Effects of a Media-Based versus Live Song Lyric Analysis Life Review on Levels of Therapeutic Exploration, On-Task and Participation of Individuals with Dementia

Dementia is a chronic disease that is considered to be one of the world's fastest growing problems. Estimates from the World Health Organization (WHO) indicate that approximately 35.6 million people worldwide lived with dementia in 2011. This figure was projected to double to 65.7 million by 2030, and triple to 115.4 million by 2050 (WHO, 2011). Current treatment of dementia centers round pharmacological management. Research has shown, however, that overreliance on medication exposes patients to high levels of risk-taking and various adverse effects including an escalation of behavioral and psychological disturbances (BPSD) (Alzheimer's Association, 2012; Prince, Bryce & Ferri, 2011). Discontinuation of medication is a huge problem in dementia care due to some patients' lack of tolerance of the adverse effects of prescribed medication (Simard & Samson, 2008). Not surprisingly, non-pharmacological interventions are being increasingly promoted as a non-invasive treatment alternative to improve cognitive functioning, manage symptoms of BPSD, and address psycho social needs in older adults with dementia (Sadovoy, Lanctot & Deb, 2008; Spijker, Vernooij-Dassen, Vasse, Adang, Wollersheim & Grol, 2008).The purpose of this dissertation was to examine the effects of a media-based versus live song lyric analysis life review intervention on levels of therapeutic exploration and on-task/ participation behaviors of individuals with mild to moderate dementia. A posttest only two independent group randomized control design with single-session intervention was employed in this study. Participants were 72 older adults (M = 32, F = 40) from a large nursing home community in the South Eastern part of the United States. Gender and dementia severity level were controlled across groups. Measurement of dementia severity level was obtained via the Mini-Mental State Examination (MMSE). The independent variables were 2 music stimulus conditions: (1) an iPad-based music therapy song lyric analysis and life review (experimental) condition; and (2) a "live" music therapy song lyric analysis and life review (control) condition. The 2 dependent variables were 2 areas of assessed behavior: (i) level of therapeutic exploration adapted from Hill's Exploration Stages (2007) [1 = no exploration stage (participant was silent or provided an unrelated/confused response); 2 = acceptance (participant indicated that (s)he felt, understood, supported and comfortable); 3 = awareness (participant demonstrated awareness of what was being asked/participant was cognitively aware or emotionally sentient of any problems/current life realities); 4 = expression (participant was actively exploring/expanding upon his/her thoughts or feelings); 5 = beyond exploration stages (participant's response demonstrated that (s)he had surpassed the 4 previous explorations stages)], and (ii) level of on-task and participation behaviors during the music and counseling portions of the intervention. Results of the levels of therapeutic exploration analysis found significant differences in participants' responses based on group (iPad or live), dementia level (mild or moderate), and gender (male or female). A significant interaction for levels of therapeutic exploration was discovered by dementia level and group. No significant interaction was found for the effects of gender by group, or for gender by group by dementia level on participants' levels of therapeutic exploration. Results of the mean exploration stage score analysis found significant differences for the effects of group and dementia level, but not gender. However, there were significant effects for both groups by dementia level, and gender by dementia level, on mean exploration stage scores. No significant difference was found for the effect of gender by group on mean exploration stage scores. Results of the levels of on-task/participation analysis discovered that females with mild to moderate dementia from the live group displayed the highest levels of on-task verbalization during music. Results comparing levels of on-task eye gaze among groups during music were also statistically significant. Post-hoc analysis revealed that levels of on-task eye gaze for the mild dementia iPad group (M = 47.83 %) were significantly different from the mild dementia live group (M = 31.33 %, p < .01), and moderate dementia live group (M = 21.33 %, p < .01). Results comparing levels of on-task verbalization among groups during counseling were statistically significant. Post-hoc analysis demonstrated that levels of on-task verbalization for the mild dementia iPad group (M = 56.28%) were significantly different from the moderate dementia live group (M = 19.47%, p < .01), as well as the mild dementia live group (M = 33.19%, p < .01). Results comparing levels of on-task eye-gaze among groups during the counseling interview also found a significant difference. Post-hoc analysis indicated that the levels of on-task eye-gaze for the mild dementia iPad group (M = 55.11 %) were significantly different from the mild dementia live group (M = 26.56%, p < .01), and moderate dementia live group (M = 27.36%, p < .01). The results of this dissertation demonstrate that both the iPad and "live" singing song lyric analysis life review interventions were able to functionally elicit verbal responses from older adults with mild to moderate dementia that reflected the various stages of exploration defined by Hill (2007) via a single session counseling intervention. Both interventions were also able engage older adults' participation during the music and counseling portions of the session. However, between the two, the iPad intervention was more effective. Based on these results, it appears that the iPad-based music therapy and counseling intervention introduced in this study has potential for development into an effective non-pharmacological intervention to cater specifically to the oft-neglected communication and counseling needs of older adults with mild to moderate dementia. Keywords: live music therapy applications, counseling, iPad, media-based interventions, older adults, dementia, song lyric analysis, life review, reminiscence.