Maybe it’s a hip fracture or pneumonia that sends your aging parent to the hospital. Or perhaps it’s a stroke or heart disease. Whatever the presenting medical condition and associated complications of recovery, there is one major risk of hospitalization for all older adults, regardless of diagnosis: delirium.
According to a recent publication by Harvard Medical School, delirium is “the most common complication of hospitalization among people ages 65 and older: 20% of those admitted to hospitals, up to 60% of those who have certain surgeries, and almost 80% of those treated in ICUs develop delirium.”
Some experience hallucinations, agitation, even belligerence, or so-called hyperactive delirium; others become withdrawn, lethargic and have difficulty waking, a condition known as hypoactive delirium. All struggle with confusion, a sense of disorientation and a disconnect with reality. Although those symptoms of delirium have been recognized by medical practitioners since the days of Hippocrates, the causes are still unknown. But the impact of acute delirium on an elder’s long-term health is sobering.
Acute Delirium Significantly Alters an Older Patient’s Health Prognosis
Dr. Mark Hammond, MD, a gerontologist who has worked with Memphis, Tenn., nursing homes for three decades, says that about a third of those who become delirious during a hospital stay are unable to get clear of the confusion and related symptoms—placing them at greater risk of additional health complications, both in the hospital and after discharge. “It causes a cascade of problems,” he says. “Their risk of death over the next 12 months doubles.”
Preventing delirium, says Hammond, can significantly alter the patient’s health trajectory. Studies of centers of excellence have shown that a combination of “common sense” treatment modalities can reduce the risk of delirium during hospitalization by 40 percent: oversight by a qualified gerontologist; ensuring the patient is well hydrated; early involvement of physical, occupational and speech therapists; prompting the patient to stay oriented to surroundings and current events; working on maintaining independence with activities of daily living—all help. So does music.
Hammond considers therapeutic use of music to be an essential part of the delirium-prevention mix. “Any music that is meaningful to the patient, the playlist of the person’s life, connections to childhood or adolescences—bridging neurological pathways can bring the patient back to reality,” he says.
Preferred Music Reduces Anxiety in Hospital Stays
In Scottsdale, Arizona, Dr. Kari Johnson, PhD, RN, ACNS-BC with HonorHealth, has been examining the connection between listening to favorite music and delirium prevention. For her doctoral thesis as a Hartford Scholar at Arizona Statue University, Johnson focused her research on how preferred music affected older patients in trauma centers.
A critical care nurse for much of her career, Johnson wondered what could ease a patient’s anxiety—a significant precursor of delirium—during hospital stays. “You have a person in a bed where you have all this unfamiliar stimuli,” she says. “They have IVs, they have alarms, people coming in and out. There is no sleep, no rest. You can see they’re anxious. They’re sick, and we need to have all this monitoring. What can we do to help ease their discomfort? I started to look at music. Everyone can relate to that.”
Johnson’s research led her to Dan Cohen and the work of Music & Memory. While the logistics of personal playlists was beyond the scope of her study, she adapted the idea of offering favorite music to patients using five different music genre playlists (synthesizer, heart, piano, orchestra and jazz). The playlists were based on other published research regarding how a musical selection’s tempo, low pitch and repetitive rhythm could lower a patient’s heart rate and blood pressure, easing anxiety.
Focusing on patients in her hospital’s trauma Intensive Care Unit and trauma orthopedic unit, Johnson conducted a randomized, controlled study of patients 55 and older. Twenty patients were given a choice of what kind of playlist they preferred, and 20 in the control group received standard care. For the playlist group, over a course of three days, Johnson offered the music for 60 minutes, twice a day, at 2:00 and 8:00 p.m. If the patients were discharged from the trauma unit after two days, that ended their involvement in the study.
Study participants were screened for delirium at the outset; all were clear of symptoms. Johnson administered assessments for confusion and delirium throughout the course of the three days, and recorded vital signs every four hours during that period.
The results? In the music intervention group, there was a statistically significant reduction in heart rate and systolic blood pressure, versus no change for the control group, indicating that the intervention had helped to reduce patient anxiety. None of the patients in either group developed symptoms of delirium over the three days; if she were to repeat the study, Johnson says she would use a more sensitive assessment tool to discern if patients were experiencing hypoactive delirium, which is more difficult to detect.
“Can’t I Just Keep the Music Here?”
In addition to the encouraging measured results, Johnson says the patients who received the music intervention were enthusiastic: “Patients asked me, ‘Can’t I just keep the music here, so I know when I become anxious I can put it back on? It helps me to sleep.’”
Nurses, too, loved the music. “They caught on and said it was awesome,” says Johnson. Trauma nurses caring for younger adults who didn’t qualify for the study followed Johnson’s lead and asked pateints’ family what music their family member preferred. Usually the answer was hard rock, quite different from the anxiety-reducing music on Johnson’s playlists. But, she says, “they calmed right down. It was quite amazing.”
Johnson adds that another patient who had suffered a stroke, who was refusing to sit up, eat or talk, and who threw things at the staff, was also soothed by her favorite music. “The nurses called me over for advice,” she says. “One of them called the patient’s sister to find the music she loved, Big Band songs. The nurse pulled it up on her phone, and after the fifth song, the patient was sitting up in her chair, cooperating, talking and eating.”
Johnson would like to see a personal music assessment become part of the standard hospital admission process, with patients having access to preferred music during their hospital stay.
While more research needs to be done, Mark Hammond believes that personal music, among other advantages, has the potential to reduce reliance on medications to reduce pain and confusion during hospital stays—given that many of these medications are a “double-edged sword” that can provoke onset of delirium.
“If we could prevent delirium, we could change lives,” he says. “We’d reduce the patient’s chances of dying after hospitalization, being moved to a nursing home, dependent on others for activities of daily living. We’d reduce fall rates and fractures. Prevention is so much more effective than treatment.”
Founded in 2010, MUSIC & MEMORY® is a non-profit organization that brings personalized music into the lives of people with cognitive or physical conditions through digital music technology, vastly improving quality of life.
Image: Bruno Nascimento