Influence Of music on Quality of life And Emotions of Aged Persons Paper

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APA format with 1" margins and Times New Roman, size 12 font. It can be single-spaced or double-spaced. no need for title page. include a reference page

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Main point and purpose The purpose of this assignment is to apply what you know about a research study and the qualities of good research. Pattern and procedure Use the article (A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia)     Review the purpose of a research critique on pages 347, 350, and 351 in your textbook. Answer the questions on pages 348-350 in your textbook. The specific questions are in the following sections: o Research question and hypothesis - Questions 1 and 4. Also, paraphrase the purpose of the research. o Review of the Literature - Questions 1 and 7 o Internal and external validity - Questions 3 and 5 o Research design - Questions 1 and 4 o Sampling - Questions 1 and 3. Also, summarize the sample in the study. o Data collection methods and procedures - Answer the questions based on the main data collection method that the researchers used - Physiological measurement, Observation, Instruments or available data and records. Also, give the dependent variable(s) that is being measured by the data collection method(s) o Reliability and validity - Questions 1 and 3 o Data Analysis - No questions - List two descriptive or inferential statistical tests that the researchers used o Conclusions, implications and recommendations - Questions 1, 2, and 4. Also, summarize the main result of the research study. o Applicability to nursing practice - Questions 3, 4, and 5 Do not just answer "yes" or "no" to a question. Give an example or explanation to support your answer.  Standards and criteria The product should be APA format with 1" margins and Times New Roman, size 12 font. It can be single-spaced or double-spaced. You do not need a title page. Please include a reference page. There will probably be only one item on the reference page unless you cite the textbook. Use APA formatting for the reference page. Aging & Mental Health Vol. 14, No. 8, November 2010, 905–916 A randomized controlled trial exploring the effect of music on agitated behaviours and anxiety in older people with dementia Marie L. Cookea*, Wendy Moylea, David H.K. Shumb, Scott D. Harrisonc and Jenny E. Murfielda a Research Centre for Clinical and Community Practice Innovation, Griffith University, Nathan, QLD, Australia; School of Psychology, Griffith University, Mt Gravatt, QLD, Australia; cQueensland Conservatorium Research Centre, Griffith University, South Bank, QLD, Australia b (Received 28 September 2009; final version received 25 January 2010) Objectives: This study, as part of a larger programme of research, sought to investigate the effect that participation in a 40-min live group music programme, involving facilitated engagement with song-singing and listening, three times a week for eight weeks, had on agitation and anxiety in older people with dementia. Methods: A randomized cross-over design, with music and reading control groups, was employed. Forty-seven participants with mild – moderate dementia, from two aged care facilities in Queensland, Australia, were recruited. Participants were assessed three times on the Cohen-Mansfield Agitation Inventory – Short Form (CMAI-SF) and the Rating Anxiety in Dementia Scale (RAID). Results: A sub-analysis of 24 participants attending 50% of music sessions found a significant increase in the frequency of verbal aggression over time, regardless of group (F(2,46) ¼ 3.534, p50.05). A series of multiple regressions found cognitive impairment, length of time living in the facility and gender to be predictors of agitation overall and by subtype. Conclusion: Participation in the music programme did not significantly affect agitation and anxiety in older people with dementia. Both the music and reading group activities, however, gave some participants a ‘voice’ and increased their verbalization behaviour. Agitation was found to be predicted by a number of background factors (namely level of cognitive impairment, length of time in the facility and gender). Future studies would benefit more from in-depth participant assessment prior to study commencement, helping to moderate the influence of low scores, and by undertaking interventions at times when assessed symptoms are most prevalent. Keywords: challenging behaviour; aged care; cognitive impairment; non-pharmacological interventions; psychosocial intervention Introduction Dementia is a syndrome that has a number of different causes, all of which result in the progressive decline of a person’s cognitive functioning. It is a degenerative condition usually occurring in older age, but not always so, and is characterized by the appearance of behavioural disturbances (Goodall & Etters, 2005). There are approximately 24.3 million people who currently experience dementia worldwide, and 4.6 million new cases are predicted to be diagnosed each year (Ferri et al., 2005). In Australia, there are an estimated 245, 400 people with dementia, which, as the age of the population increases, is predicted to rise to 1.13 million by 2050 (Access Economics, 2009a). Of this number of people with dementia in Australia, it is thought that 40% (90,000) live in long-term care (LTC) facilities (Access Economics, 2009b). Agitation is one of the more common features of dementia, being defined as ‘inappropriate verbal, vocal, or motor activity that is not explained by needs or confusion per se’ (Cohen-Mansfield & Billig, 1986, p. 712). Estimates of the prevalence of agitation in those with dementia differ considerably, ranging from 15% (Lyketsos et al., 2002) to 95%, (Sourial, McCusker, Cole, & Abrahamowicz, 2001) depending *Corresponding author. Email: m.cooke@griffith.edu.au ISSN 1360–7863 print/ISSN 1364–6915 online ß 2010 Taylor & Francis DOI: 10.1080/13607861003713190 http://www.informaworld.com on the definition used and the means of assessment (Burgio et al., 2000). Anxiety is another prominent feature in those with dementia, although there is a lack of agreement regarding how best to define the construct (Seignourel, Kunik, Snow, Wilson, & Stanley, 2008). For the purposes of this study, symptoms of anxiety include: worry, apprehension, vigilance, motor tension, autonomic hyper-activity, phobias and panic attacks (Shankar, Walker, Frost, & Orrell, 1999). Anxiety also has considerable variation in prevalence estimates, ranging from 10% (Lyketsos et al., 2002) to 70% (Teri et al., 1999). This variation is again attributed to the population studied, how anxiety is measured and also according to the subtype of dementia, with some studies finding anxiety to be more common in vascular dementia than Alzheimer’s disease (Ballard et al., 2000). The impact of agitation and anxiety on the person with dementia and their caregivers is reported to be of great significance. For instance, aggressive behaviour (one subtype of agitation, as classified by Cohen-Mansfield, 1986) is often cited as a significant problem that may offend and alienate formal and informal caregivers of those with dementia (Chrzescijanski, Moyle, & Creedy, 2007). Managers of 906 M.L. Cooke et al. LTC facilities are often apprehensive about admitting people with these challenging behaviours (Hogan, 2004), as it makes caring for the person with dementia demanding and increases caregivers’ stress (Mott & Kingsley, 1999). Such pressures may result in staff feeling frustrated in managing the behaviours, which may lead to staff burn out, decreased quality of care and, ultimately, decreased quality of life for the person with dementia. Similarly, negative outcomes are reported in relation to anxiety for people with dementia, with studies showing that it leads to decreased functional status in activities in daily living (ADL) (Schultz, Hoth, & Buekwalter, 2004) and increased mortality rates (Grasbeck, Rorsman, Hagnell, & Isberg, 1996). Given the potential prevalence of agitation and anxiety in those with dementia and the evident negative impact both have, it is perhaps surprising that relatively little research has been undertaken regarding their relationship. Of the research available, it appears two schools of thought exist; one which sees agitation as an outward expression of anxiety (Mintzer & Brawman-Mintzer, 1996) and the other which sees agitation and anxiety as completely distinct entities that should be assessed independently (Twelftree & Qazi, 2006). More research is needed to broaden the understanding of the relationship between the two symptoms (Twelftree & Oazi, 2006) and how both can be managed and treated. This is especially important given the literature, which posits the influence of other background factors on agitation in those with dementia (i.e. the extent of cognitive impairment, impairment in ADL and gender). For instance, the majority of studies have found that the greater the impairment in terms of cognition (Cohen-Mansfield, Culpepper, & Werner, 1995; Cohen-Mansfield, Marx, & Rosenthal, 1990) and performance of ADL (Beck et al., 1998), the greater the expression of agitation. This pattern, however, does not extend to those with more severe dementia because the advanced level of cognitive impairment leads to fewer displayed behaviours overall, including agitation (Cohen-Mansfield et al., 1990). Less clear results have emerged with regards to gender, as some studies have found males with dementia to be more physically aggressive (Cohen-Mansfield, Marx, & Werner, 1992) and others have found females to display higher levels of agitation overall (Burgio et al., 2000; Vance et al., 2003). In treating the symptoms of dementia, the traditional route has been through pharmacological and physical interventions (Robinson et al., 2007). However, it is now recognized that many of the commonly used pharmacological agents possess harmful side-effects (Sink, Holden, & Yaffe, 2005) and there are ethical concerns regarding the use of physical restraints (Hughes, 2002). In light of this, research attempts have sought to explore the efficacy of non-pharmacological approaches (Goodall & Etters, 2005), with the therapeutic use of music one approach that has gained increasing popularity since the early 1990s (Bruer, Spitznagel, & Cloninger, 2007). Defined as ‘the specialized use of music to change maladaptive physical, emotional and social behaviours to attain maximum levels of functioning’ (Goodall & Etters, 2005, p. 258), the therapeutic use of music is generally thought as a means of communicating with those with dementia (Goodall & Etters, 2005). This is based on the premise that, as the person’s ability to understand verbal language diminishes (Vink, Birks, Bruinsma, & Scholten, 2005), the ability to process music is retained by a part of the brain that is last to deteriorate (Crystal, Grober, & Masur, 1989). Individual studies into the efficacy of music for managing dementia have reported it as a successful intervention for reducing symptoms such as agitation and anxiety. For instance, in relation to agitation, studies have found that music played during mealtimes significantly reduced agitation in nursing home residents with dementia (Hicks-Moore, 2005). In addition, regular music sessions have been repeatedly shown to significantly improve agitation (Choi, Lee, Cheong, & Lee, 2009; Ledger & Baker, 2007; Raglio et al, 2008; Svansdottir & Snaedal, 2006; Tuet & Lam, 2006). As regards to the effect of music on anxiety, studies have found that it reduces stress levels, as measured by salivary Chromogramin A (CgA) (Suzuki, Kanamori, Nagasawa, Tokiko, & Takayuki, 2007; Suzuki et al., 2004) and that regular live music sessions can alleviate anxiety-related symptoms (Raglio et al., 2008; Svansdottir & Snaedal, 2006). However, despite the evidence that music has a therapeutic effect on agitation and anxiety of those with dementia, there are strong methodological concerns regarding available studies and there are calls for more rigorous research (Boso, Politi, Barale, & Emanuele, 2006). Specifically, studies have been criticized for failing to: randomize participants; conceal allocation of participants to treatment groups; ensure blinding of assessors; use standardized assessment tools; establish longitudinal effects and employ sufficient sample sizes (Goodall & Etters, 2005; Vink et al., 2005). In an attempt to address some of these concerns, the study described here involved a randomized controlled trial with a cross-over design. An exploration of effects of live group music, involving facilitated engagement with song-singing and listening, was undertaken over a six-month period. The study had a sample size large enough to detect significant differences and analysis followed an intention-to-treat (ITT) principle so as to avoid the overestimation of clinical effectiveness associated with analysis which omits study drop-outs (Hollis & Campbell, 1999; Kruse et al., 2002; Montori & Guyatt, 2001). Methods Aim This study was part of a larger funded research project which aimed to explore the effect of music on 907 Aging & Mental Health agitation, emotion and quality of life of older people with dementia (Cooke, Moyle, Shum, Harrison, & Murfield, 2009, in press). The results reported here are focused on agitated behaviours and anxiety, and sought to address three research questions: (1) What effect does a live group music programme, involving facilitated engagement with song-singing and listening, have on agitated behaviours and anxiety in older people with dementia? (2) What is the duration of any effects of a live group music programme, involving facilitated engagement with song-singing and listening, on agitated behaviours and anxiety in older people with dementia, over a six-month period? (3) Do background factors such as extent of cognitive impairment, length of time living in the facility, gender and level of anxiety, predict agitation in older people with dementia? Setting Participants were recruited from two mixed-gender LTC facilities, which provided low (assisted living) and high (nursing home) care. Both facilities were located north of Brisbane (Queensland, Australia). Site A had 164 residents and Site B had 94 residents. Sample The study sample size of 40–50 participants, which was anticipated to ensure a statistical power of 0.90 and included a 10% rate of attrition, was estimated by using the: effect size (Cohen’s d ) of 0.67 calculated from Suzuki et al. (2004); an level of 0.05; and the algorithm detailed in Senn (2002, p. 283). LTC facility managers identified potential male and female participants, with inclusion in the study based on residents having: (1) a confirmed diagnosis of early to mid stage dementia, OR probable dementia (i.e. a cognitive impairment level of 12–24 on the Mini Mental State Exam (MMSE) – Folstein, Folstein, & McHugh, 1975), OR features consistent with dementia of Alzheimer’s type as per DSM-IV (American Psychiatric Association, 1994) and (2) a documented behavioural history of agitation/ aggression on nursing/medical records within the last month. Design Randomization The study employed a randomized cross-over design, with a music intervention and a reading control group, which ran from October 2008 to March 2009 (Figure 1). The advantages of this methodology were that it: ensured a good level of equivalence amongst the participants exposed to the two treatments (Polit, Beck, & Hungler, 2001); saw no participant denied a potentially beneficial treatment; and allowed an examination of effects over a six-month period (Vink et al., 2005). The university human research ethics committee granted ethical approval for the study and a support statement was provided by the partner-aged care organization. The randomization process was conducted by the study’s biostatistician, who was blinded to the identity of potential participants, using a computer-generated programme. Next of kin provided informed consent but, where appropriate, consent was sought from 1st arm Intervention Music Reading Control 2nd arm Control 2 musicians 1 RA facilitator 1st arm Control Reading Control Music 2nd arm Intervention 1 RA facilitator 2 musicians Data collection points Baseline Mid-point MMSE RAID CMAI-SF Demographics Figure 1. Study design. Post-intervention MMSE RAID CMAI-SF RAID CMAI-SF 908 M.L. Cooke et al. participants themselves. All data collectors were blinded to group assignments. Intervention Both intervention and control activities ran for 40 min, three mornings a week (Monday, Wednesday and Friday) for eight weeks. Participants then ‘crossedover’ into the opposite activity and the protocol was repeated for another eight weeks. A five-week ‘washout’ period was included between cross-over to reduce potential carryover effects (Ayalon, Gum, Feliciano, & Arean, 2006), with this length of time based on studies which have found the effects of music to dissipate at one–four weeks post-intervention (Bruer et al., 2007; Svansdottir & Snaedal, 2006; Tuet & Lam, 2006). If, however, there was evidence of carry-over from the data collected during the mid-point ‘washout’ period, the analysis framework, as Senn (2002) suggests, would have needed to be reconsidered. Treatment fidelity was monitored through: a standardized procedures manual (Chambless & Hollon, 1998); musician and reading group facilitator training in delivery of the sessions and in working with older people with dementia; a practice music session conducted in an alternative LTC facility used for the study and four random spot checks made by the research team. Prior to all sessions, participants were asked if they wished to attend. This resulted in some refusals and differences in attendance levels amongst participants. The intervention was a live group music programme delivered by two musicians. Each music session involved 30 min of musician-led familiar song-singing (with guitar accompaniment) and 10 min of pre-recorded instrumental music for active listening. Group music sessions were chosen over individual interventions as previous literature has shown group sessions to be effective in reducing agitation and anxiety, (Raglio et al., 2008) and irritability (Suzuki et al., 2004) and in improving the mood and social behaviour of those with dementia (Lesta & Petocz, 2006). The maximum size of the group attending the music and reading sessions was 16 at Site A and 9 at Site B. Live interactive music was preferred over pre-recorded music as it has been shown to be superior in the short-term treatment of apathy in participants with dementia (Holmes, Knights, Dean, Hodkinson, & Hopkins, 2006). However, 10 min of pre-recorded instrumental music was included in the repertoire to allow the musicians and participants to have a short rest from performance and singing, while also ensuring that participants who had a preference for more instrumental music were catered for. During both the musician-led song-singing and listening of pre-recorded music, residents were encouraged to actively participate through singing/humming, playing instruments and, where appropriate, movement. In addition, as the personal musical preferences of participants have been shown to be most effective in alleviating agitated behaviour in those with dementia (Dileo & Bradt, 2005; Gerdner, 1997, 1999; Sung & Chang, 2005), the repertoire selection for the music sessions was based on: participants’ musical preferences; musicians’ repertoire knowledge; and the findings from the practice session. A set repertoire was established for each of the three sessions and repeated for the eight weeks. Reading sessions were chosen as the control group activity so as to provide a comparable activity that could help determine whether any significant effects in levels of agitation and anxiety were because of the music programme specifically or because of a group activity. The reading control sessi ...
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