Program Structure

Duration

Approximately 30 minutes daily and p.r.n. (as needed)

Participants in the Program

This is an intervention that is appropriate for persons with dementia (even in the advanced stages) who are agitated who have had an appreciation for, or enjoyment of music; and are able to hear a normal speaking voice at a distance of 1 1/2 feet.

Note: Agitation secondary to a medical condition, requires treatment of the underlying cause. Under these circumstances Individualized Music may be used in conjunction with the treatment prescribed by a physician

Group Size

Intervention is conducted individually.

Selection of Residents

Resident/Client exhibits agitation as operationally defined using the Cohen-Mansfield Agitation Inventory (1986). Agitation is classified into the following three syndromes: a) aggressive behavior (i.e. hitting, kicking, cursing); b) physically nonaggressive behavior (i.e., restlessness, pacing, inappropriate disrobing); and c) verbally agitated behaviors (i.e., complaining, negativism, repetitious phrases).

Residents Strengths and Qualifiers

  1. Ability to hear a normal speaking voice to insure the resident's ability to hear the music intervention. Impaired hearing may result in the distortion of sound that may be a source of irritation.
  2. May be used for individuals in the advanced stages of dementia (Global Deterioration Scale scores of 5, 6, and 7).
  3. Persons who have had an appreciation for, or enjoyment of music. It is expected that there is a positive correlation between the degree of significance that music had in the person's life prior to the onset of cognitive impairment.

Exit Criteria

  1. If the resident responds adversely (i.e., and increase in agitation) with the alternative music selection (as described above) the intervention should be discontinued.

Evidence Based Protocol

  1. Gerdner, L. A. (2001). Evidence-based protocol: Individualized music intervention. In M. Titler (Series Ed.) Series on Evidence-Based Practice for Older Adults. Iowa City, Iowa: The University of Iowa College of Nursing Gerontological Nursing Interventions Research Center, Research Dissemination Core.
  2. Gerdner, L. A. (2001). Consumer version of evidence-based protocol: Individualized music. In M. Titler (Series Ed.) Series on Evidence-Based Practice for Older Adults. Iowa City, Iowa: The University of Iowa College of Nursing Gerontological Nursing Interventions Research Center, Research Dissemination Core.
    For information on how to obtain the evidence-based protocols on individualized music, you may contact The University of Iowa Gerontological Nursing Intervention Research Center Research Dissemination Core.

    In writing:
    Marita Titler, PhD, RN, FAAN
    Director, Research Dissemination Core
    4118 Westlawn
    Iowa City, Iowa 52242
    By phone:(319) 384-4429
    By fax: (319) 353-5843
    Via internet:
    The University of Iowa Gerontological Nursing

Resources and Equipment Needed

  1. Have a portable CD/audio-cassette player (with headphones) that can be checked out from the nurses' station for use by individual residents.
  2. Family may want to purchase a CD/audio cassette player as a gift for the resident on holidays or special occasions.
  3. The facility can gradually build a music library as funds become available. The library should include a variety of musical selections that can be used for residents within the facility.
  4. Sample Music Library
    Note: These selections exemplify the diversity of preference and the diversity found within general categories of music. These examples were generated from information family provided when completing The Assessment of Personal Music Preference. This form was designed specifically for this purpose and is accessible via the link that follows:
    Popular Lawrence Welk and His Orchestra (1989). Champagne & Romance [audio-cassette]. Santa Monica, California: Hamilton Records, A WRG Co.
    Big Band The Glenn Miller Orchestra (1983). In the Digital Mood. GRP Records, Inc.
    Classical The Royal Philharmonic Orchestra (2003). Mozart: The most beautiful melodies. Alpharetta, GA: Reference Gold.
    Instrumental Bob Ralston/Jerry Burke And The Magic Organ (1980). Golden Organ Favorites. New York, New York: I & M Teleproducts, Inc. / Manufactured & distributed by RCA Records.
    Religious/Spiritual Elvis Presley. (1994) Amazing Grace: His Greatest Sacred Performances [compact disc]. RCA
    Mahalia Jackson (1991). Gospels, Spirituals & Hymns [compact disc]. New York, New York: Columbia (1954).
    Country/Western Hank Williams Sr. (1999). The Best of Hank Williams: The Millenium Collection [compact disc]. Mercury Records.
    Patsy Cline (1988) 12 Greatest Hits [cassette]. MCA Records.
    Ethnic Leo Greco (YEAR). Czech Time [audio-cassette]. Cedar Rapids, Iowa: L.G. Records; Cedar Rapids. Mastered & Produced by Sound 80, Inc. Minneapolis).
    Dean Martin (2001). Italian Love Songs. Hollywood, California: Capital Records.

Additional Creative Approaches

  1. Encourage family to share audio-tapes from residents personal music library.
  2. Family could create an anthology audio-cassette of residents favorite music. Might also consider music performed by family or close friends, either instrumental or vocal.
  3. Encourage family to assist with the implementation of individualized music during regular visits.
  4. Explore supplementing audio stimulation with complementary multisensory stimuli (visual, tactile, and olfactory. For example listed to Czech Time (polka music with accordian accompaniment) by Leo Greco while eating a kolache (Czech pastry).

Physical Environment and Equipment Required

  • Eliminate competing external environmental stimuli (e.g. television or radio that is being played inattentively).

Case Study

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