Effect Of Music Therapy On Behavioral Improvement In Dementia Patients

Dementia Care with Music Therapy

Summary Biography

choose one therapy (music therapy, pet therapy, mediation) to solve any one issue that we find from assessment. choose one of them (Agitation, depression, behavior problem) write about the issue, literature review (issue), how intervention change the sign and symptoms of the problem.

The total number of people suffering from dementia is difficult to ascertain due to the low rate of the individuals receiving formal diagnosis (Mitchell et al. 2013). However, according to Australian Department of Health (2017), dementia is the single leading cause of disability among the Australian population who are above 65. There are more than 400 00 people in Australia with dementia and out of these, 55% are men. This number is expected to increase to 500, 000 or more by the end of 2025 and 1 million by 2056.  This increase in the number of population with dementia co-relates with the total number of people who are living longer. According to Balladard et al. (2011), a significant aetiological factor of dementia is advancing with age. Alzheimer’s Society (2015) defines dementia as an umbrella term for a collection of different clinical syndromes that hampers multiple aspects of cognitive functions of a person. The main clinical manifestation of dementia includes progressive loss of memory, problems in articulating language, significant change in personality and overall reduction in the mental capacity (Balladard et al. 2011). Tom Kitwood has prominent influence in the domain of dementia care and his path-breaking work procures a theoretical framework for care plan required to address comprehensive health-care needs of people with dementia (Mc Cormack et al. 2010).

The following report aims to analyse a patient of dementia under the framework of Tom Kitwood’s Dialectical Model. Following the analysis of the patient’s need, the report will aim to analyse the effectiveness of music therapy on the overall behavioural imorvement of patient with dementia.

Sam was a 16-year old when they moved to Sydney from America with his parents and younger sister There are many memories that he had from America like his high school friends, backyards, music band and his pet dog. After emigrating, he got enrolled in a college and his holidays were spent assisting his father in his business. John’s father has a business of restaurant and his mother was a house wife. After completing his studies, Sam started assisting his father in his business. At the age of 25 years he decided to do something on his own and thus he became a phone – radio mechanic. While fixing the phone, John used to listen different types of music; it helped him to stay refreshed and concentrate in his work. During this tenure, he first met his wife, Penny; they fell in love and got married. After their second child was born, Penny gave her work as a school teacher and started looking after their children (one elder son and one younger daughter). According to John, his wife is best cook in the world and her culinary skills are better than the chef who works in their family restaurant. Sam and Penny have four grandchildren. When their grandchildren return from school, he plays with them and sings rhyme with them. After Sam retired from his job, he and his wife developed an addiction of playing cards twice a month with their common friend circle.

Assessments of Sam Needs

According to Penny, the first sign of a problem in case of Sam was expressed nearly a year ago as Sam started having difficulty with his short-term memory (age: 65). Initially Penny did not bother. According to Penny, “initially I did not find it alarming. I thought that since we are getting old, it is normal to suffer from sudden loss of memory. However, my daughter informed me that her father was facing difficulties in accumulating little things and this is not normal. She only insisted me to visit a doctor”. Doctors confirmed that Sam is suffering from the initial stage of dementia which is common at his age. However, according to Penny, Sam still remembers the lyrics of old songs which are on his favourite lists. She told, “Even in his dementia, he charisma is alive and I often start wondering whether he really has dementia?”.

The Dialectics of Dementia

The late Tom Kitwood, a lecturer and researcher of dementia at Bradford University elucidated a useful framework of reference for proper understanding the overall process of dementia that went far beyond the symptoms, signs and medical diagnosis. He frame the Dialectical Model in order to demonstrate the concepts which are involved in the dementia prognosis (Mc Cormack and Mc Cance 2010; Dewing 2008).

D= P + B + H + NA + SP

The following are the detailed explanation of the abbreviation of the formulae under the perspective of the case study

Personality (P): P reflects the personality of the person who has developed dementia. As per the case study, the social life of Mr and Penny matured after the retirement of Sam as they started playing cards with their friend twice a month. However, according to Holwerda et al. (2012), people who are suffering from dementia suffers from loneliness and not from social isolation and this further complicates the overall process of neurological disease progression. In case of Sam, his onset of dementia is making it difficult for him to participate comprehensively on the socia activity. This difficulty in participation is making his feel withdraw from the entire act. A sense of withdrawal is making him agitated. Agitation is furthering leading to lack of adequate sleep at night and thereby increasing complexity of coping.

Biography (B): Sam is earns his own living and as per the experts from his wife, he has a charismatic personality. After his retired he used to spend a significant amount of time with his grandchildren via singing rhyme and with his wife also via playing cards in team. Affect of dementia is thus not only affecting the life of Sam but also hampering the social life and peace of mind of Penny and their grandchildren.

The Dialectics of Dementia

Health Status (H): Sam due to difficulty in participating into the social activity is now facing issues with agitation. This symptom of Sam coincides with the findings of Reus et al. (2016). According to Reus et al. (2016), people who are suffering from neurological psychosis develop agitation that hampers their overall health status. In case of Sam, agitation is making his restless and this in turn is hampering his peace of mind and overall mental health. This anger and restless attitude is mainly prominent during late afternoon and during evening. This is the time, which Sam spends with his grandchildren or via playing cards.

Neurological impairment (NI): According to Richard et al. (2013), depressive symptoms are common among the majority of the population who are suffering from dementia. This depressive symptoms are associated with moderate to mild cognitive impairment along with impairment is storing and processing the information. This in turn further affects the mood and behaviour. This is exactly in the case of Sam. His inability (lack of processing information) to participate into social activities is making him agitated which is in turn is affecting mood and behaviour.

Social psychology (SP): Sam was the bread-earner of his family and his was extremely boastful about it and handled the responsibility with utter dedication. Sam’s family is aware of this thus aims to protect Sam from the sense of disempowerment or stigmatization. According to Kosmidis et al. (2012), person with dementia pass through a fragile sense of mind and this any further stigmatization with hamper the overall mental stated while accelerating the neurological impairment.

The following assessment will mainly be based on the health status needs of Sam. This is because antipsychotic medications that are used for treating depression, anxiety and agitation among the dementia patients are associated with several complications like cardiac anomalies and other infections. FDA has already issued black box warning on the use of antipsychotic medication in behavioural disorders among the older adults with dementia. Thus, effective non-pharmacological interventions will be useful in dealing with behavioural complication of aged patients with dementia.  

A review of literature was done in order to analyse whether non-pharmacological intervention via using positive music therapy have promising effect on person with dementia. It was ascertained that since Sam has natural addiction towards music, application of music therapy will help to decrease his overall tenacity of agitation and thereby improving with restlessness, insomnia and overall mental health status. The literature search was conducted through CINAHL under the application of appropriate keywords and Boolean tags.

• Dementia AND/OR Alzheimer’s disease
• Mental health AND/OR behaviour
• Older adults AND/OR aged population
• Agitation
• Music therapy
• Mood

Effectiveness of Music Therapy on Agitation in Dementia Patients

The systematic review conducted by McDermott et al. (2013) over the effect of music therapy on the people with dementia highlighted that music therapy helps in short-term mood improvement along with reduction in the behavioural disturbance. However, their systematic review failed to highlight any high-quality longitudinal studies stating the long-term benefits of music therapy on dementia. In this domain, a systematic review and meta-analysis conducted by Ueda et al. (2013) showed that music therapy has moderate effects on the behavioural symptoms, agitation and anxiety of the people with dementia. A prolong intervention of music therapy for about three months has been found to decrease the level of anxiety, restless and agitation further. The randomised control trial conducted by Ridder et al. (2013) showed that six week of music therapy is effective in reducing agitation disruptiveness among the older adults with dementia. The crossover trial of Ridder et al. (2013) conducted over 42 participants showed that there exist positive trends between dementia and music therapy. The proper yet effective application of music therapy has been found to improve the overall quality of life of the people with dementia via improving their quality sleep at night and reducing the sense of agitation. Raglio et al. (2012) used the power of review of literature to analyse the effect of music therapy on the dementia group of population. Their review which was endorsed by the Italian Psycho geriatric Association (AIP) showed that the music therapy is effective in reducing behavioural and psychological symptoms of dementia along with the improvement of the cognitive function. Johnson and Taylor (2011) aimed to identify whether using pre-recorded music induce a sense of relaxation among the patients of dementia, thereby helping them to fight with their frequent development of agitations. Their study mainly explored different articles based on the in-patient care and based on quasi-experimental format. The results revealed that the pre-recorded music during the meal-time helped in reducing the level of agitation among the patients of dementia. However, popular music with fats tempo might have negative impact of the patient. At the end, Johnson and Taylor (2011) concluded that the music preference is personal and must be assessed on an individual level. Blackburn and Bradshaw (2014) have reviewed six different studies in relation to dementia and music therapy. They elucidated that the music therapy has potential benefits in decreasing anxiety, depression and agitated behaviours among the elderly people with dementia. Blackburn and Bradshaw (2014) further opinion that the dementia helped in the improvement of the function and quality of life. Their study results coincided with the results demonstrated by Raglio et al. (2012). The randomised control trial conducted by Chu et al. (2014) stressed over the concept of the group music therapy among the dementia patients. According to them group music therapy is cost effective and in non-invasive and is effective is generating positive results among the older adults with dementia.

Conclusion

The overall research thus showed that the music therapy s effective in reducing agitation among the older adults with dementia. However, in order to reduce any form of irritability, it is crucial to elucidate what form of music is in the preference list of the target individual. The next portion of the assignment will focus on the requirement of Sam needs and while framing the plan for music therapy for Sam as a non-pharmacological intervention to reduce agitation and other behavioural problems.

Decision Making

According to Mitchell and Agnelli (2015) developing a person-centred care is an effective approach for drafting non-pharmacological interventions for patient with behavioural complications. Employing person-centred nursing framework assisted helped the healthcare professionals dealing with Sam’s care plan to frame the overall conversation in an effective way. For elements which were given importance in the overall process of conversation include pre-requisites, care-environment, person-centred processed and expected outcomes Downs and Bowers (2014). For the past one year, Sam was refusing to listen to music or to participate in social activity thus using both non-verbal and non-verbal language was crucial to understand Sam’s need. It was decided that using a time-table format will enable Sam to have proper period of rest, independence and options to participate in social activities along with time span of music therapy. Listening to favourite music was enlisted during the afternoon tenure. This is because, Sam was found to develop agitation during the late afternoon. However, during the initiation of the conversation Penny was sceptical about the success of music therapy as an intervention to reduce agitation. Proper enlightenment of penny in the domain of success of music therapy in dementia care helped her to nurture hope on this projected intervention.

Planning

Pain was ruled out as the possible cause behind John’s agitation. According to Husebo et al. (2014) physical pain is not associated with the rise of agitation among the dementia patient. It was decided that Sam will receive the music therapy in his own room. According to Dewar and Nolan (2013), delivering non-pharmacological interventions inside a comfort zone of the patient helps to achieve the desired outcomes. Dewar and Nolan (2013) further argued that environmental familiarity helps to control the behavioural stimuli in an effective way. One week before the initiation of the music therapy, no music was played and Sam’s behaviour was documented and this was later used to tally the outcomes. Sam’s non-verbal and verbal communication skills was also documented in the domain of how Sam is expression his thoughts and requirement (before the initiation of the music therapy). The Cohen-Mansfield Inventory (CMAI) was also used which helped to access the frequency of expression of agitation among the older adults (Husebo et al., 2014). The importance of recording Sam’s behaviour before and after the initiation of the therapy was important as Husebo et al. (2014) stated that it will help to elucidate the overall success of the intervention. The participating healthcare professionals were also provided proper training before the beginning of the music therapy intervention (Brooker and Latham). According to Mitchell and Agnelli (2015), reducing malignant social psychology while facilitating culture of care is important such that Sam’s need were given the first preference and not just the need to the dementia.

References

Source: Created by author

Evaluation of Criteria

In order to track the overall progression of the music therapy in the right process, a multidisciplinary team including a mental health nursing, speech therapist, psychologist and neurologist sat in a conversation with Sam and Penny in order to discuss the overall progression of the therapy process and their though-point regarding the therapy. This conversation along with the data documentation revealed that Sam used to require Olanzapine at round 5 pm in the evening in order to fight with his mood swings and agitation. According to Kales et al. (2012) Olanzapine will only found to reduce agitation partially and high dose or prolong use of Olanzapine results in accidental fall resulting in injury among the dementia individual. Penny said that Sam was about a staff during afternoon then they tried to help Sam to go to toilet and thus indicating that the agitation was becoming worse (before application of music therapy). Upon the application of music therapy for about 1 week (total tenure 3 weeks), significant decrease in the level of Sam’s agitation was documented and same was sense by Penny. Sam is now more patient, less hostile and extended a sense of co-operative gestures with the staffs. There are still certain occasions when Sam used to refuse to co-operate with the staffs but after the music therapy for about 2 weeks it was easy to negotiate with him.

As per the healthcare staffs, Sam used to have trouble in expression emotions when the agitation increases during the afternoon and thus becoming aggressive. Application of music therapy helped Sam improve on his both verbal and non-verbal communication while attaining a control over his anger. Sam would maintain eye contact while talking is more relaxed and humbled while interaction with others (post 3 weeks of music therapy). The dose of Olanzapine was reduce and the severity of insomnia along with agitation was also decreased, Sam recorded that he is now happy and listening to music makes him more happy.

A CMAI was performed before music intervention enabling the baseline score and a highlight of common behaviour displayed by Sam. The CMAI showed that before the initiation of the music therapy, Sam was more physically and verbally aggressive. Under physical aggression, Sam was found like pushing and hurting other and in verbal aggression; Sam was found screaming at the staffs. After the application of the music therapy (pre-recorded) for three weeks in Sam’s room showed reduction in the verbal and physical aggression among Sam.

Implementation for Practise

Overall procedure of the implementation of music therapy over Sam showed that education of the staffs who are procuring the therapy is essential for the overall success of the therapy. This again goes with the findings of Dewar and Nolan (2013) which revealed that proper trained nursing professionals are essential to ensure the success of the overall non-pharmacological intervention. Furthermore, implementation of the intervention and ascertaining its overall success require weekly monitoring. Bunt, Hoskyns and Swami (2013) stated that period monitoring helps to track the success rate of the intervention. Not only monitoring, but the success of the intervention also depends on framing of the intervention based on the module of the person-centred care. According to Mitchell and Agnelli (2015) person-centred care in dementia care plan deals with the in-corporation of both the patient and their family members in the process of effective decision making. The person-centred care plan also emphasised on the avoidance of the disempowering Sam. According to Downs and Bowers (2014), rather than assuming that the person suffering from dementia has lost all the decision making skills, it is required to project the treatment in such a manner that their decision gets importance and counted.

Conclusion

Thus from the above discussion it can be concluded that the music therapy is an effective non-pharmacological intervention in the dementia care for older adults. However, proper follow, in-corporation of the trained nursing professionals, person-centred care approach along with the use of the CMAI index is crucial in designing the intervention. The overall analysis of the case study and evaluation of the profession showed that Saman older adult who is 65 years old showed significant improvement in the agitation control along with behavioural issues under the 3-week application of the music therapy.

References

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