Karima Gulwani, DNP, AGNP-BC

Abstract:

Purpose: To examine the use of music therapy in nursing home (NH) residents living with dementia with agitation and aggressive behaviors and receiving as needed psychotropic medications.

Background: Agitation and aggressive behaviors associated with dementia occur in 15 to 20% of NH residents. In California, 14% of NH residents with dementia and related behavioral symptoms receive psychotropic medications despite an increased risk of side effects which can lead to falls and injury. Providers often prescribe psychotropic medications as first-line treatment for symptoms associated with dementia. Non-pharmacological approaches such as music therapy may improve dementia-related behaviors and decrease the use of psychotropic medications among residents with dementia.

Methods: This was a pretest-posttest quality improvement project with two-weeks pre-intervention and eight weeks of intervention in a single NH. Ten NH residents experiencing dementia with associated agitation and aggressive behaviors and on as needed psychotropic medications were recruited. They participated in twice-weekly, 30-minute, individualized passive music therapy delivered with MP3 device players and headphones. Residents and family were contacted to determine music choices. Prior to intervention, one 60-minute training session was provided to nursing and activity staff. Participants’ demographic and medical information were collected from electronic medical records and the most recent Minimum Data Set 3.0. Pre-intervention and intervention data on frequency and severity of agitated and aggressive behaviors and frequency of as needed psychotropic medication administration was collected from medication administration records (MAR) and an investigator-developed behavior monitoring tool (IDBM). Mean frequencies of as needed psychotropic medications, agitation and aggressive behaviors and mean severity level for agitation and aggressive behaviors pre-intervention and post-intervention were compared from the MAR and from the MDS using t-tests.

Results: A total of 10 residents participated in the study (n=5 women) with a mean age of 80 years (standard deviation [SD] 10.9). There was a significant decrease in agitation frequency from pre-intervention (17.0, SD 6.9) to post-intervention (6.28, SD 4.6) (p=.005) and agitation severity also decreased but not significantly from pre-intervention (26.8, SD 12.11) to post-intervention (15.2, SD 9.85) (p=.10). Pre-intervention aggression frequency significantly decreased post-intervention (15.2, SD 9.85 versus 6.5, SD 4.5; p= .01) and aggression severity also decreased post-intervention (26.6, SD 9.0 versus 9.0, SD 9.7; p=.02). Use of psychotropic medications decreased but not significantly and there was wide variation in psychotropic medication administration.

Conclusion: The results of the project affirmed low-cost passive music therapy twice weekly for 30 minutes significantly reduced aggression and agitation frequency and aggression severity. This project provides a systematic approach in use of music therapy in the management of the behavioral symptoms associated with dementia. The results of the project will contribute towards future research.

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