Golubovic Jelena, Neerland Bjørn Erik, Simpson Melanie R, Johansson Kjersti, Baker Felicity A
Centre for Research in Music and Health (CREMAH), Norwegian Academy of Music, Oslo, Norway.
Oslo Delirium Research Group, Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
BMC Geriatr. 2025 May 2;25(1):306. doi: 10.1186/s12877-025-05954-1.
Delirium is an acute shift in attention and arousal, usually triggered by acute illness or surgery in older dementia patients. Prognosis is poor, and pharmacological options are limited; non-pharmacological interventions and music show promise.
This randomised pilot and feasibility trial tested feasibility, acceptability, fidelity, and safety of music interventions (MIs) for delirium patients and assessed preliminary effectiveness and suitability of the selected effect outcomes. Participants from an acute geriatric ward were randomised to Preferred Recorded Music (PRM) and Preferred Live Music (PLM), delivered for 30 min over three consecutive days. Feasibility outcomes included recruitment rate, retention, adherence, deviations, and treatment fidelity. Clinical outcomes were trajectory of delirium symptoms (arousal, attention, cognition), delirium duration, hospital stay length, and medication intake. Post-intervention and between groups changes in delirium symptoms were compared using mixed linear regression models for the repeated measurements. Mann-Whitney test and Fishers exact test were used for length of stay and medication use, respectively.
26 participants (PLM = 14; PRM = 12), median age 87, most with hypoactive delirium were recruited at a rate of three participants per month. Retention rates for PLM and PRM were 64% and 33% respectively and adherence to PLM and PRM intervention protocols were 83% and 58%, respectively. Total adherence to the assessment protocols was 44%. PLM was delivered as intended, (treatment fidelity 93%), and PRM did not satisfy treatment fidelity (83%). All delirium symptoms except arousal improved on day 3 compared to baseline, with statistically significant improvement in attention. No conclusive pre-post or between-group differences were detected for any outcomes; confidence intervals were wide.
Feasibility of recruitment, interventions and assessments was indicated, and greater acceptability, safety and fidelity of the PLM intervention compared with the PRM. Adoption of external assessors is warranted in future trials, to mitigate slow recruitment and low adherence. Wide confidence intervals for most measures and comparisons indicate that the possible effect of the MIs on delirium cannot be excluded. The trial was registered at Clinical Trials, ID: NCT05398211, on 31/05/2022.
谵妄是注意力和觉醒的急性改变，通常由老年痴呆患者的急性疾病或手术引发。预后较差，药物治疗选择有限；非药物干预和音乐显示出前景。
这项随机试点和可行性试验测试了针对谵妄患者的音乐干预（MI）的可行性、可接受性、保真度和安全性，并评估了所选效果指标的初步有效性和适用性。来自急性老年病房的参与者被随机分为偏好录制音乐（PRM）组和偏好现场音乐（PLM）组，连续三天每天播放30分钟。可行性指标包括招募率、保留率、依从性、偏差和治疗保真度。临床指标为谵妄症状轨迹（觉醒、注意力、认知）、谵妄持续时间、住院时间和药物摄入量。使用混合线性回归模型对重复测量的干预后和组间谵妄症状变化进行比较。住院时间和药物使用分别采用曼-惠特尼检验和费舍尔精确检验。
招募了26名参与者（PLM组 = 14名；PRM组 = 12名），中位年龄87岁，大多数为活动减退型谵妄，每月招募三名参与者。PLM组和PRM组的保留率分别为64%和33%，PLM组和PRM组干预方案的依从性分别为83%和58%。评估方案的总依从率为44%。PLM按计划实施（治疗保真度93%），PRM未达到治疗保真度（83%）。与基线相比，除觉醒外的所有谵妄症状在第3天均有所改善，注意力有统计学意义的改善。任何指标均未检测到明确的干预前后或组间差异；置信区间较宽。
表明了招募、干预和评估的可行性，与PRM相比，PLM干预具有更高的可接受性、安全性和保真度。未来试验有必要采用外部评估者，以缓解招募缓慢和依从性低的问题。大多数测量和比较的宽置信区间表明不能排除MI对谵妄的可能影响。该试验于2022年5月31日在临床试验注册，ID：NCT05398211。
