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Literature Review: Will Music Therapy as Non-Pharmacological Intervention be Effective in Controlling Dementia-Related Agitation and Aggression in Nursing Home Residents?

According to Vink, Zuidersma, Boersma, Jonge, Zuidema & Slaets (2013), music therapy refers to using music or musical instruments such as melody, sound, rhythm, and harmony by a qualified therapist of music. Huei-Chuan, Wen-Li, Shu-Min & Smith (2011) argue that the employment of music therapy in the treatment of dementia in elderly patients has not been effective. On the other hand, Eells (2014) claims that integrating singing into music therapy is effective in treating dementia in elderly patients.

Huei-Chuan, Wen-Li, Shu-Min & Smith (2011) state that the use of music therapy in handling the issue of dementia is noninvasive and inexpensive. This argument is supported by Vasionyte & Madison (2013) who argue that music therapy is appropriate in treating dementia-related agitation as it is inexpensive and relatively easy to integrate into the routine plan of care. In addition, these researchers argue that the significance of using of music intervention in treating dementia lies in the fact that it can be implemented in various settings, including community care, acute care, and long-term care settings.

According to Eells (2014), patients with dementia are often calmer and proper adjusted when they are treated with low-tech, non-drug measures/approaches, which help in decreasing problem behaviors and promoting independence. Ridder, Stige, Ovale & Gold (2013) argue that non-pharmacologic approaches are the key to managing behavioral disturbances in patients with dementia. The precept on non-pharmacologic management is embracing the fact that individuals with dementia are no longer able to adopt and that the surrounding must be suited to the specific needs of such persons.

Raetz, 2013) claim that non-pharmacologic interventions are significant aides to psychopharmacologic agents. These interventions have been noted to be effective in dementia patients, and can be employed in handling patients who are diagnosed with dementia-related behavior disorders. The finding of Blackburn & Bradshaw (2014) also supports this finding that non-pharmacologic interventions such as music can be employed in the realization of effective treatment of dementia. However, non-pharmacological approaches are rarely embraced in clinical practice because many clinicians lack adequate knowledge on the use of these measures. As such, developing an evidence base for the efficiency and effectiveness of non-pharmacological treatments as well as education of practitioners on the use of such therapies can contribute significantly to the reduction of inappropriate use of antipsychotics in persons with dementia.

 Ragilio et al (2010) note that several non-pharmacologic interventions, such as music therapy have been discovered to the effective in treating and managing aggression and agitation in dementia.  These approaches are focused on preventing the incidence of aggressive behaviors and agitation, responding to episodes of aggressive behaviors and agitation, and reducing the duration and severity of the episode.

Music therapy has been noted to be effective in handling patients with dementia. As a therapy for dementia treatment, music therapy may take into consideration the involvement in musical activities such as playing an instrument, singing, and listening to music or songs. According to Ragilio et al (2010), patients with dementia who have undergone music therapy have been noted to show increased levels of well-being, improvements in autobiographical, and better social interaction. These improvements have been realized when music is played regularly to such patients. On the contrary, Eells (2014) notes that such improvements were not evident in dementia patients who were involved in other activities.

In a study conducted to compare three forms of interventions for individuals with abnormal vocalizations, it was noted that music therapy significantly aided in the reduction of behavior. Furthermore, in the study conducted by Ridder, Stige, Ovale & Gold (2013), it was established that a great reduction in agitation in individuals with dementia who were subjected to an individualized music program was realized, as opposed to conventional relaxation to music. As such, this researcher seem to argue that the aspect of listening to music alone is note adequate in addressing agitation issues in persons with dementia. Effective outcomes of music therapy can be realized when various measures such as singing, dancing, and playing, musical instruments are integrated.

Blackburn & Bradshaw (2014) note that when employing music therapy in addressing issues of dementia in patients it is vital for the practitioner to evaluate not only the individual’s reaction to the musical intervention, but the responses to other persons who are within the immediate surrounding and close enough to the music as well. Ragilio et al (2010) argue that several assessments should be done in relation to visual or hearing losses that can influence the person’s potential to actively involve with a musical intervention. According to Spiro (2010), impaired hearing can lead to the distortion of sound, thereby making a potential source of irritation.  Ragilio et al (2010) also point that assessment of the hearing and visual losses is essential when practitioners want to realize better outcomes using music therapy. Besides, also note that treatable causes of agitation such as noise, disruptive environmental, pain, and hunger should be done prior to the implementation of music interventions.

 From the above studies, it can be noted that all researchers agree that non-pharmacological interventions such as music are effective in the treatment of dementia. However, some researchers such as Huei-Chuan, Wen-Li, Shu-Min & Smith (2011) note that the use of music therapy in the treatment dementia cases among elderly persons is not effective. As such, furthers studies should be conducted on the effectiveness of music therapy on elderly persons suffering from dementia to help determine whether the finding of Huei-Chuan, Wen-Li, Shu-Min & Smith (2011) is justifiable. It can also be noted that researchers such as Eells (2014) point out that the use of music in treating dementia should be accompanied by other activities such as singing, and playing instruments. As such, this finding can account for the lack of effectiveness of music therapy in treating dementia among elderly patients as noted by . Considering this aspect, further research that involves music therapy alongside activities such as singing and playing instruments on elderly patients with dementia should be conducted to ascertain the effectiveness of this treatment approach. The cost effectiveness of music therapy in dementia treatment is also highlighted. The need for assessments prior to the use of music therapy in treating dementia is also emphasized.

In conclusion, it can be argued that most of the researchers seem to embrace the use of music therapy as an approach to dementia treatments. On the contrary, researchers differ from each other in terms of assessment that should be conducted prior to the use of music therapy, as well as the activities that should be incorporated in the dementia treatment involving music therapy. As such, a study that integrates music therapy and other activities such as singing, and playing instruments should be conducted.

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