How and why music therapy reduces distress and improves well-being in advanced dementia care: a realist review

People with advanced dementia are at increased risk of institutionalization and experiencing distress. Research suggests that music therapy could reduce distress, but less is known about the causal mechanisms. Here we conducted a realist review to develop a program theory for how music therapy may reduce distress and improve well-being for people with advanced dementia in institutional settings. Initially, data were extracted from key literature alongside secondary reflexive thematic analysis of semi-structured interviews and stakeholder consultation. Subsequently, systematic literature searches were conducted along with a stakeholder survey. Data were extracted to iteratively refine the rough theory. Finally, the program theory was presented to stakeholder groups for consolidation. The theory outlines the core elements of the music therapy intervention alongside the individual, interpersonal and institutional contexts required to instigate hidden mechanisms, including meeting the unmeet needs of the person with dementia in the moment and increasing communication and understanding of music therapy among staff and family members. Outcomes include short-term reductions in distress and improved well-being, with the potential for music to become embedded in the management of distress and regulation of the care environment within the institution. Insufficient data were found to theorize infrastructural factors impacting the use of music therapy with this population. This theory should be tested through empirical research and used to inform clinical practice and policy. This realist review shows that music therapy interventions must meet a person’s needs in the moment and be supported and integrated within the wider care environment to reduce distress and improve well-being for people with advanced dementia.