Musical stimulus in hospitalized patients with dementia

Álvarez Gómez, Esther; Minthe, Mamadou Bengaly; Cánovas Pareja, Carmen

doi:10.1016/j.medcle.2019.01.043

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This behavior, considered “problematic” and difficult to handle for their caregivers, could be a form of communication by patients. To figure out its meaning is a complex task. For this, it is useful to know the patient's life story in depth, from childhood to the present moment, something that can help us in this interpretation.Even so, the desired result is not always achieved, and that is where music can be useful, as an alternative or as an added aid to drug therapy.<a class="elsevierStyleCrossRefs" href="#bib0025">1–4</a>There are studies on the positive reaction of patients with dementia to musical stimulus,<a class="elsevierStyleCrossRefs" href="#bib0035">3,4</a> although it is still a poorly implemented measure in the Spanish acute hospital units.To evaluate the efficacy of this intervention in our setting, we have assessed the reaction of patients diagnosed with dementia admitted for any pathological process in an acute geriatric unit to exposure to different types of melodies, as well as their impact on behavioral disorders and agitation.It is a cross-sectional observational descriptive study, with three observers (doctors). The sample is randomly chosen from hospitalized dementia patients, assessing the type and degree of dementia (Reisberg's global deterioration scale [GDS]), behavioral (neuropsychiatric inventory [NPI] scale) and sleep disorders. These include: informed consent (family), age, sex, reason for admission, place of residence and primary caregiver. Headphones and a music player are used in the patient's room. One to 2 short musical sessions are held (15min), with 3–5 standard songs (traditional African music, classical music [Vivaldi], Spanish music and Aragonese regional music, arranged from “more to less relaxing”). The patient's response is observed during the session. Unstable, terminal patients in the final-death throe phase of the disease and/or with severe hearing loss are excluded from the study.A sample of 32 patients (2 excluded) with an average age of 86.84 years was included, 72% were women. 50% of them were institutionalized. The primary caregiver in 68.8% of cases was a son/daughter. Barthel Index ≤20 in 50% of cases. The causes of admission were infection in 34.3% and agitation in 21.8%. Mixed dementia (65.6%) and advanced dementia (GDS 5: 28.1%, GDS 6: 15.6%, GDS 7: 25%) were the most prevalent types. NPI behavioral disorders: grades 2 and 3 (25–22%). Sleep disorders: 53.1%. They use psychoactive drugs: 78%.Before the intervention 65.6% were calm and 15.6% restless. Of the 32 patients studied, 27 showed a positive response (16 increased their attention, 15 smiled, 10 sang and/or danced, 4 followed the rhythm and one showed pain relief). Two were indifferent and one aggressive. The results are not related to the type or degree of dementia. Differences are observed according to the type of music, with a greater positive response to traditional and regional music. There was a better response to the melodies best known by patients and those they listened to in their youth.Therefore, it can be said that musical stimulus, well used and timely applied, and especially if the preferences of the patient are taken into account, helps them to relax and divert their attention.<a class="elsevierStyleCrossRefs" href="#bib0025">1,2,4</a> It could also improve social interaction, sleep patterns and eating habits<a class="elsevierStyleCrossRefs" href="#bib0025">1,4</a> in those patients with sleep-wake cycle and/or eating disorders.<a class="elsevierStyleCrossRef" href="#bib0040">4</a>Music can be an effective therapeutic alternative in patients with dementia,<a class="elsevierStyleCrossRef" href="#bib0040">4</a> even in advanced stages of the disease. The patient's musical preferences determine the success of the intervention. Our future goal will be the reduction of psychoactive drugs using the musical alternative." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Álvarez Gómez E, Minthe MB, Cánovas Pareja C. Estímulo musical en pacientes hospitalizados con demencia. Med Clin (Barc). 153;2019:–e62." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Musicoterapia en la enfermedad de Alzheimer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Barcia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "2009" "paginaInicial" => "223" "paginaFinal" => "238" "editorial" => "Viguera Editores SL" "editorialLocalizacion" => "Murcia" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Music therapy and Alzheimer's disease: cognitive, psychological, and behavioural effects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Gómez" 1 => "J. Gómez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.nrl.2015.12.003" "Revista" => array:6 [ "tituloSerie" => "Neurología" "fecha" => "2017" "volumen" => "32" "paginaInicial" => "300" "paginaFinal" => "308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26896913" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caregivers in the use of music for the daily care of people with dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Dassa" 1 => "M. de Castro" 2 => "M. Mercadal-Brotons" 3 => "K. Ray" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2017" "editorial" => "World Congress of Music Therapy" "editorialLocalizacion" => "Japan" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Musicoterapia para la prevención de trastornos del estado de ánimo en personas mayores; 2017. Available at: <a target="_blank" href="http://geriatricarea.com/musicoterapia-para-la-prevencion-de-trastornos-del-estado-de-animo-en-personas-mayores/">http://geriatricarea.com/musicoterapia-para-la-prevencion-de-trastornos-del-estado-de-animo-en-personas-mayores/</a> [accessed 24.08.17]." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015300000011/v1_201911300659/S2387020619304899/v1_201911300659/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015300000011/v1_201911300659/S2387020619304899/v1_201911300659/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020619304899?idApp=UINPBA00004N"]

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Vol. 153. Issue 11.

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