Persons with cognitive impairment as in Alzheimer's disease and related disorders have a progressive decline in their stress threshold. Agitation results when this stress threshold is exceeded. A proposed mid-range theory incorporates these elements to discuss the use of individualized music to alleviate agitation. Music may provide a method of communicating with this population even in advanced stages when the person is unable to understand verbal language and has decreased ability to interpret environmental stimuli. It is predicted that the presentation of music carefuUy selected for meaningfulness to the person during his or heryoungeryears wil stimulate memory for remote events, and elicitation of memories associated with positive feelings will have a soothing effect and will alleviate or decrease agitated behaviors. Results from a pilot study andpreliminaryfindingsfrom a study currently underway are provided as beginning efforts to support this mid-range theory. An individualized music intervention that flows from this mid-range theory is discussed.
Get full access to this article
View all access options for this article.
References
1.
Aldridge, D. (1993). Music and Alzheimer's disease-assessment and therapy: Discussion paper. Journal of the Royal Society of Medicine, 86, 93-95.
2.
Bright, R. (1982). Music geriatric care. Lynbrook, NY: Musicgraphics.
3.
Bright, R. (1987). The use of music therapy and activities with demented patients who are deemed "difficult to manage."Clinical Gerontologist, 6, 131-141.
4.
Burgener, S. C., & Chiverton, P. (1992). Conceptualizing psychological well-being in cognitively-impaired older persons. IMAGE: Journal of Nursing Scholarship, 24, 209-214.
5.
Burnside, I. (1988). Dementia and delirium. In I. Burnside (Ed.), Nursing and the aged (pp. 732-794). New York: McGraw-Hill.
6.
Cohen-Mansfield, J. (1986). Agitated behaviors in the elderly II. Preliminary results in the cognitively deteriorated. Journal of American Geriatrics Society, 34, 722-727.
7.
Cohen-Mansfield, J., & Billig, N. (1986). Agitated behaviors in the elderly I. A conceptual review. American Geriatrics Society, 34, 711-721.
8.
Cohen-Mansfield, J., & Marx, M. (1989). Do past experiences predict agitation in nursing home residents?International Journal of Aging and Human Development, 28, 285-293.
9.
Cohen-Mansfield, J., & Marx, M. (1990). The relationship between sleep disturbances and agitation in a nursing home. Journal of Aging and Health, 2(1), 42-57.
10.
Cohen-Mansfield, J., Marx, M., & Rosenthal, A. S. (1989). A description of agitation in a nursing home. Journal of Gerontology, 44, 77-84,
11.
Crystal, H., Grober, E., & Mauser, D. (1989). Preservation of musical memory in Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry, 52, 1415-1416.
12.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). "Mini mental state exam" a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198.
13.
Gerdner, L. A. (1992). Thle effects of individualized music on elderly patients who are confused and agitated. Unpublished master's thesis, University of Iowa, Iowa City.
14.
Gerdner, L. A. (1995). Individualized music research basedprotocol. Research development and dissemination core. Iowa City: University of Iowa, Geriatric Nursing Research Intervention Center.
15.
Gerdner, L. A. (1996). Individualized vs. classical music on agitation in ADRD. Unpublished doctoral dissertation, University of Iowa, Iowa City.
16.
Gerdner, L. A., & Buckwalter, K. C. (in press). Music therapy. In G. M. Bulechek & J. C. McCloskey (Eds.), Nursing interventions: Effective nursing treatments (3rd ed.). Philadelphia: Saunders.
17.
Hall, G. R., & Buckwalter, K. C. (1987). Progressively Lowered Stress Threshold: A conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1, 399-406.
18.
Hartsock, J. W. (1982). The effects of music on levels of depression in orthopedic patients on prolonged bed rest. Unpublished master's thesis, University of Iowa, Iowa City.
19.
Marx, M. S., Cohen-Mansfield, J., & Werner, P. (1990). Agitation and falls in institutionalized elderly persons. Journal of Applied Gerontology, 9, 106-117.
20.
Petsche, H., Lindner, K., Rappelsberger, P., & Gruber, G. (1988). The EEG: An adequate method to concretize brain processes elicited by music. Music Perceptions, 6, 133-159.
21.
Randall, T. (1991). Music not only has charms to soothe, but also to aid elderly in coping with various disabilities. Medical News & Perspective, 266, 1323-1324, 1329-1329.
22.
Reisberg, B., Ferris, S. H., deLeon, M. J., & Crook, T. (1982). The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136-1139.
23.
Shevitz, S. (1979). The agitated patient. 7The Jou rnal of Family Practice, 9, 305-311.
24.
Silva, M. C., & Sorrell, J. M. (1992). Testing of nursing theory: Critique and philosophical expansion. Advances in Nursing Science, 14(4), 12-23.
25.
Swanson, E., Maas, M., & Buckwalter, K. (1993). Catastrophic reactions of Alzheimer's patients: Special unit compared to traditional units. Archives of Psychiatric Nursing, 7, 292-299.
26.
Swartz, K. P., Hantz, E. C., Crummer, G. C., Walton, J. P., & Frisina, R. D. (1989). Does the melody linger on? Music cognition in Alzheimer's disease. Seminars in Neurology, 9, 152-157.
27.
Taft, L. B. (1989). Conceptual analysis of agitation in the confused elderly. Archives of Psychiatric Nursing, 3, 102-107.
28.
Thaut, M. H. (1990). Neurophysiological processes in music perception and their relevance in music therapy. In R. F. Unkefer (Ed.), Music therapy in the treatment of adults with mental disorders (pp. 3-32). New York: Schimer Books.
29.
Thomas, D. R. (1988). Assessment and management of agitation in the elderly. Geriatrics, 43, 45-50.
30.
Walton, J. P., Frisina, R. D., Swartz, K. P., Hantz, E., & Crummer G. C. (1988). Neural basis for music cognition: future directions and biomedical implications. Psychomusicology, 7, 127-138.
31.
Zimmer, J. G., Watson, N., & Treat, A. (1984). Behavioral problems among patients in skilled nursing facilities. American Journal of Public Health, 74, 118-121.
