- Scholarworks @ CSU San Marcos

Transcription

Running head: MUSIC THERAPY FOR DEMENTIA
Music Therapy for Older Adults with Alzheimer's Disease
and Other Dementias: A Grant Proposal
Jamie Morales
Maria Rodriguez
Sherri Soto
California State University San Marcos
Committee:
Luis Terrazas, Ph.D., Chair
Jacky Thomas, Ph.D.
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MUSIC THERAPY FOR DEMENTIA
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Abstract
Alzheimer’s and other dementias continue to be a rising concern in the cognitive health of the
older adult population. Currently, there is no cure for these dementias; however, researchers
continue to explore the impact of dementia on brain health and to direct efforts toward
prevention of this disease. This project and grant proposal focus on the low-cost intervention of
music therapy as a complementary and alternative form of treatment for patients with dementia
in order to alleviate the symptoms of depression and agitation. The purpose of the grant proposal
is to obtain funding to adopt a music therapy intervention utilizing iPads, iPods, and iTunes at
Villa Pomerado skilled nursing facility in Poway, CA, targeting patients affected by Alzheimer's
and other dementias. Music therapy will promote mind and body stimulation, increase positive
emotional responses, and ultimately enhance social engagement for patients with dementia. It is
also hoped that such alternative interventions may reduce the use of psychotropic medications to
manage symptoms, and enhance the quality of care and well-being of patients struggling with
this disease.
Keywords: Alzheimer’s disease, dementia, older adults, music therapy, depression,
agitation, skilled nursing facility, iPods, iPads, iTunes, individualized playlist, psychotropic
drugs, anxiety
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Acknowledgments
We would like to thank Dr. Luis Terrazas and Dr. Jacky Thomas for their commitment to
our grant proposal project committee. We greatly appreciate their dedication and guidance
throughout our journey. We would also like to thank Lindsay Gumm, MSW at Villa Pomerado
for sparking our interest in the subject of the well-being of older people affected by dementia.
As students of the first graduating cohort, we would like to extend our gratitude to Dr. Luis
Terrazas for his relentless effort and perseverance in a collaborative effort to start the Master of
Social Work program at California State University San Marcos.
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Table of Contents
Page
Abstract ............................................................................................................................................2
Acknowledgments............................................................................................................................3
Chapter
1. Background of the Problem .........................................................................................................6
Purpose of the Project ..........................................................................................................7
Definition of Terms..............................................................................................................9
2. Literature Review.......................................................................................................................13
Description of Review Process ..........................................................................................14
Current Research ................................................................................................................14
Brain-Music Connection ....................................................................................................15
Music Therapy Treatment ..................................................................................................16
Medication Management Treatment ..................................................................................18
Alternative Treatment Strategies .......................................................................................20
Challenges ..........................................................................................................................21
Conclusion .........................................................................................................................21
3. Methods .....................................................................................................................................23
Project Selection ...............................................................................................................23
Identification of Potential Funding Source .......................................................................23
Criteria for Selection of Actual Grant ..............................................................................24
Submission Process ...........................................................................................................24
Target Population ..............................................................................................................25
Host Agency......................................................................................................................25
Needs Assessment and Collection of Data .......................................................................26
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4. Grant Proposal ..........................................................................................................................27
Executive Summary ..........................................................................................................27
Problem Statement ..........................................................................................................28
Music Therapy ..................................................................................................................30
Community Served ...........................................................................................................31
Needs Addressed .............................................................................................................31
Organizational Background ............................................................................................32
Project Description ..........................................................................................................32
Project Goals and Objectives ............................................................................................32
Activities and Timeline .....................................................................................................33
Project Evaluation .............................................................................................................34
Applicant Capability .........................................................................................................35
Budget Request ...............................................................................................................36
5. Discussion ................................................................................................................................. 37
Identification of Need .......................................................................................................37
Strategies to Enhance Funding..........................................................................................38
Social Work Relevance .....................................................................................................39
References .....................................................................................................................................41
Appendix: Patient Health Questionnaire-9 (PHQ-9) .................................................................... 45
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Music Therapy for Older Adults with Alzheimer's Disease
and Other Dementias: A Grant Proposal
Chapter 1
Background of the Problem
With the rapid increase in the number of older adults in the U.S., treatment of chronic
diseases of aging such as Alzheimer’s disease and other dementia cannot be overlooked. The
older adult population, many of whom are affected by dementia, is living longer than ever
before. Approximately 5.2 million Americans are living with Alzheimer’s disease or other forms
of dementia (Alzheimer’s Association, 2015). Unless a cure is discovered, by the year 2050
more than 13 million Americans will be affected by some form of dementia (Alzheimers.net,
2015). By 2030, the number of Californians suffering from dementia will nearly double to
approximately 1.1 million, affecting all racial and ethnic groups (California Department of
Public Health, 2015). For baby boomers aged 55 years and older in California alone, the risk for
developing Alzheimer’s disease is one in eight and one in six for developing dementia (Ross,
Brennan, Nazareno, & Fox, 2009).
Dementia is a disease that results in deterioration of the brain, decline in memory, and
other impairments in cognitive functions, leading to behaviors such as agitation, depression, and
anxiety. Members of this vulnerable population deserve an individualized treatment plan which
is customized to meet their needs. Preventing further decline of cognitive functioning is vital to
the well-being of those affected by dementia. Due to behavioral and psychological symptoms of
dementia, individuals suffering from this disease often experience poor quality of life (Sakamoto,
Ando, & Tsutou, 2013).
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Purpose of Project
The implementation of music therapy can reduce psychological and behavioral issues
accompanying dementia. Utilization of a personal playlist has been shown to decrease agitation,
stress, and anxiety in individuals with Alzheimer’s and other dementias, thus reducing the need
for psychotropic drugs. Furthermore, familiar music can enhance fond memories of one’s past
leading to a better quality of life (Cohen-Mansfield, 2013; Cooke, Moyle, Shum, Harrison, &
Murfield, 2010; Goodall & Etters, 2005; Sung, Chang, & Lee, 2010).
The purpose of this project is to obtain a grant to fund equipment needed in order to
produce individualized playlists of music, a form of music therapy, for individuals with
Alzheimer’s and other dementias. Equipment needed to implement this project includes iPods,
iPads, iTunes cards and headphones. Our primary goal is to obtain funding for the supplies so
that staff members at Villa Pomerado Skilled Nursing Facility in Poway can implement the
program with their patients. The data staff obtains will add to the research on older adults with
various types of dementia.
Villa Pomerado is a 129 bed skilled nursing facility which houses 26 long term patients
affected by Alzheimer’s or other dementias. Long term patients are defined as those who have
resided in the facility for longer than 180 days, do not have a discharge plan, and are unable to
return to the community. Villa Pomerado is affiliated with Palomar Health in Poway, California
in San Diego County (Palomar Health, 2014).
Music & Memory (2015) is a nonprofit organization that trains nursing home staff to
create personalized playlists of music using iPods that enable those struggling with Alzheimer’s
and other dementias to reconnect with the world through music-triggered memories (Music &
Memory, 2015). Many nursing homes across the U.S. are currently utilizing personal playlists
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for their patients. Nursing home staff members are collecting data regarding the use of music
and its effects on those with Alzheimer’s and other dementias. By obtaining equipment for Villa
Pomerado skilled nursing facility, patients with dementia will experience reduced depression and
agitation as they cope and live better, while listening to music which engages them with
memories of their past.
This matter is vital due to the rapid increase in the older adult population and the issues
revolving around the disease of dementia. The loss of independent functioning for the individual
struggling with dementia carries its impacts over to families, caregivers, and the healthcare
system. Long-term care and medical costs need to be considered for adequate care; therefore, it
is necessary to look at alternatives and effective methods to prevent declines in independent
functioning and problematic behavior.
Caregiving is often difficult and poses emotional, physical, and economic challenges.
There are significant implications for families, businesses, and communities. The rapid growth
in the prevalence of Alzheimer’s disease and other dementias will impact California’s health care
costs. With the disease as a major contributor to Medi-Cal insurance expenditure, state costs will
increase significantly (Ross et al., 2009).
As more and more nursing homes implement music therapy through the use of personal
playlists, data collection will add to the research base either supporting the program or leading to
the implementation of other methods to decrease behavioral issues among this population.
Furthermore, the community will benefit from the data collected and may use Villa Pomerado as
a model to emulate. Music therapy through the use of a personal playlist is not limited to nursing
homes. Members of the community can utilize this method of reducing behavioral issues with
family members or friends who are affected by Alzheimer’s and other dementias.
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In this project, we will explore the emotional and behavioral symptoms of Alzheimer’s
and other forms of dementia as seen in the older adult population. We will also discuss current
treatments available for this disease with a strong focus on music therapy. Although not well
researched in comparison to other forms of treatment, music therapy may prove to be an
alternative and effective intervention for treatment of symptoms associated with neurocognitive
disorders. Additionally, it is an inexpensive and viable intervention to promote mental health in
individuals affected by dementia. Furthermore, this paper will provide a literature review
analyzing existing research for dementia treatments and the significance of introducing music
therapy to older adults with dementia. An explanation of how the human brain is hard-wired to
connect music with long-term memory will clarify how reconnecting with others through
listening to a personal playlist assists in an improved quality of life for those affected by
dementia.
Definition of Terms
Dementia: The essential features of dementia are multiple cognitive deficits that include
memory impairment and disturbance in executive functioning. In other words, the ability to
think abstractly and to plan, initiate, monitor, and stop complex behavior becomes
hindered. Memory impairment is generally the most prominent early symptom. Individuals with
dementia have difficulty learning new material and retaining new information from present and
past experiences (American Psychological Association, 2015).
Alzheimer’s disease: Alzheimer’s disease is the most common form of dementia. This
disease affects the patient’s memory and other intellectual abilities significant enough to interfere
with daily functions. Alzheimer’s is a progressive disease, meaning dementia symptoms
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gradually worsen over time. Currently, there is no cure for Alzheimer’s disease or other forms of
dementia (Alzheimer's Association, 2015).
Agitation: Agitation is commonly defined as either inappropriate verbal or word
functioning, vocal or voice utterances, or motor activity that is not explained by needs or
confusion alone. In the older adult population, agitation can be provoked from a combination of
unmet needs and confusion. Agitation can be classified in the following three syndromes: (1)
aggressive behaviors (e.g., kicking, cursing, hitting), (2) physical non-aggressiveness (e.g.
pacing, restlessness), and (3) verbally agitated behaviors (e.g., complaining, negativism,
repetitious phrases) (Gerdner, 2010).
Anxiety: Anxiety is commonly presented as having constant worry or fear to the point
where it may interfere with everyday function. In older adults, these disorders can occur at the
same time as other illnesses. People with an anxiety disorder often experience constant worry
and have a difficult time relaxing. They may be easily startled, and have trouble falling or
staying asleep. They may also have physical symptoms such as feeling tired, experiencing
headaches and muscle aches, and having a hard time concentrating (National Institute of Senior
Health, 2015).
Depression: Depression is a common problem in older adults. Depression is often
described as experiencing sadness, helplessness, and/or hopelessness. Signs and symptoms of
depression in older adults include irritability, unexplained or aggravated aches and pains, anxiety
and worries, memory problems, lack of motivation and energy, and loss of interest in socializing
and hobbies (American Psychological Association, 2015).
Skilled Nursing Facility (SNF): A skilled nursing facility provides care for patients who
require intense skilled medical care. A SNF must be licensed by the state’s Department of
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Health Services and meet regulation and inspection requirements. Patients remain under the care
of skilled nurses and doctors who specialize in the care of the elderly. SNFs provide short-term
and long-term care rehabilitation services for people with acute medical conditions (Medicare,
2015).
iPods, iPads, and iTunes: iPods and iPads are electric devices that carry the capability to
store and play digital media files. These devices come in different sizes and storage
capability. They are capable of playing music and movies, while others with touch screens can
provide Internet access via wireless technology. iTunes cards are gift cards redeemable for
music downloads through iTunes, a Web site to buy and store music. The music bought through
iTunes can be stored in an iPod and/or iPad device (Apple, 2015).
Psychotropic drugs: Psychotropic medications are any medications capable of affecting
the mind, emotions, and behaviors of a person. These medications are commonly used to treat
mental disorders (National Institute of Mental Health, 2015).
Individualized playlist: The individualized music that has been integrated into the
person’s life and is based on the person’s playlist. If the patient is unable to verbalize personal
preference of music, selections can also be made knowledgeable by the patient’s family members
and friends. Music from the time period in which one grew up may also be utilized (L. Gumm,
personal communication, 2015).
Older adults: Older adults is the term used to identify people who belong to the age
group that includes adults age 65 years and older (County of San Diego, HHSA, 2015).
Music Therapy: Music therapy is the clinical and evidence-based use of music
interventions to address physical, emotional, cognitive, and social needs of individuals in order
to accomplish individualized goals within a therapeutic relationship by a credentialed
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professional who has completed an approved music therapy program (American Music Therapy
Association, 2015).
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Chapter 2
Literature Review
The prevalence of dementia is steadily rising worldwide in epidemic proportions. The
incidence of individuals affected by Alzheimer’s and other dementias is expected to increase to
over 13 million adults by the year 2050 (Melzer et al., 2008). Dementia causes severe
intellectual deterioration resulting in loss of memory, a decline in communication skills, and
personality changes which interfere with a person’s social and occupational functioning. As the
disease progresses, behavioral patterns emerge such as depression, extreme agitation, wandering,
confusion, and aggression. Agitation presents as inappropriate verbal, vocal, or motor activity
that is not explained by an attempt to meet one’s needs. Agitated behavior can be challenging
for caregivers and often times results in the decision to medicate the person struggling with
dementia (Cohen-Mansfield, 2013; Cooke et al.; 2010; Goodall & Etters, 2005).
Alzheimer’s disease can be diagnosed with up to 90% accuracy; however, it must be
confirmed by an autopsy. During the autopsy, pathologists look for plaques and tangles in brain
tissue. “Probable” Alzheimer’s disease can be diagnosed by a clinician who assesses the medical
history of the patient and conducts a physical exam, lab tests, and brain scans. Additionally, a
clinician will conduct neuropsychological tests that gauge memory, attention, language skills,
and problem solving abilities. It is important to rule out vitamin deficiencies and thyroid
problems as these can be treated, whereas Alzheimer’s is not reversible. Rather, early diagnosis
makes it easier to manage symptoms and plan for the future (Alzheimer’s Foundation of
America, 2015).
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This review evaluates complementary and alternative approaches to older adults with
Alzheimer’s and other forms of dementia. The emphasis is on music therapy as an effective
form of treatment for these conditions.
Description of Review Process
The articles selected for this literature review were found through a search of peerreviewed journals pertaining to older adults diagnosed with some type of dementia. A majority
of the articles were collected from the California State University San Marcos research database,
accessible through the Kellogg Library Web site. Additional articles were found through the
Music & Memory (Music & Memory, 2015) Web site, which focuses on the implementation of
music intervention for older adults with dementia. All articles used to complete this literature
review were selected primarily because they examined the issues of alternative treatments for
Alzheimer’s and other dementias. More specifically, the articles described how music therapy
greatly impacted the emotional and behavioral symptoms of older adults with this disease.
Additionally, references were gathered from academic textbooks focusing on health care in order
o gather information pertaining to different modalities of treatment for older adults with
dementia.
Current Research
Individuals with dementia present with multiple needs that can be challenging to
caregivers. Often times these needs go unmet. They include the need for social contact, support,
and the need for stimulation in order to alleviate boredom and stimulate the mind. Challenging
Alzheimer’s and dementia related behaviors present as inappropriate verbal, vocal, or motor
activities that are not explained by an individual’s attempt to meet a need or a state or situation in
which many things are happening in a way that is not controlled or orderly. Sensory
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interventions in the form of listening to music are geared to alleviate boredom and sensory
deprivation (Cohen-Mansfield, 2013; Cohen-Mansfield, Marx, Thein, & Dakheel-Ali, 2010).
Brain-Music Connection
The human brain is hard-wired to connect music with long-term memory. Many
individuals are aware of this by hearing a song associated with a former relationship and
instantly recalling the event. One processes music through the primary auditory center in the
temporal lobe (Goodall & Etters, 2005). This part of the brain interacts with the frontal lobe and
one feels things like rhythm, pitch, beat, and melody. When one hears the words, different areas
of the brain allow one to understand the meaning of the words. The visual cortex may play a role
as well. The motor cortex plays a role in our tapping to the music. The prefrontal cortex
stimulates memory, principally long-term memory of a particular song. Those affected by
Alzheimer’s may have difficulty communicating names, places, and facts, but music can tap
deep emotional recall. When people hear a song, they may begin to reminisce about the
past. Music accesses parts of the brain and reawakens the parts that still work. Beloved music
has been shown to calm disorganized brain activity and enable the listener to engage in the
current moment in order to connect with others. This reconnection with others assists in an
improved quality of life for the individual (Music & Memory, 2015).
The benefits of personalized music have been well-studied and documented by various
professionals, including the executive director of the Institute for Music and Neurologic Function
(IMNF), Dr. Concetta Tomaino, as well as IMNF co-founder and neurologist, Dr. Oliver Sacks
(IMNF, 2015). Individuals with dementia may appear confused, agitated, or lethargic but will
respond to music, especially if the songs are familiar to them. While listening to music
individuals will smile, keep time, and join in while regaining a part of their identity they lost as a
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result of the disease. One’s personal memories which cannot be accessed directly are embedded
in music. According to Sacks, “the past which is not recoverable in any other way is embedded,
as if in amber, in the music, and people can regain a sense of identity” (Music & Memory, n.d.,
para. 2). One does not have to be musical to respond, receive, or react to music
emotionally. Everyone can continue to do so despite severe dementia because memory, emotion,
and moods are accessed through parts of the brain which respond to music. Those with dementia
may have lost their life stories but they can have a sense of regaining them through the use of
familiar music (Music & Memory, 2015).
Patients in the stage of advanced dementia possess a reduced ability to understand verbal
language. Yet, music has a remarkable effect on decreasing behavioral problems among those
affected by dementia (Goodall & Etters, 2005; Music & Memory, 2015). It is processed in many
different parts of the brain and acts as a means of communication for those with a decline in
language ability. Music accesses many different parts of the brain through rhythm, pitch,
melody, and vibrations, particularly the right hemisphere and the limbic system which deal with
emotions. Since a function of the left hemisphere includes language, combining language and
music through song provide a greater chance to activate intact neurological pathways than using
language alone (Goodall & Etters, 2005).
Music Therapy Treatment
Significant evidence exists supporting music therapy as a means to reduce agitation in
people affected by dementia (Cohen-Mansfield, 2013; Cooke et al., 2010; Goodall & Etters,
2005). Music therapy is defined as “the clinical and evidence-based use of music interventions
to accomplish individualized goals within a therapeutic relationship by a credentialed
professional who has completed an approved therapy program” (American Music Therapy
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Association, 2005, para. 1). However, more recent evidence suggests that music therapy,
through the use of a personal playlist administered by a trained caregiver, is sufficient in
reducing agitation among those affected by dementia (Gerdner, 2010). Studies show that
familiar music of one’s choice, through the use of a personal playlist, can evoke a more positive
response than unfamiliar music as familiar music reconnects an individual with memories of past
events (Gerdner, 2010; Sung et al., 2010). A key factor contributing to the effectiveness of
music therapy is the ability to assess and identify individually meaningful music selections. This
may require assistance from family members for those who are severely affected by dementia
(Gerdner, 2010; Goodall & Etters, 2005; Sung et al., 2010). This type of music therapy is
relatively inexpensive, non-invasive, accessible, and easily implemented with agitated
individuals (Sherratt, Thornton, & Hatton, 2004a). Additionally, very little training is required
by caregivers to use this technique. The benefits of music are simply not limited to enjoyment
but improve the quality of health and life by providing peace of mind to individuals without the
use of medication or restraints (Goodall & Etters, 2005).
Although music therapy has been shown to be an effective way to combat behavior and
psychological symptoms of dementia, this type of therapy is something that needs to be
continued in order to maintain effectiveness. Svansdottir and Snaedal (2006), found music
therapy to be a safe and effective method for treating agitation and anxiety in patients presenting
with moderately severe and severe Alzheimer’s. In the study conducted in two nursing homes
and two psychogeriatric wards, 38 patients were assigned to either music therapy or a control
group. The Behavior Pathology in the Alzheimer’s Disease Rating Scale (BEHAVE-AD)
showed significant reduction in the sum of scores pertaining to activity disturbances,
aggressiveness, and anxiety in the music therapy group. However, four weeks later, the effects
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disappeared (Svansdottir & Snaedal, 2006). It is important to note, however, that this study did
not include listening to a personal playlist.
“Preferred music listening is an inexpensive and viable intervention to promote mental
health of those with dementia” (Sung et al., 2010, p. 1062). Music therapy has shown to be a
practical and less costly intervention to manage agitated behaviors in older adults with
Alzheimer’s disease and other dementias (Sung & Chang, 2005). With studies demonstrating
that music intervention has positive outcomes in reducing the occurrence of agitated behaviors in
older adults with dementia, this type of intervention is considered to have potential and may be
more cost-efficient than interventions involving psychotropic drugs or physical restraints
(Cohen-Mansfield, 2013; Gerdner, 2010; Goodall & Etters, 2005; Sherratt et al. 2004a; Sherratt
et al. 2004b).
There are progressive and positive benefits of music providing support for persons with
Alzheimer's disease and other dementias. Since music therapy affects emotional and psychophysiological pathways, music has been shown to significantly improve mood, communication,
and autonomy in individuals (Cooke et al., 2010; Goodall & Etters, 2005). Likewise, it reduces
anxiety, and alleviates phases of depression and aggressive behavior (Raglio et al., 2008).
Medication Management Treatment
While there has been a significant increase of the older adult population in society, there
is still no known cure for dementia. This makes for a limited number of medical treatment
options for older adults living with dementia. People live longer due to the expansion of western
medicine. Older adults struggling with Alzheimer’s disease and other forms of dementia are
commonly prescribed medication to help alleviate behavioral and psychological stressors. As
described earlier, there is an increase of agitation and combative behaviors in older persons with
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this condition. Medication management has demonstrated modest improvement in minimizing
psychosis and agitation (Dewing, 2010).
Through the use of cholinesterase inhibitor medications such as Donepezil, Rivastigmine,
and Galantamine, the patient’s symptoms of aggression and agitation decrease. These
medication treatments work by increasing the amount of a chemical called acetylcholine, which
helps messages to travel around the brain. Individuals with dementia have a shortage of this
chemical; therefore, potential benefits for complying with this treatment include improvements
in motivation, anxiety levels, confidence, daily living, memory, and thinking. In addition, this
medication could also delay the symptoms of dementia (Alzheimer’s Association, 2015). This
allows a sense of safety for the patients as well as caregivers and clinicians who are attending to
the patient’s needs.
These distressing symptoms of dementia can often be managed without medication.
However, individuals with Alzheimer’s and other forms of dementia have frequently been
prescribed antipsychotic drugs as a first choice of treatment potentially due to the limited options
for treatment. Older adults receiving medication treatment to help alleviate symptoms of
dementia are at a high risk of having dangerous side effects (Alzheimer’s Association, 2015).
Antipsychotic drugs have been used inappropriately in a variety of settings. For example, an
Alzheimer's Society report on dementia care in general hospitals found that psychotropic drugs
are widely used to treat people with dementia in a hospital environment and a quarter of nurses
surveyed believe that this use is inappropriate (Alzheimer’s Association, 2015). The side-effects
of antipsychotics can be very harmful and can rob individuals of their quality of life (Dewing,
2010). Recent research has shown that there is a high probability of experiencing a stroke in the
first four weeks of psychotropic medication treatment (Asanuma, Sumi, Fujii, & Sasaki, 2013),
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and that there is almost a doubling in the risk of mortality (U.S. Food and Drug Administration,
2015). Side effects include excessive sedation, dizziness, and unsteadiness, which can lead to
increased falls and injuries, as well as Parkinson’s, body restlessness, reduced well-being, social
withdrawal, and accelerated cognitive decline (Asanuma et al., 2013; Rhee, Csernansky,
Emanuel, Chang, & Shega, 2011).
Despite the potential side effects medication may cause to the patient, there is still a
noticeable decrease in agitation, significant enough where it continues to be the most popular
form of treatment for dementia. While pharmacological interventions may calm clients, they
often times lead to further decline. Caregivers who opt not to utilize medicine often times use
restraints, but this results in further agitation as the client lacks control. Furthermore, restraints
can result in injury to the client. Non-pharmacological approaches are advantageous in that they
focus on the psychosocial well-being of the client as well as the environmental explanations for
behavioral occurrences. Additionally, they avoid side effects associated with medication and
they address the problem rather than mask it (Evans, 2002; Goodall & Etters, 2005).
Alternative Treatment Strategies
There are several complementary and integrative treatments which offer potential
benefits to patients with dementia as well as their caregivers. In the case of most progressive
dementias, including Alzheimer's disease, there is no cure or treatment that slows or stops its
progression; hence, the tendency to use drugs may temporarily improve symptoms. Symptoms
of dementia may present themselves differently in each individual; therefore, it is important to
consider various forms of treatment when looking to alleviate symptoms for this disease
(Dewing, 2010). Other forms of treatment include mind-body therapies such as relaxation
techniques, meditation, guided imagery, hypnosis, psychoeducation, biofeedback, and cognitive
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behavioral therapy (Asanuma et al., 2013; Rhee et al., 2011). Patients and caregivers can also be
encouraged by professionals to engage in healthy lifestyle changes such as following a healthy
diet, disengaging from alcohol/drug use, and increasing body movement activities. Also, making
changes to the patient’s environment could potentially decrease the symptoms associated with
Alzheimer’s and other forms of dementia. Examples of environmental modifications include
adjusting the lighting in the room to suit the individual patient, providing pleasant sounds,
body/mind stimulation, pets, and positive engagements with others. These sensory activities can
minimize behaviors associated with this condition (Dewing, 2010).
Challenges
Many challenges must be considered before implementing a new intervention.
Challenges to music therapy may be selecting individual choice of music, headphone or
earphone discomfort, and controlling high volume to avoid ear damage. To begin with, many
patients with dementia lack the ability to select a personal playlist. Caregivers must rely on
family members or friends to select the music (Gerdner, 2010). Questions to consider in the
music selection include: Are friends and family truly selecting music that the client enjoyed in
the past or are they selecting music from the time period in which the individual grew up?
Selecting music from a particular time period is a method of selection if all other modes are
exhausted (Sung & Chang, 2005). To address the challenge of possible discomfort due to
headphone use, staff may want to utilize stereos and speakers instead or restrict volume settings
on the music devices. Addressing challenges before implementing a new intervention can result
in a smoother transition.
Conclusion
Research indicates that music intervention is a strong predictor of de-escalation of
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behavioral and emotional symptoms in individuals affected by Alzheimer’s and other forms of
dementia (Cohen-Mansfield, 2013; Cohen-Mansfield et al., 2010; Cooke et al., 2010; Evans,
2002; Goodall & Etters, 2005; Music & Memory, 2015; Raglio et al., 2008; Sherratt & Hatton,
2004a; Sherratt & Hatton, 2004b; Spiro, 2010; Sung & Chang, 2005; Sung et al., 2010;
Svansdoltir & Snaedal, 2006). The implementation of music therapy proves to be effective in
reducing agitation and in increasing the creative expression of older adults with dementia
(Sierpina, Sierpina, Loera, & Grumbles, 2005). The use of music therapy also appears to be a
strong support for care providers as it helps increase healthy social engagements in dementia
patients, limiting the role of medication as the main source of treatment for this disease (Dewing,
2010). Clearly, a need for continuous research remains. Dementia is a disease which presently
has no cure. However, there is sufficient evidence suggesting the viability of music therapy as a
means toward decreasing agitation and depression, thus regulating the emotional and behavioral
outbursts in older adults with this condition (Cohen-Mansfield, 2013; Cohen-Mansfield et al.,
2010; Cooke et al., 2010; Evans, 2002; Goodall & Etters, 2005; Music & Memory, 2015; Raglio
et al., 2008; Sherratt et al., 2004a; Sherratt et al., 2004b; Spiro, 2010; Sung & Chang, 2005; Sung
et al., 2010; Svansdoltir & Snaedal, 2006). Music therapy can contribute to maintaining or
rehabilitating functional cognitive and sensory abilities, as well as social skills (Raglio et. al.,
2008). Embracing the use of music therapy through the use of personal playlists among
individuals affected by Alzheimer’s or other forms of dementia could produce significant
changes in problematic behavior. Identifying ways to move patients away from a state of despair
can lead them towards a more hopeful and meaningful life while living with the challenges of the
disease.
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Chapter 3
Methods
Project Selection
The process of selecting a project began with identifying a population in need. We were
informed of a need within the population of individuals affected by Alzheimer’s and other forms
of dementia at Villa Pomerado skilled nursing facility in Poway, California. During a staff
meeting at Palomar Hospital in Escondido, California, where one of the authors of this project
grant proposal was a social work student intern, a social worker from Villa Pomerado described
behaviors that affect individuals with dementia. Agitation and depression present as common
behaviors among this population. Current research supports music therapy, primarily listening to
a personal playlist, as a way to decrease these behaviors in individuals affected by Alzheimer’s
and other forms of dementia. The Villa Pomerado social worker identified the need for
equipment, specifically iPods, iPads, iTunes cards, and headphones in order for staff members at
the facility to provide innovative services to this population, and to obtain data on the benefits of
using music as a form of intervention. We were intrigued with the idea of a non-invasive
intervention for individuals affected by Alzheimer’s and other forms of dementia. We decided to
develop a grant in order to bring the idea to fruition.
Identification of Potential Funding Source
The process of identifying a potential funding source began with an Internet search via
Google as well as links and resources provided by the California State University San Marcos
Kellogg Library Social Work link. With the assistance of the CSUSM Social Work librarian and
using key words such as Alzheimer’s, dementia, agitation, depression, music and therapy, we
selected and searched several Web sites to locate organizations that fit the criteria as potential
24
funders. Five potential funders were identified: Robert Wood Johnson Foundation, Music &
Memory, Alzheimer’s Association, Hartford Foundation, and Alliance Healthcare.
Criteria for Selection of Actual Grant
Based on a thorough assessment of the five potential funders, Alliance Healthcare was
the most appropriate fit for this project as this foundation is dedicated to advancing health and
wellness for those in need. The Alliance Healthcare vision statement is as follows: “We envision
a San Diego and Imperial County region where equitable health resources lead to universal
health and well-being” (Alliance Healthcare Foundation, 2015, para. 4). The mission statement
states: “Alliance Healthcare Foundation (AHF) works to advance health and wellness for the
most vulnerable-the poor, working poor, children and homeless in San Diego and Imperial
Counties” (Alliance Healthcare Foundation, 2015, para. 2). This project meets criteria to apply
for a Responsive Grant which funds a one-time immediate needs project for an organization to
continue its work. An immediate needs project may also include organizational and leadership
development activities that better position the organization for the future (Alliance Healthcare
Foundation, 2015).
Submission Process
Prior to the submission of the grant proposal to Alliance Healthcare Foundation, we must
submit a completed grant proposal to Palomar Health Development, Inc., for review. Palomar
Health Development is the 501(c)(3) corporation through which grant monies are channeled for
use at Palomar Health facilities. Palomar Health Development staff will edit the grant proposal
to comply with the standards of both Palomar Health and Palomar Health Development. Upon
completion, the Palomar Health grant writers will determine whether they or the authors of this
25
project grant proposal will submit the actual proposal to Alliance Healthcare Foundation (T.
Howell, personal communication, February 9, 2015).
Alliance Healthcare Foundation proposals for responsive grants are accepted throughout
the year with no deadlines. This type of grant meets the needs of projects that are time sensitive
and designed for organizational development. Prospective grants will be reviewed for the
geographic location of the program, target population, AHF priority, funding area, evidence-base
for program design, and strengths and weaknesses in the request and budget. Responsive grants
should be e-mailed to the Executive Director or Program Officer at Alliant Healthcare
Foundation. They can also be mailed to the Alliance Healthcare Foundation.
Target Population
The target population consists of long term patients affected by Alzheimer’s and other
dementias who reside at Villa Pomerado skilled nursing facility in Poway, California. These
long-term patients have resided in the facility for over 180 days. They do not have a discharge
plan as they are unable to return to the community.
Host Agency
Villa Pomerado is affiliated with Palomar Health, a local healthcare district organized
under Division 23 of the California Health and Safety Code, and is committed to providing a
continuum of care for a variety of adult patients with post-acute and long-term needs. This
skilled nursing facility offers a continuum of care for a variety of adult patients with post -acute
and long-term needs, including rehabilitation, respite, and hospice. Staff consists of highly
trained nurses, nurse practitioners, social workers and physicians who work together with
patients, family members and physicians toward the best possible outcomes. Staff members are
26
professional and empathetic as they strive to meet the needs of the patients in this home-like
atmosphere (Palomar Health, 2014).
Needs Assessment and Collection of Data
Dementia is a disease resulting in brain deterioration and a decline in memory and other
cognitive functions. These cognitive impairments lead to behaviors such as agitation,
depression, and anxiety. Individuals affected by Alzheimer’s and other forms of dementia in this
vulnerable population require an individualized treatment plan which is customized to meet their
needs. This is vital to the well-being of this population to prevent further decline in cognitive
functioning. The behavioral and psychological effects of Alzheimer’s and other forms of
dementia often result in a poor quality of life for these individuals (Sakamoto et al., 2013).
Therapeutic activity, such as music therapy, has been shown to provide adequate levels of
meaningful stimulation. This improves quality of life and helps manage behavioral symptoms
associated with Alzheimer’s and other dementias (Sherratt et al., 2004a).
27
Chapter 4
Application and Proposal
Executive Summary
Alzheimer's and other dementias are general terms used to describe the decline of
cognitive abilities severe enough to interrupt daily activities (Alzheimer’s Association,
2015). Research indicates that dementias are caused by damage to the brain cells that interfere
with the ability for brain cells to communicate with each other (Alzheimer’s Association,
2015). When the brain cells cannot communicate normally, thinking, behavior, and feelings can
become affected (Sierpina et al., 2005). Many dementias are progressive, meaning symptoms
start out slowly and gradually increase to the point where the ability to complete daily tasks
becomes difficult. Individuals struggling with this disease experience a significant number of
symptoms associated with a decline in thinking skills and memory retention. Other significant
symptoms include the increase of agitation and depression in patients affected by this disease
(Dewing, 2010).
Ongoing research for Alzheimer’s and other dementias continue to add to the knowledge
base on how to treat this disease as there is no current cure for dementia. However, the treatment
of mood symptoms, such as agitation and depression, in this population remains a challenge for
physicians and other professionals (Sierpina et al., 2005). There are very limited treatments for
dementias since a cure is yet to be discovered. The most commonly used form of treatment
being used to treat the symptoms of dementia is medication, which results in a temporary
alleviation of the symptoms.
This grant proposal focuses on increasing the use of non-medication treatments to help
decrease agitation and depression symptoms in persons with dementia. A promising treatment
28
recently gaining popularity with this population is music therapy. Music therapy presents as a
low cost intervention with a wide range of benefits, such as improvements on measures of
depression, agitation, and a variety of cognitive functions (Sherratt et al., 2004a). Music therapy
consists of vocal and instrumental strategies to improve functioning and/or facilitate changes that
contribute to the quality of life for individuals struggling with dementia (Sherratt et al., 2004a;
Sherratt et al., 2004b). This proposal emphasizes strengthening the use of music therapy through
the utilization of a personal playlist that individualizes the music to the patient’s liking in order
to decrease moods of depression and agitation for individuals with dementia (Spiro, 2010).
The beneficiaries of this funding would be dementia patients residing at Villa Pomerado
nursing care facility in Poway, California in San Diego County. By supplying this facility with
music products such as iPods, iPads, iTunes Cards, and headphones, patients would be able to
make use of music therapy treatment to treat depression and agitation symptoms associated with
their dementia. This treatment will be administered by the facility staff members who have
received previous training in music therapy. The devices will be available to the patients on a
daily basis and staff will be documenting progress notes reflecting the patient’s response to
treatment. Music therapy will be an ongoing form of treatment for patients diagnosed with
Alzheimer’s or other dementias.
Problem Statement
Currently, dementia affects approximately 5.2 million Americans aged 65 years and
older, a growing number expected to reach 7.7 million by 2030 (Alzheimer’s Association, 2015).
This disease has significant damaging effects on the functional quality of life of patients.
Although there has been extensive research examining potential disease modifying drugs to
combat dementia symptoms, the number of individuals diagnosed with the disease is rapidly
29
increasing, generating great urgency to implement non-medication interventions that may help
improve the daily functioning and quality of life of persons with dementia (Sung et al., 2010).
Memory loss, mood disturbances, and inability to complete basic daily tasks are more
prevalent among individuals diagnosed with dementia than other diseases impacting the general
population (Cohen-Mansfield, 2013). Current research shows individuals diagnosed with
Alzheimer’s or other forms of dementias experience increased agitative and depressive
symptoms (Cohen-Mansfield, 2013). Dementia-related behaviors present as inappropriate verbal
responses, vocal utterances, or motor activities that are not explained by an individual’s attempt
to get needs met. Individuals with dementia present with a significant number of unmet needs
such as the need for body and mind stimulation, social contact, and support.
There have been increasing concerns about the use of pharmaceutical drugs in individuals
with dementia (Asanuma et al., 2013). There are significant issues when providing this type of
treatment to patients in terms of patient safety and quality of care. Medication management
appears to be the most popular treatment used in patients with dementia compared with other
non-medication treatments (Rhee et al., 2011). The potential benefits of receiving
pharmaceutical treatments, however, may be outweighed by the overall risks of the medication.
Medication often produces fast results in eliminating aggressive behaviors commonly seen in
dementia patients, but at some cost to the patients (Dewing, 2010). For example, a patient who
is being verbally insulting and physically aggressive might be administered antipsychotics to
eliminate the symptoms of aggression when perhaps the patient is expressing frustration for other
misunderstood and unmet needs. This treatment does not provide good quality of care for
patients struggling with this disease. Many of the prescribed medications lead to other health
problems stemming from medication side effects (Cooke et al., 2010). It is clear that the current
30
level of use of antipsychotic medication for persons with dementia demonstrates a significant
issue in terms of quality of care, negative impacts in patient safety, clinical effectiveness, and
most importantly, the patient experience (Cooke et al., 2010).
Music Therapy
Music therapy is aimed at providing patients with opportunities for self-expression and
engagement. Current research studies indicate how music may reduce agitation and improve
behavioral issues commonly seen in the middle and ending stages of dementia (Goodall & Etters,
2005). Music therapy provides patients with a way to connect, even after verbal communication
has become problematic. The individualized playlist will be composed with music that is
familiar and enjoyable to the patient. Music will become audible through the use of iPods and
iPads where music cannot be interrupted by commercials, which in some cases could cause
confusion or frustration in patients. Music therapy will aim at creating the mood desired for the
patient (Goodall & Etters, 2005). For example, a soothing song may potentially help create a
calm environment, while an upbeat song from a patient’s childhood or young adulthood may
boost the patient’s spirit and arouse happy memories. This therapy will also encourage patients
to engage in movements such as clapping and dancing to make their music experience more
memorable. Overall, this music model will provide patients with a safe space where the patients
could connect with past experiences that will ultimately help alleviate agitation and depression,
and improve their quality of life and personal well-being.
Patients struggling with Alzheimer's and other dementias could greatly benefit from
music therapy treatment. Music therapy helps stimulate the mind, promote memory, and build a
sense of self in the treatment of older adults with dementia (Gerdner, 2010). By accessing a
personal playlist, it is hoped that patients with dementia will be able to increase their memory
31
functions resulting in positive changes in moods and emotional states (Evans, 2002). This lowcost and effective intervention will help improve the overall physical and mental well-being of
dementia patients.
Community Served
Individuals with Alzheimer's and other dementias are in need of support and care.
Patients at Villa Pomerado will greatly benefit from the implementation of music therapy as a
potential treatment for their dementia. Villa Pomerado nursing care facility provides services to
129 patients who are struggling with a physical and/or cognitive disability. Of the 129 patients,
there are 26 long-term patients currently receiving medical treatment for their mild to severe
stage of dementia. The patients who would benefit from the implementation of music therapy
would be the 26 patients receiving long-term care for dementia. The patients are older adults,
both male and female, the majority of whom are covered by Medicare insurance.
Needs Addressed
Older adults diagnosed with dementia should be presented with options for treatment.
Individuals who struggle with depression and agitation due to recurrent symptoms of dementia
would benefit greatly from engaging in music therapy treatment. Music therapy will help
patients connect with past memories, stimulate the body and mind, and ultimately enhance
mood. By providing iPods, iPads, and headphones patients will be able to listen to a personal
playlist and benefit from the sound of music. As music therapy slowly emerges as a promising
form of treatment for people with dementia, there is a need for personal listening devices in order
to implement this treatment.
32
Organizational Background
Villa Pomerado is affiliated with Palomar Health, a local healthcare district organized
under Division 23 of the California Health and Safety Code, and is dedicated to providing quality
care to a variety of adult patients with post-acute and long-term needs, including rehabilitation,
respite, and hospice care. Villa Pomerado is a 129-bed skilled nursing facility located in Poway,
California. The facility is equipped with the necessary tools and professionals to give
appropriate care to patients in need. Staff includes highly trained nurses, nurse practitioners,
social workers, and physicians who work closely with the patients and family members to ensure
the best possible outcomes (Palomar Health, 2015).
Project Description
Music therapy is an innovative treatment and a fairly unexplored option for families,
caregivers, and patients who are living with dementia. The implementation of music therapy will
assist in alleviating symptoms of depression and agitation for people with dementia. Patients
will be provided with an iPod or iPad with access to a personal playlist composed by the
patient’s family, friends, and the patient if possible. Patients will have these devices accessible
to them on a daily basis under the supervision of hospital staff members who have undergone
training in music therapy. Patients could use the music devices at appropriate times where the
music should be soothing and/or energizing with minimal distractions and a safe
environment. Patients will be able to select their music through their personal playlist.
Project Goals and Objectives
The primary goal of the project is a decline in agitation and depression among dementia
patients as a result of music therapy. This will be accomplished by setting up personalized
playlists using iPad and iPod technology, and iTunes cards to download songs. This technology
33
will provide a therapeutic intervention in the form of quality music listening. Villa Pomerado is
in need of a well-researched therapeutic intervention that can provide an alternative to
medication to aid in improving the quality of life for patients.
The following three objectives for the grant are: (1) obtaining equipment (iPads, iPods,
iTunes cards, case covers, and headphones), (2) setting an individualized playlist for each
targeted patient, and (3) implementing an individualized playlist intervention.
Activities and Timeline
The objectives listed below will be completed by the following activities and timeline in
order to meet the project’s goal:
Objective 1: Obtaining equipment
Activities and Timeline: The Social Worker at Villa Pomerado will purchase the iPads
and iPods through Best Buy, an American consumer electronics corporation. The Apple iTunes
cards will also be purchased through Best Buy. The other protective accessories including cover
cases and headphones for the iPad/ iPod will be purchased through Amazon. All purchases will
be made in month one, upon receiving the grant (see Table 1, for line item budget).
Objective 2: Setting up an individualized playlist
Activities and Timeline: Foremost, the Villa Pomerado social worker will obtain consent
from patients or their families to participate in the personalized music playlist intervention
project. After consent is received, a personal music playlist is established. Patients will be asked
to identify music that they enjoy or have enjoyed from the past. If the patients with Alzheimer’s
and other dementias cannot identify or remember any music, family members will be consulted
by Villa Pomerado staff. Family can be key members in establishing a personalized playlist by
providing music from past events such as weddings, songs patients used to sing, or music from
34
other important events in their lives. Another way to establish an individualized playlist, if the
patient is unable to make selections and family input is not available, includes going back to the
time period in which the patients grew up. For instance, if the individual grew up listening to
music in the 1960s, a genre of music from that decade can be shared with the individual to see
what they prefer. The selection of music to establish an individualized playlist will take place in
month two.
Objective 3: Implementing an individualized playlist intervention
Activities and Timeline: Villa Pomerado long-term patients impacted by Alzheimer’s
disease and other dementias from Villa Pomerado will be assigned either an iPad or iPod device
to listen to their personal playlist. These devices will be kept in their rooms since they are living
at the facility. Patients can request to listen to their personal devices for relaxation as
desired. We expect these personal playlists to alleviate symptoms of depression and reduce
agitation. This implementation will occur immediately after the playlist is established.
Project Evaluation
To measure outcomes, skilled nursing facility staff members will assess the patients
every three months. Staff will utilize personal observation of agitated behaviors and will
administer the Patient Health Questionnaire-9 (PHQ-9) for depression (Spitzer, Williams, &
Kroenke, 2001; see Appendix). The PHQ-9 is a geriatric depression scale which will be
implemented to measure any changes in mood and behavior patterns (Centers for Medicare and
Medicaid Services, 2015). Patients’ scores will be compared to their baseline scores. A decrease
in a PHQ-9 score will signify an improvement in mood. Since PHQ-9 assesses for mood, it will
be used to monitor the severity of depression in patients residing at the facility (L. Gumm,
personal communication, April 3, 2015).
35
The PHQ-9 assessment tool has nine questions on mood behavior that can be asked
directly to the patients. These nine questions address how patients rate particular situations or
problems. This questionnaire includes the use of a Likert scale (see Appendix). If patients are
unable to read the questions, a trained staff member may read the questions to
them. Additionally, if patients are not able to answer the questions, a trained staff member or
family members can answer the questions based on the patient’s behaviors.
Applicant Capability
Villa Pomerado is fortunate enough to have a staff that includes a social worker, music
therapist, social worker intern, activities director, and an assistant nurse practitioner, who are all
part of a team to bring personalized music playlist therapy to life at their nursing skilled
facility. They are a dedicated team who share the value of pursuing quality of life for their
patients. Staff members already have experience sharing the power and enjoyment of
music. Since the facility has an activity room where patients can go and sing karaoke, the team
sees the value of music for their residents. Sadly, not all patients go out to the activity room if
they are too agitated or depressed to leave their rooms. That is why Villa Pomerado would like
to see personalized playlists on iPads or iPods available in their nursing skilled facility.
The staff at Villa Pomerado believe in what individualized music playlists will bring to
their patients and facility. Staff members are motivated as well as dedicated. They also are
equipped with skills by having been trained in music and memory by completing three webinar
trainings. This type of background will help ensure continuous participation from patients and
reach improvements in levels of mood and behavior. Based on research of evidenced-based
interventions in assisting older adults with dementias, we conclude that the attainment of music
equipment will help in meeting the central needs of our patients. With the music equipment
36
necessary to launch this project, patients will utilize a personal playlist igniting memories from
their past, thus reducing agitation and depression. As writers of this grant proposal project, we
believe that this project is both a beneficial and practical plan.
Budget Request
We propose the following budget to implement music therapy at Villa Pomerado skilled
nursing facility in Poway, California (see Table 1). The actual final budget amount is subject to
approval by Palomar Health.
Table 1
Line item budget
EQUIPMENT
QUANTITY
COST
(per
unit)
GRANT
REQUEST
Apple iPad mini with Wi-Fi-16GB
30
$229.99
$6,899.70
Apple iPod Shuffle 2GB MP3 Player
(5th generation)
30
49.99
1,499.70
iTunes cards
50
40.00
2,000.00
Headphones
Sennheiser HD201 Lightweight Over-Ear
Binaural
50
29.99
1,499.50
Insten - iPad Mini TBU Rubber Gel Skin Case
Cover
30
6.39
191.70
Subtotal
Sales tax
GRANT REQUEST
190 Items
$12,090.60
$967.25
$13,057.85
37
Chapter 5
Discussion
Identification of Need
Throughout our journey to become social workers, we have been taught to serve
vulnerable and oppressed populations. On a few occasions, we were assigned to visit and report
on residential care for older adults. We noticed that many of the residents who are affected by
Alzheimer’s or other forms of dementia lacked activities. We concluded, from our observations,
that individuals affected by Alzheimer’s and dementias deserve a quality of life far greater than
what we observed. These individuals need mental stimulation to engage with life and to salvage
as many memories as possible.
Residing in a nursing home can result in feelings of social isolation, particularly for
individuals diagnosed with Alzheimer’s or other forms of dementia. In addition, for some,
family members may not live nearby and friends may have died. Through music therapy, one
can regain a sense of one’s identity by connecting with one’s memories of the past (Music &
Memory, 2015).
One of the authors of this project grant proposal heard about a project to implement
music therapy, through the use of a personal playlist, at Villa Pomerado skilled nursing
facility. The Social Worker there described current research regarding the implementation of
music therapy and a Web site called Music & Memory. The author asked the social worker if
she needed funding to obtain equipment for her project and the social worker enthusiastically
accepted the efforts directed toward her project. The author then took the idea to her colleagues,
who were intrigued by the concept. We reviewed the Music & Memory Web site together and
38
were fascinated with the research, particularly by Oliver Sacks, a neurologist and
researcher. According to Sacks (n.d.), individuals with dementia may appear confused, agitated
or lethargic but will respond to music, especially if the songs are familiar to them. Individuals
smile, keep time, and join in while listening to music, as they regain a part of their identity they
lost as a result of dementia. While an individual affected by Alzheimer’s or other forms of
dementia may not be able to access personal memories directly, these memories are embedded in
music. Anyone can benefit, even individuals with severe dementia, because memory, emotion
and moods are accessed through parts of the brain which respond to music (Music & Memory,
2015).
We searched peer-reviewed journals regarding the effects of music therapy on individuals
affected by Alzheimer’s and other forms of dementia. Our literature review supported the need
for advocacy in implementing music therapy in nursing homes.
Strategies to Enhance Funding
Based on the guidance and support from faculty and staff from the Master of Social Work
program at California State University San Marcos, and the Social Worker at Villa Pomerado
skilled nursing facility in Poway, California, some important components of completing a grant
proposal were identified. These include: Reviewing peer reviewed journals, citing experts in the
field, using current research, developing clear goals and objectives, explaining the evaluation
plan, building a partnership with the Social Worker at Villa Pomerado based on a shared vision
for the patient, and devising a detailed budget with a convincing narrative. These components,
together, make for a strong grant proposal worthy of funding.
Identifying appropriateness of fit between funder and project is another important
strategy to enhance the likelihood of funding. We researched Alliance Healthcare Foundation as
39
they work to advance health and wellness for vulnerable populations in San Diego and Imperial
Counties (Alliance Healthcare Foundation, 2015). Additionally, Alliance Healthcare Foundation
awards Responsive Grants which fund one-time immediate needs projects for organizations to
continue their work. They also fund needs projects that may provide organizational and
leadership development activities that better position the organization for the future (Alliance
Healthcare Foundation, 2015, para. 7).
Clear definitions and explanations regarding this population and their needs are vital to
gaining support for funding. It is of essence to portray the population of individuals affected by
Alzheimer’s and other forms of dementia as human beings with the same needs as anyone else,
even though they experience a decline in neurocognitive functioning.
Social Work Relevance
Older adults continue to be a vulnerable and underrepresented population. Persons with
Alzheimer’s and other dementias are navigating a transitional period that not only affects the
patient but the family as a whole. Social workers can provide support to individuals and families
as they begin to adjust to the changes brought on by the disease. Dementia can be a difficult
disease to understand. Social workers work towards providing the patients and their families
with a good representation and understanding of the illness, available treatments, and possible
prognosis of the disease. In addition, a social worker continuously works to maintain the dignity
and respect of the person with dementia will promote autonomy for the patient and family to
preserve as much power and control as possible, despite the cognitive decline seen in
dementia. The social worker provides families and patients with alternative solutions on how to
manage the symptoms of dementia as well as how to cope with significant change brought by the
illness and advocates for resources needed to provide optimal care. The social worker facilitates
40
communication between other skilled nursing facility staff and family members to ensure the
patient’s rights and needs are being met.
In dementia care, following a strengths-based approach with older adults with
Alzheimer's and their families is significant in order to ensure proper and quality
treatment. Throughout the helping process, the social worker should highlight the patient’s
strengths and use those specific qualities to empower the patient and family unit. Social workers
should be educated and prepared to talk about the hard issues that arise with dementia. They will
provide the patient and family members with information with options of treatment and linkage
to necessary resources in the community. Furthermore, social workers will possess a strong
skillset in disease-specific issues, such as problematic behaviors, delusional thinking, and
cognitive decline interfering with daily functions. Ultimately, the social worker will be working
as a family and patient partner in establishing a team of professionals to complete
interdisciplinary assessments and create an individualized care plan to maximize patient success
and quality of life. The inclusion of accessible alternate treatments, such as music therapy, can be
a vital part of strengths-based, low-cost, individualized care for older adults with Alzheimer’s
and other dementias. The inclusion of accessible alternate treatments, such as music therapy, can
be a vital part of strengths-based, individualized care.
41
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45
Appendix
Patient Health Questionnaire-9 (PHQ-9)
Over the last 2 weeks, how often have you been bothered by any of the following
problems?
More
(Use “✔” to indicate your answer)
Several
Not at all days
than half
the days
Nearly
every
day
1. Little interest or pleasure in doing things
0
1
2
3
______________________________________________________________________________
2. Feeling down, depressed, or hopeless
0
1
2
3
______________________________________________________________________________
0
1
2
3
3. Trouble falling or staying asleep, or sleeping too much
______________________________________________________________________________
4. Feeling tired or having little energy
0
1
2
3
______________________________________________________________________________
5. Poor appetite or overeating
0
1
2
3
______________________________________________________________________________
6. Feeling bad about yourself — or that you are a failure or
have let yourself or your family down
0
1
2
3
______________________________________________________________________________
7. Trouble concentrating on things, such as reading the
newspaper or watching television
0
1
2
3
______________________________________________________________________________
8. Moving or speaking so slowly that other people could have
noticed? Or the opposite — being so fidgety or restless
that you have been moving around a lot more than usual
0
1
2
3
______________________________________________________________________________
9. Thoughts that you would be better off dead or of hurting
yourself in some way
0
1
2
3
______________________________________________________________________________
FOR OFFICE CODING 0 + ______ + ______ + ______
=Total Score: ______
If you checked off any problems, how difficult have these problems made it for you to do
your work, take care of things at home, or get along with other people?
Not difficult
at all
�
Somewhat
difficult
�
Very
difficult
�
Extremely
difficult
�
Source: Spitzer, R. L., Williams, J. B., & Kroenke, K. (2001). Patient Health Questionnaire-9
(PHQ-9). New York, NY: Pfizer.

- Scholarworks @ CSU San Marcos

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