Improving delirium-associated outcomes for elderly patients: A pilot study of music as an environmental intervention in the emergency department (ED)

Delirium is a syndrome causing an acute phase decline in cognitive function. It iws frequently misdiagnosed due to its fluctuating course and non-speicifc symptoms. Importantly, it is associated with poorer patient outcomes. Sensory deprivation and sensory overload are key stressors associated with increased risk of delirium, and in a noisy yet unstimulating setting such as an ED hospital bed, this is a key concern for the risk of developing dementia. We believe that the use of slow-tempo, calming music could help to alleviate the stress of ED presentation for elderly patients.

This study was conducted as a randomised controlled trial at a metropolitan Sydney ED. Patients were included if they were above the age of 65 and had been identified as having an increased risk of delirium according to the Delirium Risk Assessment Tool (DRAT) or presented with prevalent delirium following a 3-minute Confusion Assessment Method (3D-CAM). These patients were given a music player for 2 hours, and allowed to select music from three playlists; classical, ambient and world music. In total, the study looked at a total of 211 patients.

The study found a statistically significant reduction in pain scores between the control group and the intervention group; however, the other improvements, such as in agitation levels and cognitive function, were improved but not statistically significant. A significant limitation of the project was the small sample size, hindered by the wide range of presenting patients who were unable to speak English or Mandarin. Future investigation is needed to further evaluate the efficacy of music therapy in the prevention of delirium.