A Program Using Environmental Manipulation, Music Therapy Activities, and the Somatron© Vibroacoustic Chair to Reduce Agitation Behaviors of Nursing Home Residents with Psychiatric Disorders
Mercado, Chesley, Mercado, Eduardo, Jr., Music Therapy Perspectives
ABSTRACT: Agitation is a behavior frequently associated with residents of nursing home facilities, especially persons with diagnoses of dementia or associated brain disorders. Agitated behaviors can affect the entire facility and have the potential to impact overall quality of life. Finding positive, non-pharmaceutical, interventions to control agitation is a challenge for health care professionals.
This study describes a program using multiple interventions of environmental noise reduction, controlled background music, individualized receptive and active music therapy, and vibroacoustic sessions with the Somatron. The program was implemented for 6 months and included 2 interventions. The first intervention was to manipulate the facility environment. The second intervention was to identify residents not responding to the environmental manipulation and refer them to music therapy. Three residents were referred during the intervention period. An original assessment instrument Somatron Placement Matrix was developed to assign residents to individualized music therapy sessions, Somatron sessions, or a combination of the two.
Results indicated a reduction of 82% in accidents/incidents, 91% reduction of PRN medication, 36% reduction in STAT orders by physicians, and a reduction of unplanned staff absences of 44% during the intervention period. Case study information (n = 1) of individualized music therapy sessions resulted in a 100% decrease of 2 identified agitation behaviors, 71% decrease in one identified behavior, and 11% decrease in one behavior. Case study information of the Somatron sessions (n = 2) resulted in none of the baseline agitation behaviors being present and an increase in positive behaviors of closing eyes during sessions, coherent verbalizations during sessions, and an increase in positive verbalizations.
Agitation behaviors are easily observed when entering a nursing home, especially a facility in which residents have psychiatric disorders. Behaviors associated with agitation may include muscle tension, irritability, aggression, repetitive body movements, restlessness, and inappropriate verbalizations (Cohen-Mansfield, Marx, & Rosenthal, 1989). Identifying precipitators of agitation and finding positive, non-pharmaceutical, interventions to reduce agitation will benefit individual residents and can create a calm, relaxing milieu that enhances quality of life.
Causes for agitation stem from a variety of factors and usually have multiple influences. The individual's personality before hospitalization, level of cognitive functioning, medication, and degree of disorientation and confusion may all play a role in exhibiting behaviors (Giacino, 2003). The nursing home setting consists of heterogeneous placements, large numbers of persons residing in close proximity, and regimens that are necessary for medical treatment. These factors can produce a stressful environment. Agitation may be related to this potentially stressful environment and even is a means for patients to communicate displeasure at their surroundings (Ragneskog, Kihigren, Gerdner, & Josefsson, 1998).
Environmental noise levels have also been frequently cited as a contributing factor in agitation behaviors. McClaugherty, Valibhai, Womack, and Desai (2003) evaluated the effects of noise on patients and staff in 13 nursing homes. Typical noises were intercom systems, telephones, cleaning equipment, and televisions. Behaviors reported by staff in response to high noise levels were irritability, anxiety, difficulty concentrating, and increases in errors. It is a rational assumption that patients will have similar responses to the same stimuli. Patients, however, may not have the communication or coping skills necessary to tolerate the noise. Even more importantly, patients have limited control over the situation and cannot remove themselves from the stimuli.
Using background music to mask environmental noises in conjunction with lowering the actual noise levels has been shown to reduce episodes of agitation among patients. …