Volume 6, Issue 2 (December 2020)                   Elderly Health Journal 2020, 6(2): 122-130 | Back to browse issues page

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Rebecca D, Eicher C, Ferizaj D. Evaluation of a Music Intervention on Well-being and Behavior of People with Dementia Using Dementia Care Mapping. Elderly Health Journal. 2020; 6 (2) :122-130
URL: http://ehj.ssu.ac.ir/article-1-196-en.html
Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Berlin, Germany , rebecca.dahms@charite.de
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Evaluation of a Music Intervention on Well-being and Behavior of People with Dementia Using Dementia Care Mapping

Rebecca Dahms *1 , Cornelia Eicher 1, Drin Ferizaj 1
  1. Geriatrics Research Group, Charité – Universitätsmedizin Berlin, Berlin, Germany

Article history
Received 16 Jul 2020
Accepted 5 Oct 2020


Introduction: Dementia Care Mapping (DCM) was originally developed as an observation tool to examine person-centered care in long-term care facilities and to evaluate the quality of life and well-being of people with dementia (PwD). However, the effects of a music intervention using this tool have not been investigated so far. This leads to the following research question: How does a music intervention which involves music therapy and other music-based interventions affect the observed well-being and behavior of PwD living in nursing homes?
Methods: In this 14-week, non-controlled music intervention study, data from 30 PwD aged between 52 and 97 (M = 81.4 years) were analyzed. DCM coding involves continuous observation for five hours on four days in the baseline and intervention phase. In the follow-up phase PwD were mapped on two days for five hours. The DCM method were used to measure well-being and certain behaviors of PwD.
Results: The well-being during the observation remained almost constant and corresponds to a neutral state of affect and focused contact, with no indication of positive or negative sensations. Significant improvements in certain behaviors were observed in the course from baseline to intervention phase. For example, it was shown that physical activities of the participants, such as (instructed) sports exercises, strengthening or physically challenging exercises in the intervention phase were significantly higher (M = 0.99, SD = 1.82) than at baseline phase (M = 0.00, SD = 0.00) (z = -2.37, p = .02, n = 26). Similar results were shown for expressive/creative activities or work-related activities (e.g. washing dishes).
Conclusion: In summary, it can be stated that music interventions can promote communication and movement. However, musical stimulation is not one of the essential components of improving behavioral and psychological symptoms or well-being for PwD in nursing homes.
Keywords: Dementia, Music Therapy, Behavioral Symptoms, Well-Being, Dementia Care Mapping

Copyright © 2020 Elderly Health Journal. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cite.
    Worldwide, approximately 50 million people currently suffer from dementia and this number will increase to more than 100 million by 2050 (1). Dementia is defined as a syndrome associated with a disruption of higher cortical functions (such as memory, thinking, judgment, speech, etc.) and impaired everyday functions (2). While disorders of consciousness are not present, disorders of emotional control, social behavior or motivation occasionally accompany the appearance (3).
    As dementia progresses and its severity increases, the complexity of care needs equally increases, making in-home care no longer possible. As a consequence, people with dementia (PwD) often have to move into a nursing home (4,5) which means the proportion of PwD in inpatient care facilities is growing steadily. The World Alzheimer Report from 2013 has reported four-fifths of older people in nursing homes to suffer from dementia (6). In addition, several studies have shown that PwD in nursing homes with a prevalence rate of at least 50% exhibit dementia-associated behavioral and psychological symptoms of dementia (BPSD) such as agitation, apathy, depression, disorientation, day-night rhythm disturbance and other co-existing diseases such as Parkinson's disease, which can promote dementia (7–10). These symptoms are most common, difficult to manage and have a negative impact on the functional status (limited mobility), quality of life and well-being of PwD.
    Since there are no treatments currently available to cure dementia, drug therapy is the predominant treatment for PwD, which also applies to long-term care facilities (11). In addition to drug-based dementia therapy, however, non-pharmacological therapeutic interventions such as music therapy are also recommended for psychosomatic and psychotherapeutic treatment. Music therapy or music-based interventions (supported by technology) can be used through all stages of dementia, especially in cases of severe dementia (12). Nevertheless, music therapy and music-based interventions can function as a medium for PwD to engage more physical (13) and cognitive actively with their environment as well as to improve BPSD (14, 15). Music can also assist in expressing their feelings and emotions better (16, 17). Furthermore, music therapy can help improve perceived quality of life and well-being (18, 19). Recent studies of the music and memory concept have shown that this music should be tailored to the personal needs, i.e. the musical preferences, in order to achieve the physiological, psychological and emotional impact for PwD (17, 20-23).
    In addition to music therapy as a non-drug therapy method, further psychosocial interventions in nursing practice are recommended, which on the one hand should contribute to the improvement of challenging behaviors an on the other hand should support and optimize person-centered care on the caregivers' perspective, including Dementia Care Mapping (DCM) (24–27).
    However, the effects of music therapy and music-based interventions (including technology-based interventions) based on musical preferences on PwD in nursing homes as observed by the DCM are still unknown. The following research question therefore arises: How does a music intervention involving music therapy and music-based interventions (using technology) affect the observed behavior and well-being of PwD?
Research design
    The researcher (certified study director and study staff according to the international Good Clinical Practice guidelines) conducted a non-controlled music intervention study over a period of 14 weeks in three nursing homes with PwD and their caregivers.
Data collection
    The study was divided into four study visits (see figure 1). In this paper only the results from the Demantia Care Mapping (DCM) observations of PwD were considered.
    Due to the limited ability of the PwD, prior to the start of the study, the caregivers of PwD were informed about the course and content of the study by a written and oral study information. The inclusion criteria for PwD were a clinically diagnosed dementia and they had to