Individual music therapy for managing neuropsychiatric symptoms in dementia care homes

Previous research highlights the importance of staff involvement in psychosocial interventions targeting neuropsychiatric symptoms of dementia. Music therapy has shown potential effects, but it is not clear how this intervention can be programmed to involve care staff within the delivery of patients‘ care. There is also a paucity of research into the mechanism of music therapy sessions and the role of music therapists within the context of care. This study reports initial feasibility and outcomes from a five month music therapy programme, which included weekly individual active music therapy for people with dementia and weekly post-therapy video presentations for their carers in care homes. Furthermore, the study employed video analysis to explore the core components of individual music therapy sessions and how these components impact on symptoms. A mixed-methods research design was employed throughout this two-phased study. The first phase involved a randomised controlled feasibility study. 17 care home residents and 10 care staff were randomised to the music therapy intervention group or standard care control group. The feasibility study included baseline, 3-month, 5-month and postintervention 7-month measures of residents‘ symptoms and well-being. Carer-resident interactions were also assessed. Feasibility was based on carers‘ feedback through semistructured interviews, programme evaluations and track records of the study. The second phase involved two case studies. The case studies employed video analysis of the therapy sessions to report two of the trial participants‘ behaviours and the indices of heart rate and heart rate variability implicated in these behaviours. The music therapy programme appeared to be a practicable and acceptable intervention for care home residents and staff in managing dementia symptoms. Recruitment and retention data indicated feasibility but also challenges. Preliminary outcomes indicated differences in symptoms (13.42, 95 % CI: [4.78 to 22.07; p = 0.006]) and in levels of wellbeing (−0.74, 95 % CI: [−1.15 to −0.33; p = 0.003]) between the two groups, indicating that residents receiving music therapy improved. Staff in the intervention group reported enhanced caregiving techniques as a result of the programme. The iii results of the hermeneutic analysis of the video excerpts shed light on symptom reduction as a result of emotion regulation within therapist-client interaction during the therapy sessions. The data supports the value of developing a music therapy programme involving weekly active individual music therapy sessions and music therapist-carer communication. The results also indicate that emotion regulation may serve to be the theoretical model of individual music therapy, which enables an educational role of music therapists within the care team in care homes. Furthermore, the results indicate the feasibility of implementing the current trial design, with modifications, in a more rigorous evaluation of a larger sample size.