Person Attuned Musical Interaction in Dementia Manual UK version V1.0
Research type
Research Study
Full title
Development and evaluation of the Person Attuned Musical Interaction in dementia manual UK version (PAMI-UK)
IRAS ID
293613
Contact name
Orii McDermott
Contact email
Sponsor organisation
Univeristy of Nottingham
Clinicaltrials.gov Identifier
000, n/a
Duration of Study in the UK
1 years, 4 months, 0 days
Research summary
Research Summary
The Person Attuned Musical Interactions (PAMI) in dementia manual is a staff training tool for care homes to improve meaningful interactions between care staff and resident. Within care homes, interactions have been observed to be insufficient, leading to resident’s psychological, social and emotional needs being unmet. There are several reasons for care home interactions being limited, fragmented and generally tasks orientated. The workload and time pressures on staff can lead to the prioritisation of physical health and safety. Impairments in language and social skills observed in many residents with dementia can also make interactions difficult. PAMI aims to address the barriers to care home communication. Previous research highlighted musical abilities remain for individuals with dementia even as verbal language reduces, making it potentially an effective alternative communication. PAMI provides staff with music skills and activities, which can be included in daily routines and interactions with residents. By including the skills into routines staff can meet resident’s psychological, social and emotional needs through more meaningful interactions, without losing out on physical care and safety. The PAMI skills aim to use music to balance emotions, create a safe and familiar environment and develop relationships based on memories. These elements could lead to residents becoming less agitated, more aware and more valued, which could lead to smoother and more efficient completion of tasks, reducing staff’s time and workload pressure. The study consists of two parts, a manual development which will test the initial version of the manual for 8 weeks before gaining the views and experience of care staff in interviews. The results collected in the manual development study will aid changes to the manual. The manual evaluation study will investigate the appropriateness and usability of the manual and the impact of PAMI on staff and residents for 18 weeks before conducting interviews.
Summary of Results
The two studies evaluated the usability and feasibility of the Person Attuned Musical Interaction (PAMI)- a UK version which had been adapted and modified from the resources developed in Denmark for the original PAMI intervention. The adapted version aided in making changes to make the PAMI intervention accessible to a larger proportion of care homes in the UK. Additionally, PAMI-UK was adapted to be delivered remotely to make the training accessible during the COVID-19 pandemic. The two studies explored the practicality of implementing the intervention in care homes to ensure the research could be translated into practice.
Person Attuned Musical Interactions- UK version (PAMI-UK) is a staff training tool comprising a standardised paper manual, interactive webinars and regular reflective sessions to train care staff delivering musical and non-verbal two-way interactions with residents with dementia in care homes. Study one was run in three care homes in Lincolnshire between September 2021 and January 2022. The researchers recruited eight staff members and eight residents, who were paired together to complete the study. Five staff-resident pairs completed the study. Each care home participated in the study for ten weeks, with staff using the PAMI-UK intervention for eight weeks. During the eight weeks, staff were expected to attend three reflective sessions; two staff members attended all three sessions, two staff members attended two sessions, and one staff member attended one session. In study one, all staff and residents were female. Staff members were between 28 and 50 years old, and residents were 79 to 94. All residents had a dementia severity of either moderate or severe.
Study Two was run in four care homes in Lincolnshire between April 2022 and December 2022. The researchers recruited 19 staff-resident pairs, with ten remaining in the study until the end. Four of the ten pairs that completed the study did not return their post-training documents. Seventeen of the 31 reflective sessions were attended across the four care homes, with only one care home attending all their reflective sessions. Nine staff members returned their demographic questionnaires for their residents and themselves. Eight staff members were female, and one male aged between 22 and 65. Eight residents were female and one male, aged between 61 and 96. All residents had moderate to severe dementia.
The results from both studies highlighted the potential benefits of PAMI-UK for residents, staff and the overall care home atmosphere. All staff demonstrated implementing and adapting the PAMI-UK skills to their routine and residents' needs, preferences, and abilities. Staff reported an improvement in residents’ moods, agitation levels, communication, food consumption and overall well-being. Additionally, staff observed improved stress levels, dementia awareness and mood. When music was incorporated into other tasks, staff observed an improvement in task efficiency, with residents being more cooperative. PAMI-UK aided staff in acknowledging the individual behind the diagnosis who continues to have the needs, likes and wishes of a ‘healthy individual’. Acknowledging comparisons between themselves and residents resulted in staff acknowledging the individual as a person, leading to them providing for the needs of the person, not the condition.
Residents' responses could vary between interactions depending on the residents' moods, dementia symptoms, and other external factors. Therefore, it was important for staff to continue to assess their residents and adapt their interactions accordingly. Although many residents had limited verbal communication, they could continue interacting through other more accessible forms such as singing, humming, dancing, smiling and physical touch. PAMI-UK facilitated the staff’s abilities to perceive and interpret residents’ non-verbal communication, enabling them to interact effectively with residents and sustain meaningful interactions. PAMI-UK remained accessible regardless of the resident’s dementia stages, with some staff using the skills with residents on end-of-life care. There was some disagreement over whether the intervention was appropriate for residents in end-of-life care, with one staff member feeling singing or humming was disrespectful to use with these residents. In contrast, other staff used music to comfort and connect with residents during their final days. Although research has not explored the use of PAMI-UK in end-of-life care, extensive research highlights the use of music in palliative and end-of-life care for various conditions, including dementia.
While staff could implement the intervention into routines, staff highlighted several barriers that made implementation challenging. Management was vital for implementation; when they were supportive, they provided time and encouragement for staff to plan and implement PAMI-UK. At the same time, management could be a barrier when they placed additional responsibilities on staff after observing the success of PAMI-UK. Time was highlighted as the primary barrier; staff schedules were generally full, with little time for meaningful interactions or activities. Busy schedules with limited time resulted in high staff stress, making them less motivated to implement extra activities and interactions. However, staff attempted to be more conscious about finding the time to interact meaningfully with residents after attending the PAMI-UK training. COVID-19 was also a significant barrier, with many care homes experiencing multiple lockdowns. Staff felt consistency across shifts was essential to PAMI-UK's success; residents needed to receive the same standard of interactions among staff members. Without consistency, progress made by one staff member was seen as futile, with staff having to reintroduce skills continuously.
The studies highlighted PAMI-UK’s potential to provide a large proportion of care homes with music training with regular monitoring, which can improve staff and resident interactions. By incorporating PAMI-UK into current routines and tasks, the intervention does not require additional staff time or burden, demonstrating the plausibility of introducing music interventions into care homes despite limited carers’ available time.
REC name
London - Harrow Research Ethics Committee
REC reference
21/LO/0283
Date of REC Opinion
18 Jun 2021
REC opinion
Further Information Favourable Opinion