Introduction
The purpose of this research paper is to investigate the long-term effects of music therapy on older residents’ agitation manifested with Alzheimer’s disease, dementia and other old age medical complications. Towards this end, this research paper will also take a comparative analysis of the evaluation of studies on music therapy on older residents. The purpose of this study is to compare research studies on music therapy as an intervention to medical complications experienced by older residents brought about by dementia and Alzheimer’s. In brief, this research paper seeks to conduct a comparative analysis, or systematic review of effects of music therapy in older adults to assess the quality of the evaluation of research studies in this area.
The research problem
Agitation leads to severe disturbances in the quality of life of people with Alzheimer’s disease and their carers (Lawlor, 1995). It is well known that the incidences of dementia and older people’s medical complications are steadily rising due to the partial increase in the average life expectancy observed over the past century (Miller, 2008). During the recent past, different research articles abide to the fact that there is need to adequately meet the physical, psychological and social needs of the older people. Research evidence, heath care givers, affected family members and a number of medical reports point to one fact that music and music therapy may have a unique effect on people with dementia, and more specifically on those with probable diagnosis of dementia of the Alzheimer’s type (DAT) (Wigram, Pedersen & Ole Bonde, 2002).
While most research articles abide to one fact that music therapy remains an effective intervention technique in handling the symptoms of dementia, the qualitative nature of the reviewed and methodological approaches observed in the analysis of the studies failed to effectively provide a conclusion on the most effective form of music and therapy practices. There is therefore the need to focus more energy to aid more understating on the role of music therapy on older residents.
Literature review
“The recent qualitative review of literature in the area of music and music therapy and dementia published on this topic suggest that music and music therapy is an effective intervention for maintaining and improving active involvement, social, emotional, and cognitive skills” (Lehrer, Woolfolk & Sime, 2007). In addition to the above, music and music therapy are also effective in the reduction of behavioral problems in individuals with dementias (National Association for Music Therapy, 2007). The role of these present qualitative analysis on this topic have been done with the view of understanding the quality of these studies and carry out a deep analysis on how their methodological approaches influenced the effectiveness of the therapy.
A number of literature on this topic have concurred in one conclusion on the fact that this approach in reducing the level of pain and anxiety in older resident with Dementia remain effective to date. This is because people with Dementia demonstrate different forms of symptoms. According to Lehrer, Woolfolk & Sime (2007), People with Alzheimer’s disease show a range of agitated behaviors, including repetitive acts, behaviors inappropriate to social norms, and aggressive behaviors towards self or others. Furthermore, Grocke & Wigram (2007) illustrates that music therapy is one intervention which aims to create secure, stimulating environments, to meet social and emotional needs, and to reduce agitation displayed by people with Alzheimer’s disease and other types of dementia.
Older people demonstrate high levels of agitation and anxiety often manifested in a lot stress and lack of self control. The explanations provided by a number of research articles towards the effective role of music and music therapy include the effect of music on attention. Familiar music may serve to regulate a person’s arousal to a moderate level (Michel, 1976) or redirect a person’s attention from misleading or confusing stimuli (Michel, 1976).
Hicks-Moore (2005), in his study has successfully presented a comprehensive and relevant academic, theoretical as well as empirical review of literature in his study. In the analysis of the background to the study, Hicks-Moore (2005) has first presented early studies as well as more recent information that are coherent with this article. A literature search was carried out on observations, role of different types of music and ‘phenomenology research methods’. Another well documented article on the role of music and well being of people with dementia is by Sixsmith and Gibson (2007). These authors concur with other researchers on this topic. The authors began by demonstrating the need to incorporate the element of a phenomenological approach to the study that could have an in-depth exploration of problems to be addressed in what he termed as “Seeing things up close’ – using the philosophy of Husserl as a base.
Relevant demonstrative capacity and in-depth analysis on this topic is manifested by Sixsmith and Gibson (2007) to demonstrate connections to other academic works on the topic. In this endeavor, they have achieved the relevance of this study to the current demands in understanding the problems older people with Dementia go through due to the complications of this medical problem always presented in the form of agitation and anxiety. Recent studies have focused on the need to exploring strategies aimed at reducing the effect of Dementia and Alzheimer’s on older residents through the application of music and music therapy.
In this line, Sung and Chang (2005) “Use of preferred music to decrease agitated behaviors in older people with dementia: a review of the literature” explore vast number of resources on this topic. This extensive review of the literature conducted by Sung and Chang (2005), in the area of music and music therapy, grouped, categorized, systematically coded and presented the outcomes of the research in the one of the best formats. “We use meta-analytic which aggregate effect sizes across studies in order to assess the overall relationship between variables” (Sung and Chang, 2005). Success in singing, playing instruments, moving to music, or sharing memories or views related to music, may also meet a person’s un-met needs for self-expression, achievement, and meaning in life (Schmidt -Peters, 2001). Another very effective article towards the understanding of this topic by is Choi , Lee , Cheong and Lee (2009) on “Effects of group music intervention on behavioral and psychological symptoms in patients with dementia: a pilot-controlled trial” seeks to avail the details of the comparison made among studies conducted by trained music therapists and other professionals on the interventions requiring active participation in activities like singing and playing instruments or games. When the above are analyzed comparatively to passive involvement such as listening to music, studies using live versus, taped music and an assessment of behavioral, cognitive or social variables, valid deductions can be made. While Choi, Lee , Cheong and Lee (2009), appreciate the role of music in reducing agitation and anxiety on older people with Dementia and Alzheimer’s, the need to understand the role of both active and passive music involvement is well demonstrated. It is therefore prudent enough to confidently state that the aim of these research articles, the research questions and research problems are comprehensively addressed and all literature evaluated in this research paper relevant.
The framework
Concept of intervention(s)
“Music therapy has been defined as ’an interpersonal process in which the therapist uses music and all of its facets to help patients to improve, restore or maintain health’ (Schmidt -Peters, 2001). Music therapy allover the globe has their roots from different traditions such as behavioral, psychoanalytic, educational or humanistic models of therapy. While techniques used in music therapy are also diverse, they can be broadly categorized as ’Active’, in which people re-create, improvise or compose music, and ’Receptive’, in which they listen to music (Schmidt -Peters, 2001). While the United States makes wide application of the receptive and combined approaches, the European countries lean more towards the application of the active approach.
The underlying fact under these studies is that different forms and types of music have the ability to stimulate emotional and physical changes in the body. “The receptive forms of music are more likely to be influenced by cognitive-behavioral or humanistic traditions and may involve an adjunctive activity performed while listening to live or recorded music, such as relaxation, meditation, movement, drawing or reminiscing”. (Schmidt -Peters, 2001). According to (Schmidt -Peters, 2001), it has been suggested that this form of music therapy can help reduce stress, sooth pain, and energize the body. The most training on this type of music and music therapy are done at the bachelor’s level after which one can proceed to practice professionally after attaining the Board Certification and after going through a specific number of hours in clinical practice.
In the application of active approaches, techniques to stimulate active involvement of the patient, the therapist uses clinical improvisation techniques to stimulate or guide or respond to the patient who may use his/her voice or any musical instrument of choice within his/her capability (such as percussion) (Darnley-Smith & Patey, 2003). This may involve the patients coming with their own written songs that they will sing with the music therapist. These are the models that are referred to as improvisational. They are different from the other techniques because most of them are psycho-analytically informed.
The putative mechanism that makes this technique effective is that mutually and musically developed relationship between the patient and the therapist motivates the patient to experience a different feeling of himself or herself and gain an insight into his or her relational and emotional problems through talking about the musical dialogue (Darnley-Smith & Patey, 2003). Most of these programmes are in the Masters level or more extended in-depth in the undergraduate levels. In the recent past, specialisms have evolved in particular areas, for example Neurologic Music Therapy is the specific application of music to cognitive, sensory and motor dysfunctions in neurological rehabilitation (Darnley-Smith and Patey, 2003). Most music therapeutic approaches always involve a combination of two or more approaches. The choice of approach tends to be based upon the person’s needs, the therapist’s training and the context (Miller, 2008).The delivery of music therapy takes different time periods that range from few weeks to a number of years and their intensities also varies with time. Another aspect of this technique is that it may be delivered individually or in group depending on the needs of the patient.
Paradigms in social interventions
Paradigms form basic images construed within the subject under study suggested by a researcher or prototype. (Miller, 2008), defined paradigm as a set of practices that define a scientific discipline during a particular period. Paradigms in social interventions assist researchers to understand the underlying problems in instances where other forms of paradigm cannot be used to explain certain events, anomalies, and crises. According to Michel (1976), “the social network paradigm is a construct for analysis of social relationships developed in social anthropology”. However, in its analysis and concepts, this paradigm has gone under various forms of transition and development in review of a number of researches and practice in the clinical field. It forms the fundamental basis on which basic research questions that demand further analysis are presented.
When there is a conflict between the available types of paradigms in the analysis of an effective approach to addressing research questions, a new paradigm is created. According to Michel (1976), there are three types of social paradigms which all have with them very different analytic view and expressions in reference to the society. These paradigms include the three paradigms; the structural functionalism, the social-conflict, and the symbolic integrationist. All the three types of social paradigm abide by one fact that the family forms the most fundamental unit in any type of social interaction. According to (Michel, 1976), “The primary role of the family is the socialization of children to that they can truly become members of the society into which they have been born.”
An analysis of the social interventions of the disciplinary matrix reveals six core elements. These include image, practice, theory, interest, research methodology, cognitive and exemplar. The elements of image , cognitive and exemplar are referred to as genotypic elements in that unlike the other three core elements of theory, research methodology, and practice, they generate paradigm and are explicit.
In this research paper, cognitive element will be of more focus in social paradigm intervention because of the fact that cognitive behavior therapy forms a very effective technique of handling Dementia. “Cognitive Behavior Therapy methods were initially developed for depression and anxiety disorders (Michel, 1976) and later they were modified for many other conditions, including personality disorders, eating disorders, and substance abuse. Furthermore, “they have also been adapted for use as an adjunct to medication in the management of schizophrenia and bipolar disorder” (Michel, 1976). Basic cognitive model indicate the effect of CBT on behavior and emotion of Dementia patients.
Based on the above model, music plays a very fundamental role in affecting the behavior and emotion of older residents. A combination of music therapy and cognitive behavior therapy remains effective in the reduction of pain and anxiety.
Evaluation models
“Evaluation is the systematic acquisition and assessment of information to provide useful feedback about some object” (Lehrer, Woolfolk & Sime, 2007). Evaluation that will be adopted in this research paper will be a scientific experimental model. This is mainly because it undertakes both the scientific and social concepts of the study. The empirically driven feedback can then be achieved. Evaluation as a research process cannot be done in a single phase but involves a continuous activity in the process of undertaking an evaluation of a project. There is need to understand the different interests to be served by the evaluation and that there is a chance of these interests conflicting with one another.
This continuous evaluation requires a model which consists of a series of components and statements on the systemic relationship among various factors referred to the interventions; such as the cost, internal and external factors. The goal is one criterion only. It takes into account all systemic variables that affect the result. The impact model displays three hypotheses. The first is the causal hypothesis, the second is the intervention hypothesis and the third is the action hypothesis. The action hypothesis is used as the evaluative criteria because it tests if the intervention is the causal factor. This model comes from the positivistic paradigm due to the element of causality. The goal free model involves the evaluation of the intervention. This model can be from any of the paradigms.
Qualitative model whose purpose is to derive the meaning of the intervention according to how it is perceived by those who receive it stems from the interpretive paradigm.The paper also employs critical model. This model is used when the intervention is done as praxis and the purpose is empowerment and emancipation. The population is the clientele who are described by their needs, their interpretation and social structures. It stems from the critical paradigm.
Methodology
The objective of this research paper is to carry out an analysis of the relevance and effectiveness of five peer reviewed articles on the effect of music therapy on older people. Towards this, the most effective research model (inductive model) of research was to be applied to generate generalizations. In this chapter, the research philosophy and the research strategy have been provided. The choice of the methodology approaches that have been selected and followed and have been well explained and justified.
Two views about the research process dominate literature, that is, positivism and phenomenology. The positive approach was based on the scientific discoveries made in the 18th and 19th century. It was a body of knowledge that existed independently of whether people knew it or not, and the scientists had to find the truth. The believe was that there were laws that governed the operation of the social world and that these could be discovered through social behavior that was seen as a result of external pressure acting on relatively passive people (Lehrer, Woolfolk & Sime, 2007). This traditional research approach leads to the development of methods that concentrated on producing supposedly objective data in the form of statistics.
Phenomenologists disagree with positivists in that human beings can be studied using the same physical objects or other animals. They assert that there is a difference between the subject matter of sociology and natural science (Saunders et.al, 2000). Humans are conscious, active and very capable of making choices unlike animals or objects. In order to analyze the effectiveness of music therapy on older residents with Dementia, the phenomenology approach will be adopted. This is because the social world of business management and organization is too complex to be theorized by definite laws.
Abstracts of each evaluation report
“A non-randomized experimental design was employed with one group receiving weekly music therapy (n¼26) and another group receiving standard nursing home care (n¼19). The levels of agitation were measured five times over one year using the Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, J. (1989). The authors noted that an analysis of this techniques revealed that even though music therapy participants showed short-term reductions in agitation, there were no significant differences between the groups in the range, frequency, and severity of agitated behaviors manifested over time. They summarize the article by stating that there is need for more research on the topic and that multiple measures of treatment efficacy are necessary to better understand the long-term effects music therapy programs have on this population”.
Agitation in individuals with severe cognitive impairment is a significant problem that affects care and overall quality of life. Building on research conducted by Goddaer and Abraham (1994), this quasi-experimental study proposed that relaxing music played during meals would exert a calming effect and decrease agitated behaviors among nursing home residents with dementia. It involved a study of thirty residents residing in a Special Care Unit participated in the 4-week study. The Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989) was used to gather data. Baseline data was obtained in Week 1 (no music). Music was introduced in Week 2, removed in Week 3, and reintroduced in Week 4. At the end of the 4-week study, overall reductions in the cumulative incidence of total agitated behaviors were observed. Reductions in absolute numbers of agitated behaviors were achieved during the weeks with music and a distinct pattern was observed.
While therapeutic interventions involving music have been shown to have benefits for people with dementia, little research has examined the role of music and music-related activities in their everyday lives. This paper presents the results of qualitative research that explored this role in terms of the meaning and importance of music in everyday life; the benefits derived from participation in music-related activities; and the problems of engaging with music. Data were collected during in-depth interviews with 26 people with dementia and their carers, who lived either in their own homes or in residential care in different parts of England. The paper illustrates the many different ways in which people with dementia experience music. As well as being enjoyed in its own right, music can enable people to participate in activities that are enjoyable and personally meaningful. It is an important source of social cohesion and social contact, supports participation in various activities within and outside the household, and provides a degree of empowerment and control over their everyday situations. The practical implications for the provision of care and support for people with dementia are discussed. The scope and implications for technological development to promote access to music are also explored.
Background
Music has been suggested as a feasible and less costly intervention to manage agitated behaviors in older people with dementia. However, no review of the literature focusing on study findings of preferred music on agitated behaviors in older people with dementia had been reported. Methods: A review was undertaken using electronic databases with specified search terms for the period of 1993–2005. The references listed in the publications selected were also searched for additional studies Sung & Chang (2005). Results: Eight research-based articles met the inclusion criteria and were included in the review. The preferred music intervention demonstrated positive outcomes in reducing the occurrence of some types of agitated behaviors in older people with dementia. The findings from these studies were relatively consistent in finding improvement in agitated behaviors although the findings in one study did not reach statistical significance. The small sample sizes and some variations in the application of the preferred music intervention mean that caution is needed in drawing conclusions from these studies. Conclusions: This review highlights that preferred music has positive effects on decreasing agitated behaviors in older people with dementia; however, the methodological limitations indicate the need for further research. Relevance to clinical practice: Findings from the review highlight the beneficial outcomes of preferred music in reducing agitated behaviors for older people with dementia. The incorporation of preferred music has the potential to provide a therapeutic approach to the care of older people with dementia.
We investigated the effects of group music intervention on behavioral and psychological symptoms in patients with dementia. Twenty patients were none randomly allocated to either a music-intervention group, or an usual care group. The music-intervention group received 50 minutes of music intervention 3 times per week for 5 consecutive weeks. After 15 sessions, the music-intervention group showed significant improvement with regard to agitation, and the total scores of both patients and caregivers were lower, compared with the control group. These findings suggest that music can improve behavioral and psychological symptoms, especially in patients with dementia and their caregivers.
Persons with mid-stage dementia and in special care (N = 45) were assessed in groups by a music therapy practitioner to determine the level of engagement in a 15-minute protocol that included a five-minute segment for each of three music activity types—rhythm playing, exercising with music, and singing. Activity staffs with little to no formal music training who were employed by the facility were taught to use the protocol to conduct eight subsequent activity sessions for small groups from which activity engagement data were collected for each subject. Results indicated the protocol was accessible and successful for indigenous activity staffs, initial assessments were strong predictors of subsequent engagement, and participation levels were stable over time and across each of the three activities.
Intervention analysis
Comparative analysis
Population
The six studies had very minimal range across the population. Ledge & Baker (2006) took an analysis of 45 elderly patients of both sexes while Hicks-Moore (2005) undertook a research with 30 participants of both sexes. The ages of the participants in both studies were above 65 years. The studies undertook in this analysis by Sixsmith & Gibson (2007) and Choi , Lee , Cheong & Lee (2009) examined the role of music in reducing the levels of agitations and anxiety on the elderly residents with Dementia and started with populations of 26 and 20 respectively. The last study in this research paper was undertaken by Clair, Mathews & Kosloski, (2005), and shad a total population of 45 individuals consisting of both sexes.
The studies had patients from both sexes that were all older residents with Dementia. All the six studies used in the analysis of this paper were done and concluded in the countries they were initiated. This was to provide relevant data on the specific population under research investigation. The history of the patients under study consisted of those within the mid stage Dementia, acute levels of agitation and those with severe cognitive impairment.
Conceptual Variable
In the analysis of all the six studies used in this research paper, the interventions were positivistic and interpretative paradigms. The former paradigm was manifested throughout the intervention process through the observation of the behaviors of the patients. The applied systems of interventions in the form music therapy were found to have direct relationship with the effects observed on the same patients. Each and every form of intervention carried out was the precipitating agent in the effects observed in patients with Dementia. It is therefore true that the interventions formed the driving factors that shaped the observed results in the patients.
In this sense, this formed the independent variables while the latter formed the dependent variables. Music therapy interventions techniques were applied to reduce the levels of agitation and anxiety on Dementia patients. The intervention process was undertaken in a process designed to effectively monitor the changes in the levels of agitation and anxiety on the patients. Data collection and analyses were critical in these studies. The theme of music therapy intervention is to understand its effect on patients with Dementia. While most of the studies took the positivistic form of paradigm, some studies revealed the application of interpretative form of paradigm.
In this music therapy intervention, treatment design was similar in all the six research studies with minimal variation in design, implementation and the duration of treatment. Ledger & Baker (2006), used a non-randomized experimental design where one group received weekly music therapy (n¼26) and another group received standard nursing home care (n¼19). Hicks-Moore (2005) and Sixsmith & Gibson (2007) used relaxing music during meal time in nursing homes and conducted interviews on the effect music of in every day life among the patients with Dementia respectively. On the other hand, Choi, Lee, Cheong & Lee (2009), used group music intervention on the behavior of people with Dementia. Clair, Mathews & Kosloski (2005), analyzed the active participation of patients under the study while Sung & Chang (2005), carried out an in depth analysis of eight of research articles. In this music therapy intervention, the goal model was used in evaluation of the results.
Implementation Variable
In these research studies undertaken on music therapy on patients with Dementia, three studies were carried out in hospital. These were; Hicks-Moore (2005), Sung & Chang (2005) and Clair, Mathews & Kosloski (2005) while Ledger & Baker (2006), used both home and hospital set up during the implementation of their music therapy intervention. Sixsmith &Gibson (2007), used home set up to carry out the study of music therapy on agitated dementia patients.
This music therapy intervention was both carried out in hospital and home. The people who were involved in this task were social workers and music therapists. The social workers were home care takers of the Dementia patients while the music therapists were stationed at the hospital.
A comparative analysis of the study of the application of music therapy in the reduction of pain and anxiety and agitation on elderly patients with dementia points to one fact that cognitive theories were vast in the studies undertaken. As earlier indicated, the forms of paradigms witnessed across all these studies were interpretative and positivistic. The analysis of the study revealed that their objectives were coherent in that they aimed at analyzing and coming up with valid conclusions on the effectiveness of music therapy on older patients with dementia. To achieve this central objective of this study, a number of activities were undertaken.These included rhythm playing, exercising with music and singing.
Assessment of Methodology
Criteria for Methodological Assessment
This study employed a combination of content and hermeneutic analysis in the comparative assessments of the methodologies used. Content analysis is quantities assessment showing what is expressed as well as depicted in the text. Hermeneutic assessment on the other hand highlights the meaning of the text and its totality. The main aim of using criteria in this methodological assessment was to determine the validity and soundness of each music therapeutic implementation to the patients with dementia.
This music therapeutic study on patient with dementia was analyzed on methodological variables: the research problem formulation, the research study design and data collection, data analysis and interpretation.
The methodological analysis
Scale tested all the variables. The assessment scale involved a combination of four criterions: explicitness, appropriateness, clarity and completeness. In this study, the paradigm was assessed without explicitness because the paradigm is implicit.
Four criteria were used to rate elements of methodology:
- poor
- Good
- Very good
- Excellent.
The rating ranges from between one and four with one being the lowest and four being the highest. The scores of each patient were added to obtain a numerical ranking. The data on the score for criteria were then ranked into poor, good and excellent.
Methodological Assessment Scale
Comparative Analysis: Methodology
Research problem formulation:
Research problem formulation continued:
As can be clearly observed in the research problem formulation matrix, a list of elements were applied to analyze the formulation problem. These included: paradigm, theory, independent variable, dependent variable, hypothesis, literature review, and objective.
Paradigm
All the studies had implicitly stated paradigms with positivistic and interpretative frameworks clearly spelt out. The first four studies by Ledger & Baker (2006), Hicks-Moore (2005), Sixsmith & Gibson (2007), and Sung & Chang (2005), were dominantly in the application of interpretative paradigm while the last two studies by Choi, Lee, Cheong &Lee (2009) and Clair, Mathews & Kosloski (2005) employed the positivistic paradigm. The theories advanced by the studies applied a mixture of matched and unmatched design and analysis of the intervention. Ledger & Baker (2006), Hicks-Moore (2005) and Sixsmith & Gibson (2007),achieved higher ratings on the explanations of the theories applied in their studies while the rest of the studies consisting of Sung & Chang (2005), Choi, Lee, Cheong & Lee JS (2009) and Clair, Mathews & Kosloski (2005), received fair or poor ratings in the explanations of their theories. From the matrix, it can be observed that that first three had good ratings while the last three had fair ratings.
Independent and Dependent Variables
Studies undertaken by Hicks-Moore (2005), Sung & Chang (2005) and Clair, Mathews & Kosloski (2005), reported excellent demonstration in both Independent and dependent Variables while the other studies had fair demonstration on the same. The first three studies clearly explained various parts of the interventions in vivid terms that were clear to understand. Good examples in this area were done by Hicks-Moore (2005), Sung & Chang (2005), by incorporating different modules in the analysis of both independent and dependent Variables. The incorporations of these modules are effective in the provision of data on the development of the effectiveness of the music therapy. The rest of other studies were specific in the application of the two variables thereby receiving fair grade in this category.
Hypotheses
It is not encouraging because none of the studies clearly stated their hypothesis. All the studies thus scored poor ratings in the development of their hypotheses. This is due to lack of ability to specifically address the information that can be deciphered. The studies by Choi, Lee, Cheong & Lee JS (2009) and Clair, Mathews & Kosloski (2005), portrayed more poor levels of hypotheses presentation. Even though the authors of all the studies suggested that music therapy is an effective treatment technique, they failed to demonstrate this connection to their hypotheses.
Bibliographical review
The literature reviews by Sung & Chang (2005), was an analysis of various research articles on the effect of music therapy on older residents with Dementia. Studies undertaken by Ledger & Baker (2006), Sung and Chang (2005).and Clair, Mathews & Kosloski (2005), demonstrated excellent review of literature on the purpose of the research. The rest of the studies failed to achieve higher degrees in the review of their literature and as such received fair ratings.
Objectives
All the six studies were excellent in their goal statement. Their goals were succinctly stated. All the studies assessed the effect of music therapy in elderly residents with dementia.
Design and data collection
The design and data collection of the six studies were analyzed using the combination of the following components: design, sample, instrument, reliability, validity, appropriate, control and time observed.
Design
Ledger & Baker (2006), were excellent in the design of their studies in that the study was clearly understood. Its variables were precise. The study done by Hicks-Moore (2005) applied a descriptive research design. This form of design gathers data only after the implementation of the intervention thereby making it difficult to determine causality.
Sample
Each of the six studies included elderly residents with Dementia. Five of the six scored excellent ratings due to the fact that used good samples of participants in terms of number, sex, and age. One of the research analysis by Choi, Lee, Cheong & Lee (2009) involved unspecified number of participants in its study that gave it good ratings.
Instruments
The analysis of the six studies revealed that three of them received excellent ratings as a result of instruments used in data collection. Ledger & Baker (2006) and Clair, Mathews & Kosloski (2005) were the best in the application of instruments in data collection. These included the use of relevant questions with some of them having the elements of choice. Studies documented by Choi, Lee, Cheong and Lee (2009), scored average in the application of instruments in that their instruments lacked the aspect of clarity.
Reliability and validity
Four of the six studies scored fair ratings while two of the studies by Clair, Mathews & Kosloski (2005) and Sixsmith & Gibson (2007) scored substandard ratings due to their inability to articulate the reliability and validity of their studies.
Time observed
Clair, Mathews & Kosloski (2005) and Choi, Lee, Cheong & Lee (2009), received the best ratings in this category. These two studies had with them the components of definite lengths of intervention periods as well as the analysis of the intervention process. Ledger & Baker (2006) and Hicks-Moore (2005), scored fair ratings under this category while sung &, Chang (2005), received the lowest ratings of poor due to lack of definite time line.
Data Analysis and interpretation
A comparative analysis of this section was the done using the above parameters that include: analysis of data, interpretation of data, conclusions, and report quality.
Analysis of data
All the six studies tried and achieved fair ratings in their data analysis. Each and every study focused on achieving high ability to effectively demonstrate the balance that exists between the depth of analysis and the purpose of their studies. Most of the studies were able to turn questionnaire responses from the patients themselves into quantitative data that were later analyzed to provide the qualitative component of the data.
This was the effective tool in assessing the effectiveness of music therapy in the patients under study. A total of three studies done by Clair, Mathews & Kosloski (2005) and Choi, Lee, Cheong & Lee (2009), were able to demonstrate higher levels of data analysis that took step by step approach. Furthermore, they were able to portray the existing link between the data and the methodological approaches adopted. This remained fundamental in consideration to the types of study these authors were undertaking.
Interpretation and Conclusion
The studies received fair ratings in the interpretation and conclusion. They were able to moderately interpret analyzed data into understandable criteria. This was achieved through a thorough discussion of the methodologies, interventions, and the results achieved after data analyses. The limitations of their studies were well documented and a number of relevant factors and risks associated with these studies well pointed out. Due to the nature of the studies, all the studies pointed at the social impact on their results. They were written logically and clearly to enable easier understanding of the social impact of the results obtained.
Reports Quality
Sung & Chang (2005) and Choi, Lee, Cheong & Lee (2009), demonstrated excellence ratings in quality reporting due to comprehensible and concise reporting techniques. The authors analyzed the studies and focused on organized, presentable and easily understood report formatting. The implications of the research studies on future research endeavors on the same topic were well illustrated.
Conclusion
Knowledge Development
The purpose of the comparative analysis is to use inductive research and seek to arrive at generalizations pertaining to the effect of music on older adults. The research can affect knowledge development on the following levels: factual, concepts, hypotheses, empirical generalizations, theoretical generalizations, and paradigms. The knowledge development based upon an analysis of the studies can help to the general life of older adults and prevent medical complications associated with Dementia and Alzheimer’s.
All of the studies contribute to knowledge development on a factual level. Sung & Chang (2005) and Choi, Lee, Cheong & Lee (2009), have used assessments to evaluate the role of music in reducing the levels of pain and anxiety on older residents. Scores received on the preliminary assessment were then compared to post-test results after the intervention had been implemented. The knowledge availed to the field of medical care for the older residents by these articles have contributed significantly to knowledge development and the need for further research.
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