scholarly journals The Nexus of ‘Music, Mind, and Well-being’: Effects of Harmony in the Bush Music Intervention for Residents with Advanced Dementia in Australian Rural Nursing Homes

2020 ◽  
Author(s):  
Mohammad Hamiduzzaman ◽  
Abraham Kuot ◽  
Jennene Greenhill ◽  
Edward Strivens ◽  
Daya Ram Parajuli ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Qualitative Data ◽  
Psychiatric Symptoms ◽  
Behavioural Change ◽  
Well Being ◽  
T Test ◽  
Advanced Dementia ◽  
Music Intervention ◽  
Time Points ◽  
Rural Nursing

Abstract BackgroundPersons with dementia often show aggression, depression, and anxiety and these symptoms and behaviours escalate overtime without treatment. Music has been found to be useful for managing these symptoms and behaviours and can significantly improve well-being. This paper reports the effect of music on residents with advanced dementia in rural nursing homes, as a key part of the Harmony in the Bush study.MethodsWe conducted a quasi-experimental research in five Australian rural nursing homes. Managers of nursing homes were contacted to select residents with advanced dementia, resulted in 74 residents who participated in person-centred music and culturally-appropriate group music sessions. Staff (104) and musicians (6) participated in 65 interviews and 20 focus groups. One-Way ANOVA and paired-samples t-test were performed to understand Music in Dementia Assessment Scale (MiDAS) scores. Qualitative data were thematically analysed.ResultsSeventy-four residents participated in an average of 9.5 [SD 4.73] person-centred music sessions and most of them were female (n = 52/70%). Analysis revealed the overall mean effect of the person-centred music at two-time points as 67% [during-70% {351.22 (SD:93.51)}; and after-63% {315.09 (SD:98.52)}]. The residents with (moderate to severe) pain, anxiety, sadness, and agitation at pre-intervention, presented an improvement in their levels of interest, response, initiation, involvement, and enjoyment at different time-points. The t-test showed that the MiDAS sub-categories’ mean scores differed significantly between the time-points: interest [t = 2.75, p = 0.001]; response [t = 2.94, p = 0.005]; initiation [t = 2.41, p = 0.019]; and involvement [t = 2.78, p = 0.007]. Additionally, the residents were observed at post-intervention with a reduction of agitation (87.5%), low in mood (87.5%), and anxiousness (70.3%); and an improvement in relaxation (75.5%), attentiveness (56.5%), and smiling (56.9%). Themes from qualitative data were behavioural change, meaningful interaction, being initiative, increased participation, and contentment.ConclusionFindings suggest the music intervention probably reduce the residents’ psychiatric symptoms and behaviours and improve well-being.Clinical RegistrationThe study is registered with the Australian and New Zealand Clinical. Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p; http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with advanced dementia in Australian rural aged care homes

2020 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Advanced Dementia ◽  
Music Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract BackgroundHigh rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with advanced dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. MethodsOur larger study was a quasi-experimental design conducted in five rural nursing homes in Queensland and South Australia. Medication charts (n=31) were collected retrospectively from three Australian rural aged care facilities through contacting the facility managers. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.ResultsThe median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (, 39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention However, these changes were not statistically significant, Additionally, there was a decreasing trend in the use of inappropriate use of medications. Psychotropic medications were prescribed in up to 43% and antidementia in 45% of participants for more than 6 months. Major themes extracted from qualitative data were reduced/decreased/cessation of medication use; introducing a rest period and the music intervention combination was an alternative approach for medications use, and resulting in less behaviors, and ultimately the less use of medications. ConclusionsOur findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications and inappropriate medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

scholarly journals The Outcomes of a Person-centered, Non-Pharmacological Intervention in Reducing Behavioral and Psychiatric Symptoms in Residents With Advanced Dementia in Australian Rural Nursing Homes

2020 ◽  
Author(s):  
Vivian Isaac ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Edward Strivens ◽  
Jennene Greenhill
Keyword(s):  
Nursing Homes ◽  
Psychiatric Symptoms ◽  
Trial Registration ◽  
Advanced Dementia ◽  
Aggressive Behaviors ◽  
Rural Nursing ◽  
Stress Threshold ◽  
Progressively Lowered Stress Threshold ◽  
Stress Inventory ◽  
Rural Australia

Abstract BackgroundThere is limited best- practice evidence to address behavioral and psychiatric symptoms for those with advanced dementia in Australian rural nursing homes. This study aims to evaluate the outcomes of a person-centered, non-pharmacological dementia care model, ‘Harmony in the Bush’, based on the Progressively Lowered Stress Threshold principles and person-centered music in rural Australia.MethodsA quasi-experimental study was conducted in five rural nursing homes in Queensland and South Australia. Seventy-four residents with advanced dementia participated in this intervention study, which yielded a sample power of 80%. Eighty-seven staff completed the Caregiver Stress Inventory at pre-post four-weeks of intervention. Staff training workshops focusing on the theory and delivery of the Progressively Lowered Stress Threshold principles and a music intervention. We used reported changes in agitation of the residents, measured using Cohen- Mansfield Agitation Inventory, and staff’s caregiving stress, using Caregivers Stress Inventory. Triangulation using post- intervention qualitative evaluation from 13 focus group discussion and 38 staff interviews. This study adheres to the CONSORT guidelines.ResultsMean age of residents with advanced dementia was 82.4 (7.7) years and 69% were females. The mean age of admission was 80.1(8.4) years. Baseline measures indicated that 32.7% had mild- severe pain and 30.5% reported mild-severe sadness. The results showed statistically significant decline in aggressive behaviors, physically non-aggressive behaviors, verbally agitated behavior and hiding and hoarding. There was comparable reduction in staff stress in the domains of aggressive behaviors, inappropriate behaviors, resident safety, and resource deficiency.ConclusionsThe Harmony in the Bush model is effective in reducing behavioral and psychiatric symptoms in advanced dementia with significant reduction in staff stress levels in nursing homes in rural Australia.Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR) on 20/2/2018 (Registration No: ACTRN12618000263291p). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374458

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medications use among residents with dementia in Australian rural aged care homes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Qualitative Data ◽  
Psychiatric Symptoms ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing ◽  
Limited Effectiveness

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n = 31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up. Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n = 27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medications, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration ANZCTR, ACTRN12618000263291. Registered on 20th February 2018.

A systematic review of the methodologies used in research related to adult drug and alcohol rehabilitation in therapeutic communities published 2000-2013

2015 ◽  
Vol 36 (4) ◽  
pp. 193-208 ◽  
Author(s):  
Cassandra Perryman ◽  
Genevieve Dingle
Keyword(s):  
Systematic Review ◽  
Psychiatric Symptoms ◽  
Well Being ◽  
Size Analysis ◽  
Multiple Time ◽  
Therapeutic Communities ◽  
Diverse Range ◽  
Content Type ◽  
Time Points ◽  
Multiple Time Points

Purpose – The purpose of this paper is to summarize research conducted in long-term residential rehabilitation centers, including therapeutic communities (TCs), in order to further clarify the effectiveness of this treatment approach and to evaluate the quality of TC research conducted in the period 2000-2013. Design/methodology/approach – The composite search engine UQ database Summon were used to find articles with “Therapeutic Community” as title words, and the search was limited to adult participants, peer-reviewed articles, published between January 2000 and June 2013 in the English language. The review was conducted using Cochrane Collaboration methods and reported under the Preferred Reporting Items for Systematic Review and Meta-analyses guidelines. Findings – In total, 25 studies met inclusion criteria for the review and represented data from n=5,923 participants in the USA, Australia, Spain, England, and Belgium. Evidence supports the TC approach for a diverse range of individuals who misuse a range of substances. Several studies reported a relationship between retention and outcomes however dropout from treatment is a widespread issue. A paucity of research using multiple time points precludes any firm conclusions regarding the optimal length of treatment in a TC. There is a lack of research on the interplay between individual and community-level factors on client well-being, retention, and longer term outcomes. Research limitations/implications – This review highlights the need for TC research that includes multiple time points and follow-up assessments, and measures of change in theoretically meaningful constructs alongside standard measures of demographics, substance use, and psychiatric symptoms. Practical implications – The reporting format of TC research should be better standardized in order to create a better basis for research comparison. More standardized reporting would also allow for effect size analysis, and create a more efficacious evidence base. Originality/value – This updates the systematic review body of research.

scholarly journals Person-centered, non-pharmacological intervention in reducing psychotropic medication use among residents with dementia in Australian rural aged care homes

2021 ◽  
Author(s):  
Daya Ram Parajuli ◽  
Abraham Kuot ◽  
Mohammad Hamiduzzaman ◽  
Justin Gladman ◽  
Vivian Isaac
Keyword(s):  
Nursing Homes ◽  
Psychotropic Medication ◽  
Qualitative Data ◽  
Medication Use ◽  
Aged Care ◽  
Psychotropic Medications ◽  
Care Homes ◽  
Pharmacological Intervention ◽  
Post Intervention ◽  
Rural Nursing

Abstract Background High rates of psychotropic medications are prescribed in aged care homes despite their limited effectiveness and associated adverse effects. We aim to evaluate the changes in prescription patterns for elderly residents with dementia in the ‘Harmony in the Bush Dementia Study’. Harmony in the Bush is a person-centered model of dementia care in nursing homes, based on the principles of Progressively Lowered Stress Threshold and person-centered music intervention. Methods Our larger study (12 weeks period) was a quasi-experimental design conducted in five rural nursing homes in Australia. Medication charts (n=31) were collected retrospectively from three rural aged care facilities. Medication data for each resident was collected from a three-month medication charts, pre-intervention, and post-intervention. Fifty-three staff participated in 31 semi-structured interviews and 8 focus groups at post-intervention, and at 1-month and 3-months follow up.Results The median age of the participants was 83 years, and 68% of them were female. Polypharmacy was measured in 87% (n=27) of the participants. Hypertension, hyperlipidemia, diabetes, and the Alzheimer’s disease were the major comorbidities identified in residents. None of the residents received more than the maximum dose of psychotropic medications recommended by the guidelines. There was a reduction of 22.4% (77.4% vs 55%) in the use of at least any psychotropic medication, 19.6% (39% vs, 19.4%) reduction in antipsychotics and benzodiazepines (39% vs 19.4%), and 6.5% (42% vs 35.5%) reduction in antidepressants prescription medicines, when comparing residents’ medication charts data covering 3-months pre- and post-intervention, however, these changes were not statistically significant. Additionally, there was a decreasing trend in the use of inappropriate medications. Psychotropic medications were prescribed in up to 43% and anti-dementia medications in 44% of participants for more than 6 months. Three themes extracted from qualitative data include decrease behavioral and psychiatric symptoms of dementia due to medication weaning or dose tapering, other strategies to reduce medication use, and environmental or noise control. Conclusions Our findings indicate that the Harmony in the Bush model as a non-pharmacological approach reduces the prescription of psychotropic medications in rural nursing homes as supported by findings from both quantitative and qualitative data. Trial registration: ANZCTR, ACTRN12618000263291. Registered on 20th February 2018. http://www.ANZCTR.org.au/ACTRN12618000263291p.aspx).

Evaluation of a Music Intervention on Well-being and Behavior of People with Dementia Using Dementia Care Mapping

2020 ◽  
Author(s):  
Rebecca Dahms ◽  
Cornelia Eicher ◽  
Drin Ferizaj
Keyword(s):  
Nursing Homes ◽  
Well Being ◽  
Dementia Care ◽  
Music Intervention ◽  
Intervention Phase ◽  
People With Dementia ◽  
Essential Components ◽  
And Behavior ◽  
Care Mapping ◽  
Dementia Care Mapping

Introduction: Dementia Care Mapping (DCM) was originally developed as an observation tool to examine person-centered care in long-term care facilities and to evaluate the quality of life and well-being of people with dementia (PwD). However, the effects of a music intervention using this tool have not been investigated so far. This leads to the following research question: How does a music intervention which involves music therapy and other music-based interventions affect the observed well-being and behavior of PwD living in nursing homes? Methods: In this 14-week, non-controlled music intervention study, data from 30 PwD aged between 52 and 97 (M = 81.4 years) were analyzed. DCM coding involves continuous observation for five hours on four days in the baseline and intervention phase. In the follow-up phase PwD were mapped on two days for five hours. The DCM method were used to measure well-being and certain behaviors of PwD. Results: The well-being during the observation remained almost constant and corresponds to a neutral state of affect and focused contact, with no indication of positive or negative sensations. Significant improvements in certain behaviors were observed in the course from baseline to intervention phase. For example, it was shown that physical activities of the participants, such as (instructed) sports exercises, strengthening or physically challenging exercises in the intervention phase were significantly higher (M = 0.99, SD = 1.82) than at baseline phase (M = 0.00, SD = 0.00) (z = -2.37, p = .02, n = 26). Similar results were shown for expressive/creative activities or work-related activities (e.g. washing dishes). Conclusion: In summary, it can be stated that music interventions can promote communication and movement. However, musical stimulation is not one of the essential components of improving behavioral and psychological symptoms or well-being for PwD in nursing homes.

The Predictors of and Motivations for Increased Family Involvement in Nursing Homes

2018 ◽  
Vol 60 (3) ◽  
pp. 535-547 ◽  
Author(s):  
Amy Restorick Roberts ◽  
Karen J Ishler ◽  
Kathryn Betts Adams
Keyword(s):  
Nursing Homes ◽  
Family Member ◽  
Family Involvement ◽  
Qualitative Data ◽  
Family Members ◽  
Nursing Home Residents ◽  
Well Being ◽  
Multilevel Regression ◽  
Relationship Type ◽  
Loved One

Abstract Background and Objectives Quantitative and qualitative data from a statewide survey of family members of nursing home residents were analyzed to determine the predictors of, and motivations for, family involvement. Research Design and Methods We examined 3 types of involvement: visiting, providing personal care, and family–staff communication. Our mixed methods approach used (a) multilevel regression models to examine predictors of family involvement, including family member perceptions and resident, family member, and facility characteristics, and (b) a thematic analysis of qualitative data regarding the experiences of family members and their motivations for involvement. Results Families were more involved when a short-term stay (<3 months) was expected, and when residents were in poorer physical condition. Spouses and female family members were more involved than others, yet the effect of gender varied by relationship type. At the facility level, families of residents in rural facilities reported less family involvement. Aside from these commonalities, predictors of each type of involvement varied. Themes from the qualitative data identify unique motivations for each type of involvement—to enhance residents’ identity, care, or quality of life. Discussion Families visit more and provide more hands-on assistance when they are not confident in the care being provided or the well-being and stability of their resident loved one. Receiving adequate information, perceiving staff as friendly, and residents as looking well cared for promote greater family–staff communication. Implications Findings can inform strategies to increase meaningful family involvement in nursing homes.

TERAPI MUSIK DAN TINGKAT KECEMASAN PASIEN PREOPERASI

2016 ◽  
Vol 5 (1) ◽  
pp. 1-6
Author(s):  
Wenny Savitri ◽  
Nani Fidayanti ◽  
Paulus Subiyanto
Keyword(s):  
Music Therapy ◽  
Intervention Group ◽  
Complementary Therapy ◽  
T Test ◽  
Anxiety Level ◽  
Preoperative Anxiety ◽  
Control Group ◽  
Music Intervention ◽  
Significant Difference ◽  
Anxiety Levels

Background: Surgery is one of medical interventions which can cause fear, anxiety, and stressed because of its effects toward the integrity of body and soul. Nurses have significant roles in any preoperative care which is helping patients to decrease preoperative anxiety by using complementary therapy. The use of music therapy as one of the complementary therapies is not common in Indonesia. Therefore, scientific studies to prove the role of this therapy to decrease the level of anxiety of pre-operative patients is needed. Objective: To investigate the effects of music therapy in reducing anxiety levels of preoperative patients. Methods: A quasy experimental study with pre-test and post-test design with control group was applied to 50 respondents from medical ward in Panembahan Senopati Hospital of Yogyakarta who met the inclusion criteria.Dara were then analyzed by using t-test statistical analysis. Results: The control group showed the increased value of anxiety level of0.8 without music intervention (t= - 1503, df = 24, p<.05), whereas the intervention group showed the decreased value of anxiety level of -5.52 (t=5.081, df=24, p<.05). Meanwhile the independent t-test results for both groups showed a significant difference between group (t= 3,373, df=48, p<.05). Conclusion: Music therapy has significant effect in reducing preoperative anxiety levels of patients. Keywords: anxiety, preoperative, music therapy

scholarly journals Private retirement resorts in South Africa: Guidelines for wellness and sustainability in the long term.

2013 ◽  
Vol 32 (1) ◽  
Author(s):  
Andries C. Hauptfleisch
Keyword(s):  
South Africa ◽  
Knowledge Base ◽  
Quantitative Data ◽  
Qualitative Data ◽  
Well Being ◽  
The Other ◽  
Literature Study ◽  
Optimal Profile

Unsubsidised private retirement resorts in South Africa developed during the last three decades present residents with many challenges. There is no existing generally accepted knowledge base or guidelines to serve this sensitive market. The research objective was to establish which elements are experienced by residents of retirement resorts as satisfactory and which as problematic. A literature study was also undertaken. Quantitative as well as qualitative data were obtained by means of structured questionnaires, interviews and a seminar. The results reported pertain to eight resorts in the east of Pretoria, four in Bloemfontein and two in Knysna. The study is currently being extended to other centres. The quantitative data is arranged in order of the priorities set by the biggest group (Pretoria), with the other groups in comparison. So the research was based on the sourcing of quantitative and qualitative data, as well as on descriptive evaluations. The results offer insightful knowledge and guidelines towards establishing an optimal profile for the development of long-term sustainable private retirement resorts. The implications and value of this study are that both developers of retirement resorts and prospective residents are provided with guidelines to better equip them to evaluate a specific retirement resort with regard to the sustainable well- being of residents long-term.

scholarly journals Using the Life Story Book With Mentally Alert Residents of Nursing Homes

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 487-487
Author(s):  
Theresa Chrisman
Keyword(s):  
Depressive Symptoms ◽  
Nursing Homes ◽  
Meaning In Life ◽  
Life Story ◽  
Well Being ◽  
Post Intervention ◽  
Significant Difference ◽  
Wilks Lambda ◽  
Potential Benefits ◽  
Hispanic White

Abstract Depression and lack of meaning in life (MIL) are common among residents of nursing homes (NHs) and contribute to a reduction in overall health and well-being. Life Story Book (LSB), a reminiscence intervention, is designed to provide a person with the opportunity to review their past and capture their life stories and photographs into a book. LSB has demonstrated positive outcomes for residents of NHs with dementia, yet little is known for residents without dementia. A switching replication design was used to examine the effects of LSB among 21 mentally alert residents from two NHs (NH-A and NH-B) in Houston, Texas. Participants in NH-A received three weeks of the LSB intervention, while NH-B received three weeks of care-as-usual; the intervention was then switched. The GDS-12R and the MIL questionnaire (MLQ) were used to measure depressive symptoms and MIL respectively. Participants from NH-A (n =11) and NH-B (n = 10) had a mean age of 75 years (SD =11.34); 81% female; 52% non-Hispanic white and 33% African American. Results from a one-way MANCOVA found no statistically significant difference on the GDS-12R and MLQ (F(3, 14) = 2.50, p = .102; Wilks’ Lambda = .652; η2 = .35). Further analyses comparing the pre-intervention and post-intervention scores for the entire sample (N =21) found a significant reduction in depressive symptoms (M = 2.67; SD = 2.52) and (M =1.67, SD = 2.29); (t (20) = 2.21, p = 0.039). The potential benefits of LSB for mentally alert residents of NHs warrants further research.

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