What indicators have been used to evaluate the impact of music on the health and wellbeing of people with dementia? A review using meta-narrative methods.

This review considers how research into the impact of music on people with dementia has been conducted, with a focus on the means used to measure outcomes. Although there is a rapidly growing amount of research in this relatively new area, it has evolved largely independently within different fields, such as psychology, music therapy and nursing. Using principles from the meta-narrative review method, this paper systematically surveys the qualitative and quantitative measures which have been used in studies relating to music and dementia from 1980 to the present day. Data extracted include the outcome measures used, the type of musical interventions, the setting of the studies, and methodology and study design. The quantitative studies greatly outnumber the qualitative studies, and most research has been done in long-term care settings. Instruments which measure neuropsychiatric symptoms of dementia, especially agitation, were the most frequently used. Other domains that were targeted in the studies included quality of life, physiological change, music-related outcomes and cognitive skills; the inter-relations between these domains are represented as a diagram. Researchers' rationales for choosing to target these outcomes are discussed. Although reduction of neuropsychiatric symptoms is a valuable outcome, it is important that researchers are open to the possibility of other outcomes. We suggest that measuring an increase in positive responses might be an alternative to measuring a reduction of negative symptoms, and we highlight the importance of listening to people with dementia and carers when designing studies.