Guidelines for a Palliative Approach in Residential Aged Care

agitation dropped by 56% after week 1 [252] (Level IV). Disruptive behaviours increased in the
following week when no music was played. This finding supported an earlier study that found
that music used during meal times for 30 residents who were cognitively impaired in weeks 2
and 4 resulted in a reduction in an overall reduction in agitated behaviours compared with an
increase in agitated behaviours when music was not played during weeks 1 and 3 [253] (Level IV).
Another study considered the use of recorded preferred music during bath time to reduce
the incidence of aggressive behaviour among 18 residents with severe levels of cognitive
impairment [254] (Level IV). The preference for resident’s music was determined by a family
member. The experimental group played recorded selections of resident-preferred music during
a two-week period compared with a control group that had no music played during their
bath times. The conditions were then reversed for a further two weeks. The results indicated
that playing preferred music during bath times led to a reduction in total counts of aggressive
behaviours compared with the control condition. There were also reductions in individual
aggressive behaviours such as yelling, abusive language, verbal and physical resistance; however,
these behaviours were not statistically significant. Although these results appear significant, the
sample size was too small and therefore, the results may not be generalisible to other settings.
Despite concern regarding methodological weakness of the previous study, the evidence does
indicate that playing preferred music may be beneficial in reducing the incidence of aggressive
behaviours and agitation by residents with severe dementia such as agitation [252,253] (Level IV).
Music should be provided using an individualised approach because it is probable that music
preferences, including having no music played, will vary considerably amongst residents.
CAM therapies in RACFs
Little research has been undertaken on the prevalence and role of CAM therapies in RACFs;
however, some research has been conducted with older persons. Foster and colleagues
(2000) [255] found that 30% of North Americans aged 65 years and over reported using
alternative medicines and 19% had visited an alternative medicine provider. Chiropractic and
herbal use were the most common treatments [255] (Level III-3).
Spoelhof and Foerst (2002) [256] (Level EO) have commented on issues and concerns in
managing CAM therapies in RACFs. They highlight some of the potential adverse effects
of commonly used medicinal herbs and possible side effects of the use of magnet therapy.
For example, there is evidence to suggest that herbal remedies are not necessarily safe. Ernst
(1998) [257] reviewed the data on published adverse effects of botanical preparations, and
concluded that, given the extent of use, there is an urgent need for serious research into the
risks of phytomedicines. A RCT conducted in the Netherlands found that ginkgo was not an
effective treatment for older persons with mild to moderate dementia, which contrasted with
earlier studies’ findings [258] (Level II).
An RCT evaluated the effects of cognitive stimulation therapy groups on cognition and quality
of life for 201 older persons with dementia (cognitive stimulation therapy is also known
as ‘reality orientation’) [259] (Level II). The process involved the use of a reality orientation
board that showed personal and orienting information. The topics included using money,
Guidelines for a Palliative Approach in Residential Aged Care 113