The Problem
Delirium prevention in the post-operative setting is an important aim in the geriatric population. The etiology of delirium is multifactorial. Age, uncontrolled pain, changes in medications (such as the addition of pain medication) and dementia are common contributing factors. Among older surgical patients, the risk for delirium ranges from 10 to more than 50 percent. Those who develop delirium experience prolonged hospitalizations, functional and cognitive decline, high mortality and high risk for institutionalization. This geriatric syndrome is associated with astounding costs and clinical ramifications, and it is imperative that we continue to explore non-conventional methods for delirium prevention.
Findings of a recent meta-analysis suggest that music should be offered as a way to help alleviate post-operative pain and anxiety, and potentially reduce incident delirium. In particular, personalized music that is played through headphones without distractions has the power to capture the patient’s full attention and trigger positive emotions associated with past memories.
Our Solution
We developed and implemented Confusion Avoidance Led by Music (CALM), a program. The program is available to patients seen in the POSH (Perioperative Optimization for Senior Health) clinic, a pre-operative evaluation clinic for complex geriatric patients preparing for elective surgical procedures. Patients seen in the clinic have multiple co-morbidities, cognitive impairment, mood disturbances, and limited mobility. All of these factors increase their risk for delirium and thus made them ideal candidates for the intervention.
The intervention included:
- Completion of a music preference questionnaire. During the clinic visit, the patient was seen by a member of the project team. Patients and their families were introduced to the therapeutic benefits of music for pain and anxiety reduction. Then, the patient or a family member completed a music interest questionnaire, which included questions regarding past experiences with music and music preferences.
- Delivery of a device to patient post-surgery. A project team member delivered the iPod and headphones to patient on post-operative day one, with music personalized for the patient, based on their responses from the music preference questionnaire.
- Pre-discharge patient and caregiver experience surveys using REDCap. A research database was setup to solicit the patients’ impressions of the music program.
- Music as medicine. By connecting with interdisciplinary professionals across Duke, including those in recreational therapy, Arts and Health at Duke, stress management, and nursing on 2100, 2200, 2300, and 4100, we hope to continue to promote music as adjunct therapy for patients and to integrate music into the culture of patient care at Duke University Hospital.
