Multimodal music therapy intervention for engagement and agitation reduction for persons with severe dementia: Study protocol of a pilot randomized cross‐over trial

Abstract

Background: Music‐based interventions may support the well‐being of persons with dementia (PWD). However, limited empirical evidence exists regarding the optimal use of such interventions for specific outcomes and at different disease stages. Project goals are to 1) demonstrate proof‐of‐concept and feasibility of a music therapy intervention for care facility residents with severe dementia and 2) obtain preliminary data. Here, we describe the study protocol. Method: The multimodal intervention, led by a music therapist, uses live participantpreferred music and progressively layers singing and rhythmic instrument playing concurrent with participant behavioral responses. It is grounded in the Clinical Practice Model for PWD, a person‐centered framework that presents a schema regarding why particular care strategies are important and how to implement them (Reschke‐ Hernández, 2019; 2021). This randomized cross‐over design has 4 blocks: Baseline, 3‐week treatment period, 1‐week washout (no intervention), and 3‐week treatment period. The comparison treatment consists of short stories read aloud, using the same non‐music strategies, small group format (3‐5 people per group), and dosage (2x/week for 30 minutes) as the combined music interventions. Outcomes include ratings of engagement (primary outcome), agitation, and arousal. To evaluate our study design within the care milieu, we will perform semi‐structured interviews with up to 10 caregivers at participating facilities. The Menorah Park Engagement Scale (Camp et al., 2015) and Observed EmotionRating Scale (OERS; Lawton et al., 1999) are used tomeasure engagement and agitation, and the Neuropsychiatric Inventory‐Nursing Home (Wood et al., 2000) to measure agitation and occupational disruptiveness. The OERS, data on functional transfers, pulse oximetry, and a wearable activity tracker (including sleep data) are used to measure arousal. Results: Planned enrollment is 20 PWD. Recruitment will occur in partnership with care facilities from January to May 2023, with active data collection beginning in February. Preliminary data will be available inMarch with results in July 2023. Conclusion: Progressive layering of musical stimuli coupled with purposeful activity, matched to participants' cognitive capacity, may promote purposeful engagement, thereby supporting arousal regulation and reducing agitation. A key deliverable will be enhanced practical understanding of how to measure effectiveness of music‐based interventions for PWD.