Effective Music Interventions for Delirium Management in Geriatric Patients

Background and Impact of Delirium on Older Adults

Delirium is a complex and often under-recognized clinical syndrome that predominantly affects older adults, particularly those in acute care settings. Characterized by an acute change in attention and cognition, delirium can lead to significant morbidity and increased mortality rates (O’Hanlon et al., 2014). Elderly patients are particularly vulnerable due to factors such as polypharmacy, underlying chronic conditions, and sensory impairments (Krogseth et al., 2013). The incidence of delirium in hospitalized older adults ranges from 10% to 50%, depending on the patient’s baseline cognitive function and the nature of their medical condition (Witlox et al., 2010).

The consequences of delirium extend beyond the immediate hospitalization period, impacting long-term cognitive function and increasing the likelihood of institutionalization (Marcantonio et al., 2015). The prognosis for patients experiencing delirium is poor, often resulting in extended hospital stays and diminished quality of life (Oh et al., 2017). Thus, effective management strategies are crucial for improving outcomes in this vulnerable population.

Methods for Implementing Music Interventions in Healthcare Settings

Music interventions (MIs) have emerged as a promising non-pharmacological approach to managing delirium symptoms in geriatric patients. These interventions can be broadly categorized into two types: Preferred Recorded Music (PRM) and Preferred Live Music (PLM) (Golubovic et al., 2025). The implementation of MIs involves several key steps:

1. Assessment of Music Preferences: Understanding individual preferences is vital. This can be achieved through music assessments conducted by trained music therapists, who can gather information about the patient’s musical background and favorite genres (Browning et al., 2020).

2. Customization of Interventions: Based on the assessment, the music therapist curates playlists for PRM or selects appropriate pieces for PLM. The personalization of music selection is essential as it enhances engagement and emotional connection (Li et al., 2020).

3. Delivery of Interventions: MIs can be delivered in various settings, including hospital rooms, day care centers, or even at home. Sessions typically last 30 minutes and can be conducted over several consecutive days to maximize impact (Golubovic et al., 2025).

4. Monitoring and Evaluation: The effectiveness of MIs should be evaluated through standardized assessments of delirium symptoms, patient engagement, and overall well-being. Using tools such as the Observational Scale of Level of Arousal (OSLA) and the Richmond Agitation Sedation Scale (mRASS) allows healthcare providers to track changes in cognitive and behavioral symptoms (Neerland et al., 2020).

Feasibility of Music-Based Therapies for Delirium Symptoms

The feasibility of implementing MIs in an acute geriatric setting has been supported by various studies. In a pilot trial, Golubovic et al. (2025) found that PLM showed higher adherence and treatment fidelity compared to PRM, suggesting greater acceptability among patients with delirium. The recruitment rate for participants was approximately three patients per month, with a retention rate of 64% for the PLM group and 33% for the PRM group (Golubovic et al., 2025).

Table 1: Feasibility Outcomes from Music Interventions

The study demonstrated that MIs are not only feasible but also safe, with no significant adverse events reported (Golubovic et al., 2025). The engagement levels observed during intervention sessions indicate that MIs could serve as a valuable adjunct to standard delirium management protocols, particularly in older adults with hypoactive delirium.

Outcomes of Music Interventions on Delirium Severity and Patient Well-being

The preliminary efficacy of MIs for reducing delirium symptoms has shown promising results. In the aforementioned pilot trial, significant improvements were observed in attention scores by day three of the intervention (Golubovic et al., 2025). Although no statistically significant differences were found between the intervention groups for most outcomes, the trends indicate potential benefits of MIs.

Table 2: Outcomes of Music Interventions on Delirium Symptoms

Recommendations for Future Research on Music Therapy in Dementia Care

While initial findings are encouraging, further research is necessary to establish more definitive outcomes regarding the efficacy of MIs in managing delirium symptoms. Future studies should consider employing larger sample sizes and control groups to enhance the statistical power of findings. Moreover, incorporating biomarkers to assess physiological changes associated with music interventions could provide deeper insights into the mechanisms by which MIs affect delirium (Baird et al., 2018).

It is also critical to standardize the intervention protocols across studies to facilitate comparisons and synthesize results. Developing comprehensive training for music therapists in geriatric settings will further enhance the quality of MIs. Additionally, exploring the role of socio-cultural factors in music preferences and their impact on intervention outcomes could yield valuable insights for tailoring approaches to diverse populations (Cheong et al., 2016).

FAQ

What is delirium?

Delirium is an acute and fluctuating disturbance in attention and cognition, often associated with medical conditions, surgeries, or medication use, particularly in older adults.

How can music interventions help with delirium?

Music interventions can help by providing emotional engagement, improving mood, and enhancing cognitive function, which may alleviate symptoms of delirium.

What types of music interventions are used?

Two primary types of music interventions include Preferred Recorded Music (PRM) and Preferred Live Music (PLM), tailored to individual patient preferences.

Are music interventions safe for older adults?

Yes, studies have shown that music interventions are safe for older adults, with no significant adverse events reported in clinical trials.

What outcomes are measured in music intervention studies?

Common outcomes include changes in delirium severity (measured by scales such as OSLA and mRASS), patient engagement, and overall well-being.

References

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4. Marcantonio, E. R., et al. (2015). Effect of delirium and other major complications on outcomes after elective surgery in older adults. JAMA Surg, 150(12), 1134-1140
5. Golubovic, J., et al. (2025). A randomized pilot and feasibility trial of live and recorded music interventions for management of delirium symptoms in acute geriatric patients. BMC Geriatr, 25(1), 1-12. https://doi.org/10.1186/s12877-025-05954-1
6. Baird, A., et al. (2018). Individual music therapy for agitation in dementia: an exploratory randomized controlled trial. Aging Ment Health, 17(6), 667-678
7. Cheong, C. Y., et al. (2016). Creative music therapy in an acute care setting for older patients with delirium and dementia. Dement Geriatr Cogn Dis Extra, 6(2), 268-275
8. Browning, S. G., et al. (2020). Impact of therapeutic music listening on intensive care unit patients: a pilot study. Nurs Clin North Am, 55(4), 557-569. https://doi.org/10.1016/j.cnur.2020.06.016
9. Li, X., et al. (2020). Music interventions and delirium in adults: a systematic literature review and meta-analysis. Brain Sci, 12(5), 568. https://doi.org/10.3390/brainsci12050568
10. Neerland, B. E., et al. (2020). The protocol of the Oslo Study of Clonidine in Elderly Patients with Delirium; LUCID: a randomised placebo-controlled trial. BMC Geriatr, 15(1), 7. https://doi.org/10.1186/s12877-015-0006-3