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Pragmatic Trial of Personalized Music for Agitation and Antipsychotic Use in Nursing Home Residents With Dementia

  • Ellen M. McCreedy
    Correspondence
    Address correspondence to Ellen M. McCreedy, PhD, Center for Gerontology & Healthcare Research, Brown University School of Public Health, 121 S Main St, Box G-S121-6, Providence, RI 02912, USA.
    Affiliations
    Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA

    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
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  • Anthony Sisti
    Affiliations
    Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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  • Roee Gutman
    Affiliations
    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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  • Laura Dionne
    Affiliations
    Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
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  • James L. Rudolph
    Affiliations
    Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA

    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    US Department of Veterans Affairs Medical Center, Providence, RI, USA
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  • Rosa Baier
    Affiliations
    Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA

    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
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  • Kali S. Thomas
    Affiliations
    Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA

    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    US Department of Veterans Affairs Medical Center, Providence, RI, USA
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  • Miranda B. Olson
    Affiliations
    Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
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  • Esme E. Zediker
    Affiliations
    Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA
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  • Rebecca Uth
    Affiliations
    Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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  • Renée R. Shield
    Affiliations
    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    Department of Biostatistics, Brown University School of Public Health, Providence, RI, USA
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  • Vincent Mor
    Affiliations
    Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, RI, USA

    Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA

    Center for Long-Term Care Quality & Innovation, Brown University School of Public Health, Providence, RI, USA

    US Department of Veterans Affairs Medical Center, Providence, RI, USA
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Published:January 14, 2022DOI:https://doi.org/10.1016/j.jamda.2021.12.030

      Abstract

      Objective

      To test the effect of a personalized music intervention on agitated behaviors and medication use among long-stay nursing home residents with dementia.

      Design

      Pragmatic, cluster-randomized controlled trial of a personalized music intervention. Staff in intervention facilities identified residents' early music preferences and offered music at early signs of agitation or when disruptive behaviors typically occur. Usual care in control facilities may include ambient or group music.

      Setting and Participants

      The study was conducted between June 2019 and February 2020 at 54 nursing homes (27 intervention and 27 control) in 10 states owned by 4 corporations.

      Methods

      Four-month outcomes were measured for each resident. The primary outcome was frequency of agitated behaviors using the Cohen-Mansfield Agitation Inventory. Secondary outcomes included frequency of agitated behaviors reported in the Minimum Data Set and the proportion of residents using antipsychotic, antidepressant, or antianxiety medications.

      Results

      The study included 976 residents with dementia [483 treatment and 493 control; mean age = 80.3 years (SD 12.3), 69% female, 25% African American]. CMAI scores were not significantly different (treatment: 50.67, SE 1.94; control: 49.34, SE 1.68) [average marginal effect (AME) 1.33, SE 1.38, 95% CI −1.37 to 4.03]. Minimum Data Set–based behavior scores were also not significantly different (treatment: 0.35, SE 0.13; control: 0.46, SE 0.11) (AME –0.11, SE 0.10, 95% CI −0.30 to 0.08). Fewer residents in intervention facilities used antipsychotics in the past week compared with controls (treatment: 26.2, SE 1.4; control: 29.6, SE 1.3) (AME –3.61, SE 1.85, 95% CI −7.22 to 0.00), but neither this nor other measures of psychotropic drug use were statistically significant.

      Conclusions and Implications

      Personalized music was not significantly effective in reducing agitated behaviors or psychotropic drug use among long-stay residents with dementia. Barriers to full implementation included engaging frontline nursing staff and identifying resident's preferred music.

      Keywords

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