Goals and Benefits

For the resident

1. Prevent or alleviate agitated behaviors
2. Provide a stimulus to elicit positive affect
3. Provide a stimulus to promote meaningful interaction with others

For the staff

1. Provide an alternative intervention for the management of agitation in persons with dementia
2. Promote a collaborative relationship with family

For family members

1. Provide an alternative intervention for the management of agitation during visits
2. Provide a stimulus to promote meaningful interaction with resident

Rationale

Family have valuable information regarding individual preferences of residents with dementia. Staff can collaborate with family regarding the role of music in the resident's life prior to the onset of cognitive impairment and the selection of the resident's personnel music preference specific to performers and song titles. Persons with dementia maintain the ability to process music long after their ability to process verbal communication. Therefore, music may be used as a means of communication in persons even in the advanced stages of dementia. The presentation of individualized music provides an opportunity to stimulate remote memory and change the focus of attention to an interpretable stimulus, overriding meaningless or confusing stimuli in the environment. The elicitation of remote memories associated with positive feelings is theorized to have a soothing effect on the resident with dementia to thereby prevent or alleviate agitation (Gerdner, 1997).

Elements of the Intervention

1. When agitation is exhibited, careful assessment (PDF, 44KB, 2pg.) should be conducted in an effort to determine the time of onset and potential external or internal causes that underlie these behaviors. For example, if a physiological cause is suspected (i.e, pain, infection) the physician should be contacted for appropriate medical attention
2. Family are consulted to learn about the importance that music played in the resident's life prior to the onset of cognitive impairment. In addition family are asked to assist in the identification of the resident's personnel music preference. This includes specific performers and song titles. The Assessment of Personal Music Preference (Gerdner, Harsock, & Buckwalter, 2000) (PDF, 222KB, 2pg.) for this specific purpose
3. Early signs and patterns of agitation (PDF, 82KB, 2pg.) commonly displayed by the resident are put into the care plan (PDF, 22KB, 1pg.), so staff may recognize them, and use planned approaches to prevent escalation. Staff are encouraged to identify the triggers of agitation and try to eliminate or minimize them
4. Staff may wish to post a colorful sign at resident's bedside as a reminder of the prescribed music and time of intervention Click here for a sample (PDF, 48.4KB, 1pg.)
5. Staff are trained in the use of individualized music as one approach to the management of agitation in residents with dementia.
6. If the resident begins exhibiting an increased degree of frequency of agitation with the onset of music, staff are instructed to stop the music immediately. The staff will then consult with family to reassess the resident's personal music preference to determine the cause for the resident's negative response. Family are encouraged to provide tapes from the resident's personal music library when possible and appropriate. An alternative music selection will be made with assistance of the family. The second musical selection will be played on another day. If the resident responds negatively to the alternate music the intervention will be discontinued
7. The administration is supportive of individualized music and develops a non-coercive policy which is explained to family and staff
8. The resident's response to individualized music is documented using the EDGE form Evaluation of Effectiveness of the Intervention in Meeting Goals.