Pragmatic Implementation of a Music Intervention in Nursing Homes Before and During COVID-19.
Ellen M McCreedy, Aleena Dewji, Laura Dionne and 5 others
PMID 38036026WHAT IT FOUND
Nursing homes delivered personalized music for dementia agitation less well during the pandemic: fewer residents received it, staff used it less often, and exposure averaged 2.5 minutes per exposed day.
Key findings
01Across coverage, frequency, duration, and content details, implementation adherence was worse in the COVID trial than in the pre-COVID trial.
02In the COVID trial, low-fidelity homes had 36.3% Black residents, while high-fidelity homes had 0% Black residents.
03High-fidelity homes had 3.8 nursing staffing hours per resident day in the COVID trial, compared with 3.2 in low-fidelity homes.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This paper analyses implementation fidelity, not whether music reduced agitation; the pre-COVID trial found no effect on the primary staff-reported agitation outcome. The two trials used different ways to choose music, different training leaders, and different data collection, so the pandemic and the implementation changes cannot be separated. During the COVID trial, research staff could not visit homes, so adherence data relied on phone interviews and emailed observations. Nursing home staff and residents were not blinded to treatment status. The paper does not report the final number of residents analysed after exclusions for death or discharge before four months. Staff selected residents rather than using random selection, so the enrolled residents may not represent all residents with dementia. The study reports facility-level implementation patterns, not individual patient outcomes. There is no established minimum effective dose of personalized music, so the 2.5-minute average cannot be interpreted as a clinical dose.
Declared interests
The National Institute on Aging funded METRIcAL. The authors declared no conflicts of interest.
The easy way to misread this
Do not read this as evidence that personalized music reduces agitation. The pre-COVID trial found no effect on staff-reported agitation, and this paper only describes how much music was actually delivered.