., Lee, M.S., Cheong, K.J., & Lee, J.S. (2009). Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial. Int J Neurosci., 119(4), 471-81. PMID: 19229716

Clair, A.A., & Bernstein, B. (1990). A Preliminary Study of Music Therapy Programming for Severely Regressed Persons With Alzheimer’s-Type Dementia. Journal of Applied Gerontology, 9(3), 299-311. doi:  10.1177/073346489000900305

Cooke, M.L., Moyle, W., Shum, D.H., Harrison, S.D., & Murfield, J.E. (2010). A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia. Aging Ment Health., 9, 1-12. PMID: 20635236

Lin, Y., Chu, H., Yang, C.Y., Chen, C.H., Chen, S.G., Chang, H.J., Hsieh, C.J., & Chou, K.R. (2010). Effectiveness of group music intervention against agitated behavior in elderly persons with dementia. Int J Geriatr Psychiatry. [Epub ahead of print] PMID: 20672256

Raglio, A., Bellelli, G., Traficante, D., Gianotti, M., Ubezio, M.C., Villani, D., & Trabucchi, M. (2008). Efficacy of music therapy in the treatment of behavioral and psychiatric symptoms of dementia. Alzheimer Dis Assoc Disord, 22(2), 158-62. PMID: 18525288.