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Review
A R T I C L E I N F O
A B S T R A C T
Article history:
Received 2 February 2015
Received in revised form 12 May 2015
Accepted 26 June 2015
Objective: This systematic review examines the few published studies using group music
interventions to reduce dementia-associated anxiety, the delivery of such interventions,
and proposes changes to nursing curriculum for the future.
Design: Literature review.
Methods: All quantitative studies from 1989 to 2014 were searched in CINAHL and
PubMed databases. Only published articles written in English were included. Studies
excluded were reviews, non-human subjects, reports, expert opinions, subject age less than
65, papers that were theoretical or philosophical in nature, individual music interventions,
case studies, studies without quantication of changes to anxiety, and those consisting of
less than three subjects. Components of each study are analyzed and compared to examine
the risk for bias.
Results: Eight articles met the inclusion criteria for review. Subject dementia severity ranged
from mild to severe among studies reviewed. Intervention delivery and group sizes varied
among studies. Seven reported decreases to anxiety after a group music intervention.
Conclusions: Group music interventions to treat dementia-associated anxiety is a
promising treatment. However, the small number of studies and the large variety in
methods and denitions limit our ability to draw conclusions. It appears that group size,
age of persons with dementia and standardization of the best times for treatment to effect
anxiety decreases all deserve further investigation. In addition, few studies have been
conducted in the United States. In sum, while credit is due to the nurses and music
therapists who pioneered the idea in nursing care, consideration of patient safety and
improvements in music intervention delivery training from a healthcare perspective are
needed. Finally, more research investigating resident safety and the growth of nursing
roles within various types of facilities where anxiety is highest, is necessary.
2015 Elsevier Ltd. All rights reserved.
Keywords:
Anxiety
Dementia
Music therapy
Nurses
Outcome measures
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which have led to better care-giving and social relationships (Sakamoto et al., 2013).
1.4. Group music interventions addressing anxiety in
dementia
Group music interventions involve the making of music
by two or more individuals together. Yalom (1975)
suggested that ideal groups consist of from 5 to 10 individuals. The group arrangement has been observed to
promote feelings of belonging and to provide a channel for
communication and social interaction among participants
with dementia (Ebberts, 1994; Pollack and Namazi, 1992;
Sung et al., 2006). Group music interventions is a broader
language and includes music as therapy and Music Therapy a
term which only Music Therapist claim professional
exclusivity (AMTA, 2013). Group music interventions also
produce positive mood and social behaviors in individuals
with dementia (Chu et al., 2013). A strength of group music
interventions is the group itself, which contributes to
consensual support among members and the opportunity
to socialize (Yalom, 1975). Research has shown that small
group interactions between staff and patients resulted in
easier supervision, greater likelihood of social interactions
and greater likelihood of patients making friends with one
another (McAllister and Silverman, 1999; McCracken, 1999;
Moore and Verhoef, 1999; Netten, 1993). Thus, group music
interventions have shown to be more effective in reducing
agitation, anxiety, and irritability than individual music
sessions, especially for those persons diagnosed with mild to
moderate dementia (Raglio et al., 2008; Suzuki et al., 2004).
The purpose of this systematic review is to evaluate the
strengths and weaknesses of studies using group music
interventions (which includes music as therapy and music
therapy) to reduce dementia-associated anxiety and to
guide future clinical practice. A discussion section includes
proposing changes to nursing curriculum as a precursor to
realizing the clinical guidelines.
2. Methods
All quantitative studies were searched in CINAHL and
PubMed databases using the keywords music and
dementia through mid-2014. The search of CINAHL
resulted in 379 articles and the PubMed search, 453 articles. Within CINAHL, the article search was further
narrowed using the words group music and dementia
anxiety resulting in 3 articles. All three met the criteria of
group music therapy for dementia-associated anxiety. All
453 articles in PubMed were also ltered using the words
group music and dementia anxiety resulting in
14 articles. Since few studies of group music interventions
addressing anxiety conformed to groups of 510 individuals as suggested by Yalom (1975), this review included
studies using groups of no fewer than three individuals. Of
the 14, only 6 met the criteria of having no fewer than three
individuals diagnosed with dementia in a group. Three of
these studies were duplicated in the CINAHL database
search.
To provide assurance that no other articles were
overlooked, a second and broader search was conducted
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Table 1
Summary of reviewed group music interventions on dementia-associated anxiety.
Author(s) and year
Choi et al.
(2009)
Cooke et al.
(2010)
FischerTerworth and
Probst (2011)
Raglio
et al.
(2008)
Raglio et al.
(2010)
Sung et al.
(2010)
Sung et al.
(2011)
Svansdottir and
Snaedal
(2006)
Sample size
20
n = 10 IG
47
n = 30
610
M = 7.4 IG
59
n = 30 IG
60
into groups
of 3 IG
52
n = 29 IG
55
n = 27 IG
Participants on
pharmacological
use with
intervention
Site and country
No mention
No mention
No mention
Yes
No mention
No mention
No mention
38
(groups of 3 to
4 for IG and
n = 20)
No mention
Dementia day
care unit/
South
Korea
Long term
care w/low
living ALF and
high NH care/
Queensland,
Australia
RC w/
Repeated
Measures w/
Cross-over
Design
NH/Italy
NH/Taiwan
Residential
care facility/
Taiwan
NH and
Psychogeriatric
Wards/Iceland
NR w/
Repeated
Measures &
NR by
parallelizing
of IG & CG
Mild to
moderate
dementia
GDS & MMSE
RC w/
Repeated
Measures
RC w/
Repeated
Measures
RC w/
Repeated
Measures
RC
Moderate to
severe
dementia
DSM-IV,
MMSE & CDR
Active
30 min
sessions of
3 cycles/wk.
over 4 wks
followed by
1 mo washout totaling
6 months
MT
Moderate to
severe
GDS
Dx of
dementia
NIS
Moderate or,
severe
dementia
GDS
Preferred
music
listening to
CDs over
6 weeks
(non-active
group music
intervention)
Mostly
preferred
selections.
Active
30 min
sessions 2xs/
wk over
6 wks
Active/Passive
(differed by
subject ability
to participate)
18 sessions
(3xs a week) for
30 min each
over 6 weeks
Nursing staff
(RNs and
nurse aides)
RAID
Decreased
Anxiety
Research
assistant
MT
RAID
Reduced
Anxiety
BEHAVE-AD
Decreased
Anxiety
Base = 10.04
Wk. 4 = 3.22
Wk. 6 = 3.89
P = 0.004
Mean Change
Pre tx = 1.0
Post = 0.7
4 weeks after
post = 0.8
(p < 0.01)
Type of study
NR w/
Repeated
Measures
Dx of
dementia
NIS
Type of group
music
intervention
Active
3xs/wk over
5 wks.
Early to midstage
dementia
DSM-IV
MMSE
30 min,
preferred
Active/Live
group music,
and 10 min
Active
listening over
6 mos
Delivered by
3 MTs
2 Musicians
Outcome measure
NPI-some
reduced
anxiety
Signicant anxiety
results
Pre = 1.2
Post = 0.8
p = 0.33
Repeated
Measures
w/NSCT
Dx of AD or
vascular
dementia
DSM-IV &
MMSE
Active 1xs/wk. Active
3 cycles of
45 min over
6 mos
10 sessions at
30 min each
over 4 mos
MT
Therapist,
type not
specied
RAID
NPI Reduced NPI
Measured 3xs. Anxiety
Reduced
Anxiety
Minimal
change in
anxiety levels
Base = 3.34
Mean = 6.17;
Pre M = 2.8;
7.58 and 7.50.
8 wks = 2.93
95% CI
16 wks = 2.93
t = 1.88;
4 wks post
end of
p > 05.
Post M = 1.9;
trial = 3.10
t = 1.19;
p = 0.002
p > 0.05
NPI
Decreased
Anxiety
Mean change
T0 = 2.63
T1 = 0.93
p < 0.001
Pre = 10.93
Post = 8.93
P < 0.001
M = mean; MBAC = mood behavior assessment chart; AD = Alzheimers disease; BEHAVE-AD = behavior pathology in Alzheimers disease rating scale;
CDR = clinical dementia rating; NIS = No instrument specied; DSM-IV = diagnostic and statistical manual; MMSE = mini mental state exam; GDS = global
deterioration scale; IG = intervention group; CG = control group; ABA = applied behavioral analysis; NSCT = non-standard controlled trial; RC = random
controlled; NR = non random; Dx = diagnosis.
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5. Conclusion
Clearly, as difcult as studying dementia-associated
anxiety is, there is need for more studies addressing this
problem especially in the United States. This is because
socio-cultural norms and values vary from country to
country and may play a part in the development of anxiety
in individuals diagnosed with dementia. Moreover, further
research may uncover specic effects associated with
anxiety. Pharmacological use bias interventions beyond
harmful side effects and must be accounted for in future
studies. Meanwhile, non-pharmacological interventions,
especially, group music interventions for dementia-associated anxiety point to promising treatment.
It may be that the size of the group, the age of the
persons with dementia and standardizing the best times
for treatment will inuence results; but with so little
research it is difcult to know. Credit is due to the nurses
and music therapists who pioneered the idea in nursing
care. However, consideration of patient safety and
improvements in music intervention delivery training
from a healthcare perspective are needed. It may be that
the current professional healthcare curriculum needs to be
revised to accommodate non-pharmacological interventions such as music therapy in order for professionals to
function independently. Finally, more research investigating resident safety and the growth of nursing roles within
those types of facilities where anxiety is highest, is
necessary.
Acknowledgements
Eunice Lee, RN, GNP, PhD, Associate Professor of
Nursing, University of California at Los Angeles. Thank
you for your personal assistance in the manuscript
preparation.
Conict of interest: None declared.
Funding: None declared.
Ethical approval: Not available.
References
AGS, 2012. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults. J. Am. Geriatr. Soc.
60, 616631, http://dx.doi.org/10.1111/j.1532-5415.2012.03923.x.
Ames, D., Ballard, C., Cream, J., Shah, A., Suh, G.H., McKeith, I., 2005. For
debate: should novel antipsychotics ever be used to treat the behavioural and psychological symptoms of dementia (BPSD)?
Int. Psychogeriatr. 17, 329.
AMTA, 2013. AMTA Standards of Clinical Practice. http://www.
musictherapy.org/about/standards/ (accessed 23.03.15).
Arlt, S., Lindner, R., Rosler, A., von Renteln-Kruse, W., 2008. Adherence to
medication in patients with dementia: predictors and strategies for
improvement. Drugs Aging 25 (12), 10331047, http://dx.doi.org/
10.2165/0002512-200825120-00005.
Auer, S.R., Monteiro, I.M., Reisberg, B., 1996. The empirical behavioral
pathology in Alzheimers Disease (E-BEHAVE-AD) rating scale. Int.
Psychogeriatr.
8
(2),
247266,
http://dx.doi.org/10.1017/
S1041610296002621.
Ballard, C., Waite, J., 2006. The effectiveness of atypical antipsychotics for
the treatment of aggression and psychosis in Alzheimers disease.
Cochrane Database Syst. Rev. [database online] 25, CD003476.
1783
Ballard, C., Neill, D., OBrien, J., McKeith, I.G., Ince, P., Perry, R., 2000.
Anxiety, depression and psychosis in vascular dementia: prevalence
and associations. J. Affect. Disorder 59 (2), 97106.
Ballard, C., Brown, R., Fossey, J., Douglas, S., Bradley, P., Hancock, J., James,
I.A., Juszczak, E., Bentham, P., Burns, A., Lindesay, J., Jacoby, R., OBrien,
J., Bullock, R., Johnson, T., Holmes, C., Howard, R., 2009. Brief psychosocial therapy for the treatment of agitation in Alzheimers disease
(the Calm-ad trial). Am. J. Psychiatry 17 (9), 726733.
Banerjee, S., Samsi, K., Petrie, C.D., Alvir, J., Treglia, P.M., Schwam, E.M.,
de Valle, M., 2009. What do we know about quality of life in
dementia? A review of the emerging evidence on the predictive
and explanatory value of disease specic measures of health related
quality of life in people with dementia. Int. J. Geriatr. Psychiatry
(24), 1524.
Bradford, A., Brenes, G.A., Robinson, R.A., Wilson, N., Snow, A.L., Kunik,
M.E., Calleo, J., Petersen, N.J., Stanley, M.A., Amspoker, A.B., 2013.
Concordance of self- and proxy-rated worry and anxiety symptoms in
older adults with dementia. J. Anxiety Disorders (1), 125130, http://
dx.doi.org/10.1016/j.janxdis.2012.11.001.
Bravo, G., Dubois, M.F., Paquet, M., 2004. The conduct of Canadian
researchers and institutional review boards regarding substituted
consent for research. IRB: Ethics Hum. Res. 26, 18.
Chemerinski, E., Petracca, G., Manes, F., Leiguarda, R., Starkstein, S.E.,
1998. Prevalence and correlates of anxiety in Alzheimers disease.
Depression and Anxiety 7 (4), 166170.
Choi, A., Lee, M.S., Cheong, K., Lee, J., 2009. Effects of group music
intervention on behavioral and psychological symptoms in patients
with dementia: a pilot-controlled trial. Int. J. Neurosci. (119), 471
481, http://dx.doi.org/10.1080/00207450802328136.
Chu, H., Yang, C., Lin, Y., Ou, K., Lee, T., OBrien, A.P., Chou, K., 2013. The
impact of group music therapy on depression and cognition in elderly
persons with dementia: a randomized controlled study. Biol. Res.
Nurs. 19, http://dx.doi.org/10.1177/1099800413485410.
Clark, M.E., Lipe, A.W., Bilbrey, M., 1998. Use of music to decrease
aggressive behaviors in people with dementia. J. Gerontol. Nurs. 24
(7), 1017.
Cohen, G.D., 1998. Anxiety in Alzheimers disease: theoretical and clinical
perspectives. J. Geriatr. Psychiatry 31 (2), 103132.
Cooke, M.L., Moyle, W., Shum, D.H.K., Harrison, S.D., Mureld, J.E., 2010. A
randomized controlled trial exploring the effect of music on agitated
behaviours and anxiety in older people with dementia. Aging Mental
Health 14 (8), 905916.
Cummings, J.L., 1997. The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology (48), S10S16.
Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A.,
Gornbein, J., 1994. The Neuropsychiatric Inventory: comprehensive
assessment of psychopathology in dementia. Neurology (44), 2308
2314.
Desai, A.K., Grossberg, G.T., 2001. Recognition and management of behavioural disturbances in dementia. J. Clin. Psychiatry (3), 93109.
Ebberts, A.G., 1994. The effectiveness of three types of music therapy
interventions with persons diagnosed with probable dementia of the
Alzheimers type who display agitated behaviours. Unpublished masters thesis, University of Kansas, USA. An empirical evaluation of the
global deterioration scale for staging Alzheimers disease. Am. J.
Psychiatry 149 (2), 190194.
FCA, 2006. Fact sheet: residential care options. . http://www.caregiver.org/
caregiver/jsp/print_friendly.jsp?nodeid=1742 (accessed 28.07.13).
Ferris, S.H., Mackell, J.A., Mohs, R., Schneider, L.S., Galasko, D., Whitehouse, P., Schmitt, F.A., Sano, M., Thomas, R.G., Ernesto, C., Grundman,
M., Schafer, K., Thal, L.J., 1997. A multicenter evaluation of new
treatment efcacy instruments for Alzheimers disease clinical trials:
overview and general results. Alzheimers Dis. Assoc. Disorders 11
(Suppl. 2), S1S12.
Fischer, H., 2013. Arizona legislation calls for music therapist licensing.
http://www.eastvalleytribune.com/arizona/politics/
article_99948bb2-82d7-11e2-9788-0019 (accessed 01.01.13).
Fischer-Terworth, C., Probst, P., 2011. Evaluation of a TEACCH-and music
therapy-based psychological intervention in mild to moderate dementia: a controlled trial. GeroPsychology 24 (2), 93101, http://
dx.doi.org/10.1024/1667-9647/a000037.
Frisoni, G.B., Rozzini, L., Gozzetti, A., Binetti, G., Zanetti, O., Bianchetti, A.,
Trabucchi, M., Cummings, J.L., 1999. Behavioral syndromes in Alzheimers disease: description and correlates. Dementia Geriatr. Cogn.
Disorders (10), 130138.
Galleo, J., Kunik, M.E., Reid, 2011. Characteristics of generalized anxiety
disorder in patients with dementia. Am. J. Alzheimers Dis Other
Dementias 26 (6), 492497.
Grad, R.M., 1995. Benzodiazepines for insomnia in community-dwelling
elderly: a review of benet and risk. J. Fam. Pract. 41 (5), 473481.
1784