Observing Music Therapy in Dementia: Repeated Single-case Studies Assessing Well-being and Sociable Interaction

Abstract

Objectives: This study compared behavioral expressions of momentary well-being and sociable behavior toward significant others during music therapy and regular social interaction. Methods: A 10-week active music therapy intervention was provided for people living with dementia and family caregivers. A bi-phasic AB single-case design was replicated for three sessions per dyad and coded using the Observable Well-being in Living with Dementia-Scale (OWLS) and the Verbal and Nonverbal Sociable Interaction Scale-Care Receiver (VNVIS-CR). Effect sizes (Log Response Ratio) were calculated for each session and analyzed with robust cluster meta-analysis. Results: Eleven dyads were included, and 32 sessions analyzed (2102 observations). Within sessions we found a 48% increase in well-being, and a 32% increase in sociable interaction during music therapy. Heterogeneity was high. Dementia severity predicted an increase in nonverbal sociable interaction (93% for moderate dementia). Depression and time did not predict any change. Conclusion:The potential of music therapy to increase well-being and sociable interactions toward significant others calls for further investigation of heterogeneity and covariates. Single-case designs are demonstrated to be feasible for these investigations. Clinical implications: Preference-based music therapy may alleviate some of the individual and relational consequences of living with dementia, facilitating positive emotions and connection to significant others.

Development of the Observable Well-Being in Living With Dementia-Scale

“…3,29 The anchoring of our items in well-being theory and former qualitative inquiries including people living with dementia helps to ensure that the 8 items reflect relevant and comprehensive aspects of well-being. This is further supported by the preliminary psychometric assessment of construct validity and 30 and may ease interpretation of scores in other similar contexts including people with mild to moderately severe dementia.…”

“…We interpret <20% as no change, 20-50% as a small change, 50-70% as a moderate change, and >70% as a large change. 30 Required training to use OWLS is to have basic knowledge about dementia, become familiar with the manual and coding instructions, and assess intra-rater reliability for the individual coder using the scale. If several coders are using OWLS, interrater percentage of agreement should be assessed.…”

“…This data came from a clinical trial (N = 11) comparing regular social interaction with music therapy. 30 Inclusion criteria for the clinical trial were 1) ability to provide (facilitated) informed consent; 2) a formal dementia diagnosis of Alzheimer dementia, Vascular dementia, dementia of mixed etiologies or Lewy-Body Dementia (according to ICD-10 cri-teria52); 3) Dementia severity ranging from .5-2 on the Clinical Dementia Rating Scale55; 4) Psychotropic medications were stable at least 2 weeks before pre-assessment; 5) participants were home-dwelling or in assisted living arrangement; 6) a caregiver committing to act as collateral therapist in the study. Exclusion criteria were frontotemporal dementia, severe aphasia, severe psychosis or high risk of suicide.…”

“…The clinical assessment of the participants with CDR and NPI-Q was conducted by 2 clinical psychologists (first author KGM & clinical psychologist Louise Markhus). Further details about the field-testing is available in Madsø et al 30 Utilizing the software Noldus Observer XT 12.5 ©, 31 KGM repeatedly watched video observations of different 10-minute segments from the participants' interactions to identify significant sections. 32 Behavioral expressions identified as indicating well-being were described.…”

Music Therapy in the Treatment of Dementia: A Review Article

“…Several studies were conducted to determine whether MT in people with dementia affects cognitive function, life quality, and depression. The impact of performing music therapies was assessed in randomized controlled trials on cognitive performance, psychological health, and social engagement in older persons with likely MCI or dementia [ 16 ]. A few studies also aimed to assess whether MT is beneficial in lowering distress in people with dementia [ 17 ].…”