When I was a kid, my dad\u2019s mom was always the sharpest, most pointedly funny person at our family gatherings. She was smart and witty, and also incredibly independent, living alone in a split-level house and always baking things to bring to our parties (even if everything she made tasted like cigarettes). When she was in her late 70s, however, she fell in the house and broke her hip, leading to a surgery and fairly lengthy hospital stay. We visited several times during her hospitalization, and I remember that even as a kid I could tell something wasn\u2019t right. My grandmother wasn\u2019t her normal self \u2013 she seemed like she was processing slower, and she sometimes became confused about what was happening, which I had never seen happen to her.<\/p>\n
As it turns out, this is a common after-effect of hip and knee surgery in older adults. There is a fairly high risk of cognitive impairment following these types of surgeries, with 30% to 50% of patients experiencing what is referred to as \u201cacute confusion\u201d, characterized by the older adults appearing confused, disoriented, and unable to interact with others. There are a number of contributing factors, ranging from the anesthesia to the physical discomfort to the stress of hospitalization. Obviously, these types of effects can be incredibly distressing for both the patient and their caregivers, especially when, as in my grandmother\u2019s case, the patient was cognitively healthy going into surgery. While many people recover from these effects fairly quickly, there can sometimes be a lengthy period of carryover, and about half of the patients who experience acute confusion in the hospital are still dealing with disorientation anywhere from 2-12 months after surgery. This is why it is so crucial to find ways of reducing post-op acute confusion, so Dr. Ruth McCaffrey has been exploring how music can be used as a tool to promote healthy cognitive function in older adults after hip or knee surgery.<\/p>\n
Prior to McCaffrey\u2019s study (2009), music had already been shown to help older adults by reducing anxiety and agitation (Hicks-Moore, 2005; McKinney, 1997), which are both associated with acute confusion. McCaffrey (2009) was specifically interested in how music could impact the level of cognitive functioning as well as the amount of acute confusion, the disorientation I explained above, in older patients following hip or knee surgery. Her hope was that providing music might decrease the instances of acute confusion in older adults, which would lead to better cognitive healing. She enlisted 22 older patients on their preoperative visit and evaluated each of them using two scales, one that measures cognitive function (MMSE) and one that measures the presence of acute confusion (NEECHAM). After surgery, the control group was given the standard post-op care (meaning no music, but the same care as the experimental group in every other respect), and the experimental group additionally received CD players to keep by their beds and a large selection of CDs to choose from, ranging from Barbara Streisand to Celtic guitar to nature sounds of the Caribbean. During each of the three post-op days, patients in the music condition were asked to listen to the provided music at least four times a day for an hour (although they were welcome to listen to it for longer if they wanted), and all of the participants\u2019 mental progress was measured daily using the MMSE and NEECHAM. The MMSE is presented to the patient as a short questionnaire consisting of questions like \u201cWhat town are we in?\u201d and tasks such as \u201cSpell WORLD backwards\u201d. The NEECHAM, on the other hand, is an inventory that can be completed by the nurse as she or he checks the patient\u2019s vitals, and the patient is graded on items such as his or her general attention, ability to follow a simple command, appearance, and motor behavior.<\/p>\n
McCaffrey found that the simple act of providing patients with music yielded impressive results. The experimental group exhibited less cognitive decline after surgery than did the control group, which means that music was helping them to return to normal cognitive functioning faster than they might have otherwise. They also experienced significantly less acute confusion than the control group across the post-op period. These results are something the medical world should pay attention to because they demonstrate that something as cheap and accessible as a music source can have a huge positive impact on the experience of hip and knee surgery patients. We aren\u2019t talking about an expensive medication or a time-consuming therapy \u2013 it\u2019s just music.<\/p>\n
I can\u2019t help but wonder what positive effects music might have held for my grandmother when she was hospitalized. Maybe, if she\u2019d had a CD player by her bed, she\u2019d have been her normal, sharp-witted self, making sassy comments about the nurses and demanding that someone bring her a smoke. <\/ins><\/p>\n References<\/p>\n