Depression and Dementia are significant health concerns that are widely encountered while delivering care in geriatric ward in healthcare settings and aged care centers. As highlighted by Leyhe et al., (2017) most of the patients suffering from dementia are known to suffer from depression and loneliness which again is linked with cognitive impairment. Depression has been proposed to be a major risk factor for dementia, and a prodrome of the condition as well. The complex relationship between depression, loneliness and dementia has been widely explored about in literature. A wide range of strategies have been explored constantly for understanding their applicability in reducing depression and loneliness in elderly patients suffering from dementia. One of such key strategies is music therapy. Music therapy refers to the use of specialized musical interventions and techniques for achieving care goals on the basis of the individual assessment of the patient. The aim of music therapy is to promote the wellbeing and health of the patient through promotion and restoration of emotional, spiritual, mental and physical health (Steffens, 2017).
Is music therapy effective in reducing depression and loneliness in institutionalized elderly patients suffering from dementia?
Significance of the proposal
There is an absence of quantitative studies that have explored the effects of novice strategies for reduction of symptoms of depression and loneliness in elderly dementia patients, such as music therapy. Quantitative research is important since it aims to provide an accurate picture of the effectiveness of certain interventions in relation to the care objective. The present proposal therefore outlines a research framework that can guide an empirical study to be conducted to study the As highlighted by Leyhe et al., (2017) most of the patients suffering from dementia are known to suffer from depression and loneliness which again is linked with cognitive impairment. in reducing depression and loneliness in dementia elderly patients.
A few studies have examined the impact of music therapy on dementia patients that draw in from a conceptual framework. The models of care that have been highlighted in this regard are Kitwood’s model of person-centered care (Fazio et al., 2018), and the need-driven, dementia-compromised behavior model (NDB) model (Berry, Young & Kim, 2017). Based on these two models, a conceptual consideration is developed that forms the framework for the present proposal. This is as follows-
As mentioned by Wu et al., (2017) dementia prevalence is increasing at an alarming rate in the contemporary era. There is therefore a need of delivering specialist care encompassing the holistic needs of the person. Treatments must focus on the mental wellbeing of the person that includes health factors such as depression and loneliness. Elderly dementia patients institutionalized in healthcare settings are often found to be suffering from depression and loneliness, which have a negative outcome on their health. Reduction of depression and poor mental health status holds the potential to augment the chances of health promotion for the patient (Freedman et al., 2018).
Brooks et al., (2017) pointed out the continual research is being carried out for understanding the effectiveness of novice and promising interventions for addressing dementia related poor health concerns such as depression and loneliness. One of such interventions is music therapy which refers to the use of musical interventions for supporting care needs of patients with diverse needs. van der Steen et al., (2018) mentioned that music therapy is a wide field and holds the potential to address a considerable number of health concerns, including depression and loneliness. O’Rourke et al., (2015) found in their systematic review and meta-analysis of qualitative studies that music therapy has a positive effect on the overall quality of life of dementia patients. The factors that led to increase in quality of life of dementia patients were having a sense of purpose in life, augmentation in social relationships and sense of belonging. Schall et al., (2015) through their study assessed the subjective wellbeing of dementia patients when provided with music therapy. it was found that dementia patients institutionalized in care homes express positive emotions after being subjected to music therapy. Music therapy might be helpful for encouraging the means of social interaction, thereby reducing signs of loneliness. In a qualitative study, Dennnis and Rickson (2014) had come across the fact that music therapy is primitive in fostering a sense of community in dementia patients admitted to a care setting. This is possible through improvement of relationships between the patients and their respective family members. In this regard, the study of Melhuish et al., (2015) found that music therapy worked successfully for enhancing the relationship between dementia patient residents and the care staff. It was also noted that music therapy reduced level of isolation in patients through behavior change as patients could interact with each other in a more social-able and meaningful manner.
Ray and Mittleman (2015) from their study inferred that participation in music therapy can reduce symptoms of depression in dementia patients. This effectiveness is more profound when intervention is provided in addition to usual care. The results were obtained after delivery of music therapy intervention after two weeks. In a similar study conducted by Chu et al., (2014), the researchers highlighted that group intervention for music therapy could significantly decrease symptoms of depression in residents with dementia.
Tang et al., (2018) highlighted that there is mounting evidence regarding the use of music therapy for dementia patients. However there exists a lack of studies that explore the impact of music therapy for dementia in a robust manner. This implies that the methodologies used in the studies have extensive limitations. The absence of rigorously controlled studies have impaired the ability to draw clear concept regarding the extent to which music therapy can be effective for dementia patients for controlling depression and loneliness. In short, no substantial evidence lies for supporting use of music therapy for older adults with dementia. A number of substantive gaps have been highlighted in extant literature regarding the impact of music therapy on improvement of quality of life of dementia patients. A major gap is around the utilization of music therapy for improving the condition related to depression and loneliness. The topic is of much critical significance at the present era in relation to the care delivery of dementia patients admitted to healthcare settings. Fang et al., (2017) rationalized the need of further studies in relation to impact of music therapy of dementia adults that have the focus on reduction of mental wellbeing status associated with dementia. Due to major challenges faced by healthcare professionals in caring for elderly dementia patients, it is considered imperative that further research is carried out to explore the effect of music therapy on depression and loneliness of elderly dementia patients.
Research design and methodology
Method and design
The proposed research is to have a quantitative research methodology that can successfully address the question of whether music therapy can reduce depression and loneliness in elder dementia patients in geriatric ward. The rationale for referring to a quantitative research methodology is multi-faceted. Adhering to a quantitative research method would ensure that a sound research question is addressed in a manner that does not permit emotional aspects to be included in the research. Further, scientific prediction of data generated and consequent inference allows sound information generation from the research (Parahoo, 2014). As pointed out by Moule, Aveyard and Goodman (2016) data generated from a quantitative research method is always through a structured research instrument, thereby enhancing the validity of the research. The results can also be considered as a representative of the larger population. A clear research question can be addressed in a distinct manner.
The proposed research would be a randomized controlled trial that aims to conduct a fair examination of a certain treatment to understand its effectiveness on the chosen population (Grove & Gray, 2018). In such a study, participants are allocated to two or more groups wherein one group receives a certain treatment and another group is subjected to control intervention. The justification for selecting this research design is also distinct and to be mentioned in this regard. With such type of research, the effectiveness of a treatment can be compared with another treatment or absence of treatment. The study design can be helpful for making causal inferences (Parahoo, 2014). Further, in a randomized controlled trial, selection bias and allocation bias is eliminated. The prospective study design is helpful in minimizing recall error. Randomized controlled trial has been recognized as a gold standard for conducting research to understand the effectiveness of interventions. Such form of study is therefore more publishable.
The research is to be conducted at a reputed healthcare aged care centre that institutionalizes dementia patients. A total number of thirty patients are to be recruited for the study. The study would include both and women above the age of 65 years. The inclusion criteria would be diagnosis of mild depression as defined by the Geriatric Depression Scale (GDS-SF) score between 5 and 8. Patients suffering from depression due to psychotic issues, patients on anti-depressive medications, patients with mood disorders, sleep disorders, having depression due to organic disorders, patients with hearing problems and those in need of cognitive behavioural therapy would be excluded from the study.
Potential patients fulfilling the eligibility criteria would undergo random sampling for being selected for the research. Random sampling is a sampling technique in which each potential participant has the chance of being selected for the study. A sample chosen in this method is an unbiased representation of the wider population. Such form of sampling is a simple yet effective method of recruiting participants in a study. The primary advantage is that there is an accuracy of representation of the study and ease of use. There can be no easier method for extracting a research sample from the larger population (Grove & Gray, 2018). Participants would be randomly allocated to either the control group or the intervention group. Each group would be having fifteen participants.
Instruments to be used
The Geriatric Depression Scale-Short Form (GDS-SF) and the UCLA Loneliness Scale (version 3) would be used for the data collection purpose in the proposed research. A number of instruments have been made available to measure depression in patient population. Nevertheless, the GDS-SF has been widely use for carrying out research with the elder population. The form has a set of 30 questions which the participants are required to answer by responding in yes or no. The validity and reliability of the instrument is marked in literature. The instrument has a sensitivity of 92% and its specificity is 89% when evaluation is done against diagnostic criteria (Durmaz et al., 2018). The UCLA loneliness scale is used for measuring the subjective feelings in relation to loneliness along individuals. The scores predict a variety of mental health outcomes in relation to loneliness. The instrument has become the most widely referred to instruments for measuring loneliness (Shevlin, Murphy & Murphy, 2015).
Data collection method
The study is to be conducted for a period of one month at the aged care setting selected. Participants in the experimental or intervention group would be participating in the group singing activity that would be conducted by the researcher. The group singing activity would be performed four times a week for four weeks. Duration of the group singing activity would be of around thirty minutes each. Each session would begin with the theme of energizing and de-stressing. The other themes that would be considered for the singing sessions are self-expression, management of emotions, bonding and sharing. For the theme of energizing and de-stressing, the favorite songs of the participant group as a whole would be considered for initiating participation in the sessions. For self-expression, the most favorite song for each participant would be considered. For sharing and bonding, the favorite song of others in the group would be considered. For management of emotions, songs would be sung with body movements and percussion with the help of hands giving vent to the emotions. The control group would be receiving no particular intervention. Baseline assessment and weekly assessment would be considered for both the groups with the help of the GDS-SF and UCLA Loneliness Scale. An assessment of depression and loneliness would be carried out in the respective manner (Mathew et al., 2017).
Data analysis method
Statistical method would be used for analyzing the data generated from the research. For the proposed paper it would be appropriate to use the Mann-Whitney U-test and Wilcoxon W value method. The Mann-whitney U test is a nonparametric test of the null hypothesis and determines whether two independent samples had been selected from population of same distribution. Wilcoxon W value method is useful for comparing two matched samples for assessing whether the population mean ranks have any differences (Parahoo et al., 2017).
Confidentiality is the most crucial aspects of ethical consideration while carrying out research with human participants. Upholding the confidentiality and privacy of the participants would be thee central tenet of the proposed research. The personal information of the participants would not be published after the research and responses to the data collection would be anonymous. The participants would also have the freedom to decide upon how much information they would provide regarding personal data. It would be inappropriate to obtain contact information for solicitation of participation in research (Bromley et al., 2015). The second element of research ethics is informed consent that implies that the participants have given voluntary participation in the research. For gaining informed consent from the participants, the aim of the research along with the procedures an duration and research would be explained. The participants would have the right to withdraw from the research at any point in time while the research is being conducted. The prospective benefits of the research would be explained to the participants (Grady, 2015). The data collected from the research would be stored in a secured manner out of reach of third party. Electronic data storage would be done by encrypted filed. Participant information would be deleted after the research would be complete (Doody & Noonan, 2016).
The proposed study might be marked by certain limitations such as smaller sampling size and short duration of music therapy intervention. It might be possible that intervention delivered for a longer period might influence the study results. Nevertheless, the proposed study holds valuable implication for practice in the healthcare domain. The study would be noteworthy in providing insight into the effectiveness of music therapy in reducing depression and loneliness in elderly dementia patients. It would supposedly offer a glimpse of how music therapy can augment the quality of life of elderly population suffering from the progressive neurodegenerative condition. The study would also provide an account of how music therapy in the form of group singing can bring improvement in the quality of life of elderly dementia patients. Research points out those healthcare professionals face immense burden in caring for elder dementia patients since the prevalence of depression and loneliness is more common among this population. Considering the results of the proposed literature, and referring to exiting literature, healthcare professionals can consider implementation of music therapy for addressing depression and loneliness in elderly dementia patient. At the end of the study, music therapy might be considered as a significant tool for improving quality of life of dementia patients institutionalized in healthcare setting.
Berry, B., Young, L., & Kim, S. C. (2017). Utility of the Aggressive Behavior Risk Assessment Tool in long-term care homes. Geriatric nursing, 38(5), 417-422.
Bromley, E., Mikesell, L., Jones, F., & Khodyakov, D. (2015). From subject to participant: Ethics and the evolving role of community in health research. American Journal of Public Health, 105(5), 900-908.
Brooks, D., Fielding, E., Beattie, E., Edwards, H., & Hines, S. (2017). Effectiveness of psychosocial interventions on the psychological health and wellbeing of family carers of people with dementia following residential care placement: a systematic review protocol. Jbi database of systematic reviews and implementation reports, 15(5), 1228-1235.
Chu, H., Yang, C., Lin., Y., Ou, K., Lee, T., O’Brian, A.,… Chou, K. (2014). The impact of group music therapy on depression and cognition in elderly persons with dementia: A randomized controlled study. Biological Research for Nursing, 16(2), 209-217.
Dennis, P., & Rickson, D. (2014). The Leader of the Band: A Case Story of Community Music Therapy on a Hospital Ward for People Who Have Dementia. Voices: A World Forum For Music Therapy, 14(1).
Doody, O., & Noonan, M. (2016). Nursing research ethics, guidance and application in practice. British Journal of Nursing, 25(14), 803-807.
Durmaz, B., Soysal, P., Ellidokuz, H., & Is?k, A. T. (2018). Validity and reliability of geriatric depression scale-15 (short form) in Turkish older adults. Northern Clinics of ?stanbul, 5(3).
Fang, R., Ye, S., Huangfu, J., & Calimag, D. P. (2017). Music therapy is a potential intervention for cognition of Alzheimer’s Disease: a mini-review. Translational neurodegeneration, 6(1), 2.
Fazio, S., Pace, D., Flinner, J., & Kallmyer, B. (2018). The fundamentals of person-centered care for individuals with dementia. The Gerontologist, 58(suppl_1), S10-S19.
Freedman, V. A., Kasper, J. D., Spillman, B. C., & Plassman, B. L. (2018). Short-term changes in the prevalence of probable dementia: An analysis of the 2011–2015 National Health and Aging Trends Study. The Journals of Gerontology: Series B, 73(suppl_1), S48-S56.
Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal of Medicine, 372(9), 855-862.
Grove, S. K., & Gray, J. R. (2018). Understanding Nursing Research E-Book: Building an Evidence-Based Practice. Elsevier Health Sciences.
Leyhe, T., Reynolds III, C. F., Melcher, T., Linnemann, C., Klöppel, S., Blennow, K., ... & Hampel, H. (2017). A common challenge in older adults: Classification, overlap, and therapy of depression and dementia. Alzheimer's & Dementia, 13(1), 59-71.
Mathew, D., Sundar, S., Subramaniam, E., & Parmar, P. N. (2017). Music therapy as group singing improves Geriatric Depression Scale score and loneliness in institutionalized geriatric adults with mild depression: A randomized controlled study. International Journal of Educational and Psychological Researches, 3(1), 6.
Melhuish, R., Beuzeboc, C., & Guzman, A. (2015). Developing relationships between care staff and people with dementia through music therapy and dance therapy: A preliminary phenomenological study. Dementia, 0(0), 1-15.
Moule, P., Aveyard, H., & Goodman, M. (2016). Nursing research: An introduction. Sage.
O’Rourke, H. M., Duggleby, W., Fraser, K. D., & Jerke, L. (2015). Factors that affect quality of life from the perspective of people with dementia: A metasynthesis. Journal of the American Geriatrics Society, 63, 24-38.
Parahoo, K. (2014). Nursing research: principles, process and issues. Macmillan International Higher Education.
Ray, K. D., & Mittelman, M. S. (2015). Music therapy: A nonpharmacological approach to the care of agitation and depressive symptoms for nursing home residents with dementia. Dementia, 0(0), 1-22.
Schall, A., Haberstroh, J., & Pantel, J. (2015). Time series analysis of individual music therapy in dementia. The Journal of Gerontopsychology and Geriatric Psychiatry, 28(3), 113-122.
Shevlin, M., Murphy, S., & Murphy, J. (2015). The latent structure of loneliness: testing competing factor models of the UCLA Loneliness Scale in a large adolescent sample. Assessment, 22(2), 208-215.
Steffens, D. C. (2017). Late-life depression and the prodromes of dementia. JAMA psychiatry, 74(7), 673-674.
Tang, Q., Zhou, Y., Yang, S., Thomas, W. K. S., Smith, G. D., Yang, Z., ... & Chung, J. W. Y. (2018). Effect of music intervention on apathy in nursing home residents with dementia. Geriatric Nursing.
van der Steen, J. T., Smaling, H. J., van der Wouden, J. C., Bruinsma, M. S., Scholten, R. J., & Vink, A. C. (2018). Music?based therapeutic interventions for people with dementia. Cochrane Database of Systematic Reviews, (7).
Wu, Y. T., Beiser, A. S., Breteler, M. M., Fratiglioni, L., Helmer, C., Hendrie, H. C., ... & Matthews, F. E. (2017). The changing prevalence and incidence of dementia over time—current evidence. Nature Reviews Neurology, 13(6), 327.