The different types of music used in dementia therapy

Dementia as earlier stated is caused by a varying range of causes and Alzheimer’s disease is just one of the many causes of memory deterioration but not a description of memory deterioration which in this case we describe as dementia. Dementia is a critical and its experienced worldwide as a result of factors such as lack of proper mineral and vitamin intake, sleep deprivation among others. The most notable cause however is super-aging in the society. These conditions demand establishment of therapeutically methods to reduce symptoms of the disorders. A research was therefore done based on the assumption that music therapy would help to reduce agitation in dementia. Alzheimer is the very common source type of dementia. Alzheimer disease amounts to 60-80% of dementia cases (Alzheimer society, 2018).

According to Alzheimer disease international, 2012, 36 million people worldwide are estimated to have dementia. Recent census analysis shows that 4. 7 million people aged 65 years above in the United States have Alzheimer’s disease (Markus, 2017). This situation may at most times manifest itself in the form of aggressive behaviour exhibited by the senior citizens and directed towards their caregivers. Dementia patients have problem with performing familiar tasks. For example they can wash their clothes and forget to hang them. Poor judgement; they can put food on a cooker and forget it and even leave the house completely. Misplacing things; dementia patients might keep things in the wrong places and later finds it hard to remember where they kept them. Non pharmacological management include music therapy, pet therapy, physical activities and multi-sensory rooms.

Improvement and management of mental functioning is the key practice for people with dementia. Music therapy has been gaining interest in recent years. While it still is not conclusive that music can be used in the treatment of dementia, its use is mainly based on the observable improvement in the dementia symptoms. It has been noted to improve and even enhances interaction between caregivers and patients by improving on the cognitive abilities of the patient as well as improving their general temperament; it improves self- expression of patient as well as reduces observable instances of rapid mood changes. Research is still ongoing on the actual benefits of music therapy. Currently only music therapists can be relied on to provide an accountable audit of the effects as well designing and administering effecting therapy treatments.

It should also be understood that monitoring the effects of the therapy on a patient is also a task that requires a proper understanding of the process. Implementing the therapy effectively, monitoring client progress and tailoring the therapy to suit specific clients based on the data collected in the entire process are processes geared toward improvement of the therapy. Obtaining specific empirical and conclusive data may still be a long way coming due to the differences of responsiveness to the therapy. Agitation in dementia is considered as the main symptom giving patients distress and burden to caregivers (Brown et al. Agitation refers to motor or vocal activity of an individual leading to confusion (Cohen-Mansfield, 2011). Symptoms of agitation are; aggressive or abusive behaviour towards others or self, inappropriate behaviours that are not in line with social standards.

Woods, 2001 argues that, agitation maybe described as a reaction to psychosocial needs that are not met and therefore tries to communicate these needs and how to cope. We therefore have to focus on the cause of agitation and stuff in the nursing homes has to develop interpersonal interactions with dementia patients and understand their personal feelings (Stein-parbury et al. When the caregivers actively sing to dementia patients, the effect is increased as compared to playing pre-recorded music (Hammar et al. This approach reduces resistance and aggressiveness between the caregiver and dementia patients. Brown et al. , 2001 documented that dementia patients joins in active singing. Music therapy helps in recollection of lost memories, improves on verbally disruptive behaviours and reduces depressive symptoms. The study protocol was designed to take place in Norway and Denmark using a group of clinicians.

It was therefore easy to collect data in many nursing homes. Human Research Board of Ethics in Faculty of Humanities from Aalborg University approved the project. Recruitment of participants commenced in July/ August 2010. Data was collected in fall 2010, fall 2011 and spring 2011 in three 15 weeks periods from 14 nursing homes (10 in Norway and 4 in Denmark). The researcher conducted interviews through phones. Proxy interviews were carried out same day for each participating pair and data was collected. A clinician trained in music therapy, carried out music therapy biweekly for six weeks this totalled to 12 secessions of study. The music therapy treatment involved five types of activities: singing to unknown songs, pre-recorded music or well-known music, instrumental improvising or vocal, listening to pre-recorded or live music, moving or dancing and other activities such as going for walks, talking etc.

The clinicians were aware of three methods of apply music as therapy to patients with dementia. Frequency scale (CMAI-fr) ranged from 1-7, and the descriptive scale (CMAI-di) ranged from 1-5. Decrease in CMAI score was explained as a decreased agitation. Medicine prescription was registered in week 0 and revised at week 14. Changes in medication were recorded and corresponding dates. This included a prescription of antidepressants, antidementia and antipsychotic drugs. Randomized participants were analysed regardless of whether they were able to receive the intended music therapy. This was a conservative strategy that allowed inferences of patients that were referred to music therapy. There was transformation of difference in standard care or music therapy scores into effect sizes. The second strategy was more powerful than the first one and therefore it was used for inferential purposes.

The study evaluated all available participants regardless of whether they were able receive the whole therapy. RESULTS In the study, there was randomization of 42 participants after the collection of baseline to either music therapy (n=21) or standard care (n=21). Majority of participants from Norway (76%) and were females (69%). The age range was 66 to 96 years with 81 years being the mean age. The t-test was used to test the means difference between two groups. The following flow diagram can be used to show the participant flow. 012* Global deterioration scale 20 5. 079 Staff proxy level 21 2. 597 Agitation, frequency (CMAI-fr) 21 30. 868 Agitation disruptiveness(CMAI-di) Quality of life (ADQRL) age 21 16. 720 Medication % n n Any psychotropic medication 15 71% 15 71% Antipsychotics 7 33% 8 38% Antidementia medication 9 43% 8 38% Note pa: mean difference t-test. 80 minutes on average. Some sessions took place in participants’ living rooms and this was 77% of the total sessions.

26% of time, music therapists and participants were singing participants’, 26% of the time participants were talking or going for a walk, 24% of the time they would listen or therapists making music, 16% of the time they would be moving or dancing to music and 7% participants were improvising music. Among the music therapists, none was registered as newly educated or having little experience in music therapy. However, 29% had minimal experience working with dementia patients in dementia care. (Ridder et al. , 2013) The primary outcomes of music therapy concerning quality of life and agitation were recorded on Table 2. There was increase in agitation frequency during standard care (0. 46) as compared to during music therapy where agitation frequency decreased (-2. The difference between standard care and music therapy was -3.

First, for those who received the music therapy later), there was great improvement (disruptiveness in agitation was reduced by 8 points) than those who received its first (a small reduction from 15. This could be explained by viewing music therapy as a trial in the initial stages. Second, during standard care, patterns of change did not depend on the way standard care was received. In the course of standard care, there was difference in quality of life and agitation frequency. In this study, 71% of participants referred to music therapy were prescribed to psychotropic medication. During standard care, there was increase in psychotropic drugs as compared to during music therapy. DISCUSSION The study shows that, there was significant drop in agitation disruptiveness in dementia patients when they were subjected to music therapy as when subjected to standard care.

Moreover, there was rise in psychotropic medication in time of standard care as compared to during music therapy were psychotropic medication was not increased. Agitation behaviours are disturbing and disruptive to caregivers. Therefore, reducing disruptiveness caused by agitation, gives caretaker and easy time. CONCLUSION In this study, it was found out that, there was decreased agitation disruptiveness in dementia patients and therefore, music therapy was recommended as a valid treatment for agitation as well as reducing psychotropic medication and prevents burnouts in caregivers. Agitation in dementia patients is a serious problem worldwide leading to high levels usage of psychotropic medicines. Music is simple and affordable therapy that provide a patient with comfort, spark of identity and familiarity. Music therapy can be delivered in several ways that suits the patient and caregiver.

The positive results concerning to quality of life and agitation frequency therefore demands further study with a large sample size. London: JKP. Rolland, Y, Andrieu, S. , Crochard, A. , Goni, S. , Hein, C. Journal of Clinical Nursing, 20, 969–978. Cohen-Mansfield, J. Instruction manual for the Cohen-Mansfield Agitation Inventory (CMAI). Rockville, MD: The Research Institute of the Hebrew 5. Rabins, P. H. , de Leon, M. J. , & Crook, T. The global deterioration scale for assessment of primary degenerative dementia. , Rabins, P. V. , & Kasper, J. D. Alzheimer disease related quality of life user’s manual (2nd Ed. , Murad, H. , Regier, N. G. , Thein, K. , & Dakheel-Ali, M. London: JKP. Rolland, Y, Andrieu, S. , Crochard, A. , Goni, S. , Hein, C. , Schulz, K. F. , Montori, V. , Gøtzsche, P. C. The impact of music therapy on language functioning in dementia.