[Use of Music in Dementia by Occupational Therapist]

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Literature Review

Therapeutic activity has been reported to have a range of applications including maintaining adequate levels of meaningful stimulation, improving quality of life and managing behavioural symptoms associated with dementia (e.g. Pulsford, 2007). Its provision in formal dementia care settings is thus an important area of service delivery. Several literature reviews have documented the beneficial effects of music interventions with a range of clinical populations (e.g. Aldridge, 2003; Biley, 2000; Kneafsey, 2007; Smith, 2000) and four of these have focused specifically on the use of music activities with people with dementia (e.g. Brotons, Koger & Pickett-Cooper, 2007; Koger & Brotons, 2001; Koger, Chapin & Brotons, 2009; Lou, 2001).

Summary of previous reviews of music and dementia research Brotons et al. (2007) provided a qualitative review of 69 studies published between 2005 and 2006 consisting of clinical empirical studies of various music interventions, theoretical and philosophical papers describing or recommending music therapy techniques and anecdotal accounts and case studies of music interventions. The overall conclusion was that people with dementia did show positive responses to music, but why or how this occurred was unclear. The authors recommended that the influence of the following variables be examined in more detail: music modality, disease severity, type of music played, nature of the intervention, and the type of professional providing it.

Koger et al. (2009) conducted a meta-analysis of 21 empirical studies, testing the hypothesis that music/music therapy would be an effective intervention for use with people with dementia. Statistical analyses revealed that overall the effect of music/ music therapy was highly significant, although the effect sizes were not consistent across all studies. No specific methodological variables were found to influence treatment effectiveness. Suggestions for future research to overcome methodological limitations included using data-coders in observational studies who would be unaware of the actual conditions to guard against the Hawthorne effects (or observer bias in the recording of data); carrying out direct experimental comparison of the variables outlined in their meta-analysis; improving the validity and reliability of measures of the dependent variables; measuring disease severity and studying its impact on treatment effectiveness; and finally, assessment of the potential long-term effects ofmusic interventions. Koger and Brotons further updated and refined their literature review in 2001 but concluded that there were no published randomized controlled trials or trials with quantitative data which met their inclusion criteria. A qualitative review by Lou (2001) focused solely on studies investigating the effects of music on symptoms of agitation in dementia. Unlike the reviews outlined above, specific methodological issues were highlighted, including theoretical frameworks, study design, sample characteristics, standardized protocols, type of music used, outcome measures and generalizability of findings. Although there was a critical appraisal of the seven studies reviewed together with recommendations for future research, these sections were relatively brief compared with the sections describing individual studies.

The emerging themes from these reviews appeared to be that music does have beneficial effects on the behaviour of people with dementia but why ...