@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(4):275-281

Background
Old age is a critical period of life and noticing the problems and needs of this stage is a social necessity [1].
Previous Studies
... [2-11]. Music therapy in the elderly leads to their calmness, reducing depression and loneliness in them and stimulation of the brain`s alpha waves [12]. ... [13-16].
Aim(s)
This study aimed to determine the effect of group music therapy on the disturbed behaviors of elderly women with Alzheimer's disease.
Research type
This study is applicable as is quasi-experimental in terms of method in the design of pretest-posttest with a control group.
Research society, place and time
This study was carried out in 2015 in Islamic Azad University of Shiraz among all the patients with Alzheimer's disease who have been introduced by the Welfare Department of Shiraz.
Sampling method and number
20 female patients (65-75 years old) with Alzheimer's disease living in Farzanegan Nursing House of Shiraz were selected through available sampling method. Inclusion criteria for the study were: the female gender and the age range of 65-75, definitive diagnosis of Alzheimer's disease and a minimum time of 6 months after the diagnosis, obtaining less than 7 scores out of 10 on the Abbreviated Mental Test (AMT) regarding the cognitive status of patient, being able to diagnose disturbed behaviors according to the definition of Cohen-Mansfield including inappropriate motor and verbal activities that are recorded in the patient`s files by caregivers, history of residence in nursing homes for at least 6 weeks ( the minimum time for the elderly patient with Alzheimer's disease to adapt to the new environment), sound hearing and not suffering from depression along with Alzheimer's disease which is diagnosed and recorded in patient`s files by the physician. The subjects were randomly divided into experimental and control groups, each with 10 people.
Used devices&materials
In order to evaluate the cognitive function of the elderly, 10-item Abbreviated Mental Test (AMT) questionnaire was used [17] which has been made in 1972 by Hodkinson to determine the cognitive status of the elderly. This tool has a high speed for cognitive assessment of elderly patients with Alzheimer's disease and based on the findings of Swann et al. the AMT provides high predictive value like the Mini–Mental State Examination (MMSE) to assess the elderly`s cognition [18]. The translation, reliability and validity of AMT in Iran was conducted in 2007 by Foroughan et al. and its scores had positive correlation with the scores of Mini–Mental State Examination (p <0.001). In order to determine the specific reliability of this tool, the questionnaires were given to 10 participants, and again a week later the questionnaires were given to the same subjects, and Pearson reliability coefficient was determined between the two stages of calculation (r=84%) and reliability [19]. Moreover, to measure disturbed behaviors (aggressive and non-aggressive physical behaviors, verbal aggression and secrecy) among elderly women with Alzheimer's disease, Cohen-Mansfield Agitation Inventory (CMAI) was used which was constructed in 1986 to measure agitation in patients with cognitive defects. The questionnaire is a 7-point grading tool including 29 items which is scored based on incidence, from 1 = never to 7 = several times an hour according to the observations of the last 2 weeks [20]. According to the latest research reviews by Zare`h et.al on the psychometric properties of Cohen-Mansfield agitation questionnaire in Iran, four factors were determined including aggressive physical behaviors such as spitting, beating and kicking others (15 items), non-aggressive physical behaviors like walking without any destination, wearing inappropriate clothes and making strange noises (8 items), verbal aggression such as saying repeated sentences, complaining and negativism (4 items) and secrecy like hiding objects (2 items). Disturbed behaviors include these four factors. The reliability coefficient of the retest and its two halves were 0.99, 0.92, respectively. Cronbach's alpha coefficient for the whole questionnaire and the factors related to ranging were obtained 0.82 and 0.60 to 0.81, respectively. According to the results of factor analysis and convergent and consistent reliability of assessors, it can be mentioned that this questionnaire has a favorable reliability. Examining the factor structure and construct validity of the questionnaire with regard to the factor analysis method of the questions with varimax rotation has demonstrated four main factors (aggressive behaviors, non-aggressive behaviors, verbal aggression and secrecy) [21]. The experimental group was exposed to music therapy for four weeks, each week for three 30 to 45-minute sessions. In these meetings, a collection of calming wordless music from the package of enduring songs which were collected on a CD was played for the members of the experimental group. The control group received no intervention. The data was collected in two stages; before the intervention (pre-test) and after 12 sessions of group music therapy (post-test). Before the start of each treatment session, all the members of the experimental group gathered together in a quiet place and then their group music therapy began. Data was analyzed using SPSS 19 software. In order to summarize and describe the data, descriptive statistics (mean, standard deviation and variance) was used and for testing the hypothesis, analysis of covariance was employed. According to the results of Levene equality of error variances test and homogeneity of variances of each variable, the equality and homogeneity of the groups` variance, consistency of regression slope and the correlation of covariate and independent variable, analysis of covariance was used.
Findings by Text
All the participants were women. 12 (60%) and 8 (40%) people were in the age range of 65-70 and 70-75, respectively. In addition, 5 patients (25%) were married and 15 patients (75%) were single. 12 (60%), 6 (30%) and 2 (10%) people had degrees less than Diploma, Diploma and higher education, respectively. The longest residence in nursing homes was for 12 to 18 months with a frequency of 6 patients (30%) and the longest duration of diagnosing the disease was 2 to 3 years with the frequency of 8 patients (40%). In the pre-test, the mean of disturbed behaviors between experimental and control groups did not differ significantly (p>0.05) but in the post-test, the mean of physical aggressive (p=0.001) and non-aggressive (p=0.04) behaviors, verbal aggression (p=0.01) and secrecy (p=0.04) in the experimental group was significantly lower than the pre-test stage and the control group. There was no significant difference in the control group between pretest and posttest (p>0.05; Table 1).
Main comparison to the similar studies
The results of this study are consistent with some previous researches and others` opinions like Svansdottir and Snaedal [22], Clark et al.[23], Gordner [24], … et al. [25], Song and Chung [2], Holmes and Vianko [26], Garland et al. [27], Rasilo et al. [28], O'Connor et al. [29], Park et al. [30], Choi [31], Zar`eh et al. [5] confirm these findings. However, the results contradict some researches such as the study by Ledger and Baker [32]. ... [33-46].
Suggestions
Care centers and nursing homes are suggested to use music programs to influence the behavioral disorders in the elderly with Alzheimer's disease.
Limitations
The limitations of this study include the nature of Alzheimer's disease and its increasing development so there is the possibility that this issue has somehow affected the results.
Conclusions
The use of group music therapy is effective on decreasing the disturbed behaviors of elderly women with Alzheimer's disease.
Acknowledgments
The authors are grateful to the Research Deputy of Islamic Azad University of Shiraz.
Conflict of interest
Non-declared
Ethical Permissions
Ethical considerations were totally observed regarding the patients at all stages of the experiment.
Funding Sources
This study was financially supported by the Research Deputy of Islamic Azad University of Shiraz.

TABLES and CHARTS

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