Persons with dementia have health problems that include cognitive decline, language deterioration, poor judgment, restlessness, confusion, and changes in social-behavioral problems [1] . Among these problems, agitation has become a major issue because it increases nursing-home placement, health maintenance costs, and the burdens of caregivers [2] -[4] . Pharmacological interventions are often necessary to control agitation in persons with dementia, but they bring about undesirable effects such as a high risk of fall, declined cognition levels, and monetary burdens [5] [6] . To reduce the undesirable effects of pharmacological interventions, music intervention is currently being provided to control agitation because it is relatively convenient, non-pervasive, and cost- effective. Music therapy is defined as “an established allied health profession using music and music activities to address physical, psychological, cognitive and social needs of individuals with disabilities” [7] .

Many studies have reported the positive effects of music intervention on diverse health problems in persons with dementia, including cognitive decline, less-alert responses, lack of engagement between caregiver and care- receiver, disruptive behaviors, impaired language function, inattention, lack of food intake, and poor social relationships [8] -[13] . Many studies have also reported the positive effects of music intervention on agitation in persons with dementia [14] -[18] . Music intervention consists of music group activities, listening to music, singing, or playing instruments [9] [16] [17] . Most music-intervention studies have been performed in nursing facilities, with only one study that was conducted at the client’s residence [17] .

Music intervention to control agitation in persons with dementia has been performed by diverse healthcare providers. The providers can be categorized into two groups: music therapists and non-music therapists (the latter includes nurses, certified nursing assistants, recreation specialists, and family members; [15] [19] [20] . Music therapists are inclined to use different methods of music intervention compared with non-music therapists, reflecting their different educational backgrounds and clinical experiences. Even though music intervention providers tend to use different types of music intervention to control agitation, there has been no description regarding how the interventions are different depending on the different educational backgrounds of the music intervention providers. A few studies reviewed the effects of music intervention on agitation, and a review focused on the findings of music interventions, but not on music contents and music providers [21] -[23] .

The present study was undertaken to fill the knowledge gap by examining how the content of music intervention is different between music therapists and non-music therapists based on a review of published research articles. The findings reveal more of the strengths and weaknesses of music intervention by each group, and also how music interventions might be improved. Specifically, the present review focused on how the contents of music intervention used to control agitation in persons with dementia differed between music therapists and non- music therapists. This new knowledge should aid in developing more practical guidelines of music intervention for each group of music providers.

The present study was undertaken to review the differences of music interventions to control agitation in patients with dementia between music therapists and non-music therapists, with the aim of providing practical ideas to improve the interventions for each group. Music-intervention studies by music therapists were inclined to have more subjects compared with non-music therapists. A more reasonable sample size needs to be included using calculation of the sample size, and furthermore the rationale for determining the sample size needs to be presented in the studies. All studies except two studies took place in nursing homes, health center, nursing facility, long-term care facility, skilled care facility, and so on and only two studies were performed in the patients’ own homes [17] . Thus, more music intervention studies need to be conducted on different communities including patients’ own home for the future studies.

In terms of the findings about music interventions, 4 out of the 7 music therapists’ studies reported significant effects of music interventions compared with the other group. In non-music therapists’ studies, most studies showed significant decreases in agitation compared with the baseline, but only 5 out of 27 studies showed significant effects of music interventions to the comparison groups. For future studies, a comparison about the effects of music on agitation with different types of music needs to be conducted using a more sophisticated level of research design, such as randomized controlled trials.

The Cohen-Mansfield Agitation Inventory (CMAI) is not only the most commonly used instrument to measure agitation in the music therapists’ studies but also for the non-music therapists. To increase the validity of the study findings, another measurement, such as video analysis, observation or interviews with caregivers, might be added to measure agitation for both types of music providers. In addition, while music therapists provided music interventions any time, such as morning, noon, or afternoon, the non-music therapists performed music interventions mostly at peak agitation time, mealtime, or bathing time [17] [24] [25] . The reasons for performing the intervention at those times are assumed to be that meal time and bathing time are important moments to care for patients with dementia for the usual care and is also the time when it is likely for agitation to often occur, so that the care providers want to control agitation during the meal time and bathing time with music.

For the contents of music interventions, the music therapists’ studies provided music interventions including diverse methods with group activities, such as singing, playing instruments, improvising, or dancing. On the other hand, the non-music therapists’ studies usually provided music interventions using recorded music for background music and they were likely to perform the intervention for individual patients with dementia. The differences of offering music intervention methods between the studies are based on their educational backgrounds and clinical experiences. For future studies, to consider the pros and cons of each music provider’s education background and clinical experiences, multi-disciplinary music intervention studies need to be carried with music therapists, nurses, or recreational therapists.

The current study reviewed the differences in the contents of music intervention studies to control agitation between the music therapists and non-music therapists, with the goal of providing practical guidelines for music providers. The music therapists’ studies had a more reasonable sample size, various music activities, and the comparison groups. Whereas, the non-music therapists’ studies had a more theoretical framework of music interventions, used the recorded music for the background music, provided music at more diverse times such as peak agitation time, meal time, or bathing time. For future studies, multi-disciplinary music intervention studies including music therapists, nurses, recreational therapists, occupational therapists and so on are recommended to improve the effects of music intervention on agitation

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the South Korean Ministry of Education (2015R1D1A3A01017843).

HeeokPark, (2015) Difference in the Contents of Music Intervention to Control Agitation by Music Providers. Open Journal of Nursing,05,740-748. doi: 10.4236/ojn.2015.58077