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Abstract
Introduction Dementia affects the quality of life. Excessive noise in care environments can exacerbate stress and related symptoms. Headphone-based music interventions may help improve the quality of life for people with dementia in long-term care homes. This review aims to explore and synthesise research on headphone-based music interventions for people with dementia in long-term care homes, focusing on enablers and barriers to implementing headphone-based music interventions.
Methods and analysis Joanna Briggs Institute guidance for scoping review and Preferred Reporting Items for Scoping Reviews and Meta-analyses extension for Scoping Reviews will guide the review and report process. CINAHL, MEDLINE, Embase, Web of Science, Scopus, AgeLine, PsycINFO and ProQuest databases will be searched for relevant literature from June 2010 to January 2024, supplemented by hand searches and Google for grey literature. Two research assistants will independently screen citations, followed by a full-text review. Data will be extracted using a data extraction tool. We will present the data in a table with narratives that answer the questions of the scoping review.
Ethics and dissemination This scoping review does not require ethics approval and participation consent, as all data will be publicly available. The scoping review results will be disseminated through conference presentations and an open-access publication in a peer-reviewed journal. The findings will provide practical insights into the adoption and efficacy of headphone-based music programmes for dementia in long-term care homes, contributing to education, practice, policy and future research.
- Dementia
- Nursing Care
- GERIATRIC MEDICINE
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STRENGTHS AND LIMITATIONS OF THIS STUDY
The scoping review will consider diverse types of sources and study designs.
The scoping review will involve patient and family partners with lived experiences.
Since we will follow the Joanna Briggs Institute Scoping Review Guidelines, we will not do a methodological appraisal of the quality of studies.
Literature in languages other than English will not be considered.
Introduction
More than 55 million people have dementia worldwide. Every year, there are nearly 10 million new cases. Dementia results from a variety of diseases and injuries that affect the brain. Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally.1 Symptoms associated with dementia, such as stress and anxiety, significantly impact the quality of life for patients and caregivers.2 According to a systematic review by Janus et al,3 noise such as human voices and electronic devices in nursing homes was associated with decreased nighttime sleep and increased symptoms such as agitation in dementia. A systematic meta-analysis by Meng et al 4 showed that noise exposure may be a specific risk factor for dementia. Therefore, managing environmental noise is crucial to enhancing the quality of life for people with dementia.3
Headphones can be a tool for people with dementia to engage with their choice of music to avoid unwanted sounds.5 In this review, we focus on headphones as a non-pharmacological music intervention. A pharmacological approach such as antipsychotic drugs involves a dangerous risk of cerebrovascular issues, falls, drowsiness, agitation and mortality rate, especially in long-term care homes.6 Hung et al 7 showed that music delivered by silent disco headphones in an older adult mental health unit is acceptable and feasible for patients. Findings showed that music delivered by silent disco headphones provides a personalised and immersive experience that helps people focus better and minimise distractions.8
There are some literature reviews indicating the positive effect of music therapy on cognitive and psychological functions in patients with dementia. Ueda et al 6 revealed that music therapy had moderate effects on behavioural symptoms and anxiety and that interventions lasting more than 3 months were associated with greater decreases in anxiety. A meta-analysis by Pederson et al 9 suggests that music intervention can reduce agitation in persons with dementia. Also, a systematic review by Gómez-Romero et al 10 reported that music therapy improves behavioural symptoms, anxiety and agitation in people with dementia. Garrido et al 11 revealed that prerecorded music could be effective in reducing a variety of affective and behavioural symptoms, in particular agitation, even where a trained music therapist is not present. A recent literature review by Notis Paraskevopoulos12 reported that using personalised music playlists and headphones results in mood improvement and a significant reduction in behavioural disturbance in people with dementia.
While some studies have shown the positive effects and the increased popularity of headphones for the delivery of music interventions, comprehensive analyses of their reach, delivery methods, effectiveness and associated challenges remain sparse. Taiwan researchers reported the drop-out rate in the intervention group could be up to 61.5%.13 Moreover, older participants from a qualitative study complained about their discomfort with the use of headphones, and residential aged-care staff also expressed concern about the accessibility of music equipment.14 In view of this, a thorough review of the literature on headphone-based music programmes is warranted.
This scoping review will examine the use of headphones in music programmes for people with dementia, aiming to identify both enablers and barriers to their implementation in long-term care homes. The findings are intended to serve as a useful resource for researchers, staff, policy-makers and other people involved in caring for people with dementia in long-term care homes. The objective is to find key strategies for advancing the implementation of headphone-based music programmes.
We conducted a preliminary search of MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports on 15 June 2023 and found no systematic review examining enablers and barriers to implementing headphone-based music programmes for people with dementia in long-term care homes. A scoping review is useful to systematically identify and synthesise the current knowledge on a research topic that is new and has not been fully explored, as suggested by JBI.15 Moreover, the scoping review is appropriate for this work because the objective is to collate and map how headphones have been used to implement music programmes for people with dementia in long-term care homes and to identify implementation enablers and barriers. The findings will be presented in tabular and narrative formats using a structured approach outlined by the JBI methodology for rigorous scoping review.15
Review questions
What evidence exists regarding the methods and effectiveness of delivering and receiving music programmes through headphones?
What are the barriers to implementing headphone-based music programmes for people with dementia living in long-term care homes?
What are the enablers and strategies for overcoming barriers to headphone-based music programmes for people with dementia living in long-term care homes?
Methods
Eligibility criteria
Participants
Residents of long-term care homes who have been diagnosed with dementia and participated in a headphone-based music programme will be included in this scoping review.
Concept
This scoping review aims to summarise the research on the implementation and outcomes of headphone-based music programmes for people with dementia in long-term care homes and identify the enablers and barriers to implementing these programmes. The core concept is headphone-based music programmes.
Headphones are audio devices designed to be worn over the ears or inserted into the ear canals to listen to audio content, such as music. Headphones can be wireless, eliminating the need for cables and offering greater freedom of movement. Headphones let a single user listen to an audio source privately, in contrast to a loudspeaker, which emits sound into the open air that may disturb others.16 Modern headphones incorporate features like noise cancellation to create an immersive listening experience.
Context
Long-term care provides support for people with chronic health and/or mental health conditions.17–19 This scoping review focuses on headphone-based music programmes provided in long-term care homes, either publicly or privately funded. There are two types of long-term care homes: institutional and community-based. Institutional facilities offer 24-hour round-the-clock nursing care, personal care and other allied health services. Examples include nursing homes, rehabilitation facilities, intermediate care facilities, mental health facilities, hospices and hospital palliative care units. Community-based long-term care homes, on the other hand, offer care supervision and personal care from trained staff, allowing residents to live as independently as possible, for instance, in personal care apartments and group homes.
Types of sources
Original articles, conference abstracts and student theses or dissertations published in English will be considered. We will consider an extensive range of study designs. Both experimental and quasi-experimental study designs will be considered, including randomised controlled trials, non-randomised controlled trials, before and after studies and interrupted time-series studies. In addition, descriptive and analytical observational studies, including prospective and retrospective cohort studies, case-control studies and cross-sectional studies, will be considered for inclusion. The scoping review will also include qualitative studies, such as phenomenology, grounded theory, ethnography, qualitative description, action research and feminist research. Mixed-methods studies, case series, text and opinion papers will also be considered for inclusion in this scoping review.
To enhance reliability, we will adopt the JBI methodology for scoping reviews.20 This methodology has clear steps for conducting a scoping review, as well as broad popularity among international scientists. This scoping study will take place between 1 June 2010 and 31 January 2024. We framed our search parameters to span 13 years because our preliminary search identified limited studies before 2010. Also, we will include review articles that mentioned studies before 2010.
Search strategy
The planned start and end dates of the scoping review will be 1 March 2024 to August 2024. The three-step search strategy will be adopted as suggested in the JBI review guidelines.20 The first step is an initial limited search of MEDLINE (via PubMed), CINAHL (via EBSCO) and the JBI Database of Systematic Reviews and Implementation Reports databases to identify articles relevant to the topic. In the second step, text words contained in the titles and abstracts of relevant articles and the index terms used to describe the articles were used to develop a full search strategy for Embase, Web of Science, Scopus, AgeLine, PsycINFO (via ProQuest) and ProQuest. The search strategy will be adopted for each included database. Please see the full search strategy for MEDLINE and CINAHL (see online supplemental appendix 1). The third step will be screening the reference lists of all included literature for additional literature. Google Scholar will also be searched by using combining terms for headphone-based music programmes: ‘Headphone music’ OR ‘music’ OR ‘music therapy’ OR ‘music intervention’ OR ‘individualized music’ OR ‘personalized music’, terms for dementia: ‘Dementia’ OR ‘Alzheimer’ and terms for long-term care homes: ‘long-term care’ OR ‘nursing home‘ OR ‘residential care ‘ OR ‘care settings’ OR ‘hospital’ OR ‘assisted living’ OR ‘group homes’ OR ‘halfway houses’ OR ‘homes for the aged’. We have been collaborating with a university medical librarian to further refine the search strategy so that we can make sure that we capture the key literature. The academic professor (LH) in the team is familiar with key literature and will provide guidance for specific reference searches throughout the process.
Supplemental material
Study/source of evidence selection
Following the search, all identified citations will be collected and imported into the Covidence, which will automatically delete the duplicates. Two research assistants will then independently screen the titles and abstracts for assessment by referring to the inclusion criteria. Potentially the relevant literature will be retrieved in full, and their citation details will be uploaded into the JBI System for Unified Management, Assessment and Review of Information.21 Two researchers will assess the full text of the selected literature in detail by referring to the inclusion criteria. The first author (LH) will check with the medical librarian and refine the searching and selecting process. We will record and report the reasons for the exclusion of full-text studies that do not meet the inclusion criteria. If there are any disagreements between the reviewers at any stage of the literature selection process, reviewers will resolve them through discussion. The academic professor (LH) will make a decision if a consensus cannot be reached. We will report the results of the search in full in the final report. We will also present them in a Preferred Reporting Items for Systematic Reviews and Meta-analyses for Scoping Reviews flow diagram.
Data extraction
Two researchers will use a data extraction tool to extract data from the literature included in the review. We will extract the following details: author, year and country of publication, publication source and name, long-term care settings, type of articles, participants, inclusion criteria, exclusion criteria, study design, intervention, comparator, outcomes, measurements and key findings (including enablers, barriers and impacts (eg, behavioural, psychological, neurological and cognitive impacts)) of music delivered by headphones for people with dementia in long-term care homes.
Please see the data extraction tool (see online supplemental appendix 2). We will do a pilot test with the data extraction tool. Two researchers will do the extraction from three studies independently and compare the results. We will adjust the data extraction tool and revise it during the process of data extraction if needed. We will describe the adjustments in the scoping review report. Depending on the discussion in the study team meeting, if necessary, we will go back to any included literature to further explore and present results that are not in the extracted data. If there are any disagreements between the reviewers, the reviewers will resolve them through discussion. The academic professor (LH) will make decisions in case consensus cannot be achieved.
Data analysis and presentation
Extracted data will be reviewed and discussed by the review team. We will note the range of headphone-based music programmes, the benefits and disadvantages of using headphones in these programmes, and the geographical differences in the adoption of such programmes. We will use a table to present the extracted data. We will also include a table that summarises the study type and the country where the study took place. Following the table, there will be a narrative summary to describe the enablers and barriers to implementation. We will adopt a content analysis approach to analyse our data from the literature on the enablers and barriers, assisted by qualitative data analysis software NVivo. We will conduct a thematic analysis by coding the data, grouping codes into categories and grouping categories into themes, referring to our research questions. The findings of the scoping review will be evidence to inform future practice, policy and research.
Patient and public involvement
We will involve patient and family partners (ie, people living with dementia or caring for a family member with dementia) in the scoping review. They collaborated with the first author (LH) on research, including a few scoping reviews. Patient and family partners will help review the full texts of selected items of their choice. We expect that each partner will review one to two items. Regular meetings through Zoom will be held with patient and family partners. They will also help with data analysis as a team by giving feedback on the synthesised findings. They will support the dissemination of the findings, for example, by delivering presentations at conferences.
Ethics statements
Patient consent for publication
Acknowledgments
The authors thank the Medical Research Librarian, Katherine Miller, at the University of British Columbia for her assistance. We would like to thank Dr Mahdiyeh Sarraf-Razavi, who was involved in preparing parts of the first draft.
Supplementary materials
Supplementary Data
This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.
Footnotes
X @karenwonglokyi2, @odrose
Contributors LH and KLYW were involved in the scoping review design. MSY and SJK reviewed and analyzed the background literature. LH, KLYW, KH, MSY and SJK constructed and edited the protocol. DSKC was involved in critically reviewing the protocol and giving feedback. All authors approved the latest version of the protocol.
Funding The Canada Research Chair in Senior Care (Grant number: GR021222) will support the funding of this scoping review.
Competing interests None declared.
Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.