A new study has found that nursing homes that implemented an individualized music program to help seniors cope with Alzheimer’s disease and related dementias found success, with fewer residents exhibiting disruptive behaviors, as well as fewer residents on antipsychotic and antianxiety medications.
However, according to researchers at Brown University, the program, called MUSIC & MEMORY, did not produce a significant improvement in mood.
“This is promising,” said co-lead author Rosa Baier, M.P.H., an associate professor of practice at the Brown University School of Public Health. “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 Dr. Kali Thomas, an assistant professor of health services, policy and practice at Brown.
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, such as Merle Haggard and Johnny Cash.
“When we put the earphones on him, his breathing relaxed and his grimaced face relaxed,” Thomas said.
To better understand how widespread such effects may be and how they might become clinically meaningful, the researchers designed the new evaluation to test the program’s effects with greater national breadth and statistical rigor than previous study designs.
The work was part of the mission of Brown’s Center for Long-Term Care Quality and Innovation, which tests interventions to improve post-acute and long-term care that appear promising, but haven’t yet been rigorously evaluated, said Baier, the center’s associate director.
To evaluate the program, the research team identified 98 nursing homes that had received formal training in the MUSIC & MEMORY program during 2013 and then assembled a list of similar nursing homes, accounting for Medicare quality rating, geography, the age mix of residents, and other factors, that did not implement the program. The researchers included in the study all residents in each kind of home who had dementia and cognitive impairment, but who were not receiving hospice care and were not comatose.
In all, 12,905 such residents lived in homes with the program, while 12,811 residents lived in nursing homes that did not offer it.
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, they did find that:
- 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. In non-program homes the rate fell to 20 percent after 2013 compared to 24.8 percent before.
- Behavior 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.
Behavioral improvements not only help the dementia 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.
Thomas and Baier acknowledge there are limitations in their study. Because they did not track everything each nursing home might be doing to achieve these care improvements, they can’t be sure that all the improvements resulted from MUSIC & MEMORY.
On the other hand, because the researchers didn’t know which or how many program home residents actually received the intervention, they had to assume that every eligible resident did. Since it might be that only a fraction of residents actually received the interventions in program homes, the results of the study might be understated because they are “diluted” by people who were assumed to receive the intervention but did not.
“In other words, the program may have an even greater impact than reported,” Baier said.
The study was published in the American Journal of Geriatric Psychiatry.
Source: Brown University