以系統性文獻回顧檢視音樂介入在失智症老人護理實務的運用

The Use of Music Intervention in Nursing Practice for Elderly Dementia Patients: A Systematic Review

背景：近年來，音樂輔助療法被大量使用於失智症老人之身心治療及緩解症狀困擾，但研究結果卻未顯示一致性的成效。目的：文旨在進行以音樂輔療為主要措施對失智症老人之臨床實驗性研究之系統文獻回顧。方法：搜尋2004至2013年發表於MEDLINE、Cochrane Library、ProQuest、EBMR、CINAHL及CEPS等資料庫，使用關鍵字音樂或音樂治療（music or music therapy）及失智症（dementia），共272篇，選取符合篩選標準並排除重複出現，找出18篇音樂治療之臨床試驗研究，進行文章的分析與統整。結果：音樂輔療可顯著改善失智老人的認知、精神症狀及進食問題，但對躁動行為的成效不一致，其中以音樂種類及執行流程之影響最大。文獻多採個案喜愛或熟悉的音樂（61.1%）為主，治療時間多以每週2次每次30分鐘，持續時間共6小時，執行者以音樂治療師或受過訓練的醫護人員執行佔多數（77.8%）。結論／實務應用：本研究結果歸納失智症老人音樂輔療的護理實證成效，可提供臨床照護人員發展音樂輔療措施及流程之參考。

Background: Although music therapy is now applied widely as an intervention for elderly dementia patients, the effectiveness of this therapy is not yet well understood.Purpose: This study conducts a systematic review of clinical studies that address the effectiveness of music therapy in elderly dementia patients.Methods: Databases including MEDLINE, Cochrane Library, ProQuest, EBMR, CINAHL, and CEPS were searched for relevant articles published between 2004 and 2013 using the key words ”music” or ”music therapy” with ”dementia”. An initial 272 original articles were identified. Applying inclusion criteria and excluding duplications left 18 articles that used randomized controlled trials to assess the effectiveness of music therapy in elderly participants for further analysis and synthesis.Result: Music therapy was found effective at improving cognitive functions, mental symptoms, and eating problems. However, this therapy was not found effective at improving irritable behavior. Type of music and method of presentation were the most important factors affecting results. Most studies (61.1%) used songs familiar to / favored by the participants; most studies delivered 30-minute interventions twice weekly; and most studies used a therapy duration of 6 hours. Finally, most studies (77.8%) had music therapy sessions performed by either music therapists or trained healthcare providers.Conclusions / Implications for Practice: This study supports that music therapy is an effective nursing intervention for elderly dementia patients. The authors hope that findings are a helpful reference for clinical nurses to develop practical music therapy procedures and protocols.