Effectiveness of music therapy for persons with dementia in residential homes.

Abstract

Behavioural and psychological symptoms of dementia (BPSD) such as aggression, screaming, restlessness, agitation and wandering are often present in people with dementia living in the residential settings. Pharmacological interventions for the management of BPSD has been associated with a higher mortality and morbidity rate in residents with dementia. Therefore, non-pharmacological interventions have been recommended in professional and government policy as first line treatment. However, the evidence of their effectiveness is still limited. Thus the study attempted to review evidence that identified the effectiveness of Music Therapy (MT) compared with the delivery of normal care in reducing agitation levels among residents with dementia. In the reviewed studies patients were offered MT instead of psychotic medications to reduce some of their adverse effects. The PICO question for this study was formulated as follows: "How does music therapy compare with no intervention, in reducing agitation amongst persons with dementia in residential homes?" Persons with dementia aged 60 or over living in a residential home were included in the studies and all underwent a multidimensional assessment for the diagnoses of dementia. Studies that considered patients with neurological, psychiatric and medical conditions were excluded. Citation checking was undertaken using CINHAL, PubMed, Medline, The Cochrane Library and Google Scholar in July, 2011. The search was limited to articles in the English language. One systematic review, 2 RCT's and 3 quasi experimental studies were reviewed. The studies reported that MT influenced the behaviour of older people with dementia in a positive way by reducing their levels of agitation. A significant reduction in agitation levels was noted when researchers implemented participants' preferred music as their background MT and when relaxing music was played during mealtimes. However, methodological limitations were noted throughout each of the studies reviewed. These findings have direct implications for the way a multidisciplinary team could structure the environment in nursing homes and help them provide incentives to residents in order to provide interventions such as MT that optimizes engagement in persons with dementia.