Problem Identification and Description Using PICOT Format
Introduction
Since I’ve been a nurse in hospital settings for the past 20 years, either in acute care or long-term acute, I have always noticed that my patients both young and old, all enjoyed and appreciated that I play music for them when I’m in the room longer than 5 minutes. They also enjoy a quick back rub when it’s time to turn or a 5-10-minute back massage when they can’t seem to fall asleep or get comfortable. I feel that music and touch has been very therapeutic in relaxing the patients and for this next few weeks, I would like to focus on the benefits and healing influence they have on people with Alzheimer’s or other dementias in a board and care settings that are under hospice care or services.
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The problem that I see here is that not all Alzheimer’s patients are introduced to this service and some are still using pharmacological measures to help manage their behavior, therefore, my PICOT question here is: For people with dementia, do non-pharmacological interventions such as music and massage therapy compared to pharmacological treatments produce benefits in the quality of end of life care?
It is estimated that by 2025, there will be approximately over 16 million Americans with dementia or Alzheimer’s Disease and by 2050, there will be two types of people, the dementia and the ones caring for the dementia. There are many stages of AD and they progress differently but not all stages are experience by all persons with AD. Dementia or AD is diagnosed when that individual is gradually developing difficulties with memory, thinking, language and daily activities. Predominantly, people with dementia exhibit behavioral symptoms such as disruptive vocalization (screaming), repetitive questions, restlessness, wandering, pacing and physical aggression towards self or others. These associated issues with behavioral and emotional problems are what tend to reduce elderly with dementia quality of life.
Currently, there are a wide range of treatment and interventions being use by healthcare professional and caregivers including chemical and physical restraint for behavioral symptoms, but these can lead to risk for falls in the elderly with AD, therefore it is better to incorporate non-pharmacological intervention such as music and massage therapy.
It has been confirmed that when the dementia is severe, it may be difficult for the ones suffering from AD or dementia to communicate verbally. According to some research, it has been proven that even when people with “dementia may no longer speak, they may still be able to hum or play along with music.”
Music is known to be the universal language that people of all ages can relate to and enjoy. Its value however can go beyond simple listening. Music can bring out certain memories, feelings and evoke different sensations. It has been found to be very beneficial for older adults with various type of dementia. According to the founder and executive director of Center for Music Therapy in New York, elder clients either meeting individually or within a group “express themselves and recall the memories that music sparks and stimulates.” John Carpente, the founder of the Center for Music Therapy believes that by listening to live music and being involved in live music-making experiences, a greater quality of life is possible. He also found that music “empowers his clients to emerge from the isolation imposed by Alzheimer’s disease and dementia.” He also noted that music therapy is used to improve the overall mental and physical wellbeing of the dementia clients including memory recall, positive changes in moods and emotional states. In addition, it improves a sense of control over one’s life, it manages pain and discomfort and stimulates and promotes interest even when other approaches are ineffective. It also promotes periodic and continuous movement or vocal articulacy and allows for opportunities to intermingle socially with others.
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Another form of therapy that I strongly feel that people with Alzheimer would benefit is touch or massage therapy. Therapeutic touch is a non-pharmacologic intervention that has been minimally used for the treatment of behavior seen in patients with AD. There are a few different terms associated with therapeutic touch, such as Reiki, healing touch or massage therapy. According to Ann Catlin, founder of the Center for Compassionate Touch and an expert in the field of massage therapy in elder care and hospice, “people with Alzheimer’s disease don’t lose the capacity for human emotion or recognition of a caring touch.” Studies have indicated that there are many benefits touch or massage therapy offers people with dementia. Besides building reassurance, trust and help calm agitation, massage therapy also increases body awareness and alertness, as well as reducing feelings of confusion and anxiety. It also helps alleviate the effects of isolation, loneliness and boredom at the same time encourages feelings of well-being and worthiness.
In 2002 R. Remington did a research on the effect of calming music and hand massage on agitated behavior in persons with dementia and found that both calm music and hand massage help reduce verbal agitation and that the benefit was sustained for up to one hour.
Conclusion
Dementia, Alzheimer’s Disease affects millions of people worldwide and its associated behavioral symptoms that result can be very challenging for the patient, family, and/or caregivers. Currently, there are many different pharmacological treatments being used to help ease those behavioral symptoms however it is not always safe and could be a high risk for falls in the elderly when use excessively. Fortunately, with the advances in the care for the aging population with AD have led to the use of music and touch/massage therapy as an intervention to treat agitated behaviors. We all have choices and preference of therapy when it comes to those we love or care for, so, if your family member who is suffering from AD is exhibiting these behaviors, would you play some music while you gently stroke their hand and/or give them a back rub to show them love as you help them relax?
I strongly believe for people with dementia that such therapeutic and holistic approach, a non-pharmacological interventions such as music and massage therapy compared to pharmacological treatments would produce benefits in the quality of end of life care.
References
- http://www.todaysgeriatricmedicine.com/news/story1.shtml Retrieved on 1/19/2019
- https://www.amtamassage.org/articles/3/MTJ/detail/2495/a-touch-of-compassion-massage-therapy-and-alzheimers-disease Retrieved on 1/20/2019
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PICOT is a mnemonic derived from the elements of a clinical research question – patient, intervention, comparison, outcome and (sometimes) time. The PICOT process generally begins with a vague clinical query. Each element of the process helps develop a well-structured question.
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