Individualized Music Intervention
to Reduce Agitation in Persons
with Dementia
Linda A. Gerdner, PhD, RN
Assistant Professor
University of Minnesota
School of Nursing
Agitation
“An inappropriate verbal, vocal, or motor activity
that is not explained by needs or confusion per se”
(Cohen-Mansfield & Billig, 1986, p. 712)
Factors that Result in an Increases
Risk for Agitation
•
•
•
•
•
Cognitive impairment
Fatigue
Misleading stimuli or inappropriate stimulus levels
Affective response to perception of loss
Internal or external demands that exceed functional
capacity
• Physical stressors (pain, discomfort, infection)
(Algase, et al., 1996; Cohen-Mansfield, Culpepper, & Werner, 1995, Deutch & Rovner, 1991;
Hall& Buckwalter, 1987; Hall, Gerdner, Zwygart-Stauffacher, & Buckwalter, 1995;Ragneskog,
Gerdner, Josefssom & Kihlgren, 1998)
Studies have shown that agitation may:
• interferes with care delivery and social interaction
(Legér et al., 2002)
• cause an increase in falls among residents in LTCF
(Marx, Cohen-Mansfield, Werner, 1990)
• interferes with onset and duration of sleep (CohenMansfield & Marx, 1990)
• a major source of stress to staff in LTCFs (Legér et al.,
2002; Ragneskog, Kihlgren, Karlsson, & Norberg, 1993)
Cognitive
Impairment
Lowered Stress
Threshold
Agitation
Decreased
Agitation
Individualized Music
Intervention
Figure 1. Mid-range theory of individualized music intervention for agitation. From
Gerdner, L. (1997). An individualized music intervention for agitation. Journal of the
American Psychiatric Nurses Association, 3(6), 178.
Individualized Music
Music that has been integrated into the
individual’s life and is based on personal
preferences (Gerdner, 1992).
Propositions of the Mid-Range Theory of IMAI
• The temporal patterning of agitated behaviors in persons with
ADRD is often predictable based on application of the PLST Model
(Hall & Buckwalter, 1987).
• Music evokes an individualized emotional response within the
listener, that is associated with personal memories.
• Response to personal memory is enhanced when music selection is
based on the patients past personal preference.
• The presentation of an individualized music intervention alleviates
agitation in the person with ADRD.
• There is a positive relationship between the degree of significance
that music had in the person’s life prior to the onset of cognitive
impairment and the effectiveness of the intervention.
• Individualized music intervention is most effective when the
intervention is implemented approximately 30 minutes prior to the
peak level of agitation.
Evolution
PILOT STUDY: Gerdner, L. A., & Swanson, E. A. (1993). Effects of individualized
music on elderly patients who are confused and agitated. Archives of Psychiatric
Nursing, 7(5), 282-291.
MIDDLE RANGE THEORY: Gerdner, L. A. (1999). An individualized music intervention
for agitation. Journal of the American Psychiatric Nurses Association, 3(6), 177-184.
THEORY TESTING: Gerdner, L. A. (2000). Effects of individualized vs. classical
“relaxation” music on the frequency of agitation in elderly persons with Alzheimer’s
disease and related disorders. International Psychogeriatrics, 12(1), 49-65.
EVIDENCE-BASED PROTOCOL: Gerdner, L. A. (2001). Evidence-based protocol:
Individualized music intervention. In M. Titler (Series Ed.) Series on Evidence-Based
Practice for Older Adults. Iowa City, Iowa: The University of Iowa College of Nursing
Gerontological Nursing Interventions Research Center, Research Dissemination Core.
TRANSLATIONAL RESEARCH: Gerdner, L. A. (2005). Use of individualized music by
trained staff and family: Translating research into practice. Journal of Gerontological
Nursing, 31 (6), 22-30.
Indications
• Exhibit agitation as defined by Cohen-Mansfield (1986)
• Score between 3 to 7 on the Global Deterioration Scale
(Reisberg, Ferris, deLeon, & Crook, 1982)
• Hear a normal speaking voice at a distance of 1 1/2
feet
• No obvious signs of pain or infection
• Family member provide information on
personal music preference.
Assessment of Agitation
• Determine the time of onset and potential
external or internal causes that may underlie
these behaviors
• If a physiological cause is suspected (i.e.,
pain, infection) the physician should be
contacted for appropriate medical attention.
Timing
Optimal effectiveness is achieved by implementing prior to the
patient’s “peak level of agitation”
Monitor the patient over several days to determine any possible
temporal patterning. For example, does the person usually
begin showing signs of agitation during
mid-afternoon.
The prescribed time of intervention should precede
this identified time by approx. 30 minutes.
P.R.N.
• When patient first begins exhibiting signs of
anxiety/agitation assess for possible internal
and external stressors.
• Eliminate potential stressors.
• Play music when the patient first begins
exhibiting signs of anxiety.
Assessment of Personal
Music Preference
(Gerdner, Hartsock, & Buckwalter, 2000)
Designed to obtain details on the:
• resident’s specific music preference
• importance of music during independent living
Completed by knowledgeable family member if
degree cognitive impairment prevents the resident
from providing this information
Examples of
Individualized Music
King of Western Swing: Bob Wills and his Texas
Playboys
The Best of Hank Williams
Elvis Presley Amazing Grace: His Greatest Sacred
Performances
Mahalia Jackson Gospels, Spirituals, and Hymns
The Very Best of Frank Sinatra
Intervention Protocol
Check out audio cassette/CD player from nurses’
station
Play music at prescribed time for approx. 30 minutes
daily & p.r.n.
Set volume to appropriate level
Determine need and appropriateness for
headphones
Assessment
Assess need and appropriateness for headphones
Conduct ongoing assessment of patient’s response
to music.
Monitor other patient’s in the immediate
environment. Remember what is pleasing to one
person may be irritating to another.
Adverse Response
• It the agitation becomes more pronounced - stop the
music.
• Reassess music preference with patient or family
member
• Provide alternative music selection on the following day
• If patient responses adversely to the second selection,
discontinue the intervention.
Conclusion
Individualized music intervention utilizes family
expertise to promote humanistic,
individualized care in an effort to enhance
quality of life.
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