Feasibility of an Individualized Music Intervention for Agitation in Persons with Alzheimer's Disease and Related Disorders

2.50
Hdl Handle:
http://hdl.handle.net/10755/152636
Type:
Presentation
Title:
Feasibility of an Individualized Music Intervention for Agitation in Persons with Alzheimer's Disease and Related Disorders
Abstract:
Feasibility of an Individualized Music Intervention for Agitation in Persons with Alzheimer's Disease and Related Disorders
Conference Sponsor:Sigma Theta Tau International
Conference Year:2002
Conference Date:July, 2002
Author:Gerdner, Linda, PhD
P.I. Institution Name:University of Minnesota
Title:Assistant Professor
Objective: This pilot study evaluated the feasibility of individualized music, as an alternative intervention, in the management of agitation in persons with Alzheimer's disease and related disorders (ADRD) when implemented by trained staff and family members. Design: Pre-experimental pretest/post-test in which subjects served as their own control. Sample: The nonprobability convenience sample consisted of 7 White and 1 African-American female (mean age 83.3 years) residing in a long-term care facility in central Arkansas. All had ADRD with severe cognitive impairment and exhibited agitation. Subjects could hear a normal speaking voice at a distance of 1-1/2 feet and had no obvious signs of pain or infection. Written consent was obtained from the legally authorized representative. Concept/Intervention: ADRD is accompanied by agitation in 70-90% of individuals. Agitation has been correlated with an increased incidence of falls, delayed onset of sleep, and disruption of nighttime sleep in persons with ADRD. These behaviors often lead to placement in long-term care when family members are no longer able to cope. Certified nursing assistants (CNAs) provide 90% of personal care in these facilities. Limitations and concerns related to the traditional management of agitation (i.e., chemical and physical restraints) have lead to research on behavioral interventions for managing agitation. The behavioral intervention which has the most research based evidence regarding its efficacy is the use of music. It is theorized that individualized music or music that is based on personal preference will provide the opportunity to stimulate remote memory. The elicitation of memories associated with positive feelings will have a soothing effect on the person with dementia, which in turn will prevent or alleviate agitation. Given its efficacy when implemented by research staff, it is now important to evaluate the feasibility when implementation by trained nursing home staff and family members. Methods: Baseline data was collected by CNAs over a four-week period using the Cohen-Mansfield Agitation Inventory (CMAI) to determine the overall level of agitation on day and evening shifts. Following this period, the investigator conducted a structured education program on individualized music for persons with ADRD to nursing staff (RNs, LPNs, CNAs) and family members of subjects enrolled in this pilot study. To promote and sustain the use of this intervention, an experiential method of learning was used. Each participating staff and family member received a $15 gift certificate to purchase an audiocassette or compact disc of preferred music. A portable stereo sound system was placed in the employee lounge to promote personal use of music for relaxation during breaks. Following the training session, family members completed the Assessment of Music Preference to determine music selection for the subject. Trained CNAs administered individualized music as an alternative intervention for agitation during the subsequent two months. Music was presented "free field" on a portable audio cassette player for 30 minutes daily at a time selected to precede the subject's peak level of agitation. Individualized music was also implemented on an "as needed" basis by staff and family, when the subject began exhibiting anxious or agitated behaviors. The Engagement In Music Inventory (EMI), a visual analog scale of 1 to 10, was used to evaluate the perceived degree of agitation immediately before and after the intervention. The CMAI was completed weekly, during the two month intervention period. In addition, staff and family were interviewed to identify barriers and facilitators for implementing this intervention. Findings: The compliance rate of this intervention by CNAs was 97.8%. Analysis of variance for a mixed effects repeated measures model showed a significant reduction in agitation (p<0.0001) during the eight week intervention period using the EMI. A significant reduction in the overall level of agitation was noted on the day shift during weeks 1-4 (p<0.0001) and weeks 5-8 (p<0.0001). A significant reduction was noted on evening shift during weeks 5-8 (p<0.005), but not during weeks 1-4 (p<0.171). Conclusions: CNAs and family members enjoyed playing music and the subject's response. Head phones were used on one subject when it was discovered that the selected music annoyed to her roomate. Future research is warrented using a larger sample size to expand generalizability. Implications: Music preference may be incorporated into the assessment of each patient. Information can be enhanced by collaborating with family. Use of individualized music as an alternative approach to the management of agitation is relatively inexpensive and requires minimal time expenditure.

Repository Posting Date:
26-Oct-2011
Date of Publication:
Jul-2002
Sponsors:
Sigma Theta Tau International

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFeasibility of an Individualized Music Intervention for Agitation in Persons with Alzheimer's Disease and Related Disordersen_GB
dc.identifier.urihttp://hdl.handle.net/10755/152636-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Feasibility of an Individualized Music Intervention for Agitation in Persons with Alzheimer's Disease and Related Disorders</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Sigma Theta Tau International</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2002</td></tr><tr class="item-conference-date"><td class="label">Conference Date:</td><td class="value">July, 2002</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Gerdner, Linda, PhD</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Minnesota</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">gerdn001@umn.edu</td></tr><tr><td colspan="2" class="item-abstract">Objective: This pilot study evaluated the feasibility of individualized music, as an alternative intervention, in the management of agitation in persons with Alzheimer's disease and related disorders (ADRD) when implemented by trained staff and family members. Design: Pre-experimental pretest/post-test in which subjects served as their own control. Sample: The nonprobability convenience sample consisted of 7 White and 1 African-American female (mean age 83.3 years) residing in a long-term care facility in central Arkansas. All had ADRD with severe cognitive impairment and exhibited agitation. Subjects could hear a normal speaking voice at a distance of 1-1/2 feet and had no obvious signs of pain or infection. Written consent was obtained from the legally authorized representative. Concept/Intervention: ADRD is accompanied by agitation in 70-90% of individuals. Agitation has been correlated with an increased incidence of falls, delayed onset of sleep, and disruption of nighttime sleep in persons with ADRD. These behaviors often lead to placement in long-term care when family members are no longer able to cope. Certified nursing assistants (CNAs) provide 90% of personal care in these facilities. Limitations and concerns related to the traditional management of agitation (i.e., chemical and physical restraints) have lead to research on behavioral interventions for managing agitation. The behavioral intervention which has the most research based evidence regarding its efficacy is the use of music. It is theorized that individualized music or music that is based on personal preference will provide the opportunity to stimulate remote memory. The elicitation of memories associated with positive feelings will have a soothing effect on the person with dementia, which in turn will prevent or alleviate agitation. Given its efficacy when implemented by research staff, it is now important to evaluate the feasibility when implementation by trained nursing home staff and family members. Methods: Baseline data was collected by CNAs over a four-week period using the Cohen-Mansfield Agitation Inventory (CMAI) to determine the overall level of agitation on day and evening shifts. Following this period, the investigator conducted a structured education program on individualized music for persons with ADRD to nursing staff (RNs, LPNs, CNAs) and family members of subjects enrolled in this pilot study. To promote and sustain the use of this intervention, an experiential method of learning was used. Each participating staff and family member received a $15 gift certificate to purchase an audiocassette or compact disc of preferred music. A portable stereo sound system was placed in the employee lounge to promote personal use of music for relaxation during breaks. Following the training session, family members completed the Assessment of Music Preference to determine music selection for the subject. Trained CNAs administered individualized music as an alternative intervention for agitation during the subsequent two months. Music was presented &quot;free field&quot; on a portable audio cassette player for 30 minutes daily at a time selected to precede the subject's peak level of agitation. Individualized music was also implemented on an &quot;as needed&quot; basis by staff and family, when the subject began exhibiting anxious or agitated behaviors. The Engagement In Music Inventory (EMI), a visual analog scale of 1 to 10, was used to evaluate the perceived degree of agitation immediately before and after the intervention. The CMAI was completed weekly, during the two month intervention period. In addition, staff and family were interviewed to identify barriers and facilitators for implementing this intervention. Findings: The compliance rate of this intervention by CNAs was 97.8%. Analysis of variance for a mixed effects repeated measures model showed a significant reduction in agitation (p&lt;0.0001) during the eight week intervention period using the EMI. A significant reduction in the overall level of agitation was noted on the day shift during weeks 1-4 (p&lt;0.0001) and weeks 5-8 (p&lt;0.0001). A significant reduction was noted on evening shift during weeks 5-8 (p&lt;0.005), but not during weeks 1-4 (p&lt;0.171). Conclusions: CNAs and family members enjoyed playing music and the subject's response. Head phones were used on one subject when it was discovered that the selected music annoyed to her roomate. Future research is warrented using a larger sample size to expand generalizability. Implications: Music preference may be incorporated into the assessment of each patient. Information can be enhanced by collaborating with family. Use of individualized music as an alternative approach to the management of agitation is relatively inexpensive and requires minimal time expenditure.<br/><br/></td></tr></table>en_GB
dc.date.available2011-10-26T11:43:48Z-
dc.date.issued2002-07en_GB
dc.date.accessioned2011-10-26T11:43:48Z-
dc.description.sponsorshipSigma Theta Tau Internationalen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.