“Healthy People 2021” at Ethan Allen Residence

On any given day in October of 2018, one would enter the Ethan Allen Residence and feel as though they were taken back a few decades. As the leaves began to fall outside, and the temperatures were slowly dropping, residents were getting cozy alongside pumpkins and gourds in the communal areas of the building, and shared with one another, in nostalgic comfort, the music of their youth. The music they enjoyed was a carefully selected playlist that was created for the Healthy People 2021 Project, a study done at the residence to see what effect music therapy could have on residents with dementia, by a team of medical students.

As the number of elders in the United States diagnosed with a form of dementia continues to grow, the memories of those diagnosed with the disease continue to diminish. The first signs of dementia are often forgetfulness and confusion, and over time, as the disease progresses and cognitive functioning declines, those living with dementia exhibit severe memory loss– to the point where they may not be able to remember a conversation from even ten minutes ago. This often results in agitation, including increased anxiety and irritability. Typically, when someone with dementia becomes anxious or agitated, the standard method for treatment is an antipsychotic drug, although administering this type of medication to calm the individual has shown to be beneficial only in the short term, leading to long term decrements in quality of life.

Aging should be a conscious process, one that celebrates the health, comfort, and happiness of elders. Living Well Group is always looking for new, holistic approaches to facilitate the aging process to support vital aging by elevating individuals for a healthy, enjoyable life. Music is an innovative, therapeutic approach that could help relieve symptoms of anxiety and agitation of those living with dementia. A remarkable aspect about this disease, that impacts the lives of a large number of older Americans, is the brain’s ability, in some cases, to retain some long term memories. With this disease, the area in which music is processed suffers significantly less degradation. Oftentimes, music and lyrics are some of the last memories those living with dementia may retain.

Much research has been done on the use of music therapy to help manage the common symptoms of dementia, and studies have shown that music therapy does have a positive effect on managing these symptoms. In 2013, Ridder’s study explored individual music therapy for agitation in dementia and indicated that over the course of six weeks, patients with dementia who engaged in individual music therapy showed significant decreased agitation and were less likely to need an increase in medication, compared to those who did not participate in music therapy.

Living Well Group currently offers residents the opportunity to participate in art, movement, and music therapy programs at all three residences. These types of programs engage the mind, body, and spirit of each resident, creating a space for an active journey through the aging process. The highly enjoyed music programs inspired Living Well Group to participate in a Public Health Project that would explore the idea that music therapy could ease the anxiety and agitation that elders with dementia so often exhibit.

The Public Health Project was conducted at the Ethan Allen Residence in partnership with the Larner College of Medicine at the University of Vermont and United Way of Northwest Vermont. Dr. Shaden Eldakar-Hein, a hospitalist at the University of Vermont Medical Center, guided a group of students to complete this project. This is Dr. Eldakar-Hein’s third year participating in a Public Health Project, and when asked why she chose to oversee this project specifically, she explains, “Any sort of small thing we can do to help the quality of life of people who are experiencing some cognitive impairment and/or memory loss would be beneficial.”

The initial goal of the study was to have a group of six to eight medical students work one-on-one with residents living with dementia and gather data on how the residents reacted to certain songs. The idea was to find out what type of music, and more specifically, what songs, would help each individual resident when they were feeling anxious or agitated. In theory, by finding a “prescription playlist” for each resident that made them feel happier and more comfortable in times of distress, the symptoms of dementia would be more manageable and medical interference would not be necessary. Unfortunately, as limitations to the original objective arose, the study ended up becoming a more general approach to considering the effects of music therapy on residents with dementia. The new objective was to analyze the effect of nostalgic music therapy administration on individuals with dementia.

Twenty-four residents who live at the Ethan Allen Residence who had been diagnosed with moderate-severe dementia were selected to participate in the study, which comprised of two parts. The first part consisted of a specific Spotify playlist played on speakers throughout the residence during the month of October 2018. The playlist was composed of about two-hundred songs that the residents would, in theory, remember from approximately their third decade of life. It started before breakfast, and continued playing during lunch and dinner, as well as leisure time in between.

The second portion of this study assessed whether music could be used as a therapeutic intervention before PRN intervention. PRN medications are administered when agitation and anxiety increase so much that the person needs immediate, calming relief. The caregivers at Living Well Group are trained to handle these situations using Teepa Snow’s Positive Approach to Care, and PRN medications are administered as the final alternative. This part of the study tested to see if music could be a therapeutic intervention before PRN intervention. For the month of October 2018, the medication cart in the Ethan Allen Residence was equipped with an iPod that contained the same playlist that was played throughout the residence. The med techs were trained on how and when to use the iPod to play the music before administering a drug. In combination with Teepa Snow’s Positive Approach, music would ideally prevent the use of PRN intervention.

The residents were assessed both prior and post treatment. Staff members, consisting of four caregivers, two activity staff, one registered nurse, the Director of Nursing, the Director of Resident Programs, and the Building Administrator, administered pre and post treatment surveys assessing the behavior of each of the residents, with an average of three surveys per resident. The quantitative data was collected by means of Qualidem, an evaluation to assess the quality of life of individuals with dementia. Residents were evaluated on items (“Is cheerful,” “Cries,” “Rejects help from nursing assistants” “Is restless,” etc.) that fell into several subscale categories, including, but not limited to, “Care relationships,” “Social relations,” and “Feeling at home.”

The results of this study as a whole indicated that there was not a significant statistical change in the quantitative data collected by the Qualidem surveys pre and post treatment of musical therapy during the month of October. However, there was significant qualitative feedback that suggested the music therapy was beneficial for some of the residents. Comments included observations such as: “Resident has changed so much with her decline from her disease. That said, she still perks up when she hears certain songs or artists like Elvis” and “Music has a very positive and noticeable effect. Music can be used to maintain calm and/or return resident to ‘calm state’ if agitated.”

Dr. Eldakar-Hein explains the possible reasoning for these results: “Living Well Group is a great facility because they were already offering lots of music therapy options, and so I think that sometimes the quantifiable difference might take a larger population to show that, because I think that the differences might be a little bit smaller to see. If they are smaller differences, you need a larger population to find that significance. Since they were already utilizing music therapy there, and we were just sort of adjusting the type of music therapy they used, and it was a shorter period of time, then it is possible that that would not show a difference over that smaller period of time or with the smaller population.” Dr. Eldakar-Hein suggests that a future study, one that takes place over a longer period of time in a facility that does not already offer music therapy, would be beneficial.

One important finding garnered from this experience was that some staff members, at no fault of their own, were not comfortable or adept using iPods and tablets. As a result of this finding, Living Well Group is working to construct a program with Technology for Tomorrow that teaches staff the fundamental skills needed to operate any technological device that may be used throughout the residences. This opportunity would not only benefit the level of care in the residences, but would also prepare staff with the skills to further their career beyond Living Well Group.

Although this particular study did not statistically support the evidence that music therapy has a positive effect on anxiety and agitation of those struggling with dementia, Living Well Group continues to provide its residents with the opportunity for holistic treatment so their quality of life is not defined by their age and fully believes the impact music provides for residents. It is important to recognize opportunities where therapeutic interventions may be beneficial for those living with dementia. When asked her opinion as a physician on music as a therapeutic approach for those living with dementia, Dr. Eldakar-Hein explains, “What is important in memory loss is some reminder of home or your life. I do think music is a part of our lives, and so anytime you can introduce something that is reminiscent to that person, it’s always going to make us all comfortable… It makes sense to me that [music therapy] would improve quality of life, and there’s really no side effects to it, and I often think that if there are no side effects or harm, then adding something that has been shown to benefit is sort of a no brainer.”

As a result of this project, Living Well Group will continue to search for opportunities with partnering organizations to further develop a “prescription playlist” for each resident living with dementia. As a nonprofit organization, this goal would need to be achieved through the generous time donated by an organization itself, as well as volunteers and interns who are passionate about redefining the aging process in elder care.

Thank you to Jan Carney and Tori Dobbs from UVM College of Medicine and our team of medical students and advisors.

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