Date of Award

2014

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

Faculty

Faculty of Health, Engineering and Science

First Supervisor

Anne Wilkinson

Second Supervisor

Anne Williams

Abstract

There is an increasing body of research evidence to support the use of music as a therapeutic modality in reducing the agitated behaviour frequently associated with late-stage dementia. Although much of this evidence suggests that music interventions are most effective when they are “individualized”, this type of intervention is often difficult to implement in large, busy, aged care facilities where residents may be located together in communal areas during the day. The challenge therefore is to try and identify a particular musical genre which, when played as “ambient” or “background” music, demonstrates a consistent capacity to reduce agitated behaviour in late-stage dementia across resident populations in multiple facilities. This study was designed to test the comparative utility of three different types of background music identified in the existing research literature as being of possible benefit in this context. These three types of music were: gentle classical music, familiar music and baroque music.

Using a sample of 65 older people with late-stage dementia living in a total of eight residential aged care facilities, this quasi-experimental study used quantitative measures to assess a specific range of agitated behaviours over a one week intervention period. The specific agitated behaviours were documented using the Scale for the Observation of Agitation in Persons with Dementia (SOAP-D) scale (Hurley, Volicer, Camberg, Ashley, Woods, Odenheimer, Ooi, McIntyre, & Mahoney, 1999). In addition, the Quality of Life in Alzheimer’s Disease (QoL-AD) tool (Logsdon, 1999) was used to collect collateral information from family members or experienced care staff at each of the participating facilities about whether they perceived that the playing of music exerted any influence on the quality of life of participants.

Participants were randomly assigned to one of five experimental subgroups of equal size. Participants in three of the five groups received exposure to audio recordings of music. Participants in one of the two remaining sub-groups were exposed to a non-musical intervention (audio recordings of storybooks) at the same time of day as the participants in the three music groups. Data relating to behaviour and perceived quality of life were recorded in the same manner for this group. The final group of participants acted as the control group for the study. Quantitative data were collected in the same manner for this group: however, they were exposed to no intervention.

In addition, a series of structured interviews was undertaken with experienced care providers at each of the participating residential aged care facilities. The purpose of this procedure was to determine whether the experiences and subjective opinions of staff regarding the utility of music as an intervention to settle agitated behaviour in late-stage dementia and improve quality of life were consistent with the observational data recorded using the SOAP-D scale in conjunction with the proxy-rated QoL-AD scale.

Results of the study indicated that overall levels of agitated behaviour were less within the three groups exposed to music compared with the nonmusic intervention group and the control. However, perceived quality of life was not measurably improved in any of the three music intervention groups. This study supports the continued use of music as a therapeutic intervention in the management of maladaptive behaviour associated with late-stage dementia, although the results do not support the preferential use of any of the three selected music forms.

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