None listed
Conditions
Brief summary
In the absence of effective alternatives, residential aged care (RAC) still resort to using pharmacological interventions, such as antipsychotic and sedating medications, to manage behaviours of dementia despite there being strong evidence that these are ineffective and are associated with severe adverse outcomes for the person with dementia. Non-pharmacological interventions are recommended as best practice to mitigate adverse outcomes associated with behaviours of dementia. There is considerable evidence that listening to preferred music reduces agitation in dementia. However, there is also robust evidence that dementia-related wandering and agitation are distinct phenomenon. Therefore we cannot assume that an intervention effective in reducing agitation will also reduce aspects of wandering that incur risk or result in negative outcomes for the person with dementia. There have been no known trials of music based interventions for people with dementia who wander, despite the pressing need for non-pharmacological interventions in this area. The goal of this applied research is to test the feasibility of using an intervention protocol, previously found to be effective in reducing agitation for people with dementia, to determine if it can be used with people who wander. Therefore the aims of this feasibility study are: 1) For people with dementia who wander and exhibit boundary transgression (BT) (entry into out of bounds and hazardous areas) in residential aged care (RAC): a. Is listening to music for a period of 20 minutes five times per week for 3 weeks tolerated? b. Is listening to the music via ear bud head phones tolerated? c. Do participants enjoy listening to the music? 2) Does listening to preferred music daily for 20 minutes under two conditions: a) Reduce risky aspects of wandering including frequent ambulation and boundary transgression (BT)? b) Reduce participant agitation? c) Provide immediate pleasure to the participant? 3) Are facility care staff able to reliably identify residents with dementia who wander and exhibit BT at an intensity that is observable? 4) Do care staff and family members perceive the music intervention to be beneficial for resident with dementia who wander? This feasibility study will use cluster randomisation (Facility 1 and Facility 2) to trial two intervention conditions: Condition 1: Daily (Mon-Fri) session of listening to preferred music for 20 minutes, 30 minutes before unique peak activity period Condition 2: Daily (Mon-Fri) session of listening to preferred music for 20 minutes at a randomly selected time between 10 am-7pm not including 30 mins prior to individual peak activity periods. Pre, during and post intervention measures of wandering characterisitics (frequency, boundary transgression, pattern), mood and agitation will be collected.
Interventions
Non-drug trial
Participants with severe dementia living in long term care with a history of wandering will listen to a selection of preferred music as selected by the participants next of kin. The music will be downloaded on to an iPod shuffle and listened to through head phones or speakers depending on preference. There are 2 conditions (2 participating facilities):
Condition 1: Each participant will listen to their selection of music in a quiet area for 20 mins, 5 days per week (Mon-Fri), for
Non-drug trial Participants with severe dementia living in long term care with a history of wandering will listen to a selection of preferred music as selected by the participants next of kin. The music will be downloaded on to an iPod shuffle and listened to through head phones or speakers depending on preference. There are 2 conditions (2 participating facilities): Condition 1: Each participant will listen to their selection of music in a quiet area for 20 mins, 5 days per week (Mon-Fri), for 3 weeks, 30 minutes before an individuals unique peak activity period. Condition 2: Each participant will listen to their selection of music in a quiet area for 20 mins, 5 days per week (Mon-Fri), for 3 weeks, at a randomized time not including 30 minutes before an individuals unique peak activity period. Participants will be randomised to any 20 minute time period not 30 mins prior to peak activity periods or during scheduled meal times between 8am-6.30pm Mon-Fri. Cluster randomization at the level of the facility was used to assign conditions - Facility 1 assigned condition 1; Facility 2 assigned condition 2. Condition assignment was chosen by a colleague not associated with the project. Participants only received 1 condition The intervention will be delivered by trained research assistants who will remain with the participant during the intervention to observe reaction to the music (duration of time listening to music) and mood using Lawton's Modified Behavior Stream. To measure protocol fidelity, the person conducting the music session completed a checklist of essential protocol items (pre music session checklist (asked participant if they would like to listen to music, wearing appropriate clothing, elimination needs attended to, offered a drink), time music session commenced, duration of music session, mood that participant listen to music (headphones/speaker), location that music session was conducted, and comments about deviations from protocol). 10% of all interventions were observed by the principle investigator or project manager for inter rater reliability.
Sponsors
Queensland University of Technology
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
> 55 years Severe dementia as documented in medical history and confirmed with Global Deterioration Scale Positive history of wandering as reported by care staff and confirmed using Revised Algase Wandering Scale Independently ambulant (wheelie walker and walking stick acceptable Not experiencing an acute mental illness Able to listen to music Enjoys listening to music Walks > 5000 step per day
Exclusion criteria
Not severe dementia Not independently ambulant Does not walk > 5000 steps per day Experiencing an acute psychotic episode
Outcome results
None listed