Abstract
Clinicians have, over the years, recognized and utilized the therapeutic properties of music in alleviating the psychological and behavioral symptoms of dementia for patients and their caregivers. Dementia encompasses a range of conditions and diseases characterized by the progressive impairment and deterioration of a person’s cognitive domains. Without a cure or treatment available, various non-pharmacological interventions are necessary to optimize the effectiveness of the provided remedies and enhance the well-being of the patients and their carers. Numerous studies have enumerated music therapy’s cognitive and behavioral benefits, mainly when listening or singing is offered in group settings. Such interventions provide a wide range of behavioral, cognitive, and psychosocial advantages to patients. The therapy also enhances the mutuality of communication between clinicians and their clients, increases engagement, and reduces stress levels. This paper explores the clinical effectiveness of music therapy in mitigating the behavioral and psychological effects of dementia on patients and caregivers by reviewing the available quantitative and qualitative literature.
Introduction
Dementia ranks prominently among the most prevalent neurocognitive impairments and is a primary cause of disability, mortality, and dependency. The absence of an effective treatment modality for the disorder has necessitated the development of innovative interventions to assist patients and their caregivers in managing the progressive psychological and behavioral deterioration associated with the condition. The aim of undertaking this literature review is to establish the effectiveness of music therapy in helping people living with dementia and their carers cope with the condition and alleviate the symptoms’ severity. The analysis will evaluate quantitative and qualitative research articles to illuminate the effectiveness of singing and listening to music as a non-pharmacological intervention for dementia patients and their carers.
Background
Historically, healthcare professionals have exploited music’s therapeutic qualities and integrated them to treat and assist patients with mental illnesses. They have used it to improve the health outcomes of their patients, especially in the management and alleviation of the behavioral and psychological symptoms generated by dementia. Montinari et al. (2018) note that music, as a therapeutic intervention, has been used across civilizations for promoting mental and physical healing. Music therapists help caregivers release stress, enhance patient engagement, and promote a mutuality of communication, which significantly stimulates their cognitive, behavioral, and psychosocial wellbeing.
Problem Statement
The problem explored by this literature review is the effects of music therapy on the psychological and behavioral symptoms of patients living with dementia and their caregivers. The analysis will specifically address music’s benefits as a clinical intervention for mentally ill people and those who provide care. The review aims to gain an in-depth understanding and expand the existing knowledge on the therapeutic effects of music in promoting the overall well-being of nurses and alleviating dementia’s adverse behavioral and psychological symptoms. The insights gained are critical in developing future clinical interventions for managing symptoms and enhancing the accomplishment of positive outcomes for the patient and caregivers.
Literature Review
Dementia patients experience reduced quality of life due to the psychological and behavioral symptoms associated with the condition. The neurological disorder is characterized by the progressive deterioration and impairment of a person’s emotional, cognitive, social, and behavioral functions. The available pharmacological interventions have limited effectiveness in treating numerous aspects and features of the disease. However, other treatment modalities, such as music therapy, have proven effective in decelerating the cognitive decline and significantly restoring standard body functionalities. Further, interactive music sessions accompanied by activities such as dancing and clapping have demonstrated higher efficacy than passive listening.
Effects of Music on Emotional Functionality in Dementia Patients and their Caregivers
Listening and actively participating in music boosts mood, reduces agitation, and promotes emotional stability among dementia patients and their caregivers. A qualitative study exploring the impacts of music therapy-singing group of 37 participants showed that such interventions have multifaceted benefits to the patients and caregivers (Cho, 2018). The survey demonstrated that music experiences significantly promote emotional functionality and stability among the patient and caregivers due to the fulfillment and enjoyment resulting from active engagement. This study provides valuable insights regarding the profoundness and significance of the shared interactions, which activate the patient and carers’ reward system, promoting their positive feelings and overall wellbeing. Although this survey involved a relatively small sample, the findings’ integrity was adversely affected by the reliance on the participants’ self-reports, which was a significant flaw.
Moreover, music as a treatment option deepens social inclusion and positively impacts relationships, resulting in mutually gratifying and fulfilling interactions. Osman et al. (2016) posit that singing for dementia patients is a suitable and effective psychosocial intervention that benefits caregivers, particularly in easing stress, burnout, and mental and emotional exhaustion. A qualitative study involving 20 respondents established that music integration as a therapy enriched the thoughts, emotions, memories, and diagnosis acceptance by the patients and significantly alleviated caregivers’ burden. Sarkamo et al. (2016) noted that singing and music listening improved the caregivers’ and patients’ scores for emotional wellbeing. Although the small sample used by the researchers considerably reduces the study’s statistical power, it provides critical insights into the dual benefits of music in dementia treatment.
Further, dementia is a degenerative disease characterized by the progressive deterioration of its clinical manifestations. This implies that it is critical for clinicians and caregivers to implement a treatment modality that slows the decline of functionality. Sakamoto et al. (2013) contend that interactive music therapy is a more effective and beneficial intervention for alleviating the severity of symptoms. A qualitative study conducted on 39 people with severe Alzheimer’s disease showed that interactive music sessions significantly improved the patients’ emotional states. Although the experiment lasted for a few weeks and utilized a small sample size, it showed a long-term reduction in the condition’s clinical indications among the participants, including the restoration of emotional and cognitive functions. These findings are corroborated by King et al. (2019), who asserts that integrating music into the therapy for dementia plays an influential role in restoring and enhancing the effectiveness of brain function. The registered improvements in the reduction of symptom severity positively impact the caregivers’ wellbeing. The studies explored heterogeneous musical therapies, indicating the general effectiveness and benefits of singing and listening to music for carers and patients in reducing stress and reinforcing their emotional sturdiness.
Impacts of Music on the Cognitive Functionality of Dementia Patients and Carers
Various findings suggest that music therapy positively impacts cognition, particularly in patients with Alzheimer’s disease. Moreira et al. (2018) argue that singing and listening to music effectively restores memory, attention, and other cognitive functionalities. For instance, a mixed-method study conducted by Cunningham et al. (2019) on 14 respondents demonstrated the remarkable positive influence of music on patients and their caregivers on the quality of life and improved memory scales. Another quantitative survey finding involving 27 dementia patients revealed improved overall cognitive operations and mental skills as measured by the mini-mental state examination tool. Although the low sample size could adversely impact the statistical power of these two studies, they provide valuable insights into the effectiveness of music therapy in reducing cognitive deterioration in patients with Alzheimer’s.
Moreover, music boosts all the subdomains of cognitive functionality, including attention, verbal fluency, visuospatial, and language skills. A quantitative survey of 20 dementia patients demonstrated significantly restored cognition among the respondents who participated in the study (Brancatisano et al., 2019). In the survey, nine of the participants recorded improved attention while none showed any deterioration. In another quantitative experiment, individualized music sessions resulted in a remarkable decline in the number of dementia patients enrolled for antipsychotic and anxiolytic drugs, indicating the intervention’s effectiveness in improving respondents’ cognitive wellbeing (Thomas et al., 2017). Although this study involved a substantial sample size, the researchers could not control any differences, which could have impacted the outcomes.
Effects of Music Therapy on Behavioral Symptoms of Dementia
Dementia is associated with numerous behavioral signs and clinical indications, such as disinhibition, anxiety, psychosis, agitation, aggression, and sleep disorders. A quantitative study involving 42 patients demonstrated the significant effectiveness of music therapy in alleviating language disorders, hallucinations, irritability, delirium, and the patients’ inability to suppress unwanted or inappropriate behavior (Gallego & Garcia, 2017). Although this study produces insightful and vital findings, its integrity and statistical strength could be negatively affected by the small sample size and the brevity of the intervention. A randomized controlled, mixed-method survey involving 27 patients with moderate and severe dementia showed that music therapy considerably reduced psycho-behavioral disturbances among the participants (Pigliautile et al., 2019). For instance, some respondents registered improvements in declined verbal aggression and repetitive actions, further affirming the clinical effectiveness of singing and listening to music. This study yields practical insights which can be applied as an alternative treatment modality for dementia. However, the integrity, generalizability, and probity of this survey are substantially eroded by the heterogeneity of the respondents and the small sample size.
Further, caregivers of dementia patients experience high levels of burden, potentially exposing them to increased risk of diseases, including chronic stress, clinical depression, anxiety, and exhaustion. The results of a quantitative survey in which 75 people participated evaluated the effectiveness of music therapy in reducing the carers’ burden. The findings showed that the classical Turkish music intervention considerably reduced the caregivers’ burden and enhanced the regulation of patients’ blood pressure (Ugur et al., 2019). This study generates valuable illumination and reinforces the clinical benefits of music to dementia patients and their caregivers. Although the integrity of the results could be negatively affected by the relatively small sample, the duration of the study, which lasted for one year, enhances the validity of the outcomes. These findings are corroborated by a study involving 48 patients and caregivers evaluating the therapeutic implications of music in reducing apathy and depression. Overall, the study showed a negative causal relationship between music intervention, apathy, depressive symptoms, and general carers’ burden (Massaia et al., 2018). However, the integrity of this experiment is adversely affected by the inconclusive nature, particularly regarding whether the registered benefits were long-term.
Summary
Although the global disease burden for dementia continues to grow, there is no effective pharmacological intervention to help patients manage behavioral and psychological symptoms. However, clinicians and caregivers are increasingly adopting music as an alternative treatment option and therapeutic intervention. Multiple studies have demonstrated the effectiveness of this strategy in decelerating the progression of behavioral and psychological symptoms and reducing their severity. Notably, music therapy is also beneficial to caregivers as it decreases the associated stress, burnout, and emotional exhaustion.
Implications
This study’s overall clinical implication is that despite the absence of an effective pharmacological intervention for dementia, musical therapy should be viewed as an alternative treatment option for the condition. Additionally, the survey recommends implementing interactive music sessions to ensure the realization of maximum benefits for the patients and caregivers. Generally, people living with dementia should join a music therapy program following a conclusive diagnosis confirming the condition. This will be critical in delaying the onset of the debilitating clinical manifestations and symptoms. These findings underscore the essence of widespread surveys utilizing consistent methods and approaches targeted to homogenous caregivers and dementia patients. Another implication of these studies, experiments, and results is that music therapy in dementia treatment is still a largely understudied subject. This has substantially contributed to the generation of inconclusive or indefinite inferences and deductions.
Ideas for Future Research
Future qualitative and quantitative research should explore the therapy’s effectiveness in alleviating dementia symptoms using consistent methods, standardized music, and relatively large sample sizes. A specific approach under the quantitative method should encompass an experimental technique to establish the overall effectiveness of a particular music genre on an identified clinical manifestation, such as the improved memory retention scale. Similarly, qualitative research should evaluate the patients’ and caregivers’ perception of music therapy and how that opinion impacts the intervention’s overall effectiveness. These studies would advance the existing knowledge on the subject and illuminate specific areas of music therapy in dementia treatment.
Conclusion
The therapeutic properties of music are a valuable and powerful tool in the care and treatment of persons with dementia. Overall, Osman and colleagues’ qualitative research provides the most significant and insightful contribution as it simultaneously explores the benefits of music therapy to patients and caregivers. However, the absence of a consistent methodological approach, standardized music and low sample size in the studies adversely impact the generalizability, statistical power, and overall validity of the studies.
References
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