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Jul08

Music can help reduce delirium in older adults after surgery

by Various Writers

This article was written by Lauren Winemaker, and is part of a series provided by upper year health sciences students at McMaster University.

Last fall, my grandfather was experiencing severe chest pains. He was diagnosed with angina, meaning that the arteries supplying his heart with blood were clogged. As a result, he had to undergo bypass surgery in order to improve blood flow to his heart.

After his surgery I went to go visit him at the hospital and he seemed to be recovering well. However, he had to stay in the Intensive Care Unit (ICU) longer than usual, as he had issues regulating his heart rate. After a few days, my family and I noticed that he was beginning to act quite strange. He was constantly sleeping and always forgetting where he was. The doctors told us that he could be experiencing delirium, which is extremely common in older adults who have been hospitalized.

Delirium is a disturbance in mental abilities, which can occur when there is an impairment to neurotransmitters, which send and receive signals in the brain. One of the major ways this occurs is through the neurotransmitter acetylcholine. Acetylcholine plays a major role in one’s ability to learn and remember. Delirium occurs when levels of acetylcholine plummet. Additionally, older adults produce less acetylcholine to begin with, making them more susceptible to delirium. This deficiency can be caused by a number of factors that create stress in the brain, including a medical condition (stroke, heart attack), an infection, or even undergoing surgery. My grandfather’s doctor explained to us that this condition is often seen in patients in the ICU after surgery.

Delirium has the potential to create additional health complications, which is why prevention of this condition is extremely important. Many physicians administer medications to prevent delirium; however, this is risky as delirium can actually be caused by adverse reactions to medications. In fact, many scientific studies reveal that prevention methods, without the use of medication, are much more productive. Interestingly, the use of music in these setting has proven to be extremely effective.

When patients come out of surgery, the environment is often unfamiliar and unsettling. They are surrounded by nurses, and often hooked up to monitors. This can cause patients to become stressed and anxious in their environment, which can ultimately lead to delirium. This is why it is important to present patients with relaxing stimuli, like music. Music has been proven to regulate stress and emotions through soothing compositions including a slow tempo, low pitch, and repetitive rhythms. This has been seen to decrease heart rate and rate of breathing. Music has also been shown to decrease levels of cortisol, one of the main stress hormones in the body.

Furthermore, music can be useful in bringing up positive memories in a patient’s post-surgery recovery. In the brain, the amygdala is responsible for storing deep memories. It also serves to associates music with these memories. Listening to customized playlists composed of a patient’s favorite songs can familiarize patients with their surroundings through strengthening their connection to their deepest memories.

For these reasons, music has proven to be a beneficial alternative to medications, and is extremely effective in preventing delirium.  

 

Room 217 has an extensive collection of articles and webinars about music and health in its reference library. If you want to learn how to incorporate music into your care practice, visit our Music Care Training page. We also have resources for use in a number of care settings.