Music Intervention for older adults: Evidence Map of Systematic Reviews

1. Introduction

The world’s population is aging rapidly, with older adults accounting for a significant proportion of the population. In China, the number of older adults has reached 264 million, comprising 18.7% of the total population.[1] As the population ages, chronic diseases are becoming more prevalent, which places an increasing burden on families. Chronic diseases not only affect the physical health of older adults but also their psychological health, resulting in negative emotions such as anxiety, depression, and stress that significantly affect their quality of life.[2]

As the world’s population ages, the number of older adults living with chronic diseases such as Alzheimer’s Disease continues to rise. Alzheimer’s Disease is one of the most common progressive central nervous system degenerative diseases associated with aging, affecting over 50 million people worldwide.[3] Furthermore, estimates suggest that the number of people living with dementia is expected to double every 20 years, reaching 131.5 million by 2050 and imposing significant personal, social, and economic burdens.[4,5]

Cognitive impairment poses significant challenges for individuals with dementia, leading to a decline in physical functioning, difficulties in rehabilitation, reduced independence in daily activities, decreased ability to cooperate with care, heightened agitation, and social isolation. These challenges place substantial burdens on caregivers and contribute to the prevalence of depression, isolation, and apathy among dementia patients. Consequently, families may opt for institutional care, placing additional strain on social healthcare resources and financial resources.

Non-pharmacological interventions have been shown to be safe and effective in improving the physical, emotional, psychological, social, and cognitive needs of older adults, thus improving their quality of life.[6,7] Music therapy and music interventions are closely related concepts within the field of using music for therapeutic purposes. Music therapy is a specialized form of treatment that involves the professional practice of trained music therapists. It utilizes music and its elements to achieve specific therapeutic goals, such as enhancing communication, emotional expression, and cognitive functioning. Music therapists assess individuals’ needs and tailor interventions to address their unique circumstances. On the other hand, music interventions encompass a broader range of applications that utilize music and its elements for improving health and well-being. While music therapy is a specific discipline conducted by trained professionals, music interventions can be implemented by nonprofessionals, healthcare providers, volunteers, or other relevant professionals. Music interventions can include music therapy but also encompass other forms of music-based interventions such as music activities, music appreciation, and music training. Therefore, music therapy is a subset of music interventions, with the former involving specialized training and a therapeutic focus, while the latter encompasses a broader scope of music-related interventions.[8] Music intervention has been shown to have beneficial effects on the cognitive, physiological (such as heart rate, blood pressure, respiratory rate, cortisol levels, immune function markers, and other relevant biomarkers), and psychological problems of older adults.[9]

In fact, research has shown that listening to and playing music can change brain functions, improving cognitive functions such as memory[10] and attention,[11] as well as behavioral symptoms of older adults.[12] Long-term music training and learning of related skills can even stimulate the brain development of older adults.[13] Music intervention has also been shown to alleviate negative emotions such as anxiety[14] and depression,[15] and activate the subcortical circuit, limbic system, and emotional reward system, thereby stimulating well-being and improving the quality of life.[16] On the other hand, some studies report that the short-term effects of music intervention are limited in improving the cognitive function and emotion of older adults.[17,18]

Despite the existing reviews on the health benefits of music interventions for older adults, there is a need for a comprehensive synthesis and systematic evaluation of the available scientific evidence. The Global Evidence Mapping initiative, established in 2007, aims to identify knowledge gaps and future research needs through systematic and wide-ranging searches, presenting the results in a user-friendly format, such as visual graphs or searchable databases.[19] This study aims to address this need by providing a clear and concise map of music prescriptions and research findings related to health outcomes for older adults. For this study, the Global Evidence Mapping initiative was utilized to conduct an Evidence Map on the impact of music interventions on the health of older adults. By conducting a rigorous review of the literature using standardized methodologies, we aim to overcome the limitations of previous studies and provide a more robust understanding of the effects of music interventions on the health of older adults. Our research seeks to bridge the gaps in the current knowledge by exploring the specific impacts of music interventions on cognitive functioning, psychological well-being, and overall health in older adults. The findings of this study will contribute to the existing body of knowledge, inform evidence-based practices, and potentially guide the development of clinical guidelines and future research studies in this field.

2. Method

The search strategy included systematic reviews, meta-analysis. The systematic reviews were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines[20] and the Evidence Map methodology[21] to ensure a reliable summary of the best available evidence. Tableau was used to graphically display the number of reviews, intervention effects, confidence levels, and health outcomes.

2.1. Data sources

We conducted a comprehensive search for relevant studies across multiple databases, including PubMed, Web of Science, Embase, Cochrane, SinoMed, National Knowledge Infrastructure, and WanFang datebase, without any language restrictions, from the inception of each database to November 2022. The search included the use of keywords such as “systematic review” or “meta-analysis,” as well as “music intervention” or “therapy, music,” or “music* intervention*,” or “music,” in conjunction with terms such as “aged,” “older,” “older people,” “elderly,” or “older adults.” A combination of subject words and free words was used in the search strategy, and detailed search strategies can be found in Table 1.

Systematic reviews focused on music intervention for older adults, which self-identified as a “systematic review” or “meta-analysis” that reported the search sources and accounted for identified studies, were eligible for inclusion.

2.2.2. Population:

Systematic reviews of older adults aged 60 years and older, the majority of the participants were considered to be older adults according to the Chinese definition,[22] regardless of their health status, were eligible for inclusion. Studies that did not focus on music intervention for older adults were excluded.

2.2.3. Intervention:

Systematic reviews of the effects of music intervention for older adults, including combination therapies incorporating music intervention, were eligible for inclusion. Systematic reviews that did not systematically search for music intervention studies and reviews were excluded.

2.2.4. Comparison:

Comparison included pharmacological treatments, usual treatments, and placebo treatment.

2.2.5. Outcomes:

Systematic reviews reporting on health outcomes of older adults were eligible for inclusion. Specifically, we focused on the effects of music interventions on the psychology, cognition, physiology, quality of life, and well-being of older adults. Systematic reviews of acceptance, prevalence, costs, and unreported study design characteristics or patient health outcomes were excluded.

2.3. Procedures

To select eligible studies, all identified hits were imported into Endnote (Version X9). Two independent reviewers, screened all the systematic reviews. The full-text publications were also screened by 2 independent reviewers according to the specified inclusion criteria. Firstly, duplicate records were removed manually and by software. Secondly, the titles and abstracts of the remaining records were examined to exclude irrelevant documents. Finally, the full texts of the remaining studies were retrieved for further screening. Disagreements were resolved by consensus, and if necessary, an additional reviewer was consulted. The reasons for exclusion of full-text publications were recorded and presented in Figure 1.

Figure 1.:

PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers.

2.4. Methodological quality assessment

A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2 tool)[23] was utilized to assess the methodological quality of the systematic reviews included in this study. This tool is composed of 16 items, with 7 critical items (items 2, 4, 7, 9, 11, 13, and 15). For each of these items, the responses “Yes” (Y), “Partial Yes” (PY), or “No” (N) were used to evaluate specific questions. The overall confidence in each item was then classified as “Critically Low” (CL, “more than one critical flaw with or without non-critical weaknesses”), “Low” (L, “one critical flaw with or without non-critical weaknesses”), “Moderate” (M, “more than one non-critical weakness”), or “High” (H, “No or one non-critical weakness”).

2.5. Data extraction

Data extraction was performed by 2 independent reviewers who read all articles and extracted baseline information according to predefined criteria. This information included the article’s title, first author, year of publication, whether it mentioned Preferred Reporting Items for Systematic Reviews and Meta-Analyses or other reporting guidelines, number of randomized controlled trials, sample size, interventions, comparisons, outcomes, quality assessment tool of included primary studies, effects (summarized according to the views of the author of the original document), funding source, and AMSTAR2 rating overall confidence. Methodological quality assessments were also conducted. Disagreements between the reviewers were resolved through consensus, and a third reviewer was consulted when necessary.

3. Results

After the initial search yielded 513 citations, 67 studies ultimately met the inclusion criteria. In total, 209 unique outcomes were identified, with some studies reporting more than one relevant outcome. Furthermore, a single article may have included information on different populations, multiple types of music interventions, and more than 2 outcomes. Of the 67 included studies, there were 21 systematic reviews with meta-analysis, 33 systematic reviews without meta-analysis, and 13 meta-analysis. In this evidence map, we included 67 studies published in the past 2 decades that evaluated 106,253 older adults (only the number of subjects proposed by the author in the article is included). We observed a significant increase in the number of publications over time, with 45 of the 67 included studies published in the last 5 years. This suggests a growing interest in understanding how music impacts the health of older adults.

3.1. Quality of the included systematic reviews

Regarding the quality assessments of the overall confidence level for each systematic review, most studies showed a low level of confidence (n = 23 studies), indicating limitations in the methodology or reporting of the systematic review. Fifteen articles each were classified as having a high or moderate confidence level, suggesting more rigorous methodology and reporting. Fourteen studies were rated as having a critically low level of confidence, indicating serious flaws in the methodology or reporting.

3.2. Population

The majority of the systematic reviews included in this study focused on older adults or individuals diagnosed with cognitive impairment or dementia (n = 49 studies), while 11 systematic reviews included patients with mental disorders, and 7 systematic reviews included other types of older adults such as those with sleep disorders or healthy older adults. Table 2 provides an overview of the main characteristics of the sixty-seven systematic reviews, including sample size, patient characteristics, interventions, and primary outcomes.

Table 2 - The main characteristics of the sixty-seven systematic reviews. No First author Country Year of publication Mention of prisma Populations Number of RCTs Sample size Interventions Comparison Outcomes Quality assessment tool Effect Fund Amstar2 rating overall confidence 1 Peter Hoang Canada 2022 Y Adults aged 65 years or older 70 8259 Animal therapy, psychotherapy or cognitive behavioral therapy, multi component, counseling, exercise, music therapy, occupational therapy, reminiscence therapy, social interventions, and technological interventions Individual animal therapy Loneliness BMJ best practice grading of recommendations assessment, development and evaluation of evidence tool No effect N H 2 Kayla Atchison Canada 2022 Y Older adults living in long-term care (LTC) 80 NA Music Usual care, social interaction Anxiety symptoms Cochrane rob 2 tool Positive effect N M 3 Claire V. Burley Australia 2022 Y Dementia 37 2636 Education training, therapeutic activities, cognitive rehabilitation or cognitive stimulation, reminiscence-based, physical activity, music, and other approaches Pharmacological intervention Depression Several different previously used tools Potentially positive N H 4 Nigussie Tadesse Sharew Ethiopia 2022 Y Older people with dementia 19 NA Physical exercise, music, and cognitive interventions Unimodal non-pharmacological interventions or control group with no intervention Cognitive function Robins-i tool for non-randomized control trial studies and the Cochrane risk-of-bias tool for randomized trials (rob 2) Positive effect N H 5 Bai Zhifan China 2022 N The elderly in pension institutions 16 1039 Pet therapy, comprehensive psychological intervention therapy, cognitive behavior therapy, music therapy, reminiscence therapy and problem solving therapy General health education Depressive symptoms Cochrane handbook Positive effect N L 6 Catherine Jordan Ireland 2022 Y Age range 60–85 years with mild cognitive impairment 9 586 Music interventions Usual care Cognitive function and/or behavior, cognitive domains included executive function, visuospatial function, working memory, attention, verbal fluency and memory, behavioral domains included measures of depression, apathy, anxiety, and quality of life The evidence project risk of bias tool Potentially positive Y M 7 Teerapon Dhippayom Thailand 2022 Y Older adults aged ≥ 60 years 15 1144 Active music therapy, receptive music therapy, music medicine Usual care Depression Grade assessment Positive effect N M 8 Hui-Fen Hsu China 2022 Y Older adults aged 65 and older 8 524 Live music, recorded music, and active music, with a variety of music styles and genres Usual care Chronic pain JBI Potentially positive Y M 9 Erika Ito (mean age ranged from 60 to 87 years old Japan 2022 Y Men and women aged 60 + with a clinical diagnosis of cognitive im pairment or dementia 19 1024 Music-based intervention or community music activity including listening to music, singing, playing an instrument, and music with movement or exercise No intervention/usual care, meditation, pharmacological intervention, exercise intervention, late intervention, and painting or other art related activities General cognitive function, the frontal assessment battery (executive function), and the auditory verbal learning test (episodic memory) Consolidated standards of reporting trials (consort) statement Positive effect Y L 10 Zhao Yiran China 2021 N Age > 60 years old; simple mental state examination (MMSE) > 24) 10 397 Music intervention Usual care Cognitive function, executive function, memory and attention JBI Positive effect Y M 11 Zhi Hui Fong China 2021 Y Older persons aged 60 with mci 11 817 Arts-based, which includes dance/movement, drama, music, or visual arts Appropriate control group (e.g., age matched, mci status, no treatment/waitlist/active control) Global cognition, learning and memory, complex attention, executive functioning, language, and perceptual-motor function Cochrane rob 2 tool Inconclusive effect Y L 12 Ya-Jing Chen China 2021 Y Participants aged 65 years and older with a primary diagnosis of any depressive disorder 35 3797 Intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention Treatment as usual (usual care, no intervention, waiting list treatment), or active non-pharmacological intervention Depression Cochrane handbook Positive effect Y L 13 Yo-Jen Liao Bsn USA 2021 Y Pain in people living with dementia 11 486 Massage, ear acupressure, music therapy, painting and singing, personal assistive robot, exercise, social activities, cognitive behavioral therapy, reflexology, tailored pain intervention, play activity, and person-centered environment program Routine pain mausual caregement Pain The johns hopkins nursing evidence-based practice research evidence appraisal tool Positive effect N H 14 Ma mengning China 2021 N Elderly patients with dementia 15 1101 Passive music intervention, passive music intervention, group intervention Treatment as usual Cognitive function Cochrane handbook Positive effect Y L 15 Sekyung Jang Ireland 2021 N Older adults (age: 60 or older) 20 NA Types of music experiences reported in the selected studies were singing, movement to music, music listening, instrument play, improvisation, music-guided reminiscence, song writing, music guided relaxation, guided imagery to music, and instrument making Usual care Depressive symptoms, general mood states, stress and relaxation, affective disturbance, decrease in negative mood, increase in positive mood, expression of positive emotion, dealing with difficult emotions such as frustration and sadness, and self-confidence and shared feelings of joy Standardized assessment forms (clear-npt) Positive effect N M 16 Chia-Te Chen China 2021 Y Older adults aged 60 years and older 5 288 Music intervention Standard care (or no treatment) Sleep quality Cochrane handbook Positive effect N L 17 Cong Wang China 2021 Y Older adults 9 489 Music interventions, including passive and active music interventions No control group, blank and waitlist control group, usual care or other interventions Sleep quality, sleep latency, sleep duration, sleep efficiency and sleep of daytime dysfunction Cochrane risk of bias (rob)tool for RCTs and the risk of bias in non-randomized studies - of interventions (robins-i) tool for non-RCTs Positive effect Y L 18 Jennie L. Dorris USA 2021 N Older adults with probable mci and mild or moderate dementia 21 1742 Cognitive functioning, emotional well-being, and social engagement

View original article

MEDICINE

Like

Share Bookmark

0 0 0 0 0 0 0

More from this channel

Music Intervention for older adults: Evidence Map of Systematic Reviews

Comments (0)