A person-centered framework for designing music-based therapeutic studies in dementia: current barriers and a path forward

Abstract

Objectives: Music-based interventions have received growing attention to improve quality of life for people diagnosed with dementia. Results of randomized controlled trials and meta-analytic reviews to date, however, reveal a lack of conclusive evidence for or against the effectiveness of such interventions. Herein, we critically review the basic assumptions and methodological issues ingrained in the cultures of research and care as they relate to evaluating music-based treatments for people with dementia, and propose a shift in the methodology by which music interventions are empirically evaluated.

Method: We begin by reviewing existing barriers to achieving clarity on the effectiveness of music interventions, and we highlight methodological and sociocultural constraints that have limited our ability to reach concrete conclusions in research studies to-date. We then consider several key factors that have demonstrated relevance in matching people to specific music-based interventions. Based on these key factors, we developed a person-centered framework integrating elements from precision-medicine methodology to guide intervention studies.

Results: Our organizing framework systematically integrates the following factors to inform the design of intervention studies: 1) person-centered goals and desired outcomes; 2) differences among individuals in clinical, cognitive, and historical attributes; and 3) the context of intervention and access to resources.

Conclusion: Integration of the proposed framework into empirical investigations of music interventions for people living with dementia will inform precise and tailored interventions that will bring clarity to this growing body of research. Another aim of this framework is to foster a more humane, person-centered approach to our culture of care.

Keywords:

• Music therapy
• music intervention
• dementia
• person-centered care
• non-pharmacologic treatment

Disclosure statement

The authors report no conflict of interest.

Notes

1 Low-quality evidence is defined by the Cochrane GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, which assigns quality ratings to a body of evidence ranging from very low to high according to several factors. These include limitations in the design and implementation of studies suggesting high likelihood of bias, unexplained heterogeneity or inconsistency of results, imprecision of results, and more (Higgins et al., 2019).