In this project, funded by the National Institute for Health and Care Research (NIHR), we will co-design a new music therapy intervention protocol and guide for NHS dementia wards with stakeholders and experts-by-experience, called MELODIC.We will then pilot MELODIC on 2 dementia wards to make sure it is possible to deliver and has the potential to be helpful for patients,family members and staff.
About the Project
Distress is common for people with dementia on hospital mental health wards, but music might help. There are lots of reasons why people get distressed. Sometimes it is a result of symptoms like hallucinations, and sometimes it is because the care they receive does not meet their needs. If a person with dementia is so distressed that they behave in a way that puts themselves or others at risk, they may be admitted to a hospital mental health ward. The aim of the hospital stay is to understand and treat their distress, so that they may be discharged with an appropriate support plan. This can take a long time. There is little research looking at these hospital wards, which can be very different to general hospital wards or care homes. It is hard to care for someone who is very frightened and distressed and both staff and patients can get hurt (staff experience more physical assaults than prison officers). Calming medications (antipsychotics) are often given to a person with dementia on these wards when distressed. This is a worry because research suggests that these increase the risks of falls and death. Music therapy has helped lower distress for people with dementia living in care homes, and supported staff to understand why someone might be distressed. But we do not know enough about how music therapy can help people with dementia in mental health wards. Our own research on mental health wards found that on the days the therapy took place there were fewer assaults and staff could see a positive impact on the ward. But not all mental health wards have music therapy. People with dementia and their family members that we spoke to also found music helpful and supported the idea of having this therapy on wards.
- To co-design a music therapy protocol and guide, with accompanying programme theory, to reduce distress on NHS inpatient mental health dementia wards
- To pilot the intervention on 2 NHS wards with differing experiences of music therapy to enable theory and intervention refinement, and to test the feasibility of outcome measures in this setting
Two literature reviews have been conducted to date:
- A systematic review of psychosocial interventions in inpatient mental health dementia wards has enabled us to look at outcomes, characteristics and facilitators and barriers to implementing interventions in this setting (Thompson et al., 2023, paper under review)
- A realist review of music therapy in advanced dementia care has enabled the development of a programme theory of how and why music therapy can reduce distress and improve wellbeing for people with advanced dementia in non-community care settings.
The following research activities will be completed by the completion of the project:
- Talking to people with dementia, relatives and staff with experience of mental health wards in focus groups and interviews. This will help us understand how distress is currently managed and the support people need. We will also ask about the ways that music, and music therapy if offered, are currently used on the wards.
- Co-creating a music therapy manual with people with dementia, relatives and staff based on findings from the reviews and focus groups. This will be done through a co-design workshop, followed by an iterative process of refinement where the co-design group will be sent draft versions of the manual for feedback.
- Testing the music therapy manual over four weeks on a mental health ward that already has music therapy. Following this pilot, we will make changes to the music therapy manual based on our findings and feedback.
- Testing the music therapy manual over four weeks on a mental health ward that has never offered this before. This will help us see how the intervention works in a place that is unfamiliar with music therapy, and make additional changes to improve the manual.
At the end of the project we plan to hold sharing events where we will show the final version of the music therapy manual and our findings with participants and the public.
The main output will be a co-developed, standardised and costed music therapy treatment protocol and guide for inpatient NHS mental health dementia wards, with accompanying programme theory. The clinical and cost-effectiveness of the intervention will then be tested in a cluster randomised controlled trial.
Papers and Resources
- Protocol for a systematic review: PROSPERO CRD42023429983
- Protocol for a realist review: PROSPERO CRD42023409635
- Thompson, N., Iyemere, K., Underwood, B. R. and Odell-Miller, H. (2023) 'Investigating the impact of music therapy on two in-patient psychiatric wards for people living with dementia: retrospective observational study', BJPsych Open, 9(2), e42.]
- Thompson, N. and Odell-Miller, H. (2022) 'An audit of music therapy in acute National Health Service (NHS) settings for people with dementia in the UK and adaptations made due to COVID-19', Approaches: An Interdisciplinary Journal of Music Therapy.
Who is involved?
- Chief Investigator: Dr Ming-Hung Hsu, Anglia Ruskin University
- Co-chief Investigator: Prof Helen Odell-Miller, Emeritus, Anglia Ruskin University
- Principle Investigator: Dr Ben Underwood, Cambridgeshire and Peterborough NHS Foundation Trust, University of Cambridge
- Principle Investigator: Dr Emma Wolverson, University of Hull, Dementia UK
- Research coordinator: Naomi Thompson, Anglia Ruskin University (corresponding researcher)
- Public research member: Chris Pointon