Soundscape Awareness Intervention Reduced Neuropsychiatric Symptoms in Nursing Home Residents With Dementia: A Cluster-Randomized Trial With MoSART+

Janouk Kosters, Sarah I.M. Janus, Kirsten A. van den Bosch, Tjeerd C. Andringa, E. Oomen de Hoop, Michiel R. de Boer, Ronald A.J. Elburg, Steven Warmelink, Sytse U. Zuidema, Hendrika J. Luijendijk*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

Objectives: Auditory environments as perceived by an individual, also called soundscapes, are often suboptimal for nursing home residents. Poor soundscapes have been associated with neuropsychiatric symptoms (NPS). We evaluated the effect of the Mobile Soundscape Appraisal and Recording Technology sound awareness intervention (MoSART+) on NPS in nursing home residents with dementia. Design: A 15-month, stepped-wedge, cluster-randomized trial. Every 3 months, a nursing home switched from care as usual to the use of the intervention. Intervention: The 3-month MoSART+ intervention involved ambassador training, staff performing sound measurements with the MoSART application, meetings, and implementation of microinterventions. The goal was to raise awareness about soundscapes and their influence on residents. Setting and participants: We included 110 residents with dementia in 5 Dutch nursing homes. Exclusion criteria were palliative sedation and deafness. Methods: The primary outcome was NPS severity measured with the Neuropsychiatric Inventory–Nursing Home version (NPI-NH) by the resident's primary nurse. Secondary outcomes were quality of life (QUALIDEM), psychotropic drug use (ATC), staff workload (workload questionnaire), and staff job satisfaction (Maastricht Questionnaire of Job Satisfaction). Results: The mean age of the residents (n = 97) at enrollment was 86.5 ± 6.7 years, and 76 were female (76.8%). The mean NPI-NH score was 17.5 ± 17.3. One nursing home did not implement the intervention because of staff shortages. Intention-to-treat analysis showed a clinically relevant reduction in NPS between the study groups (−8.0, 95% CI –11.7, −2.6). There was no clear effect on quality of life [odds ratio (OR) 2.8, 95% CI –0.7, 6.3], psychotropic drug use (1.2, 95% CI 0.9, 1.7), staff workload (−0.3, 95% CI –0.3, 0.8), or staff job satisfaction (−0.2, 95% CI –1.2, 0.7). Conclusions and Implications: MoSART+ empowered staff to adapt the local soundscape, and the intervention effectively reduced staff-reported levels of NPS in nursing home residents with dementia. Nursing homes should consider implementing interventions to improve the soundscape.

Original languageEnglish
Pages (from-to)192-198.e5
JournalJournal of the American Medical Directors Association
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 2023

Bibliographical note

Funding
This work was supported by ZonMw [733050833]. ZonMw is a nonprofit organization that finances health research and healthcare innovation. ZonMw was not involved in the collection, analysis, and interpretation of data, the writing of the report, or in the decision to submit the article for publication.

Publisher Copyright:
© 2022 The Authors

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