Can music with calming and uplifting lyrics reduce stress and anxiety in hospitalized dialysis patients and mitigate decline in mental status?

The Effects of Music on Mental Status in Hospitalized Dialysis Patients

Music therapy with calming and uplifting lyrics can effectively reduce stress, anxiety, and depressive symptoms in hospitalized dialysis patients, potentially mitigating mental status decline. 1, 2

Evidence for Music Therapy in Dialysis Patients

Impact on Psychological Symptoms

• Results from small-scale studies suggest that music and spiritual interventions may reduce the prevalence of depressive symptoms in dialysis patients 1
• Music therapy has been shown to effectively reduce anxiety levels in patients on maintenance hemodialysis, with meta-analyses demonstrating a medium effect size (pooled standardized mean difference = 0.76; 95% CI: 0.55,0.98) 3
• Music interventions have demonstrated effectiveness in reducing both anxiety and depression in hemodialysis patients, contributing to improved quality of life 4
• A comprehensive meta-analysis found music-based interventions have a small-to-medium effect on reducing anxiety (-0.16 Hedge's g) in patients with chronic kidney disease receiving hemodialysis 2

Physiological Benefits

• Music therapy has been shown to reduce pain perception during arteriovenous fistula cannulation, a common source of discomfort for dialysis patients 1
• Music interventions can help reduce heart rate (-0.15 Hedge's g) and blood pressure (systolic: -0.14, diastolic: -0.11) in patients undergoing hemodialysis 2
• Music therapy can reduce perceived physiological stressors in hemodialysis patients, with statistically significant differences between pre-test and post-test scores 5

Implementation Considerations

Practical Application

• Music therapy can be implemented as an independent nursing intervention to help fulfill physical, emotional, and psychological requirements of dialysis patients 5
• Music interventions are particularly valuable as they lack adverse effects, unlike many pharmacological approaches to managing psychological symptoms 1
• Music therapy offers flexibility in delivery mode and accessibility, even during intradialytic intervals, making it practical to implement in hospital settings 1

Advantages Over Pharmacological Approaches

• Pharmacological management of anxiety and depression in dialysis patients is challenging, as SSRIs have not shown consistent benefits over placebo and have documented increased adverse effects, particularly gastrointestinal issues 1
• No existing randomized controlled trials address pharmacological management of anxiety in kidney failure populations, making non-pharmacological approaches like music therapy particularly valuable 1
• Music therapy avoids the potential for drug interactions and reduces the burden of polypharmacy in an already medically complex patient population 1

Limitations and Considerations

• While evidence supports the use of music therapy, the quality of evidence is variable, with many studies having small sample sizes 6
• Heterogeneity exists across studies (I² = 75%), indicating inconsistent results that warrant cautious interpretation 6
• The strength of evidence for music interventions in dialysis patients has been rated as "very low" in some systematic reviews, suggesting that further research could substantially change our understanding of its effects 6

Clinical Recommendation

• Consider implementing structured music therapy sessions with calming and uplifting lyrics as part of routine care for hospitalized dialysis patients experiencing anxiety, depression, or mental status changes 1, 5
• Music therapy should be considered as a complementary approach alongside other non-pharmacological interventions such as cognitive behavioral therapy, mindfulness, and exercise, which have also shown benefits in this population 1
• Patient preferences regarding music selection should be considered to maximize engagement and therapeutic benefit 5

Music therapy represents a low-risk, potentially high-reward intervention that can be readily implemented in hospital settings to support the mental health of dialysis patients, potentially reducing the need for pharmacological interventions that carry greater risks in this vulnerable population.