Music therapy intervention in community-dwelling older adults with mild cognitive impairment: A pilot study.

The purpose of the pilot study was twofold, seeking to investigate both the feasibility and preliminary effects of a music therapy intervention on the global cognitive state (attention, immediate and delayed memory, and executive function) and gait parameters (gait velocity, cadence, and right and left stride length) in older adults with mild cognitive impairment (MCI). Sixteen participants attended the one-hour music therapy sessions three times a week for 12 weeks. The intervention was feasible, achieving a retention rate of 84%. Significant effects were found in global cognitive state (p = .001), attention (p = .007), immediate memory (p < .001), delayed memory (p = .001), executive function (p = .002), gait velocity (p = .021), right stride length (p = .007), and left stride length (p = .014). These results suggest that music therapy intervention is a potentially innovative strategy for improving cognition and gait parameters in older adults with MCI.

Use of Music Therapy to Improve Cognition in Older Adults With Dementia: An Integrative Review.

BACKGROUND AND PURPOSE: Dementia is considered a public health priority due to physical, psychological, economic, and social repercussions in older adults, their families, and caregivers. To address this issue, healthcare providers can use music therapy as a complementary therapy. This manuscript was elaborated to analyze and synthesize the current evidence of the use of music therapy to improve cognition in older adults with dementia. METHODS: Using the Whittemore and Knafl (2005) method, databases searched were PubMed, CINAHL, Ovid, EBSCO, ProQuest, and PsycINFO, using the terms such as "Music Therapy," "Acoustic Stimulation," "Music," "Cognition," "Memory," "Attention," "Aged," and "Dementia." Studies that met the eligibility criteria were screened by title, abstract and full text. Quality of the studies were evaluated using critical appraisal tools and Cochrane "Risk of Bias" tool. RESULTS: A total of 211 articles were screened by title and abstract, but only 28 articles met the inclusion criteria and were full text screened. Of the 28 articles, only five studies were analyzed and synthesized as they focused specifically on music therapy and cognition. Three of the studies showed that active and active-passive approaches of music therapy produce significant effect on cognition in older adults with dementia. The common characteristic was the participation of music therapists or music teachers who delivered the music therapy sessions that resulted in improved cognition. IMPLICATIONS FOR PRACTICE: As a safe, inexpensive intervention, it should be considered as a complementary therapy to positively impact cognition in older adults with different types of dementia and levels of severity.

Mild cognitive impairment: A concept analysis.

AIM: To clarify the concept of mild cognitive impairment (MCI) and identify its attributes to enhance understanding of its implications for nursing practice and research. BACKGROUND: MCI is a concept that has evolved, thus clarification of this concept is essential for the advancement of nursing science. DESIGN: Walker and Avant's eight steps of concept analysis strategy was used. DATA SOURCE: Manuals of mental disorders and databases such as PubMed, Springer, PsychINFO, Cumulative Index to Nursing and Allied Health Literature, and Education Resources Information Center (ERIC) from 1982 to 2018. REVIEW METHODS: A literature search was conducted using keywords such as "mild," "cognitive," "impairment," and "deterioration." RESULTS: The concept of MCI is defined as the transitional state between cognitive state normal for age and the early manifestation of dementia states. It is characterized by the presence of objective and subjective evidence of impairment in one or multiple cognitive domains, independence in daily activities, can be reversible, and is a risk factor for dementia. CONCLUSIONS: Clarification of MCI serves as a framework for identification, treatment, and interventions that may support healthy aging in older adults.

Midcareer Faculty Needs Identified by the Midwest Nursing Research Society Midcareer Scholars Task Force.

The midcareer academic period is largely unexplored despite its lengthy duration and challenging career expectations at academic institutions. The Midwest Nursing Research Society (MNRS) formed a Midcareer Scholars Task Force to address this gap. All active members of MNRS were invited to participate in a cross-sectional survey, of which 286 members completed. The most frequently perceived institutional support for midcareer scholars was for conference attendance followed by librarian assistance. Most assistant and associate professors perceived mentoring as a critical MNRS organizational activity to advance their research and careers; however, full professors saw MNRS's responsibility in mentoring midcareer scholars differently. Existing academic institutions were perceived as limited in their support and success in midcareer scholar mentorship efforts. There are considerable needs for midcareer scholar support and mentoring, and professional organizations can play an important role to fill this gap. Targeted mentoring and professional development initiatives are needed to better support midcareer faculty.

Concept Analysis: Music Therapy.

Down through the ages, music has been universally valued for its therapeutic properties based on the psychological and physiological responses in humans. However, the underlying mechanisms of the psychological and physiological responses to music have been poorly identified and defined. Without clarification, a concept can be misused, thereby diminishing its importance for application to nursing research and practice. The purpose of this article was for the clarification of the concept of music therapy based on Walker and Avant's concept analysis strategy. A review of recent nursing and health-related literature covering the years 2007-2014 was performed on the concepts of music, music therapy, preferred music, and individualized music. As a result of the search, the attributes, antecedents, and consequences of music therapy were identified, defined, and used to develop a conceptual model of music therapy. The conceptual model of music therapy provides direction for developing music interventions for nursing research and practice to be tested in various settings to improve various patient outcomes. Based on Walker and Avant's concept analysis strategy, model and contrary cases are included. Implications for future nursing research and practice to use the psychological and physiological responses to music therapy are discussed.

Psychometric Evaluation of the Physical Activity Enjoyment Scale in Adults with Functional Limitations.

Enjoyment is an important construct for understanding physical activity participation, and it has not been examined in adults with functional limitations. This secondary analysis reported the reliability and validity of the Physical Activity Enjoyment Scale (PACES) in a convenience sample of 40 adults with functional limitations. The participants completed the PACES, Center for Epidemiological Studies Depression Scale (CES-D), and the Late Life Function and Disability Instrument (LLFDI) prior to beginning a 12-week feasibility dance intervention study. Results indicated reliability as Cronbach's alpha was .95 and mean inter-item correlation was .52. To further support reliability, homogeneity of the instrument was evaluated using item-to-total scale correlations. Homogeneity was supported as all items had corrected item-to-total correlations greater than .30. For validity, the PACES was significantly related to only the Physical Function component of the LLFDI (r = .38, p = .02), but not the CES-D. Exploratory factor analysis revealed a 3-factor structure that accounted for 73.76% of the variance. This feasibility intervention dance study represented the first attempt to examine the psychometric properties of the PACES in adults with functional limitations. The findings demonstrate support for the scale's reliability and validity among adults with functional limitations. Results are informative as further psychometric testing of the PACES is recommended using randomized clinical trials with larger sample sizes. Enjoyment for physical activity is an important construct for understanding physical activity participation in adults with functional limitations.

Depression, Social Isolation, and the Lived Experience of Dancing in Disadvantaged Adults.

This qualitative study described the lived experience of dancing as it related to depression and social isolation in 16 disadvantaged adults who completed a 12-week dance intervention. It is the first qualitative study to explore the experience of dance as an adjunct therapy, depression, and social isolation. A descriptive phenomenological framework consisted of two focus groups using semi-structured interviews. A Giorgian approach guided thematic analysis. Four themes emerged: (1) dance for myself and health, (2) social acceptance, (3) connection with others: a group, and (4) not wanting to stop: unexpected benefits from dancing. As the participants continued to dance, they developed a sense of belonging and group identity, which may have maintained group involvement and contributed to reducing depression and social isolation. Thus, dancing is a complementary therapy that should be considered when working with adults with depression and social isolation.

Effects of dance on upper extremity activities in underserved adults.

PURPOSE: This secondary analysis examined the immediate and maintaining effects of a 12-week line-dancing intervention on upper and lower extremity activities in underserved adults who receive care from a nurse-managed clinic (NMC). DATA SOURCES: This one-group, repeated measures, feasibility study consisted of 40 participants recruited from an urban apartment complex that housed a NMC. Of the 40 participants, 21 participants completed the 12-week line-dancing intervention. Physical function of the upper and lower extremities was measured with the Late Life Function and Disability Instrument at baseline, 12, and 18 weeks to determine the maintaining effects. CONCLUSIONS: Age ranged from 45 to 87 years (M = 63; SD = 7.8), body mass index (BMI) was 33.4 (SD = 7.8), 92% were female, and 75% were African American. At baseline, participants showed limitations in all aspects of physical function. Significant improvements in upper and lower extremity activities were noted at 12 weeks and maintained at 18 weeks. IMPLICATIONS FOR PRACTICE: Although line-dancing mainly involves the lower body, there were significant improvements in upper extremity activities at 12 weeks, which were maintained at 18 weeks. The maintaining effects support line-dancing as an intervention to improve upper and lower extremity activities needed for independent living. NMCs are important settings for health promotion interventions in underserved adults.

Effects of dance on depression, physical function, and disability in underserved adults.

This study documented the feasibility and immediate effects of a dance intervention two times per week for 12 weeks on depression, physical function, and disability in older, underserved adults. The one-group, pretest-posttest study had a convenience sample of 40 participants recruited from a federally subsidized apartment complex located in an economically depressed, inner-city neighborhood. Depression, physical function, and disability were measured at baseline and 12 weeks. Average age was 63 years (SD = 7.9), 92% were female, and 75% were African American. At baseline, participants reported increased depression (M = 20.0, SD = 12.4), decreased physical function (M = 56.6, SD = 10.9), and increased disability limitations (M = 65.7, SD = 14.9). At posttest, paired t tests showed that the dance intervention significantly decreased depression, t = 6.11, p < .001, and disability, t = -2.70, p = .014, and significantly increased physical function, t = -2.74, p = .013. The results indicate that the 12-week dance intervention may be an effective adjunct therapy to improve depression, disability, and physical function in underserved adults.

Psychometric evaluations of the efficacy expectations and Outcome Expectations for Exercise Scales in African American women.

This secondary analysis tested the reliability and validity of the Self-Efficacy for Exercise (SEE) and the Outcome Expectations for Exercise (OEE) scales in 126 community dwelling, middle aged African American women. Social Cognitive Theory postulates self-efficacy is behavior age, gender and culture specific. Therefore, it is important to determine ifself-efficacy scales developed and tested in older Caucasian female adults are reliable and valid in middle aged, minority women. Cronbach's alpha and construct validity using hypothesis testing and confirmatory factor analysis supported the reliability and validity of the SEE and OEE scales in community dwelling, middle aged African American women.

A mindful eating group intervention for obese women: a mixed methods feasibility study.

The purpose of this mixed methods study was to: 1) describe the effect of an 8-week mindful eating intervention on mindful eating, weight loss self-efficacy, depression, and biomarkers of weight in urban, underserved, obese women; and 2) identify themes of the lived experience of mindful eating. A convenience sample of 12 obese women was recruited with data collected at baseline and 8 weeks followed by a focus group. Only self-efficacy for weight loss significantly increased over 8 weeks (t=-2.63, P=.04). Qualitative findings of mindful eating supported quantitative findings and extended understanding about the effect of the intervention.

Dietary challenges of managing type 2 diabetes in African-American women.

The purpose of this qualitative study was to explore the challenge of self-management of diet in African-American women living with type 2 diabetes. Specifically, the women were asked to talk about dietary challenges of managing diabetes in the context of their personal lifestyle factors, such as daily routines, family responsibilities, and individual needs. Using a phenomenological approach, a descriptive, exploratory design was implemented using four facilitated focus groups. A convenience sample of 24 African-American women was recruited from a family practice center in the midwest. Data from each of the four focus groups were audiotaped and transcribed verbatim. Themes were compared and contrasted within and across each of the four focus groups until consensus was reached. Four themes were identified: frequent difficulties in changing dietary habits, need for individual guidance, support, and misinformation gaps. Overall, the participants expressed the need for more attention to the personal lifestyle factors they viewed as obstacles to managing diabetes.

Body mass index and injury severity in adolescent males.

Childhood obesity's relationship to injury severity has not been determined. This study examined the relationship between obesity and injury severity, differences in injury severity between weight groups, and injury predictors. The sample included 611 adolescent males treated for injury at a 10-day camping event in Virginia. Findings indicate a significant relationship between body mass index percentile and injury severity (r = .08, p = .04) and less injury severity in normal-weight adolescents, F(2, 608) = 5.27, p < .01. Predictors of injury severity were cause, place injury occurred and injury type, R(2) change = .07, F(5, 601) = 6.52, p < .01. Implications are that overweight/obese adolescents may have increased risk of serious injuries. Examining predictors may decrease incidence of injuries at future events.

Late life function and disability instrument in African American women: function component.

Obesity, age, and comorbidity can lead to limitations in physical function, especially in middle aged, community-dwelling, African American women. To determine the clinical implications of limitations in physical function, instruments that assess physical function need to be tested in this population. The purpose of the authors in this secondary analysis was to report the internal consistency and validity of the Physical Function component of the Late Life Function and Disability Instrument in middle-aged, community-dwelling, African American women. In 2006, 126 community-dwelling African American women completed the Physical Function component, the Physical Activity Scale for the Elderly, and the 6 Minute Walk Test at baseline. Results indicated Cronbach's alphas were excellent (all >.92) for the Physical Function component and the three subscales. The Physical Function component correlated directly with the Physical Activity Scale for the Elderly (r = .37, p < .01) and the 6 Minute Walk Test (r = .36, p < .01) but was inversely correlated with age (r = -.42, p < .01) and comorbidity (r = -.35, p < .01). However, obesity was not correlated (r = -.11, p > .05). A three-factor structure of the Physical Function component was confirmed. Thus, the Physical Function component was a reliable and valid measure to screen African American women who were at risk for function limitations. Future recommendations are discussed.

Culturally specific dance to reduce obesity in African American women.

This article provides evidence of a culturally specific dance intervention to decrease obesity as measured by body fat and body mass index (BMI) in African American women. A community partnership was formed with two African American churches to develop an intervention to address the issue of obesity. The culturally specific dance intervention was delivered two times per week for 8 weeks, choreographed to gospel music selected by the experimental group participants, and taught by an African American woman. Body fat and BMI were assessed at three time points and revealed significant differences between the two groups. Attending a minimum of 7 classes was enough to show an observed dose effect and the intervention was found to be culturally specific by understanding their roles as African American women. This community partnership was an effective way to promote a church-based, culturally specific dance intervention to improve the health of African American women.

Dance and peer support to improve diabetes outcomes in African American women.

PURPOSE: The purpose of this pilot study was to test a dance intervention and explore the role of peer support to improve the diabetes outcomes of A1C, weight, body fat, and blood pressure in African American women with type 2 diabetes. METHODS: This study was conducted in a community-based outpatient clinic. A mixed methods design was used. A total of 46 women, 26 to 83 years of age, were randomized to either the 12-week dance group or usual care group. Both between group and intraindividual group differences were analyzed from baseline to 12 weeks. Focus group interviews explored the role of peer support through semistructured discussions for the women enrolled in the dance group. RESULTS: Results showed significant group mean differences in systolic blood pressure (BP) and body fat. Paired t tests showed significant reductions in all the diabetes outcomes for the dance group and significant increases in glycolated hemoglobin (A1C) and systolic BP for the usual care group. The emergent themes of the focus groups were that a diabetes diagnosis was devastating, and changing eating habits and taking medications was often difficult. Peer support in the dance group was expressed as camaraderie, enjoyment, and laughter, which fostered attendance. CONCLUSIONS: Dancing 2 times per week for 12 weeks produced significant group differences in systolic BP and body fat and significant intraindividual changes. The implications are that dancing in a supportive environment with peers may be an effective strategy for diabetes educators to help those with diabetes to become more physically active and improve diabetes outcomes and overall health.

The theory of music, mood and movement to improve health outcomes.

AIM: This paper presents a discussion of the development of a middle-range nursing theory of the effects of music on physical activity and improved health outcomes. BACKGROUND: Due to the high rate of physical inactivity and the associated negative health outcomes worldwide, nurses need new evidence-based theories and interventions to increase physical activity. DATA SOURCES: The theory of music, mood and movement (MMM) was developed from physical activity guidelines and music theory using the principles of statement and theory synthesis. The concepts of music, physical activity and health outcomes were searched using the CINAHL, MEDLINE, ProQuest Nursing and Allied Health Source, PsycINFO and Cochrane Library databases covering the years 1975-2008. DISCUSSION: The theory of MMM was synthesized by combining the psychological and physiological responses of music to increase physical activity and improve health outcomes. It proposes that music alters mood, is a cue for movement, and makes physical activity more enjoyable leading to improved health outcomes of weight, blood pressure, blood sugar and cardiovascular risk factor management, and improved quality of life. CONCLUSION: As it was developed from the physical activity guidelines, the middle-range theory is prescriptive, produces testable hypotheses, and can guide nursing research and practice. The middle-range theory needs to be tested to determine its usefulness for nurses to develop physical activity programmes to improve health outcomes across various cultures.

Self-efficacy and social support as mediators between culturally specific dance and lifestyle physical activity.

Culturally specific dance has the potential to generate health benefits but is seldom used even among studies advocating culturally specific interventions. This study examined the components of self-efficacy and social support as mediators between culturally specific dance and lifestyle physical activity in African American women (N = 126). An experimental design compared intervention and control groups for mediating effects of self-efficacy and social support on lifestyle physical activity. Findings indicated that only outcome expectations and social support from friends mediated effects. Culturally specific dance is a first step in encouraging African American women to become more physically active and improve health outcomes. The implications are that culturally specific dance programs can improve health outcomes by including members of underserved populations.

A culturally-specific dance intervention to increase functional capacity in African American women.

This study examined a culturally-specific dance intervention on functional capacity in African American women at three time points. The intervention was two times per week for 8 weeks using two African American churches randomly assigned to either the experimental or comparison group, had 126 participants, ages 36-82 years. Analysis of covariance revealed that both groups improved over time and the only significant difference between groups was at 18 weeks. The increase at 18 weeks in the experimental group remained when controlling for baseline covariates. This study supported culturally-specific dance as an intervention to improve functional capacity in African American women.