Therapy

Dementia is defined as a loss of mental ability severe enough to interfere with normal activities of daily living lasting more than six months, not present since birth and not associated with a loss or alteration of consciousness (MedlinePlus). Dementia currently affects an estimated 39 million people (MedlinePlus, 2008) worldwide and 2.4 to 5.1 million live in the United States. This number is expected to climb to an astonishing 72 million people by the year 2030. The most common form of dementia is known as Alzheimers disease. Alzheimers disease was discovered by Dr. Alois Alzheimer in 1906. This means that in a span of 102 years (since the NIA 2008 study) Alzheimers has grown from affecting the very first patient, August D to disabling millions of patients, families, and caregivers. One of the main hallmarks of Alzheimers disease is abnormal clumps of amyloidal plaques and tangled nuerofibullary tangles also known as plaques and tangles. No one is sure why these plaques and tangles start to form. Alzheimers disease is also known as the long goodbye disease, lasting as long as 20 years. There are a few other dementias besides Alzheimers disease that are as common. Vascular dementia and mixed dementia are other common dementias along with rare dementias such as Cruetzfield-Jakobs and Normal Pressure Hydrocephalus. There are many more in between that have been identified and defined and others that have not. Alzheimers disease and dementias do not have FDA approved drugs for treatment or a cure. Alzheimers disease and dementia brings along many side affects besides memory loss. Side effects include inability to complete tasks, language problems, difficulties in job performance, and losing ones way in a familiar neighborhood. Wandering may become a

Therapy significant problem. Also, dementia patients may become unable to care for themselves.

Grooming and dressing standards quickly decline. Dementia patients often dress inappropriately for each season and sometimes dress out of sequence putting on pants first and underwear second. Lastly, significant behavior changes will occur. Non psychotic behaviors that are connected with dementia include agitation, wandering, and aggression. Agitation and aggression can represent a bundle of physical manifestations that suggest emotional and physical distress or restlessness. According to the American Academy of Family Physicians patients who display physical or verbal aggression, which often is associated with delusional misidentification, may require a combination of pharmacologic and non-pharmacologic treatments (AAFP, 2011). Non-pharmacologic treatment for aggressive behavior in dementia patients includes different types of therapies. Therapy is a treatment planned to relieve or heal a disorder. Therapies include physical therapy, occupational therapy, touch therapy, and music therapy. Physical and occupational therapies deal with the physical ailments. However, touch and music therapies are a more spiritually stimulating therapy. While touch and music therapies are popular, touch therapy (including massage therapy) is usually only seen in hospice care unless a private contractor is hired for a specific patient. Music therapy can be available in a number of settings including assistant living, hospice, and independent living. According to the American Music Therapy Association (AMTA), music therapy is the clinical and evidence based use of music interventions accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed and approved music

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therapy program (AMTA). Music therapy interventions have been designed and created to promote and improve wellness, alleviate pain, improve communication, enhance memory, and express feeling; all of those subjects are highly beneficial to aggressive behaviors in dementia patients. According to Cook, Moyel, Shum, Harrison and Murfield (2010) Therapeutic use is based on the premise that, as a persons ability to understand verbal language diminishes, the ability to process music is retained by a part the brain that is the last to deteriorate. This can give an explanation as to why even the most demented person can remember a melody of a song. A music therapy session can incorporate many different elements such as music making, writing songs, or passively listening to the music. While music therapist often aim to foster the patients emotional development, there can be many other goals that are in a music therapy session. These goals include relief of stress, anxiety, aggression, improvement of mood, and above all else, improvement of quality of life. Music therapy is effective because music seems to positively affect state of mind and behaviors, particularly those affected in dementia including social behaviors, emotion, depression, anxiety, and most importantly serious aggressive behavior (Spiro, 2011). Musical types matter in behavior recovery as well. With the help of family and friends, a dementia patients music therapy can be specified to a specific genre and time frame. For example, my grandmother is fixated on gospel music from her childhood that her mother used to sing. She was born in 1932; her mother was born in 1900. That would mean her mother was more than likely singing Negro based spiritual gospel music. My grandmother sings those songs even when shes having her senior moment. This form of musical therapy is also a form of validation. A similar scenario was proven when the founder of validation, Naomi Feill sung church songs with dementia patient Gladys Wilson. What Naomi was doing was a form of music

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therapy. By singing an old gospel song, Gladys had found her lost self in a familiar place. This is exactly what music therapy is striving to accomplish with aggressive behaviors in dementia patients, validation. Even though music therapy has many benefits attached to it such as improvement of mood, relief of anxiety, stress and quality of life, not everyone agrees on the level of benefits from music therapy. There is still much research to be done as Cook states despite evidence that music has a therapeutic effect on agitation and anxiety of those with dementia, there are still methodological concerns regarding available studies and there are calls for more rigorous research. One major issue that has been found while researching music therapy on aggressive behaviors in dementia patients there has to be continuity. According to Wall and Duffy (2010) it was noted that while music therapy reduced aggressive behaviors, including anxiety, irritability and restlessness, these improvements were not present in the findings 1 month after the sessions, implying the effects of music therapy did not last 1 month. This is important because it shows that, just like pharmaceutical therapies, music therapy has to be a long term and ongoing treatment and therapy. No doctor would recommend taking a depression, high blood pressure, or diabetes medication for just one month. Why? Because the body will start to see the benefits of the medication after a month and then stopping will allow the body to return to its previous state of existence. The continuation of music therapy, just like any therapy or medication will continue to show benefits in the long run to its patients. Since dementia patients with aggressive behaviors are usually in an older population, they are more than likely using Medicare or Medicaid to cover necessary medical cost. In 1994,

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Medicare, according to the American Music Therapy Association, has identified music therapy as a reimbursable service under benefits for Partial Hospitalization Programs (PHP). And under Medicaid there are currently a few states that allow payment for music therapy services through the use of Medicaid Home and Community based waivers with certain client groups. As far as the lucky few percent that is fortunate enough to have private insurance, AMTA reports that approximately 20% of music therapist receive third party reimbursement for the services they provided. Of course there are some guidelines to receive these benefits. Surprisingly, the guidelines are not as difficult to get approved as one might think. According the AMTA, guidelines to receive covered music therapy is be prescribed by a physician, must be reasonable and necessary for a patients illness, treatment must be goal directed and based on a treatment plan, and the individual MUST show some level of improvement. All of the research points to all of these qualifying factors for aggressive behaviors in dementia patients.

In conclusion music therapy has major, long-term, effective benefits to treat aggressive behaviors in dementia patients. Dementia is the fastest growing, cognitive disorder in the world. With so many different diagnosis and branches of dementia, aggressive behaviors can show itself in many different forms. Music therapy has been shown to diminish not only aggressive behaviors in dementia patients, but also anxiety, aggression, and aid in the improvement of quality of life. There are, however, some setbacks and even some lack of evidence to further prove that music therapy works for dementia patients. These setbacks include lack of studies to prevent the most accurate information to further benefit patients and not using music therapy as a long-term care solution. There has also been improvement in the recognizing of the benefits of

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music therapy from various personal and federally funded insurance companies. Even with the certain guidelines that insurance companies have, obtaining music therapy for aggressive behavior in dementia patients is totally plausible and accessible. Music therapy has been dated as far back as the ancient Greek civilization. The Pythagoreans and Aristotle recognized the positive and powerful effects of music on the psyche. With music therapy being around for a long time and time to come, it is important to show that it can positively benefit not only aggressive behavior in dementia patients but any type of behavior in any kind of mental illness.