Measuring Effects of Nondrug Interventions on Behaviors: Music & Memory Pilot Study

摘要

BACKGROUND/OBJECTIVES Most people with Alzheimer disease and related dementias will experience agitated and/or aggressive behaviors during the later stages of the disease. These behaviors cause significant stress for people living with dementia and their caregivers, including nursing home (NH) staff. Addressing these behaviors without the use of chemical restraints is a growing focus of policy makers and professional organizations. Unfortunately, evidence for nonpharmacological strategies for addressing dementia‐related behaviors is lacking. DESIGN Six‐month, preintervention‐postintervention pilot study. SETTING US NHs (n = 4). PARTICIPANTS Residents with advanced dementia (n = 45). INTERVENTION Music & Memory, an individualized music program in which the music a resident preferred when she/he was young is delivered at early signs of agitation, using a personal music player. MEASUREMENTS Dementia‐related behaviors for the same residents were measured three ways: (1) observationally using the Agitation Behavior Mapping Instrument (ABMI); (2) staff report using the Cohen‐Mansfield Agitation Inventory (CMAI); and (3) administratively using the Minimum Data Set–Aggressive Behavior Scale (MDS‐ABS). RESULTS ABMI score was 4.1 (SD = 3.0) preintervention while not listening to the music, 4.4 (SD = 2.3) postintervention while not listening to the music, and 1.6 (SD = 1.5) postintervention while listening to music ( P ?.01). CMAI score was 61.2 (SD = 16.3) preintervention and 51.2 (SD = 16.1) postintervention ( P ?.01). MDS‐ABS score was 0.8 (SD = 1.6) preintervention and 0.7 (SD = 1.4) postintervention ( P =?.59). CONCLUSION Direct observations were most likely to capture behavioral responses, followed by staff interviews. Nursing‐home based, pragmatic trials that rely solely on available administrative data may fail to detect effects of nonpharmaceutical interventions on behaviors. Findings are relevant to evaluations of nonpharmaceutical strategies for addressing behaviors in NHs, and will inform a large, National Institute on Aging–funded pragmatic trial beginning spring 2019. J Am Geriatr Soc 67:2134–2138, 2019