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Use of Music Therapy as a Nursing Intervention and its Effect on Agitation and Anxiety
Among Geriatric Patients with Dementia
Morelia Adrianzen & Amelia Smyth
School of Nursing, Oakland University
NRS 3012: Research for Evidence-Based Nursing Practice
Dr. Sarah Newton
April 21, 2022
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Use of Music Therapy as a Nursing Intervention and its Effects on Agitation and Anxiety
Among Geriatric Patients with Dementia
Agitation and anxiety, an important manifestation among geriatric patients with
dementia, is often misdiagnosed, understudied, and inadequately managed by nurses (Sung et al.,
2010). Dementia is a gradual deterioration in cognitive function, which includes the incapability
to process sensations (Sung et al., 2010). The decline of processing sensations may increase the
probability for anxiety and agitation to occur (Sung et al., 2010). The current standard of nursing
care that directly treats anxiety and agitation experienced by geriatric patients with dementia, are
activities of daily living, social activities, basic nursing care (Sung et al., 2010). Geriatric
patients with dementia are given antipsychotic medications to resolve behavioral symptoms,
even though they show little improvement in these symptoms (Coxey et al., 2021). Research has
shown nonpharmacological interventions, such as music therapy, when implemented as a nursing
intervention to reduced anxiety and agitation among older adults (Davison et al., 2016). The use
of music therapy as a nursing intervention for patients with dementia is relevant to the
professional nursing practice because it is an independent intervention that improves patient
outcomes without negative side effects (Sung et al., 2010). The purpose of this paper is to write
an empirically based literature review related to the use of music therapy as a nursing
intervention and assess its effect on agitation and anxiety among geriatric patients with dementia.
Review of Literature
In a study by Kim and Kang (2021), the purpose was to determine the effect a group
music intervention with rhythmic exercises program had on cognitive function and mental health
outcomes (depression, anxiety, and life satisfaction) among Korean nursing home residents with
dementia. The sample consisted of 40 participants (experimental: 14 females and 6 males;
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control: 17 females and 3 males). The participants were recruited from three long-term care
facilities in D-city South Korea. The participants were all 65 years or older, resided in a care
facility for more than 6 months, and had the ability to understand the content of questionnaires
and follow directions (Kim & Kang, p. 651). A randomized controlled study design was
employed. The method used was a music intervention that took place over 12 weeks. Each
intervention took place in the recreation room of the nursing home, and one music therapist and
one nurse performed each session. The music intervention was a 50-minute session consisting of
a 5-minute warm-up, 45-minute main session and a 5-minute wrap-up. During the warm-up, the
participants were greeted with the musical experience with the goal of making the participants
feel relaxed and comfortable. During the main session, the participants engaged in singing and
rhythmic exercises, such as hand clapping, stretching, dancing, or playing a percussion
instrument. The participants were able to choose their preferred music and were encouraged to
recall past events including childhood experiences, romance, marriage and family life. The wrapup consisted of open discussion between the participants, musical therapist and nurse to reflect
on their overall experience with musical intervention. Data was collected using the Geriatric
Anxiety Inventory (GAI), consisting of 20 items that assess common anxiety symptoms with the
final scores ranging from 0-20, the higher score indicating greater anxiety. Cognitive function
was assessed using the Mini-Mental State Examination (MMSE)- Korean version. With scores
24-30 indicating normal cognition, 19-23 as mild impairment, 10-18 as moderate and less than or
equal to 9 as severe cognitive impairment. Between the participants, 87.5% indicated as mildly
impaired, and the remaining 12.5% as moderately impaired, at baseline. Depression was
measured using the Geriatric Depression Scale (GDS-SF), a 15-item self-report assessment.
Questions are answered as “yes” or “no” with one point assigned to each answer. The scoring is
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set as 0-4 indicating “normal”, 5-10 as “mildly depressed”, and 11-15 as “severely depressed”.
Among the participants, 67.5% scored as mildly depressed, 20% as normal, and 12.5% as
severely depressed, at baseline. Life satisfaction was measured using a 20-item Life Satisfaction
Scale. Participants rate their level of life satisfaction on a three-point Likert scale (0=almost
never, 1=sometimes, 2=almost always). Cronbach’s ɑ in the current study was .81. The
intervention group participants had a significant decrease in their anxiety and depression scores
compared to the control group. Anxiety pre-experimental group (M=8.40 SD=0.20), post
experimental (M=3.00 SD=0.20); pre-control (M=8.20 SD=0.22), post-control (M=9.60
SD=0.02), p<0.01. Depression pre-experimental (M=7.50 SD=0.23), post experimental (M=3.30
SD=0.17) pre-control (M=7.50 SD=0.23), post control (M=9.40 SD=0.27),
p<0.001. Participants who received the group music intervention also had significantly higher
levels of cognitive function and life satisfaction scores than those in the control group. For
cognitive function, pre-experimental (M=21.10 SD=3.58), post experimental (M=24.50
SD=2.85); pre-control (M=21.10 SD=2.78), post control (M=20.75 SD=2.55), p=0.024. Life
satisfaction pre-experimental (M=20.60 SD=0.39), post experimental (M=30.00 SD=0.22); precontrol (M=19.80 SD=0.27), post control (M=15.40 SD=0.34), p=0.013. Kim and Kang (2021)
concluded that the use of music therapy led to reduced anxiety levels in geriatric patients with
dementia residing in Korean nursing homes.
In a study by Sung et al. (2010), the purpose was to evaluate a “preferred music listening
intervention for reducing anxiety in older adults with dementia in nursing homes'' (p.1056).
Initially, the sample consisted of 53 older people with dementia from one nursing home in
Taiwan, however over the course of the study, one participant withdrew due to being
hospitalized. The sample was 55.8% male and 44.4% female, mean age was 80.12 years, and
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50% of the sample was categorized as presenting severe cognitive decline. There were several
inclusion criteria, including that the people be 65 years of age or older; medically diagnosed with
dementia; have a Global Deterioration Scale of score of 4-6, which falls under moderate to
severe cognitive impairment; presenting symptoms of anxiety; and had no hearing loss. The
study used a pretest and posttest design and was conducted over the course of six weeks. The
method used was recruiting participants from two different units within one nursing home; one
unit consisting of 29 participants, post-attrition, was the experimental group and the other unit
consisting of 23 participants was the control group. The experimental group received music
therapy in addition to standard care. The control group received only standard care. The standard
care consisted of activities of daily living, social activities, basic nursing care, and meal
assistance. The study involved determining the participant’s preferred choice of music that
would be used as the intervention. A preferred music survey was used to determine the
participant’s music of choice. Family or caregivers assisted with completion of survey for
participants with severe dementia or unable to convey information. The nurses from the facility
conducted the intervention in the experimental group by using a CD player. The participants
listened to their music preference for 30 minutes in the middle of the day two times a week. Over
the course of six weeks, a total of 12 sessions were provided. Anxiety was measured using the
Rating Anxiety in Dementia (RAID) tool, which evaluates anxiety in people with dementia by its
manifestations. The nurses who took care of the patient and monitored the patient’s changes in
behavior completed the RAID tool. The RAID tool was completed before applying intervention
and this served for the pre-anxiety test or baseline. The RAID tool was completed a second time
at the completion of the study and this served for the post-anxiety test. The RAID consists of 18
items and each item was rated on a 4-point scale, with 0 = absent, 1 = mild, 2= moderate, and 3 =
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severe. A score of 11 indicates significant anxiety. The results indicated that geriatric patients
with dementia who received 6 weeks of music therapy had a significantly lower anxiety score
than those participants who only received standard care; the findings were statistically significant
(p = 0.001). The experimental group’s mean anxiety score decreased from 10.93 (pre-test) to
8.93 (post-test), whereas the control group slightly decreased from 9.53 (pretest) to 9.35
(posttest). Sung et al. (2010) concluded that determining music preference of geriatric patients is
important prior to implementing the use of music therapy, and the results suggest music therapy
to reduce anxiety in geriatric patients with dementia.
Summary
In summary, the literature reviewed indicated that the use of music therapy as a nursing
intervention was effective in reducing agitation in geriatric patients with dementia (Kim & Kang,
2021; Sung et al., 2010). In the study by Kim and Kang (2021), the results showed that the levels
of anxiety were significantly lower in the experimental group compared to the control group after
receiving music therapy as an intervention. The study by Sung et al. (2010) revealed that a
preferred music listening intervention was effective at lowering anxiety levels in older patients
with dementia as assessed by the nurses. Both studies concluded that the use of music therapy
interventions resulted in significant reductions in anxiety among geriatric patients with dementia.
Nursing Implications
The nursing implications related to the use of music therapy as a nursing intervention to
reduce anxiety and agitation among geriatric patients with dementia embrace the nursing
process. Nurses caring for this patient population should assess anxiety and agitation, as this is
the foundation for quality care and identifying current issues that may exacerbate their condition
(Sung et al., 2010). Anxiety assessment tools, such as the GAI and the RAID can be used during
this part of the nursing process (Kim & Kang, 2021, Davison et al., 2016). The assessment then
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leads to the development of a nursing diagnosis (Coxey et al., 2021). After the nursing diagnosis
is created, the nurse and patient/family collaborate to establish an individualized care plan that
targets the patient’s goals and desired outcomes. Once the patient-specific goals and outcomes
are developed, the nurse will implement and execute the plan of care, including music therapy as
a nursing intervention to reduce the patient’s anxiety and agitation (Davison et al., 2016). Music
therapy along with standard care was found to lower anxiety and agitation among geriatric
patients with dementia(Coxey et al., 2021). Therefore, nurses should implement music therapy as
an evidence-based practice after determining if this intervention is appropriate for the collected
data and individualized goals (Davison et al., 2016). The nurse then needs to evaluate the
effectiveness of music therapy to determine if the intervention was effective in decreasing the
patient’s anxiety and agitation (Sung et al., 2010). Further nursing research is warranted and
should conduct studies for a longer period of time that is built upon the preferred music listening
study to produce more rigorous findings (Sung et al., 2010).
Conclusion
In conclusion, agitation and anxiety are common issues among geriatric patients with
dementia (Sung et al., 2010). The utilization of music therapy as an independent nursing
intervention is a valuable tool that nurses can use in nursing practice to promote decrease of
anxiety and agitation. Current studies indicate that music therapy when implemented with
standard care leads to reduced anxiety levels (Sung et al., 2010). Music therapy is a nonpharmacological intervention that facilitates a decrease in anxiety while maintaining the patient’s
dignity and independence (Davison, et al. 2016). By implementing music therapy in the patient’s
plan of care, nurses can enhance more positive outcomes as music has shown to promote mental
health while integrating anxiolytic effects in geriatric patients with dementia (Kim & Kang,
2021; Sung et al., 2010).
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References
Coxey, J. P., Kameg, B., Novosel, L. M., & Lee, H. (2021). Music and nursing home residents
with dementia: A literature review. The Journal for Nurse Practitioners, 17(7), 808–814.
https://doi.org/10.1016/j.nurpra.2021.03.011
Davison, T. E., Nayer, K., Coxon, S., Bono, A., Eppingstall, B., Jeon, Y., Ploeg, E., &
O’Connor, D. W. (2016). A personalized multimedia device to treat agitated behavior and
improve mood in people with dementia: A pilot study. Geriatric Nursing, 37(1), 25–29.
https://doi.org/10.1016/j.gerinurse.2015.08.013
Kim, H. S., & Kang, J. S. (2021). Effect of a group music intervention on cognitive function and
mental health outcomes among nursing home residents: A randomized controlled pilot
study. Geriatric Nursing, 42(3), 650–656. https://doi.org/10.1016/j.gerinurse.2021.03.012
Sung, H., Chang A. M., & Lee W. (2010). A preferred music listening intervention to reduce
anxiety in older adults with dementia in nursing homes. Journal of Clinical Nursing,
19(7-8), 1056–1064. http://doi.org/10.1111/j.1365-2702.2009.03016.x