Untitled

Abstract

beyond the organization's or local responder's abilities to cope. Disasters overwhelm natural defenses, established contingency plans, incapacitate people and/or deplete institutionalized resources [1,2]. Persons with Alzheimer's disease and related disorders (ADRD) are uniquely vulnerable during times of disaster. In part, this is attributed to a lowered tolerance to stress [3]. There are 5.3 million Americans diagnosed with Alzheimer's disease [4] with an estimated 44 million people throughout the world diagnosed with ADRD. This number is expected to triple by the year 2050 [5]. A number of resources have been written to guide family and health care providers in the care of these vulnerable older adults during and following a disaster [6][7][8]. All identify a decreased tolerance to stress in persons with Alzheimer's disease that leads to an increase in behavioral and psychological symptoms of dementia (BPSD), such as agitation. Levine and Kallymer [8] even provide actual case examples that spotlight the presentation of wandering and other agitated behaviors. Diversional activities have been recommended to alleviate these behaviors, but no specific guidelines have been provided. In addition, the Alzheimer's Association et al., [6] identify the importance of person-centered care to promote quality of life. Furthermore, Toner and Almai [9] emphasize the need to implement evidence-based interventions during times of disaster to promote quality of life.The purpose of this article is to supplement existing resources on the care of persons with ADRD during and following disaster, by providing a theory driven, evidence-based guideline for the use of individualized music for the management of agitation in this population. We begin by explaining the lowered tolerance to stress as experienced by persons with ADRD throughout the normal disease process with enhanced vulnerability during and following a disaster. The theory driven evidence-based guideline for individualized music is explained for the daily management of agitation in persons with ADRD. This content is conceptually applied to persons with ADRD for the management of agitation when confronted with overwhelming external stressors during and following a disaster. Agitation in Persons with DementiaADRD is characterized by cognitive impairment, a key antecedent to agitation [10][11][12]. Studies have reported agitation as high as 67.5% to 90% in persons with dementia [11,13]. This is attributed to a progressive decline in the stress threshold resulting in an increased susceptibility to anxiety, advancing to agitation and without intervention culminating in catastrophic behaviors [3].With a lowered stress threshold, person's with ADRD become especially vulnerable to both internal and external stressors [3,14,15] that include: fatigue; change of environment, caregiver, or routine; misleading or inappropriate stimulus levels; affective response to perception of loss; internal or external demands that exceed functional capacity; and physical stressors (i.e., pain, d...