Cognitive and Behavioral Effects of Music Therapy on Older Adults with Dementia


Master's Thesis, 2017

109 Pages, Grade: A


Excerpt

Table of Contents

ACKNOWLEDGEMENT

DEDICATION

List of Abbreviations

Keywords

Summary/ Abstract

1. INTRODUCTION
DESCRIPTION OF THE CONDITION
DESCRIPTION OF INTERVENTION
JUSTIFICATION

2. LITERATURE REVIEW
Epidemiology of dementia
Concept of Dementia with older adults
Impact of music therapy on cognitive functions of older adult patients with dementia

3. METHODOLOGY
METHODS
SEARCH STRATEGY:
Aims and objectives

Reference List
Internal References:
External References:
Additional References:
Key References

APPENDICES:

ACKNOWLEDGEMENT

It is a great opportunity for me to write about the subject like ‘Dementia’, where the scope of research is still available. At the time of the study period, I had tried my heart and soul to go through different books, articles, journals, websites like CINAHL, Psych Info, Hinari, PubMed, Google scholars and so forth; which helped me to get acquainted with this topic. I am focusing on those specific topics, which are important for us for further resource allocation.

This entire study based on a vigorous work. All supervisors, librarians (especially the 24/7 Seaborne and Riverside Library), classmates and associated persons of this respected British institution; have lent their helping hands in this venture and without them, this systematic review could not be accomplished appropriately.

By this systematic review, I have got the advantage to work on this project with our Program Leader Pauline Alexander and had got opportunities to learn from her. Through her high supports, feedbacks and her excellent methods of teaching in everysteps, I think I can come up with a comprehensible systematic review.

Also, I express on record, my sense of gratitude and sincere thanks to all of them who have provided me all the necessary facilities, valuable guidance, information, encouragement, appreciation. There may be short comings, factual errors, a mistaken opinion which is all mine and I am alone responsible for those, but I will try for a better quality of writing in my future studies.

I would like to thank my teachers, parents, siblings, well-wishers, last but not the least, ‘The One and Only Almighty’.

Thank you and Best wishes to all…..

Tarannum Rahman

DEDICATION

I dedicate this Systematic Review to the Almighty,my parents, teachers and well-wishers; who have guided me and supported me with patience and encouraged me to develop a better career in future life.

List of Abbreviations

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Keywords

Randomized Control Trials (RCTs), Dementia, Cognitive, Behavioural Therapy, Psychological Symptoms,Music Therapy, Clinical Trials;Quality of Life; Treatment Outcomes; Single-Blind Studies;Nursing Home Patients;REVMAN Analysis; Aged, 80 and Over; Aged; Male; Female; Geriatric Depression Scale; Questionnaires; ClinicalAssessment Tools; Psychological Tests; Scales; Interview Guides

Summary/ Abstract

The background of this study is to determine whether there is an association between music intervention and cognitive, behavioural and psychological effect in healthy older adults, and if so, music therapy intervention can be used as first-line non-pharmacological treatment. This study is a systematic review and meta-analysis of clinical trials that will examined the effects of music intervention. A comprehensive and systematic literature review was performed on PubMed, PscyhInfo, CINAHL, the Cochrane Library. A total of 31 studies were found relevant to the topics; all of them had an acceptable quality based on the CASP scale score. There was positive evidence to support the use of music intervention on treatment of cognitive,behavioural and psychological function of dementia patients in elderly.

The Music Therapy Checklist is useful for music therapists to monitor and evaluate the music therapeutic process. A list of different types of behaviorswere selected based on results derived from applying the Music Therapy Coding Scheme. The use of a checklist to code the events with a recording method based on 1-min. intervalsallows observation without data-processing systems and drastically reduces coding time. At the same time, the checklist tags the main factors in musical interaction.

Muñiz, R., Olazarán, J., Poveda, S., Lago, P., & Peña-Casanova, J. (2011). NPT-ES: A measure of the experience of people with dementia during non-pharmacological interventions. Non-Pharmacological Therapies in Dementia, 1(3), 1-11.

Raglio, A., & Gianelli, M. V. (2013). Music and music therapy in the management of behavioral disorders in dementia.

Raglio, A., et al. (2007). "Comparison of the Music Therapy Coding Scheme with the Music Therapy Checklist." Psychological Reports 101 (3): 875-880.

1994 by the American Academy of Neurology:

doi: http:/​/​dx.​doi.​org/​10.​1212/​WNL.​44.​12.​2308 Neurology December 1994 vol. 44 no. 12 2308

http://www.neurology.org/content/44/12/2308

We developed a new instrument, the Neuropsychiatric Inventory (NPI), to assess 10 behavioral disturbances occurring in dementia patients: delusions, hallucinations, dysphoria, anxiety, agitation/aggression, euphoria, disinhibition, irritability/lability, apathy, and aberrant motor activity. The NPI uses a screening strategy to minimize administration time, examining and scoring only those behavioral domains with positive responses to screening questions. Both the frequency and the severity of each behavior are determined. Information for the NPI is obtained from a caregiver familiar with the patient's behavior. Studies reported here demonstrate the content and concurrent validity as well as between-rater, test-retest, and internal consistency reliability; the instrument is both valid and reliable. The NPI has the advantages of evaluating a wider range of psychopathology than existing instruments, soliciting information that may distinguish among different etiologies of dementia, differentiating between severity and frequency of behavioral changes, and minimizing administration time.

A SYSTEMATIC REVIEW OF COGNITIVEANDBEHAVIOURALEFFECT OF MUSIC THERAPY ON OLDER ADULTS WITH DEMENTIA

1. INTRODUCTION

47.5 million people are affected with age-related neuro-cognitive andbehavioural disorder named as Dementia, and 1.9 million people have died due to this disease according to the world health report of 2015 whereas 7.7 million new cases are occurring every year (Candy, 2015). One in four people aged 85 and over; will have different forms of dementia; by the end of the year 2050 (HSCIC, 2016). However, in the year of 2013, this fatal psychological disease lead to 1.7 million annual deaths, whereas in 1990; there were only 0.8 million deaths per annum due to dementia; which indicates that the rate of affected patients and case fatality rate are increasing gradually (Konno, Kang &Makimoto, 2014).

Music therapy is a quick form of non-pharmacological, non-invasive intervention for the rising number of demented patients besides the medical as well as pharmacological intervention. Because these traditional interventions have proven their ineffectiveness and handled to side effects of medicinein demented patients (Vasionye& Madison, 2013).

Nationwide, about 10% of the population, develop dementia at some point in their lives. It is a common form of brain defects which occur due to theageing process and genetic abnormalities. Approximately half ofthe entire dementic population is over 85 years old and over. 3% individuals aged between 65–74 years have dementia in 2016; whereas 19% people with this disease aged between 75 - 84 years,which indicates that the percentage of individuals who are getting dementia is proportionate to the gradual increase of their age (Brett, Traynor&Stapley, 2016).

By the blessings of modern medicine where more people are living longer, dementia is becoming more and more common in the population which overrides the percentage ofcardiac illness, hypertension and other neurological age-related problems. Furthermore, for individuals with a younger age group, dementia is less frequent in the developing countries. Due to decrease risk factors and caring environment for the elderly persons, more carer within the family, family values and morals; dementia has not taken ittolls in countries like Bangladesh.Dementia isan excellentcause of disability among the old in various parts of the world. This fatal disease has increased the economic burden by which costs of care increases byUSD 604 billion a year worldwide in 2010. People with dementia are often physically and mentally restrained from a higher degree of benefit out of medication and pharmacological care which is necessary for their existence. Furthermore, theseelderly people could be an excellent source of knowledge, experience, wisdom for their future generations, but due to lack of self-consciousness, behavioural fluctuation, cognitive un-equilibrium, and so on; they are becoming the burden of the so-called societal aspect. Social stigma against these affected people is common because patients are not usually aware of their rights as well.

At present, for an example of dementia in the developed world, 8.5 million people are suffering from this fatal psychological illness out of 65.5 million total population in the United Kingdom; which is 1.3 % has been estimated to rise above another one million by the year 2021 stated by the Mapping Dementia Services In The South West Finland the Alzheimer's Society UK Report, 2017.

On the contrary, in developing countrieslike Bangladesh; it is estimated that people with dementia in Bangladesh will rise to 8,34,000 in 2030 and 21,93,000 in 2050 respectively.

Demented patientsin Bangladesh also have a growing concern related to increased social burden and challenges regarding thecost associated with dementia epidemic. For Bangladesh, bearing the world’s eighth-largest population which is 164.8 million in 2017, patients with dementia are counted as 4.6 people million in 2017, which are 0.3% of thetotal population of Bangladesh. This comparision between developed and developing countries indicate that developed countries’ older persons are more prone to get dementia than developing countries population because of the social structure, race, religion, population density, morality, genetic factors, etc(Alzheimer's Society Bangladesh Report, 2017).

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Figure 1: Alzheimer's Society, 2017

The costs of caring for these populations have been estimated currently to be around USD 8 billion for direct medical care, rising to over USD 20 billion if full communal costs are taken into contemplation, which is more than the combined costs of cancer and heart disease care. The majority of these expenses are for long-term residential care (40% of total expenditure) and informal caregivers (55% of total spending), with only 5% of costs going in primary and secondary care due to medication. Meanwhile the prevalence of dementia increases abruptly with time and person’s age; these costs are set to escalate sharply in future due to the growth of the ageing population stated by a PhD Project Proposal named living well with dementia (Sung, Lee, & Watson, 2012).

DESCRIPTION OF THE CONDITION

Dementia is a neurological syndrome which consists of deterioration in memory, thinking and behaviour which leads to loss of ability to perform everyday activities. There are four common subtypes of dementia regarding the frequency of occurring disease and illness prevalence. Alzheimer's disease is the common type of dementia which comprises of 60–70% of total dementia patients according to WHO Report, 2016. Lewy-body- dementia (15%), vascular type of dementia(25%) andfrontotemporaldementia (3%) are the additional varieties of dementia. Less common causes include normal pressure hydrocephalus, Parkinson's disease, syphilis, and Creutzfeldt–Jakob disease among others (Van de Winkel, Fey, De Weerdt& Dom, 2004).

Beyond one category of dementia may occur in the same person in the same time. A small proportion of dementia cases are inherited in families. Dementia is reclassified under the neurocognitive disorder, with various components of severity. Diagnosis is usually based on the history of the illness, cognitive testing with medical imaging, blood testing used to rule out other possible causes, genetic or family history, etc. The mini-mental state examination is one commonly used cognitive test to assess the level of this disease. Efforts to prevent dementia include trying to decrease risk factors related to high blood pressure, stroke and other associated neurological illness.

The music therapy intervention is helpful in the state of stimulating the neuron cells by sound waves which will help the older adults to recover their previous degenerating neurons (Standring, 2015). Dementia is a broader type of brain disease that causes a long-term and often gradual decrease in the ability to think and remember; that is significant enough to affect a person's daily functioning. Other common symptoms include emotional and language problems and low motivation. A person's consciousness is usually not affected. Naturally, genetic, environmental and other associated conditions may cause dementia. A dementia diagnosis requires a change from a person's normal mental functioning and a greater decline than ageing. This disease also has a significant effect on the patient’s family members, close relatives and caregivers.

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Figure 2: NICE Guideline and quality standard for dementia

DESCRIPTION OF INTERVENTION

The use of music therapy in older adults with dementia helps to stimulate communication and memory skills which have been reported by The Rebecca Centre for Music Therapy in New York, 2016. The Founder of the centre, John Carpenter and other licensed board-certified music therapists proved by their studies that listening to previously acquainted music and being involved in live music assist in making experiences come to life and empowers clients to get back into real life from the isolation which is superimposed by dementia(Sung, Lee, & Watson, 2012).However, the advantages of music therapy are theability to remember or gain the previous memories, positive changes in moods, attitudes towards life, emotional and psychological improvement of themind, a sense of control over life. It is a non-invasive procedure and non-meditational, but rather effective (Standring, 2015).

Music therapy is a non-pharmacological medication for pain, disability and discomfort according to the Age UK Report, (2016). According to WHO, 2016; some registered music therapist of USA, this therapy is used to maintain and increase levels of physical, psychological, social, and emotional functioning. Music is used as a sensory and intellectual stimulation which can help dementia patients to maintain and improve their quality of life (QOL), quality adjusted life years(QALY), etc.

Neuroscientists, now equipped with brain scanning technology, e.g. MRI, CT scan, PET CT(APPENDIX:4, FIGURE:6). Have a changed interest in finding how music affects our neural circuits.

How might the intervention work?

According to ‘Dementia: Music and the Mind Report’, May 2016; researchers in Finland using MRI, it was found that listening to music recruits not only the auditory areas (e.g. amygdala, fifth auditory nerves’ pathways) of the brain but also employs large-scale neural networks. For instance, they discovered that the processing of musical or rhythmic impulse recruits motor areas by redirecting their pathways in the brain. It supports the idea that music and memory are closely interconnected. Limbic and gyrus areas of the brain, known to be associated with psychological and behavioural pathways which were found to be involved in rhythm. Processing of timbre and tonality, music is strongly associated with activation of the default memory pathways (Gray’s Anatomy, 2014).

There is no cure for dementia, medications only reduce the symptoms.Cholinesterase inhibitors such as donepezil are often used and may be beneficial in mild to moderate disorder.However,theoverall benefit is very minor. Cognitive and behavioural interventions may be appropriate to improve the quality of life of people with dementia and their family members as well as caregivers. Educating and providing emotional support to the caregivers is also important.Exercise programs may be beneficial concerning activities of daily living and potentially improve outcomes. Treatment of behaviouralproblemswith antipsychotics is common but not usually recommended due to the little benefit and side effects, including an increased risk of death.

According to Vink et al., 2014; maintenance of the treatment often decreases due to carelessness of the family members, lack of knowledge of the practitioners, by WHO, 2016 (Wittwer, Webster, & Hill, 2013).

JUSTIFICATION

It is a global health problem which is increasing throughout the years, e.g. by the year 2030 the incidence of dementia people will be double, and by 2050 it will be triple according to WHO Report, 2016.

At present, 35.6 million people are living with dementia which is not only affecting them but also affecting family life, socioeconomic and health dimensions by increasing disability adjusted life years or DALY (Dr Margaret Chan, WHO Report, 2016)

Dementia is the principal reason of dependence and disability in the elderly person worldwide.The Framingham Heart Study assessed the temporal regoin damage in the incidence of dementia over last three decades which shows that it is increasing the average life expectancy of a human being so that economic burden will be increased exponentially as well (Satizabal, Beiser, Chouraki, Chêne, Dufouil, & Seshadri, 2016). This catastrophic cost destroys the economic stability of many poor households (WHO, 2016).

This non-communicable disease is one of the biggest challenges for the development of 21st Century (Mental Health Gap Action Program, 2008, High-level Meeting of United Nations General Assembly, 2011).

The overall estimated global expenditures of dementia were 604 billion US dollar in 2010. In high-income countries, informal nursing care and support cost 45%, and formal social care costs 40% of the majority of costs among all other medical expenses, which is 15% lower in low-income and lower-middle-income countries. Their social care and informal care cost are lesser because it is provided by their own family on an unpaid basis towards elderly as a cultural norm (WHO Report, 2016).

Cognitive, behavioural and psychological effects of music therapy on older adults with dementia were done in different settings in various occasions even with gold standard randomised control trials, case-control and cohort studies,and so forth(Raglio, 2015). However, itis not doneonmany occasions as a systematic review and meta-analysis. To fulfil this gap between studies, a systematic considerationof both qualitative and quantitative research in this related field will provide newer and precise stronger results and findings.

The use of music therapy in older adults with dementia helps to stimulate communication and memory skills which been reported by The famous and legendary Rebecca Centre for Music Therapy in New York, 2016.

However, the advantages of music therapy to remember or gain the previous memories, changes in moods, attitudes towards life, emotional and psychological improvement of , a sense of control over . It is a non-invasive procedure and non-meditational, but (

Music therapy is anon-pharmacological medication for pain, disability and to the Age UK Report, (2016). According to some registered music therapist of USA, this therapy is used to maintain or increase levels of , behavioural, psychological, social, and emotional functioning. Music used as a sensory and intellectual stimulation can help which can and improve quality of life (QALY) by For centuries, music has been known to people without medication and withdraw the stress and tension by producing soothing sound waves. Neuroscientists, now equipped with brain scanning e.g. MRI, CT scan, PET CT(APPENDIX:4, FIGURE:6), etc. have a changed interest in finding how music affects our neural circuits (Johnson, Deatrick&Oriel, 2012).

It is a global health problem which is increasing throughout the years e.g. by the year 2030 the incidence of dementia people will be double and by 2050 it will be triple according to WHO Report, 2016.

At present 35.6 million people are living with dementia which is not only affecting them but also affecting family life, socio-economic and health dimensions by increasing DALY (Dr. Margaret Chan, WHO Report, 2016)

Dementia is the principal reason of dependence and disability in the elderly person worldwide., The Framingham Heart Study assessed the temporal trends in the incidence of dementia over last three decades which shows that it is increasing with the average life expectancy of human being so economic burden will be increased exponentially as well (Satizabal, Beiser, Chouraki, Chêne, Dufouil, &Seshadri, 2016). This catastrophic cost destroys the economic stability of many poor household (WHO, 2016).

This non-communicable disease is one of the major challenges for the development of 21st Century (Mental Health Gap Action Program, 2008, High level Meeting of United Nations General Assembly, 2011)

The overall estimated global expenditures of dementia were 604 billion US dollar in 2010. In high-income countries, informal nursing care and support cost 45% and formal social care costs 40% of the majority of costs among all other medical costs, which is 15% lower in low-income and lower-middle-income countries. Their social care and informal care cost are lesser because it is provided by their own family in an unpaid basis towards elderly as a cultural norm (WHO Report, 2016).

Cognitive, behavioural and psychological effects of music therapy on older adults with dementia were done in different settings in various occasions even with gold standard randomized control trials, case-control and cohort studies, etc.(Raglio, 2015). But it is not done in any occasions as a systematic review and/or meta-analysis. To fulfil this gaps between studies, a systematic review with both qualitative and quantitative studies in this related field will provide newer and precise stronger results and findings.

The use of music therapy in older adults with dementia helps to stimulate communication and memory skills which has been reported by World famous and legendary Rebecca Center for Music Therapy in New York, 2016. The Founder of the centre, John Carpenter and other licensed board certified music therapist proved by their studies that listening to previously acquainted music and being involved in live music make experiences come to life and empowers clients to get back into real life from the isolation which is superimposed by dementiaHowever, the advantages of music therapy are ability to remember or gain the previous memories, affirmative changes in moods, attitudes towards life, emotional and psychological improvement of mind, a sense of control over life,etc. It is a non-invasive procedure and non-meditational, but ( Music therapy is anon-pharmacological medication for pain, disability and to the Age UK Report, (2016). According to some registered music therapist of USA, this therapy is used to maintain or increase levels of physical, psychological, social, and emotional functioning. Music used as a sensory and intellectual stimulation can help maintain and improve quality of life (QALY).

For centuries, music has been known to people without medication and withdraw the stress and tension by producing soothing sound waves.

Neuroscientists, now equipped with brain scanning e.g. MRI, CT scan, PET CT(APPENDIX:4, FIGURE:6), etc. have a changed interest in finding how music affects our neural circuits.

According to ‘Dementia: Music and the Mind Report’, 2016; researchers in Finland using MRI, it was found that listening to music recruits not only the auditory areas (e.g. amygdala, 5th auditory nerves’ pathways) of the brain, but also employs large-scale neural networks. For instance, they discovered that the processing of musical or rhythmic impulserecruits motor areas by redirecting their pathways in the brain. It supports the idea that music and memory are closely interconnected. Limbic and gyrus areas of the brain, known to be associated with psychological and behavioural pathways which were found to be involved in rhythm. Processing of timbre and tonality, music is strongly associated with activations of the default memory pathways (Gray’s Anatomy, 2014).

WHY IS IT IMPORTANT TO DO THIS REVIEW?

According to ‘Dementia: Music and the Mind Report’, May 2016; researchers in Finland using MRI, it was found that listening to music recruits not only the auditory areas (e.g. amygdala, fifth auditory nerves’ pathways) of the brain but also employs large-scale neural networks. For instance, the scientists discovered that the processing of musical or rhythmic impulse recruits motor areas by redirecting their pathways in the brain. It supports the idea that music and memory are closely interconnected. Limbic and gyrus areas of the brain, known to be associated with psychological and behavioural pathways which were found to be involved in rhythm. Processing of tonality, music or sound waves are strongly associated with activation of the default memory pathways (Gray’s Anatomy, 2014).

Table 2 Effectiveness of different types of music interventions (Vasionye& Madison, 2013)

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Why an empirical research is not carrying out here; instead of a systematic review?

Systematic reviews are the gold standard of all the research methodologies. They are transparent, lack of biases, cannot be replicated (Boland, Cherry and Dickson, 2014). In the study of Bergenholtz&Kvist, 2014; identified intervention ‘music therapy in dementia patient’ will be investigated and addressed by this research by carrying out a rigorous data analysis; which is not done in empirical studies. These evidence-based findings of the systematic review can be used to formanew intervention for adementia patient, which also navigates towards a well-developed empirical study. It also prepares the groundwork for thedevelopment of clinical guidelines and assistsdementia caregivers in decision-making to choose wise intervention(Higgins & Green, 2011).

2. LITERATURE REVIEW

Epidemiology of dementia

Prevalence and impact:

The term ‘Dementia’ had been stated in different ways in different articles, journals and books. Cognative, behavioural and psychological symptoms of dementia (BPSDs) have a melodramatic effect on persons with dementia (PWD), especially in the progressive stages of the disease. Non-pharmacological management, comprising with music interventions, have been proposed for the reduction of BPSDs in PWDs (Shagam, 2009).The number of people with dementia are on the rise dramatically with increased longevity. The core dementia symptoms are cognitive, behavioural and psychological deterioration mainly. In case of doing literature review, the selected studies/papers are written in English language, studies evaluating the psychological, behavioural, cognitive function before and after music therapy intervention to manage symptoms of dementia patients, studies with a comparator groups, separate groups or before/after comparisons, studies with quantitative results in which all participants had dementia in different levels and various types. Types and levels of dementia had not been separated in the criteria of the studies so in most of the studies calculated the effect size (ES) rather than meta-analysis because of various variables. The most widely used and recommended (Jeon et al., 2011) clinical tool for evaluating BPSD is the Neuropsychiatric Inventory (NPI) (Cummings et al., 1994) and for cognitive evaluation most of the studies done MMSE (Mini-Mental State Examination/Score) since 1973, discovered by Paul. MMSE is essential in quantitative assessment of cognitive performance with high reliability and validity.

There are five types of dementia: Alzheimer’s disease, Vascular dementia, frontotemporal dementia, dementia with Lewy bodies, Young onset dementia. Alzheimer’s disease(prevalence 60-70%) cause poor memory function, cognitive disability, poor insight, lack of awareness and language dysfunction. It develops gradually from mild to severe form including disorientation which hampers their everyday performance.Vascular dementia or multi-infarct dementia (MID), is the second most common type of dementia, which is a most common after effect of strokes. As a result, it causes gradual deterioration of memory following slow recovery period, but language and communication are not affected in this case of dementia patients. On the other hand, frontotemporal dementia or pic’d disease affect behaviour and personality which can be found in younger people aged between 45-65 years old, but this type of dementia can be confused with depression, psychosis or OCD (obsessive compulsive disorder) as dementia is not common in younger people, though there is Young Onset Dementia which is unexpected as well. Dementia with Lewy bodies, cognitive impairment can fluctuate, and movements are particularly affected, with poor motor control. Tremors may be noticed in Parkinson’s disease. Due to the nerve cell damage of Lewy bodies, hallucinations are often present in those with this type of dementia. These hallucinations can be both visual and auditory. Memory is often less affected. As with all dementias, Lewy bodies are progressive, and symptoms will worsen over time.

Introduction

In the beginning, I would like to focus on the concept of dementia and its various treatments that are needed to care for the older adults in the community properly. Various researchers discuss on the cognitive theory, behavioural theory, physiological approach and the benefit of the music therapy for the treatment of dementia in the context of older adults. The variables will be discussed critically based on the past studies and the secondary research studies. In this section, the selected research issues have concluded, and it has discussed how the older adult patients with dementia are treated by the health and social care organisations through the newer approach of Music Therapy.

Past studies

From the previous studies over the dementia issues biologically, it has expressed that the issue dementia has been prevalent in the age of people over the age of 65 years. Kanatli et al., (2007) stated that about 10% of the people who are over the age of 65 years had faced this issue of dementia and 47% of the people are at the age of 85 years are suffering from this issue. From the announcement, it has expressed that ageing is a universal issue. As a result, the brain alters due to such physical and mental changes that include ‘apoptosis, oxidative stress, telomere loss, neuroendocrine alterations, autoimmune changes, and others’ are affecting the mental ability of the human being by Theories Of Aging And Dementia- Alzbrain (n.d.). The World Health Organization (2012) added to the theory that worldwide more than 47 million people are facing the issue of dementia and among them, most of the patients are in their older age. From the statement, it can be explicited clearly that the issue of dementia is seen mostly among the older adults. The cognitive functions are improved by using music therapy which has been implemented by the healthcare organisations for treating these patients. From the past studies, it has concluded that for dementia, music therapy is the standard issue that has proved its effectiveness over standard care through different randomised control trials (RCTs) in older adults.

Concept of Dementia with older adults

The issue dementia is the typical issue that affects people most after a specific age group because, by the age, the mental ability reduces, and hence a person becomes unable to remember numerous things. Prince et al., (2016) mentioned in the research paper that after the specific age group, 65 and above, the nervous system of a human being become weaker that causes the person unable to remember anything for a long time. The report of WHO has interpreted that from a long time the issue of dementia has seen in the community because it is not a disease, it is an effect of the natural cause named ageing. WHO has also presented a fact in the report that the patients of dementia are rising every year. Almost 47 million of people worldwide are facing the issue of dementia that is expected to reach nearly 131 million by the year of 2050 (World Health Organization, 2012).

Impact of music therapy on cognitive functions of older adult patients with dementia

The cognitive theory is being used by the health and social care organisations in the community for taking care of dementia older adults. Mac Pherson et al., (2002) specified that the issue of dementia is the part of a human age that is affecting the mental ability of the human being after a specific age group of 65 and above. Vink et al., (2014) added that the cognitive theory is one of the best as well as the most effective techniques that are helpful for taking care of the old adults, suffering from dementia. The statement has presumed that a health and social care organisation might follow cognitive function assessment in the community such as mapping of dementia, self-assessment chart and small comprehensions at the workplace. Johnson et al., (2012) added to the discussion that, people who have dementia are not an actual patient, only the difference is their mental capability reduces, cognative function deteriotes with their age.The statement has deduced that the dementia patients need a universal care from the health service provider.

Impact of music therapy on behavioural and psychological functions of older adult patients with dementia

The behavioural and the psychological functions or activities increases after the music therapy performed by the healthcare service providers which are the fundamental factor that put an impact on the mind of the dementia patients. In the above therapy, the cognitive, behavioural and psychological functions have been enhanced with the mean for taking care of the dementia patients. Wortmann (2012) explained that, in the workplace, there should be a mutual understanding between the behavioural approach of the service provider with the patient while providing them with music therapy. The statement has perceived that it might be possible that the patient of dementia failed to understand the behavioural approach of the service provider. Hence, it is the responsibility of the service provider or the music therapist that he should understand the behaviour and help the patient.

Benefits of music therapy on the older adults with dementia

From the research paper of Raglio et al., (2015), it has been observed that the people who are suffering from the issue of dementia in the community love to listen to music. From the research paper of Fanget al.,(2017), it has even interpreted that the music therapy acted positively at the workplace for entertaining the dementia patient as well as treating them and helping them recover and activate previous memory. In favour of this statement, it has been concluded that music has a rhythm that attracts the patients as well as increase the frequency level of the mind. Further, this helps the service provider to control the mind as well as the behaviour of the patient. The statement has even deduced that the wave of the music psychologically connects the mind of the patient with the rhythm that further helps the service provider to take care of that patient. From the discussion, it has been concluded that the music therapy is a compelling factor as well as a beneficial factor that helps a dementia patient to remember any information quickly.

3. METHODOLOGY

Methods are the technique to gather data and analyse it and methodology is the process of doing the research which is a design lying behind the choice and use of methods (Parahoo, 2006).This study has been done by following the nine steps of doing a systematic review (Boland, 2012) using quantitative research approach: writing a systematic review research proposal (step 1), literature review(step 2), screening for research relevant titles and abstracts(step 3), obtaining papers (step 4), and full text (step 5),quality assessment (step 6), data extraction (step7),analysis and synthesis (step8), writing up and editing the whole systematic review (step 9) by Boland et al., 2014. A systematic review is a gold standard way to do secondary research which locates, evaluate and combine the best available evidence relating to specific studies. Here, the RCTs that are relevant to this study have been selected and analysed through meta-analysis (Gray, 2014).

Research paradigm (Beauchamp & Childress, 2008) is the theoretical and philosophical process of doing any research which has different approaches according to the research questions and criteria of research designs. It reflects the values, attitudes of the researchers which impinge the research design, data collection; here gathering all primary data from all the relevant randomised control trials, methods, nature of investigations involved in the field of study (Bowling, 2014).

In case of following research paradigm (Denscombe, 2007), this systematic review has followed positivist research approach, which is a process of quantifying social phenomena step by step; whereas regarding epistemology, it is objectivism.The systematic review has followed a deductive process of positivism which is emphasising and quantifying specific concepts, verifying researcher’s gaps and hunches. It has fixed design according to the methodology section and seeks generalised approach while selecting RCTs. Internal and external validity and reliability have been kept in mind while selecting the RCTs (Pink, 2007).

According to Punch, 2014; there is an alternative paradigm named as a naturalistic or interpretative paradigm, which has inductive, qualitative, flexible design, seeks pattern, not ageneralisation, just opposite to the positivism’s paradise. There is also another combined form of research paradigm named as a mixed method which combines both the qualitative and quantitative research approaches in the systematic review. Here the quantitative approach has been chosen based on the research question and study selection criteria which are relevant to the topics of this study (ESRC,2012; Department of Health, 2005 & Office of Public Sector Information, 1998).

Here, in case of the research process, in the first step‘epistemology’, objectivism has been chosen; according to the theory of knowledge according to the lecture-3of Research Module and Crotty, 1998; the foundation of social studies. Here, experimental research designs, RCTs have been chosen as per methodology section and statistical measurement, the techniques used in the data gathering and analysing process. Furthermore, there is no pragmatic approach or core principles; described in Denscombe, 2007; for doing any systematic review. Based on the research questions, methods, as well as methodology, has been formed and shaped to do a review.

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Figure 3: Research Process (Watson & Keady, 2008)

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Figure 4 RESEARCH STAGES (Watson R & Keady (2008)

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Figure 5: Research Steps (Followed) (Watson R & Keady (2008)

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[...]

Excerpt out of 109 pages

Details

Title
Cognitive and Behavioral Effects of Music Therapy on Older Adults with Dementia
College
University of Chester
Course
Masters of Science in Global Health
Grade
A
Author
Year
2017
Pages
109
Catalog Number
V538444
ISBN (eBook)
9783346135902
ISBN (Book)
9783346135919
Language
English
Tags
cognitive, behavioral, effects, music, therapy, older, adults, with, dementia
Quote paper
Tarannum Rahman (Author), 2017, Cognitive and Behavioral Effects of Music Therapy on Older Adults with Dementia, Munich, GRIN Verlag, https://www.grin.com/document/538444

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Title: Cognitive and Behavioral Effects of Music Therapy on Older Adults with Dementia



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