The Effect of Individualized Listening to Music on Agitated Behaviors in Older Persons with Dementia

Main Article Content

Lalita Sawangchan
Porntip Malathum
Nuchanad Sutti


Abstract: This quasi-experimental research aimed to examine the effect of individualized listening to music on the agitated behaviors of older persons with dementia. A crossover design was used to compare mean changes in agitated behaviors of older persons with dementia between the intervention period (listening to music) and the control period without music. Purposive sampling was used to recruit a sample of 16 older persons from a nursing home. Each participant’s sequence of these two periods was randomly assigned to the intervention group or control group by drawing lots. The sample in the intervention period listened to music that they chose for 30 minutes, three times per week, a total of four weeks, while those in the control group did not listen to music. The washout duration of two weeks was set between the two periods. The agitated behaviors were assessed with the Cohen-Mansfield Agitation Inventory every week (the 1st to the 4th weeks) and after finishing the music program (the 5th and the 6th weeks) from the baseline. The analysis showed that the mean changes in the total score of agitated behaviors in the intervention period significantly decreased more than in the control period in the first two weeks. For subsets of agitated behaviors, the mean changes in physically non-aggressive scores and verbally aggressive behaviors in the intervention period significantly decreased more than in the control period in the first two weeks. The mean changes in verbally nonaggressive behaviors and physically aggressive behaviors were not significantly different between the two periods. However, when the listening to music period ended at the 5th and the 6th weeks, the mean changes in verbally non-aggressive behaviors significantly increased more than in the control period. In conclusion, this study showed that the
individualized listening to music program could decrease overall agitated behaviors. For the subsets of agitated behaviors, the program could decrease physically non-aggressive behaviors and verbal behaviors even though not consistently, but it could not decrease physically aggressive behaviors. Thus, the caregivers of older persons with dementia may use the program as an option to decrease their non-aggressive behaviors.
Keywords: Music, Individualized listening, Agitated behaviors, Older persons, Dementia

Article Details

How to Cite
Sawangchan L, Malathum P, Sutti N. The Effect of Individualized Listening to Music on Agitated Behaviors in Older Persons with Dementia . Nurs Res Inno J [Internet]. 2022 Aug. 23 [cited 2024 Mar. 4];28(2). Available from:
Author Biographies

Porntip Malathum, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Associate Professor, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Nuchanad Sutti, Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University

Lecturer, Ramathibodi School Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University


Tantirittisak T. Clinical practice guidelines: dementia. 1st ed.Bangkok: Prasat Neurological Institute; 2014. (in Thai)

Chansirikarnjana S. Knowledge about dementia. 3rd ed.Geriatrics medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University; 2007. (in Thai)

Alzheimer’s Disease International. World Alzheimer Report 2015: the global economic impact of dementia.London, Alzheimer’s Disease International; 2015.

Aekplakorn W. Thai national health examination survey-NHES V. Nonthaburi, Health System Research Institute;2014. (in Thai)

Bureau of Policy and Strategy. Thailand public health statistics 2013. Bureau of Policy and Strategy, Office of the Permanent Secretary of Public Health; 2013. (in Thai)

Sittironnari G. Behavioral and psychological symptoms of dementia (BPSD): concept and treatment. Journal of the Psychiatrist Association of Thailand. 2011;56(4):449-62.(in Thai)

Cerejeira J, Lagarto L. Mukaetova-Ladinska EB. Behavioral and psychological symptoms of dementia. Front Neurol.2012;3(73):1-21.

Maneerat S, Boonchai S. Development of a psychosocial nursing care model for elderly with dementia in Suansaranrom

psychiatric hospital. Princess of Naradhiwas University Journal of Humanities and Social Sciences. 2012;2(1):52-62.(in Thai)

Gerdner LA. An individualized music intervention for agitation. J Am Psychiatr Nurses Assoc. 1997;3(6):177-84.

Sung HC, Chang MA. Use of preferred music to decrease agitation behaviors in older people with dementia: a review of the literature. J Clin Nurs. 2005;14(9):1133-40.

Cohen-Mansfield J, Libin A, Marx MS. Nonpharmacological treatment of agitation: a controlled trial of systematic individualized intervention. J Gerontol. 2007;62(8):908-16.

Pimrat O. Music intervention for reducing agitation in elders with dementia: evidence-based nursing. [dissertation].Nakhon Pathom: Mahidol University; 2011. (in Thai)

Sung HC, Chang SM, Lee WL, Lee MS. The effect of group music with movement intervention on agitated behaviours of institutionalized elders with dementia in Taiwan. Complement Ther Med. 2006;14(2):113-9.

Miyamoto Y, Tachimori H, Ito H. Formal caregiver burden in dementia: impact of behavioral and psychological symptoms of dementia and activities of daily living.J Geriatr Nurs. 2010;31(4):246-53.

Pattanayak RD, Jena R, Tripathi M, Khandelwal SK.Assessment of burden in caregivers of Alzheimer’s disease from India. Asian J Psychiatr. 2010;3(3):112-6.

Lertpaiboon J. Report of knowledge about complementary intervention for person of dementia. Department of Psychiatric

Nursing, Faculty of Nursing, Prince of Songkla University; 2008.

Raglio R, Bellandi D, Baiardi P, Gianotti M, Granieri E.Listening to music and active music therapy in behavioral disturbances in dementia: a crossover study. J Am Geriatr Soc. 2013;61(4):645-7.

Vink AC, Zuidersma M, Boerama F, Jonge PD, Zuiderma SU, Slaets JPJ. The effect of music therapy compared with general recreation activities in reducing agitation in people with dementia: a randomized controlled trial. Int J Geriatr Psychiatry. 2013;28(1):1031-8.

Tuet RWK, Lam LCW. A preliminary study of the effects of music therapy on agitation in Chinese patients with dementia.

Hong Kong J Psychiatry. 2006;16(3):87-91.

Cabrera E, Sutcliffe C, Verbeek H, Saks K, Soto-Martin M,Meyer G, et al. Nonpharmacological interventions as a best practice strategy in people with dementia living in nursing homes: a systematic review. Eur Geriatr Med. 2015;6(2):134-50.

Eun-Hi K, Myonghwa P. Effects of music therapy on agitation in dementia: systematic review and meta-analysis. Korean

J Adult Nurs. 2015;27(1):106-16.

Charoensuk S. Music for brain-enhancement. 1sted.Bangkok. Dream Catcher Graphic; 2007.

Dossey BM. Critical care nursing: body mind-spirit. 1sted.Philadelphia. J.B. Lippincott; 1992.

Synovitz BL, Larson LK. Complementary and alternative medicine for health professionals: a holistic approach to consumer health. 1sted. Burlington: Jones & Barlett Learning; 2013.

Binson BE. Music therapy. Bangkok. V Print; 2010.

Herdener M, Esposito F, Salle F, Boller C, Hilti CC, HabermeyerB, et al. Musical training induces functional plasticity in human hippocampus. J Neurosci. 2010;30(4):1377–84.

Esch T, Stefano BG. The neurobiology of pleasure, reward processes, addiction, and their health implications. Neuro

Endocrinol Lett. 2004;25(4):235-51.

Gerdner LA. Individualized music for dementia: evolution and application of evidence-based protocol. World J Psychiatry.


Faul F, Erdfelder E, Buchner A, Lang A-G. Statistical power analyses using G* power 3.1: test for correlation and regression analysis. Behav Res Medthods. 2009;41:1149-60.

Limpawattana P, Tiamkao S, Sawanyawisuth K, ThinkhamropB. Can Rowland Universal Dementia Assessment Scale (RUDAS)

replace Mini-Mental State Examination (MMSE) for dementia screening in a Thai geriatric outpatient setting?.Am J Alzheimers Dis Other Demen. 2012;27(4): 254-9.

Julsiri A, Chadcham S. Effects of listening to the pleasant Thai classical music on enhancing working memory capacity in

elderly: an electroencephalogram study. Research Methodology and Cognitive Science. 2013;11(1):1-18. (in Thai)

Cohen-Mansfield J, Libin A. Assessment of agitation in elderly patients with dementia: correlations between informant

rating and direct observation. Int J Geriatr Psychiatry.2004;19(9):881-91.

Park H, Specht JK. Effect of individualized music an agitation in individuals with dementia who live at home.J Gerontol Nurs. 2009;35(8):47-55.

Ridder HMO, Stige B, Qvale LG, Gold C. Individual music therapy for agitation in dementia: an exploratory randomized

controlled trial. Aging Ment Health. 2013;17(6):667–78.

Geethanjali B, Adalarasu K, Jagannath M. Music induced emotion and music processing in the brain-a review. J Clin

Diagn Res. 2018;12(1):1-3.

Cummings J, Pillai J. Neurodegenerative diseases: unifying principles. United Kingdom: Oxford University Press; 2016.

Freeman R. Music and the brain’s reward and bonding system; 2020 [cited 2020 June 1]. Available from: https:// 201604/music-and-the-brains-reward-and-bonding-systems

Hay PD, Klein TD, Hay KL, Grossberg TG, Kennedy SJ.Agitation in patients with dementia: a practical guide to diagnosis

and management. Washington, DC.: American Psychiatric Publishing; 2003.

Banno K, Nakaaki S, Sato J, Torii K, Narumoto J, Miyata J,et al. Neural basis of three dimensions of agitated behaviors

in patients with Alzheimer disease. Neuropsychiatr Dis Treat.2014;10:339-48.