Regenstrief, Mayo Clinic seeking to decrease delirium in older adults in ICU using music

INDIANAPOLIS – Researchers from the Regenstrief Institute and Mayo Clinic are leading the first study to test whether exposure to music can decrease delirium in older adults who are receiving mechanical ventilation in the Intensive Care Unit (ICU) of a hospital.

“Decreasing Delirium through Music in Critically Ill Older Adults” (grant R01AG067631) is expected to total $1.96 million over the next five years. The study is supported by the National Institutes of Health’s National Institute on Aging and National Eye Institute through a new initiative to promote research on music and health.

The Regenstrief-Mayo randomized controlled trial will evaluate the effectiveness of seven days of slow-tempo classical music in reducing delirium, a form of acute brain failure, in mechanically-ventilated ICU patients age 65 and older. Half of the 160 study participants will be exposed to slow tempo, relaxing music through noise cancellation headphones for one hour in the morning and one hour in the evening. The other half of the study participants will simply be given noise cancellation headphones for an hour in the morning and an hour in the evening. This will enable comparison of the effects of music on delirium with simple noise cancellation.

More than a million adults in the United States receive mechanical ventilation in ICUs annually. As many as 80 percent of these individuals could develop delirium. Older ICU patients with delirium are predisposed to short-term and long-term complications including the development of cognitive impairment and dementia. Previous Regenstrief studies have shown that developing delirium increases the likelihood of being discharged to a nursing home after hospitalization.

“We do not know for certain why the majority of ICU patients on mechanical ventilation develop delirium but studies conducted by our group and others have clearly shown that drugs do not decrease the likelihood of developing this horrific brain failure that could lead to dementia,” said Babar A. Khan, M.D., a co-principal investigator of the new study. Dr. Khan is a Regenstrief Institute research scientist, an Indiana University School of Medicine associate professor of medicine, and current president of the American Delirium Society. “We are investigating whether listening to music, a non-pharmacological strategy that has been shown to decrease over-sedation, anxiety and stress in critically ill patients — all factors that predispose to ICU delirium, decreases the likelihood of developing delirium, saving the brain from potentially devastating insults.

“The study will explore if the low-cost, uncomplicated introduction of music in the ICU by a nurse or other staff member could be easily integrated into current ICU patient management and break the cycle of sedation and stress that negatively affects cognition in the aging brain,” Dr. Khan said.

###

Study participants will include older ICU patients from Eskenazi Health and Indiana University Health hospitals. This work is based on promising results from an earlier pilot study conducted by Dr. Khan and Linda Chlan, PhD, R.N., Mayo Clinic’s associate dean for nursing research, at Eskenazi Health and funded by a Regenstrief innovations grant.

Investigators on the new study in addition to Babar A. Khan, M.D., and co-PI Linda Chlan, PhD, R.N., ATSF, FAAN, are Fred Unverzagt, PhD, Sujuan Gao, PhD, and Regenstrief Institute research scientist Sikandar Khan, D.O., all of IU School of Medicine. Consultants are Annie Heiderscheit, PhD, of Augsburg University, a certified music therapist, and Hunter Downs, PhD, a medical physicist and chief executive officer of Area 10 Labs.