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B760 Mental Health Nursing Question Write a literature review towards the use of music interventions for older adults in care homes to alleviate depressive symptoms. Answer Music Interventions For Older Adults Suffering From Depression Introduction Late life depression can have serious consequences and hence is an important public health problem. It is associated with an increased risk of mortality and morbidity in the older adults, increased risk of suicides and decreased physical, cognitive, greater self-neglect and decreased social functioning of the adults (Fiske, Wetherell & Gatz, 2009). While pharmacotherapy and certain alternative treatments have been found to be effective in treating the depression in the older patients, this paper on the other hand focuses on the effectiveness of the music therapy in older adults living in aged care homes. Discussion Depression in the older adults differ from that of the depressions in the earlier years. The etiology, presentation, risk and other protective factors are the aspects that attributes to the depression in the older adults (Fiske, Wetherell & Gatz, 2009). Half of the geriatric patients suffer from major depression due to the experiencing of a new condition arising from old age. Depression in the older adults in aged cares suffer from more depression and anxiety as compared to that of the one living with their own families. As per  Fiske et al., (2009) more than half of the residents of the aged care homes face from depressive symptoms of depression , feel uninterested in activities, hopeless about the future, guilt about the past and may even desire death. It has been found that the incidence rate of suicide is as high as 46 % in older adults living in the residential care unit.  According to Choi  et al., (2008), people entering in the residential care unit have been found to be older than those living with their families. They generally suffer from more complex care needs due to their cognitive and physical difficulties. They can also face difficulties in adjusting with the changes setting or to the loss if the independence and routine (Choi et al.2008). Furthermore the physical deterioration, chronic illness and social isolation and loneliness makes this group of people susceptible to developing depression.   In light of this alarming statistics specific interventions should be taken to mitigate the problem of depression and anxiety among the elderly people. There is a requirement of proper aged care support and peer group to address the problem. The paper reflects upon the effectiveness of the music therapy in reducing the depression among the older adults. Since the earlier period of civilization, music has been used to heal the soul and the body and to express whatever that cannot be articulated by words. The history of the music therapy can be dated back to 1940, where community musicians used to visit the traumatized and institutionalized soldiers after World War II.  According to Maratos ,(2008), positive physical as well as emotional responses has been noted in patients subjected to music therapy. In a study by Leubner and Hinterberger, (2017), 89 people within the age 18 to 50 with depression and receiving the standard pharmacological treatment has been taken for the study. One group received that same standardized psychotherapist treatment and the other group received an additional 20 bi-weekly music therapy sessions lasting for 60 minutes. As per the depression scores measured at the month end, participants who received the music therapy showed significant level of improvement in the depressive symptoms (Leubner & Hinterberger, 2017). According to Leubner and Hinterberger, (2017), Music therapy is a preventive and a recuperative therapy that helps in recovering the mood of the patient, improving their self-esteem, strengthening their immune system and hence forth improving their quality of life. Studies have found that their improved mood improved their family communication, reduced their loneliness or alienation. When a study involving the application of the music therapy in patients were conducted, it was interesting to note the enthusiasm with which the participants participated in the intervention program (Leubner & Hinterberger, 2017). As systematic review by Jespersen et al., (2015), have found that music improved sleep quality among the older adults and also plays a role in the relaxation. Music has been found to be giving a therapeutic approach in patients after a heart surgery. Research on music and its effect on the brain function have provided insights on the concept of neural plasticity (Hegde, 2017). It should be remembered that musical performance involves a set of cognitive function such as processing, attention, memory, emotions. Music is known to have benefits for the emotional, social and the cognitive wellbeing of the patient (Hegde, 2017). According to Chanda and Levitin, (2013), the neurological changes due to the music can be perceived in four domains – Motivation and pleasure mediated by the opoids and the dopamine Stress and arousal which is mediated by the cortisol levels, ACTH adrenocorticotrophic hormone and the corticotrophin-releasing hormone (CRH). The adaptive immunity mediated by the serotonin level and the social affiliation mediated by the oxytocin. Cochrane reviews have supported the fact that the music interventions can be useful in elderly people suffering from schizophrenia or similar disorders (Mossler et al., 2011). Listening to music has been found to have beneficial effects in enhancing the mood and certain cognitive functions. It has been found that that evidence based music therapy has been found to be effective in improving the sensorimotor skills, language and cognitive function in a person even from a non-musical domain Maratos, (2008). It has been found that music changes the psychophysiological aspects such as relaxations, blood pressure, respiration, heart rate and pain perception (Hole et al., 2015). According to Chan et al., (2012), a person in depression experiences discomfort, anger and stress, due to which the heart rate and the blood flow will change. The adrenaline release from the adrenal medulla would affect the heart rate. A study by Chan et al., (2012), have examined the relationship between the musical rhythm and the listener’s respiratory pattern. It has been found that music exerts its effect in the body by entrainment of the rhythm of the body. When musical rhythm and the heart rhythm lock in t a phase they vibrate in harmony It has to be noted that the elderly individuals under an aged care suffer from loneliness and social exclusion. As stated by Chan et al., (2012), music can be considered as a strong elicitor of the emotions and helps to regulate the emotions. Music has been found to be associated with the activation of the cortical network involved in the emotions, such as the frontal lobe of the brain that is responsible for the processing of the emotions. Music engages the mesolimbic area of the brain, the reward point of the brain responsible for real life emotional experiences. Elliott et  al., (2011) ,have discussed about the type of the music that can possibly alleviate depression among the older adults. It has been uniquely found that slow progressive melodies were mainly selected by the participants of a study conducted by the researcher. It was found that in the relaxing piece the melodic progressions mainly progressed from low notes to high notes and contained short intervals. In a word that sounds were all harmonious, peaceful, serene, joyous and sad in some tracks (Elliott et  al., 2011). Conclusion In conclusion it can be said that the older patients suffer from depression and other neurological problems. It has been found that the music therapy is not only useful to reduce the depression in the patients but also shows beneficial effects for the older adults in the functioning in their everyday life. As per the evidences music therapy has been found to be associated with the activation of certain part of the human brain that is responsible for the processing of the emotions. Hence such an approach can be helpful for the aged care staffs in improving the quality of life of the older adults in the care homes. References Chan, M. F., Wong, Z. Y., Onishi, H., & Thayala, N. V. (2012). Effects of music on depression in older people: a randomised controlled trial. Journal of Clinical Nursing, 21(5?6), 776-783. Chanda M. L. & Levitin D. J. (2013) The neurochemistry of music. Trends in Cognitive Sciences, 17, 179–193.  Choi, N. G., Ransom, S., & Wyllie, R. J. (2008). Depression in older nursing home residents: The influence of nursing home environmental stressors, coping, and acceptance of group and individual therapy. Aging and Mental health, 12(5), 536-547. Elliott, D., Polman, R., & McGregor, R. (2011). Relaxing music for anxiety control. Journal of Music Therapy, 48.3 : 264-288. Fiske, A., Wetherell, J. L., & Gatz, M. (2009). Depression in older adults. Annual review of clinical psychology, 5, 363-389. Hegde S., Bharath R. D., Rao M. B., et al. (2016) Preservation of cognitive and musical abilities of a musician following surgery for chronic drug-resistant temporal lobe epilepsy: a case report. Neurocase, 22, 1–6. Hegde, S. (2017). Music therapy for mental disorder and mental health: the untapped potential of Indian classical music. BJPsych International, 14(2), 31–33. Hole J., Hirsch M., Ball E., Meads C. (2015). Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet 386, 1659–1671. 10.1016/S0140-6736(15)60169-61 Jespersen K. V., Koenig J., Jennum P., Vuust P. (2015). Music for Insomnia in Adults. London: The Cochrane Library. Leubner, D., & Hinterberger, T. (2017). Reviewing the Effectiveness of Music Interventions in Treating Depression. Frontiers in Psychology, 8, 1109. Maratos A., Gold C., Wang X., et al. (2008) Music Therapy for Depression. Cochrane Library. Mossler K., Chen X., Heldal T. O., et al. (2011) Music therapy for people with schizophrenia and schizophrenia-like disorders. Cochrane Database of Systematic Reviews, (2), Cd004025.

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