Music can be a cheap and easy way to provide relief to the nursing home residents coping with Alzheimer's disease and related dementias.
Now nursing home employees and families can look to the results of the first national study to compare key outcomes in homes that implemented an individualized music program called MUSIC & MEMORY with similar homes that did not adopt the program.
The Brown University evaluation found that after homes adopted the program, residents with dementia became significantly more likely to discontinue antipsychotic and anti-anxiety medications and significantly less likely to engage in disruptive behaviours, compared to those residing in homes used for comparison. But the study of more than 25,000 residents in 196 nursing homes did not identify a significant improvement in mood.
"This is promising," said co-lead author Rosa Baier. "It's a first step to understanding that there may be improvements that can be attributed to this intervention."
Baier noted that many gerontology experts and advocates for patients have called for ways to reduce the use of antipsychotic and antianxiety medications through a national campaign led by Medicare.
"Providers are looking for non-pharmacologic interventions to address dementia behaviors," she said. "This adds to the evidence base that can help improve patient care for these residents."
The study's findings also reinforce personal reports among caregivers and family members, including those presented in the documentary "Alive Inside," suggesting that personalized music helps patients even when their dementia is highly advanced, said co-lead author Kali Thomas.
Thomas, who directed the study's evaluation, said her family tried a custom playlist with an uncle with dementia and saw him appear more at ease after listening to his favorite music, including from artists Merle Haggard and Johnny Cash.
"When we put the earphones on him, his breathing relaxed and his grimaced face relaxed," Thomas said.
Using federal Medicare and nursing home data, the researchers then compared the before-2013-and-after changes among residents in each group on four metrics: ending antipsychotic medication, ending antianxiety medication, reductions in disruptive behavior and improvement in mood. While there were no significant differences in mood, here's what they found otherwise:
Antipsychotics: The rate of discontinuing these medications rose to 20.1 percent of program home residents after implementation in 2013 compared to 17.6 percent in a similar period before. By comparison, in non-program homes, the rate stayed flat: 15.2 discontinued after 2013 while 15.9 percent discontinued before.
Antianxiety: The discontinuation rate rose to 24.4 percent after MUSIC & MEMORY implementation in program homes, compared to 23.5 percent before, but in non-program homes the rate fell to 20.0 percent after 2013 compared to 24.8 percent before.
Behaviour improvement: The rate of reduction in behavior problems increased to 56.5 percent in program homes from 50.9 percent before the program. In non-program homes the rate stayed flat at 55.9 percent after and 55.8 before.
Behavioural improvements not only help the individual patients, Thomas said, but also enhance quality of life for the residents around them and the morale of nursing home staff.
"Research suggests there is a relationship between nursing staff turnover and residents' behaviors," Thomas said.
To improve their evaluation, Baier, Thomas and their colleagues plan to conduct a second study in which they will randomize some homes to implement the program and some comparison homes to continue without it. By randomizing and collecting data about how the program is implemented, they'll be able to account for the current limitations. They have applied for funding to proceed.
The study appears in the journal American Journal of Geriatric Psychiatry. (ANI)
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