Music Therapy in ICU: A Study on Delirium in Elderly Patients
He is stressed. Slow, classical music is played to relax. Breathe. One, two, and three. Sounds are used to calm, accompany, and regulate emotions. Thus, for years, it has been thought that music could also help in one of the harshest hospital environments: the Intensive Care Unit (ICU). The question arises: Could it assist older patients connected to mechanical ventilation?
A recent investigation published in JAMA Internal Medicine evaluated whether listening to soft melodies twice a day could reduce the onset or duration of delirium—a state of acute confusion experienced by nearly 75% of patients admitted to the ICU. Delirium is not only troubling but is also associated with longer stays, cognitive sequelae, and a greater risk of dementia after discharge. In the absence of effective pharmacological treatments, alternative strategies, such as music therapy, have received increasing attention in recent years.
The trial, dubbed DDM (Decreasing Delirium through Music), was conducted in hospitals affiliated with the Indiana University School of Medicine and the Mayo Clinic in Rochester, United States. A total of 158 patients aged 50 years or older, all connected to mechanical ventilation, participated in the study.
For a maximum of seven days, one group listened to slow tempo music (between 60 and 80 beats per minute) during two daily sessions, using tablets and noise-canceling headphones. The control group underwent identical sessions in time and duration but received a subtle placebo of silence.
Monitoring the music was facilitated by an application developed specifically for this purpose (Soundese), which allowed researchers to keep accurate track of the “dose” of intervention administered—an aspect that was poorly controlled in previous music therapy studies.
The researchers measured the number of days free of delirium or coma, along with the intensity of delirium, pain, and anxiety. The results indicated no significant differences between the two groups. Those who listened to music had a median of 2.5 delirium-free days in the first week, compared to three days in the control group.
“Despite the apparent logic of using calming music in the ICU environment, our research shows that a prescribed playlist does not reduce delirium, pain, or anxiety,” explains Dr. Babar A. Khan, co-lead author of the study, in a statement. “These data help adjust expectations and indicate that future interventions should consider personalization and therapeutic support.”
Dr. Linda L. Chlan, co-investigator and professor at the Mayo Clinic, adds that music is a complex stimulus that requires emotional connection. “It is possible that a uniform selection for all patients was not meaningful enough. The tastes and musical history of each person can be determining elements.”
Although the main result was negative, the study detected interesting trends. Patients who received at least seven complete sessions experienced slightly more days free of delirium or coma, and the same pattern was observed among those treated with benzodiazepines—sedatives that usually increase the risk of delirium. These signals, while not reaching statistical significance, could guide future research.
The authors agree that the results do not rule out the role of music in treating delirium, but they indicate that its effectiveness could depend on when it is applied, how long it is provided, and, most crucially, whether the musical selection responds to the identity and preferences of the patient.
In a healthcare environment where available pharmacological treatments have not demonstrated clear efficacy against delirium, this research contributes to refining clinical practice. It raises new questions that need answering. The challenge of alleviating acute confusion in older ICU patients remains open.
By adopting a more individualized approach to music therapy, there lies potential for future studies to explore various musical genres and formats, understanding that emotional connections to music can significantly alter physiological responses. Tailoring music therapy to match the diverse backgrounds and preferences of patients may unlock new avenues in improving their overall care and recovery.
Listening to music fosters a comforting environment that, at the very least, can be beneficial for emotional regulation, even if it does not directly impact the clinical outcomes related to delirium in this specific context. With the continuous evolution in medical methodologies and patient care, it becomes essential to embrace innovation and maintain an open mind regarding unconventional therapies that might one day prove indispensable in enhanced patient recovery.