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“Music comes with no side effects, no black box warning, little expense and will certainly help with the majority of individuals and patients.”

Therapeutic Music in Hospice Care

by

Mark L. Hammond, M.D.

In 1986, I finished my residency in Internal Medicine armed with the latest education, technology and high hopes that the medications I had been trained to prescribe could help patients and alter their struggles with acute and chronic diseases. While some of these medications were beneficial, I soon discovered that there were significant limitations in treating chronic diseases, especially those I was treating in my growing nursing home practice. 

Over the first 10 years of my career, my practice grew to where I was taking care of over 500 nursing home residents, in addition to my office and hospital practice. My biggest epiphany during this time was that the medication I had been trained to use for altering chronic diseases, such as congestive heart failure, COPD, dementia and other conditions, had limited efficacy.  Many of these individuals came to me with 10+ scheduled medications prescribed.  Over the years, the number of prescribed medications has grown in volume. 

The Need for Palliative Care

By 1996 it became clear to me that my focus, in taking care of the nursing home population, was missing a component in the care of these individuals. More than focusing solely on the treatment of ‘symptoms’, there needed to be more focus on ‘comfort’. At that time, there was very little interest among physicians in how to best provide palliative care to these individuals. There were obvious voids in treatment, as many of these individuals presented severe frailties, regardless of what their underlying diagnoses were. Certainly, with aggressive therapies, some of these individuals could return home, but many were clearly entering the final stage of their disease. 

Although I would occasionally meet an individual and/or family that wanted everything possible done to enhance survival, most wanted their remaining days to be comfortable. Additionally, these individuals wanted to maintain their autonomy in making these decisions. Given the choice between aggressive treatment or palliation, most individuals choose palliation. At that time, the medical model in the United States had limited abilities to effectively support this decision.

Fortunately, in 1996, The American Academy of Hospice and Palliative Medicine began providing certification for physicians. I was thankful for this opportunity to study and prepare for the board examination. My studies taught me the science behind medications and how to safely and effectively manage symptoms of pain and non-pain symptoms at end-of-life.

Non-Drug Therapies

In 1997, I was certified by the Academy and utilized this new knowledge in my practice as Medical Director in both nursing home and hospice environments. While the use of narcotics was a central theme of my education, it was also clear that other non-drug therapies, such as therapeutic music, would prove to be extremely helpful. 

One of the dreaded complications encountered at end-of-life is Terminal Agitation. This condition occurs for various reasons, but many times its exact cause is a mystery. Terminal Agitation is usually marked by severe agitation with visual and/or auditory hallucinations. These episodes are obviously extremely distressing to both patient and loved ones. At times, medications such as Ativan or Haldol can help, but often these meds are only partially effective.  Based on my own observations in caring for these individuals, THERAPEUTIC MUSIC improved the quality-of-life of these individuals, most notably in these terminally agitated patients or individuals.

Studies Confirm My Personal and Professional Observations

In 2005, Hilliard, et.al. at SUNY performed meta-analysis of 11 studies on therapeutic music in Hospice and Palliative Care. In 6 of these 11 studies, there were significant differences shown, where therapeutic music was supported. There were a number of factors that therapeutic music showed a POSITIVE effect-on… pain, fatigue, anxiety, mood, spirituality and quality-of-life. 

Published in 2015, a randomized control trial of 84 hospitalized patients was performed in Heidelberg, Germany. This study supports therapeutic music as an effective treatment, with a low dropout rate, for the promotion of relaxation and well-being in terminally ill patients.

A 2017 article from U.S. News and World Report entitled ‘How Music Therapy Helps Terminally Ill Patients’ discusses the many benefits of therapeutic music in this population. This article refers to the growing body of scientific proof of efficacy. 

While more research will be helpful, I am convinced we can confidently use therapeutic music in the Hospice setting. As in other medical situations, music comes with no side effects, no black box warning, little expense and will certainly help with the majority of patients and individuals. 

Currently there are around 7,000 certified Music Therapists in this country. I believe they can be a significant and integral part of the Hospice team. Music Therapists can help guide the type of music provided and help with the specific “dosage” and timing of intervention. In this way, they can also support and be a great asset to therapeutic music programs working to provide these types of non-drug solutions.

In addition, therapeutic music can be an important bridge of communication with families and caregivers. Many hospices have already integrated therapeutic music programs into their plans of care. I applaud these efforts and feel that this safe and effective strategy will grow in acceptance in the coming years.

 

More Studies & News

“Music Therapy in Palliative Care”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671329/pdf/Dtsch_Arztebl_Int-112-0788.pdf

 

“Music Therapy in Hospice and Palliative Care: a Review of the Empirical Data”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1142188/

 

“How Music Therapy Helps Terminally Ill Patients”

https://health.usnews.com/wellness/mind/articles/2017-01-25/how-music-therapy-helps-terminally-ill-patients

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