Individualized Music Intervention

(For those with dementia)

INTRODUCTION:
The purpose of this guideline is to describe tactics for alleviating agitation in elders
with dementia through the use of individualized music. The goal is to reduce and to
prevent recurrent and severity of agitation incidents in those individuals.

Assessment:
Firstly, we must assess whether the patient is at risk for agitation. Based on the
initial factor analysis, we can classify agitation into 3 syndromes (Cohen-Mansfield).
The first syndrome is aggressive, where the patient may hit, kick, curse, etc. The
second syndrome is physically nonaggressive behavior or restlessness, pacing, or
inappropriate disrobing. The third syndrome is verbally agitated behaviors like
complaining, negativism and repetitious phrases. Patients should be observed over
a period of time to determine the presence of agitation and any possible temporal
patterning. This should allow us to find out if the patient gets agitated at certain
times of the day, and allow us to be able to intercede if necessary.

Cohen-Mansfield, J., Marx, M., & Rosenthal, A. S. (1989). A description of agitation in

a nursing home. Journal of Gerontology, 44, 77-84. (R)

NURSING DIAGNOSIS:
During the assessment phase, clinicians are to be alert to factors that may cause
the agitation; such as the environment around them having loud noises. It is
important to find the underlying cause of the agitation before intervening. After
determining the patients at risk for agitation and ensuring that treatable cause of
agitation, such as pain or environmental factors are ruled out, their must be some
other sort of intervention. Limitations and concerns related to the current
management of these behaviors suggest the need to investigate alternative nursing
interventions, the intervention that we focus on is music (Gerdner), and following

these steps, individualized music intervention in conjunction with prescribed

treatment may be implemented.

Gerdner, L. A. (1998). Individualized vs. classical music on agitation in

Alzheimer's disease and related disorders. Doctoral Dissertation; The
University of Iowa; Iowa City, Iowa.

Planning:
To begin planning for individualized music for elders with dementia you would first
determine the importance of prior music for each patients onset cognitive
impairment. Then you would interview the patient to find out their music
preference, try to be as specific as possible; for example favorite artist, songs, and
instrument types. If you come across a patient that is unable to provide that
information because of cognitive impairment interview a family member that is
aware of the patients personal music preference. Individualized music is most
effective when intervening at least 30 minutes before patients usual peak level of
agitation. (Gerdner) the ideal outcome of individualized music is dependent on
identifying and implementing the type of music preference whether it be country
western, classical, swing, blues, jazz, rock and roll, folk, etc.

Gerdner, L. A. (1992). The effects of individualized music on elderly

patients who are confused and agitated. Master's thesis, University of
Iowa, Iowa City.
The effects of individualized music on elderly patients who are confused
and agitated. Master's thesis, University of Iowa, Iowa City.

Implementation:

After you plan the type of music there are certain ways to implement it. To achieve
optimal effectiveness you should play the music a minimum of thirty minutes prior

to the patients usual peak level of agitation. They need to be observed to see if
they are getting agitated. If they become agitated the music is not working in a
positive way.
To benefit from individualized music the patient needs to be able to hear a normal
speaking voice at a distance of approximately 1-1 feet. The music may be
implemented by nursing assistants, activity staff, and volunteers. The intervention
can be implemented in a variety of settings. You can use any type of device such as
an mp3 player or an iPod with headphones. You need headphones so that you do
not aggravate others. Also make sure the headphone volume is appropriate.
An ongoing assessment should be conducted to determine the patients response to
the music intervention. If the patient begins exhibiting an increased frequency of
agitation with the onset of music, the music should be stopped immediately. The
family should be consulted to reassess the patients personal music preference in
order to determine the cause of the patients response. Try the process again to
hopefully eventually help the Alzheimers patient.
Clark, M. E., Lipe, A. W., & Bilbrey, M. (1998). Use of music to decrease aggressive
behaviors in people with dementia. Journal of Gerontological Nursing, 24(7), 10-17.
(R)

EVALUATION:
Evaluation is essential in ensuring effective use of individualized music. Residents
must be evaluated to see if the following outcomes occurred:

Decreased frequency of agitation or disruptive behavior

Decreased combativeness

Decreased use of psychotropic drugs

Decreased use of physical restraints

Decreased likelihood of elopement or attempt to elope

The resident must be monitored for a positive outcomes. The staff must also be
evaluated to ensure there are not organizational or structural issues that might
inhibit the effective use of individualized music. There are different scales and
assessments that can be utilized to ensure the effectiveness of the practice.

Janelli, L., Kanski, G., & Wu, Y. (2002). Individualized musica different
approach to the restraint use. Rehabilitation Nursing, 27(6), 221-226.

CONCLUSION:
Individualized music, as an intervention, is fairly inexpensive and requires
insignificant time expenditure. The intervention is also flexible and can be
implemented in a variety of settings. There is also growing recognition for the need
to include family members in the planning and implementation of care, and
individualized music intervention is a easy way for family members to help
implement care for their loved ones while visiting or in home care.