Music Therapy: A Breakthrough in Dementia Care?

‘Severe’ or ‘advanced’ dementia is a terminal neurodegenerative disease that causes considerable patient discomfort and necessitates hospitalization. Previous research has suggested that music therapy has soothing properties, although clinical evidence and molecular understandings of this intervention remain limited.

In a recent realist review published in the journal Nature Mental Health, researchers developed a program theory for using music therapy in dementia care through a multiphase approach that included both scientific (including systematic reviews and meta-analyses) and stakeholder (experts, caregivers, and family) input.

The resulting program theory incorporates individual, institutional, and interpersonal contexts to explain the principles of music therapy, distinguishing between trained therapist-provided interventions and music-based interventions delivered by untrained facilitators. These features may activate hidden mechanisms such as fulfilling unmet patient demands and boosting caregiver situational comprehension, with results indicating immediate, observable reductions in agitation and anxiety after music therapy. While more research is needed to understand the effect of therapy duration, frequency, and infrastructural support in music therapy outcomes, this realist review emphasizes the therapy’s potential application and urges for additional clinical research to improve its delivery.

Background: dementia and the need for innovative treatment alternatives.

‘Dementia’ refers to a range of chronic neurodegenerative disorders that severely impair a patient’s cognitive and memory functions, hindering regular (day-to-day) tasks. Dementia is a degenerative disease that has no known cure. Alarmingly, dementia incidence has been increasing at an unprecedented rate; more than 55 million individuals already suffer from the ailment, with that figure anticipated to rise to 78 million by 2030 and 139 million by 2050.

Given the lack of a cure, conventional research has concentrated on ways to prevent or delay dementia onset and progression. However, given the wide range of illnesses reported and the variability in patient responses to broad therapies, researchers have begun to focus on improving living conditions for patients and their families. Recent assessments have revealed a change from a previous emphasis on physical support to frameworks centered on mental health.

“The National Institute for Health and Care Excellence (NICE) states that psychosocial, or nonpharmacological, interventions should be the first line of treatment for distress behaviors in dementia care. The World Health Organization highlights the need for more research to enable the development of clinical and cost-effective toolkits for psychosocial interventions to manage distress.”

Music therapy

Music therapy is a relatively new practice in which a trained practitioner uses music to address unmet emotional, physical, cognitive, and social needs of patients. Recent clinical data indicate that music therapy may have the clinical potential to reduce distress (in the short term), promote patient engagement, and give holistic relief from dementia-related anxiety.

Unfortunately, the field’s novelty, along with the lack of a standardized testing framework, complicates the interpretation of study results. Clinical applications of music therapy are further hampered by a widespread lack of understanding of the mechanisms behind the observed effects.

About the study

The study was carried out in three interactive stages. The first step included using’reflective thematic analysis (RTA)’ on music therapist interview data (n = 11) and sentence completion exercises with study participants (advanced dementia patients, n = 5). The second step used the Rayyan platform to undertake a large-scale systematic literature review using the keywords, phrases, and texts found in phase one. Notably, this literature analysis included music-based therapies without the supervision of certified music therapists. In the third phase, researchers created three intervention frameworks called context-mechanism-outcome configurations (CMOCs), which address individual (CMOC 1), interpersonal (CMOC 2), and institutional (CMOC 3) aspects.

“CMOC 1 – Music therapy delivered regularly and flexibly (C) attunes to and meets unmet needs in the moment (M), reducing distress and improving well-being in the short term (O). CMOC 2 – When staff and families are involved in music therapy sessions (C), reciprocity, communication, and mutual understanding with the person with dementia increase (M), changing staff attitudes and impacting care delivery (O). CMOC 3 – Structures and time for knowledge exchange (C) enable regular communication between staff, families, and music therapists (M), with music used to manage distress and regulate the environment (O).”

Study findings and recommendations

While the neurophysiological mechanisms underpinning music’s advantages in dementia care remain unknown, the current analysis demonstrates that music therapy can nonverbally address ‘unmet’ dementia patient requirements. The collection and analysis of prior literature resulted in the identification of 16 research publications that provide a rough foundation for music therapy interventions. This framework is made up of two parts:’mechanism’ (resource + reasoning) and ‘outcomes’ (short-term + overall).

This rough framework was supplemented by 11 systematic reviews, 3 meta-analyses, and 29 research studies (including randomized controlled trials) to generate context-mechanism-outcome configurations (CMOCs), which are divided into layers of reality based on individual needs, interpersonal dynamics, and institutional contributions. While an infrastructural CMOS is inferred, the lack of particular data limits its applicability.

“Key areas of uncertainty not addressed in the current theory were the role of staff training, type and purpose of the setting, the impact of medication, the impact of hearing, and outcomes for staff and family members.”

Conclusions

The current study justifies the use of music therapy as a stress-reducing strategy in advanced dementia. It builds on more than 50 earlier research to provide three context-mechanism-outcome configurations, each targeting a different participant in the institutional environment. These CMOS serve as conceptual frameworks and guidelines for future clinical trials, especially since current evidence is insufficient to define treatment aspects such as appropriate therapy length, session timing, and long-term effects.

“The theory supports much of the current training and practice of music therapy in dementia care internationally, particularly the focus on meeting needs at the moment. It also highlights the contextual factors required for collaboration with staff and family members to ensure the short-term benefits of music for the individual can be embedded in everyday care and contribute to the management of distress in the wider environment.”