Complementary Therapies in Medicine (2009) 17, 190—195

available at www.sciencedirect.com

journal homepage: www.elsevierhealth.com/journals/ctim

Perceptions of group music therapy among elderly

nursing home residents in Taiwan
Shu-Ling Chen a,∗, Hui-Chuan Lin a, Sui-Whi Jane b

a
Department of Nursing, Hung Kuang University, Taiwan
b
Department of Nursing, Chang Gung Institute of Technology, Taiwan
Available online 29 April 2009

KEYWORDS Summary
Elderly; Objective: To explore the perceptions of group music therapy among elderly nursing home
Perceptions; residents in Taiwan.
Nursing home; Methods: Focus group methodology was used to explore the perceptions of elderly participants
Group music therapy; about their experience of group music therapy. Verbatim transcripts of audiotaped interviews
Focus groups were analysed by content analysis.
Results: In total, 3 focus groups were held with 17 wheelchair-bound elderly residents. Analysis
of participants’ perceptions of group music therapy revealed two major themes: (1) strength
derived from the group dynamic and (2) enhanced quality of life. The first theme included three
subthemes: (1) sense of energy, (2) distraction from suffering, and (3) confirmation as a person.
The second major theme included four subthemes: (1) variety added to life, (2) motivation to
exercise, (3) learning positive behaviour, and (4) greater life satisfaction.
Conclusion: Elderly, wheelchair-bound residents of a nursing home in Taiwan positively viewed
their experiences with our group music therapy programme, particularly its active component.
The findings of this study suggest that healthcare providers should consider integrating group
music therapy into their programmes for elderly nursing home residents and design the therapy
to add variety to their life, give them a sense of autonomy by having them choose their preferred
musical activities, and improve their cognitive function.
© 2009 Elsevier Ltd. All rights reserved.

Introduction
Aging populations are a global phenomenon, which is much
more pronounced in developed countries. In Taiwan, the
population ≥ 65 years old grew from 1,490,804 (7.1%) in 1993
to 2,287,029 people in 2006.1 In the past, Taiwanese adult
children cared for their elderly parents, but social and cul-
∗ Corresponding author. Tel.: +886 4 26318652x3005;
fax: +886 4 26331198.
E-mail address: slchen@sunrise.hk.edu.tw (S.-L. Chen).
tural changes have led to a shift in focus from the traditional
extended family to the nuclear family.2 In addition, couples
have fewer children and more women are entering the labor
force, resulting in fewer family caregivers available to pro-
vide direct care for elderly family members.2 Furthermore,
70% of Taiwanese elders suffer from one or more chronic ill-
nesses, which are a major cause of disability.3 This increase
in the number of chronically ill and disabled elders has
increased the demand for institutionalised long-term elder
care in Taiwan.4
Elderly persons who are relocated to an institutional liv-
ing environment may experience distress, social isolation,

0965-2299/$ — see front matter © 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ctim.2009.03.002
Perceptions of group music therapy among elderly nursing home residents in Taiwan
sadness and profound hopelessness, resulting in an over-
all decline in physical and psychological functioning.5,6 To
improve the physical, psychosocial, cognitive, and spiritual
performance of elderly residents, healthcare providers at
nursing homes recognise the importance of implementing
activities such as music therapy.7—9 Most studies on the ther-
apeutic effects of music therapy have been quantitative,7—16
and only a few have been qualitative.17—19 Among the quali-
tative studies, only one examined the perspective of elderly
nursing home residents,17 but that study was published in
Chinese. Since many elderly Chinese people live in the west,
it is important for western clinicians to better understand
why music therapy works for elders and under what circum-
stances, thus facilitating implementation of this programme
in nursing home facilities. Therefore, the purpose of this
qualitative study was to examine the perceptions of group
music therapy among elderly residents of a nursing home in
Taiwan.
Characteristics and beliefs of elderly nursing home
residents
Elderly persons admitted to a nursing home are often
characterised by a deterioration in their physical and/or
mental health status. They have chronic health problems
accompanied by a gradually waning functional ability,20,21
physical disabilities, and lack of family support.22 Institu-
tionalised elders report feelings of being abandoned, of
feeling stressed by a lack of personal freedom and privacy,
restrictions placed on their movements, and loss of control
over many aspects of their life.21,23—25 As a result, many
regard residential care homes as the ultimate ‘‘dumping
place,’’ where they will ‘‘idle till death.’’2626(p605) They
often consider their situation as ‘‘living in jail.’’2121(p913)
Also, many institutionalised elders tend to isolate them-
selves due to disease-related deterioration.27
Therapeutic use of music
Since the 1940s, music has been used as a non-
pharmacologic intervention to change behaviour, emotions,
and physiology28,29 in the areas of pain management, demen-
tia, palliative care, and oncology.12,30 Music therapy has two
main branches: active and passive therapy.10,31 Active music
therapy requires that participants play musical instruments
or sing along with the therapist. In passive music ther-
apy, participants listen to live or recorded music.10,31 Music
provides sensory and intellectual stimulation that reduces
stress in the elderly, increases their pain tolerance, relaxes
them, and distracts them from their pain.7,32 Music therapy
improves older adults’ sleep quality33 ; decreases agitated
behaviour,8,9,34 aggressive behaviour,35 and depression13 in
patients with dementia.
Methods
Design
An exploratory qualitative design was used to gain a deeper
understanding of the perceptions of elderly nursing home
191
residents regarding their experience of group music ther-
apy. Focus group methodology was chosen because it permits
nurse clinicians to explore a specific phenomenon in small
groups of older adults36 and to capture their dynamic
interactions when they share commonality.37 Focus groups
also encourage a dynamic exchange among the partici-
pants, enabling them to react and build on the response
of others.38,39
Sample and setting
Participants in the focus groups (N = 17) were recruited
by purposive sampling from a 350-bed nursing home in
Changhua City, central Taiwan. The facility was for elders
confined to a wheelchair. Eligible participants were (1)
≥age 65 years, (2) had participated in group music ther-
apy at least 3 months, (3) scored ≥24 on the Mini-Mental
State Exam40 to ensure they could express their feelings
and perceptions about participating in group music ther-
apy, and (4) were willing to participate in a focus group
interview.
Among the 17 participants (11 females and 6 males) who
participated in 3 focus groups, 4 participated in 2 focus
group sessions, with the remainder participating only in one.
The participants’ mean age was 80.5 years (range = 70—90
years), and all had chronic illnesses. Nine participants
(52.9%) had not received any formal education, but were
able to speak and understand Mandarin. The remaining
47.1% had received primary education.
Group music therapy
The elderly participants received group music therapy for
1 h each week for 3 months, then once every 2 weeks
from May 2004 to May 2005. The group music therapy
was adapted from previously described procedures,10,11 and
included both active and passive musical activities. Each
session was subdivided into eight sections: initial phase,
warm up, dancing, group play with percussion instruments,
musical group play, listening to relaxing music, listening
to a musical performance by a guest performer, and the
concluding phase. For the initial phase, the facilitator (sec-
ond author, HCL) greeted each participant by name and
welcomed them to the activity. During the warm up, the
participants massaged each other’s hands or were assisted
by volunteers. The elderly then moved their upper bodies in
time to the music, which varied gradually from a slow to a
fast rhythm. While they ‘‘danced,’’ they shook small bells
and clicked castanets. Then the group played with percus-
sion instruments (e.g., drums, cymbals, or wood blocks),
followed by group-play without instruments (e.g., playing
ball, blowing bubbles, or story telling), and listened to relax-
ing music. In the final activity, participants listened to an
invited guest sing or play an instrument. In the concluding
phase, HLC expressed her appreciation to the participants
and shook hands with each one. After the music activities,
HCL also showed her respect for participants by asking about
their feelings, asking what songs they would prefer next
time, or suggesting that they hum a song if they did not
know the words.
192
Data collection
Before data were collected, permission was obtained from
the head administrator at the nursing home since Taiwanese
nursing homes do not have institutional review boards.
Elderly residents were fully informed about the study before
each focus group, assured of the confidentiality of their
data, and their oral consent was obtained. Permission was
requested to tape-record the session and take notes.
After 6 months of music therapy, focus groups were con-
ducted by SLC and HCL at the nursing home in the same
room used for the group music therapy. The focus groups
were guided by three questions: (1) Can you please tell me
about your feelings and thoughts when you attended this
group music activity? (2) Which aspect of the group music
activity influenced you the most? (3) What part of this group
music activity did you like best and why?
In total, three focus groups were held, each with six to
eight participants attending, and lasting for about 1 h. Focus
groups were held until no new information emerged from the
data analysis (data saturation).38
Data analysis
Verbatim transcripts of the audiotaped interviews were
analysed by two stages of inductive content analysis.41 In the
first stage, verbatim transcripts of the three focus groups
were independently coded by SLC and HCL. In the sec-
ond stage, the two researchers compared and discussed
their coding to reach consensus on coding, thus enhanc-
ing dependability of the analysis. The dependability of the
analysis was further enhanced by sharing the research find-
ings with participants, who confirmed that the findings
accurately reflected their experiences.42 Finally, the trust-
worthiness of the data was ensured by using focus groups,
which typically have high face validity due to the credibility
of participants’ comments.39,43
Results
Analysis of participants’ comments about their experiences
of group music therapy revealed two major themes: strength
derived from the group dynamic, and enhanced quality of
life. These major themes and subthemes are described in
detail below.
Strength derived from the group dynamic
This major theme refers to the positive aspects of engaging
in group musical activities. The music therapy programme
evoked a group dynamic that energised elders, helped dis-
tract them from their psychological distress and physical
discomfort, and confirmed their self-worth.
Sense of energy
During music therapy, the participants met residents from
different units and participating nursing students. When
involved in playing instruments together, the participants
felt a sense of energy from the group dynamic, making them
feel stronger and more alive. As one participant (A) said,
S.-L. Chen et al.
‘‘This group music activity makes me want to move because
the group has a powerful effect.’’ Similarly, participant (J)
said, ‘‘After I attended the group music activity, I felt happy
and energetic, especially with so many other people of my
age group, as well as volunteers and nursing students join-
ing in the activity.’’ Another participant (P) commented,
‘‘Because there were many other elderly people that joined
in this activity, I felt alive rather than sit around drowsing
all day long.’’
Distraction from suffering
While attending the group music programme, elderly resi-
dents gradually forgot their pains and discomforts, instead
focusing on the music activity. For example, one participant
(E) said, ‘‘Before this activity, I just waited for my 3 meals
each day. I suffered in my mind about not being able to
go home. When attending this group, I concentrate on the
activities and I forget how distressed I feel.’’ Another partic-
ipant (H) related, ‘‘I have had Parkinson’s disease for a very
long time, and I get tired from the tremors, they are very dis-
tressing. However, after attending this activity, I feel calm, I
forget the pain in my teeth, and I forget to be annoyed with
my tremors.’’
Confirmation as a person
The participants felt taken seriously when greeted by name
and welcomed to the activity. They felt respected as indi-
viduals. One participant (I) explained, ‘‘At the beginning of
the activity, you [researcher] greeted me and shook my hand
after the activity. That made me feel respected and a very
important member.’’
This sense of being respected as a person and an indi-
vidual gave them the feeling that participating in the group
music activity increased their autonomy. They often felt a
lack of personal control in the nursing home, but when they
attended the music activity, they could choose their pre-
ferred percussion instrument and sing old, familiar songs.
For example, one participant (C) said, ‘‘When I joined this
activity, I could choose the drum and play it at full force,
it felt so great.’’ Similarly, another participant (G) said, ‘‘I
felt such freedom to shake the tambourine and to sing aloud
in this group music activity.’’
Some of the participants asked for more information
about group music therapy and the music. For example, one
participant (O) said, ‘‘I would like to know more about the
history or background of each song, because it would expand
our knowledge.’’
Enhanced quality of life
This major theme describes the elderly nursing home res-
idents’ perception that participating in the group music
activities positively impacted their quality of life in several
ways. The programme added variety to their lifestyle, moti-
vated them to exercise, taught them positive behaviours,
and enhanced their life satisfaction.
Variety added to lifestyle
The residents often felt that the nursing home lifestyle was
rigid, with an inflexible schedule for meals, bedtime, and
rising. When they joined the group music therapy, they at
Perceptions of group music therapy among elderly nursing home residents in Taiwan
least experienced some variety in their life. As one partici-
pant (D) said, ‘‘The lifestyle in this nursing home is so routine
. . .eating, watching TV, and sleeping all day long. Every day
is so boring. When I joined this activity, my life became
more interesting.’’ Similarly, another participant (N) said,
‘‘Before this activity, during the daytime, no one would talk
to us or arrange any activity for us. I had no freedom to
act on my own in this nursing home and I could only sit on
the bed unless someone helped me into my wheelchair. My
daily life is extremely boring and totally meaningless. The
only thing I can do is waiting for each meal every day. Since
attending this group, my life has changed and I look forward
to it all week.’’
The elderly participants felt involved, they enjoyed the
group music therapy, and it left them with the memory of
the musical rhythm, which afterwards stimulated them to
exercise in the nursing home. For example, participant (L)
said, ‘‘Before, I waited for meal times and bed time each
day. Now when I get up in the morning, I have music in my
heart and begin to exercise by myself [taps his right hand
with the left hand].’’
Motivation to exercise
The participants perceived that their physical function had
improved since participating in the music activity. One par-
ticipant (A) said, ‘‘I have more strength in my hands and feet
than before. Now, I don’t depend on the bed handrail, and I
can get up quickly from bed [shows how he gets up quickly].
I am quite happy to learn many skills and I feel motivated
to exercise.’’
Most participants expressed that since attending the
music therapy, they actively used skills they had learned to
compensate for their impaired health. For example, par-
ticipant (M) said, ‘‘Through this activity, I learned how
to massage myself and tap my body to avoid deteri-
orating health.’’ Likewise, another participant (B) said,
‘‘Sometimes, even when you [the researcher] didn’t come,
I still had a musical rhythm in my heart and I exercised by
myself [demonstrates by lifting his paralyzed left hand with
his right hand].’’
Learning positive behaviour
The majority of participants felt that the group music activ-
ities helped them to control their emotions better. For
example, participant (G) said, ‘‘By watching and listen-
ing to others in this activity, I learned how to help and
care for others [in the nursing home], and I’m more open-
minded.’’ Another participant (K) observed, ‘‘I feel that
some of the people have better habits since they joined this
activity. They follow group regulations and don’t grab the TV
remote controller.’’ Similarly, participant (Q) said, ‘‘Before
the music therapy activity, we had little respect for each
other. We always argued with each other. After attending
these music activities, we are more prepared to wait for
each other and show more respect to each other.’’
Greater life satisfaction
Participants felt that their suffering was somewhat eased
and derived more satisfaction from life. Their mood changed
from negative (e.g., death wishes) to more positive, and
they felt encouraged to face their future.
193
For example, participant (F) said,
‘‘In the beginning I often wanted to die, because I did not
want to be a burden to my family. But, when I attended
the group music activity I wanted to live my life as good
as I could, and exercise my body and take care of myself.
Thus, I changed my mind and decide to persevere with
my life.’’
Another participant (O) said,
‘‘I was afraid of my deteriorating health. My bones used
to ache and I did not know what to do about it, and
when I got up in the morning, both my hands and feet
were so cold. But now, after joining this activity, I know
how to make my body warm, and the music activities
make me feel cheerful and relaxed, and now I have more
confidence to face the future and live.’’
Discussion
This study found that 6 months after elderly residents of
a nursing home in Taiwan participated in a programme
of group music therapy, they perceived that they derived
strength from the group dynamic and their quality of life was
enhanced. The findings suggest that such a programme could
be used in residential care homes to counter the beliefs of
elders that these homes are the ultimate ‘‘dumping place’’
where they ‘‘idle till death.’’26
The elderly participants perceived that these music
activities improved their physical function and made it eas-
ier for them to look after their own health. This finding is
consistent with Guzzetta’s assertion29 that music therapy
encourages clients to become active participants in their
own health care. The move to a nursing home is often accom-
panied by major changes in an elderly person’s health.5,6 The
elderly participants described their mood as having changed
from mostly depressed to happy and cheerful. These findings
are similar to those of other studies conducted in Taiwan
using music therapy to improve activity and psychological
status of elderly nursing home residents.15—17 Unlike those
studies, however, our study used a qualitative approach to
data collection and included both active and passive music
activities. These methods allowed us to understand partici-
pants’ perspectives and to engage them more actively in the
music therapy.
Through group music therapy, the elderly participants
were gradually distracted from their suffering. This find-
ing is similar to a previous report7 that older people with
osteoarthitis pain who listened to music had reduced stress
levels and increased pain tolerance, simply by being dis-
tracted from their pain. In addition, 10 of the 17 elderly
residents in our study perceived improvements in their
depression, anxiety, and agitated behaviour. This finding
is consistent with previous reports that music therapy
decreased stress and irritable behaviour in the elderly.9,44
The elderly participants were also able to draw strength
from the group dynamic. The synergistic effects of the
music and seeing other wheelchair-bound elders moving
their upper limbs to the music and acting cheerfully moti-
vated everybody in the room. This dynamic helped them to
learn positive behaviours. Moreover, the participants greatly
increased their interactions with other residents. This find-
194
ing is consistent with a previous report that dynamic music
therapy promotes socialization.10 Thus, music therapy can
be used to improve the physical, mental, and social func-
tions of elderly nursing home residents.
In addition, the participants confirmed that they felt
truly respected and confirmed as individuals when the
researcher greeted them and shook their hands. This find-
ing is consistent with a previous finding that older adults
were more satisfied with providers who treated them as
individuals.45 Our study participants enjoyed the autonomy
of choosing their own instruments and playing the instru-
ments as forcefully as they wanted. This aspect may have
released some of the negative emotions they possibly har-
boured for having to live in a nursing home. This idea is
consistent with the proposition that music and movement
will help the elderly become aware of their bodies, release
any negative energy, and help them achieve a proper body-
mind balance.29
Our study also found that the participants experienced
more satisfaction from life, which enhanced their quality
of life. This finding has not been mentioned in previous
studies.8—11,34,44 The reactions of the elderly in our study
may be due to the qualitative approach and active form
of music therapy we chose (dynamic music activity for an
entire year). Participants in our study learned/refined musi-
cal skills and were encouraged to move their bodies in time
to the music, which made exercising less burdensome and
improved both their health and their overall mood. Since the
participants were not only older residents of a nursing home,
but were also confined to wheelchairs by illness, providing
physical activity and variety to their life was a challenge.
This activity and variety were provided by our group music
programme, thus enhancing their quality of life. Therefore,
our study results offer a unique way to enhance quality of
life for this population.
Conclusion
Our findings illustrate that elderly wheelchair-bound res-
idents of a nursing home in Taiwan positively perceived
their experience of our group music therapy, particularly
the active component of the programme. The positive expe-
riences of this programme brought them increased joy and
improved both their perceived health and quality of life.
Our findings suggest that healthcare providers should con-
sider integrating group music therapy into the routine of life
in nursing homes. The findings of this study also add to the
body of knowledge about the positive effects of music ther-
apy in both gerontological nursing education and in clinical
practice.
References
1. Ministry of Interior. Social welfare report. Available at:
http://www.moi.gov.tw/stat/index.asp; 2006 [accessed May
16, 2007].
2. Chao SY, Roth P. Dimensions of quality in long-term care facili-
ties in Taiwan. J Adv Nurs 2005;52(6):609—19.
3. Wu SZ, Chiou CJ. The exploration of related factors of nurs-
ing care problems in home health care patients. J Nurs Res
1997;5:279—89.
S.-L. Chen et al.
4. Department of Health, Executive Yuan. Available at: http://
www.doh.gov.tw/EN2006/index EN.aspx; 2005 [accessed May
02, 2007].
5. Chapin R, Dobbs-Kepper D. Aging in place in assisted living:
philosophy versus policy. Gerontologist 2001;41:43—50.
6. Chenitz WC. Entry into a nursing home as status passage: a
theory to guide nursing practice. Geriatr Nurs 1983;4:92—7.
7. McCaffrey R, Freeman E. Effect of music on chronic osteoarthri-
tis pain in older people. J Adv Nurs 2003;44:517—24.
8. Sung HC, Chang SM, Lee WL, Lee MS. The effects of group music
with movement intervention on agitated behaviours of institu-
tionalized elders with dementia in Taiwan. Complement Ther
Med 2006;14:113—9.
9. Suzuki M, Kanamori M, Watanabe M, Nagasawa S, Kojima E,
Ooshiro H, et al. Behavioral and endocrinological evaluation of
music therapy for elderly patients with dementia. Nurs Health
Sci 2004;6:11—8.
10. Pacchetti C, Mancini F, Aglieri R, Fundarò C, Martignoni E, Nappi
G. Active music therapy in Parkinson’s disease: an integra-
tive method for motor and emotional rehabilitation. Psychosom
Med 2000;62:386—93.
11. Hayashi N, Tanabe Y, Nakagawa S, Noguchi M, Iwata C, Koubuchi
Y, et al. Effects of group musical therapy on inpatients with
chronic psychoses: a controlled study. Psychiatry Clin Neurosci
2002;56:187—93.
12. Lou MF. The use of music to decrease agitated behaviour of the
demented elderly: the state of the science. Scand J Caring Sci
2001;15:165—73.
13. Hanser SB, Thompson LW. Effects of a music therapy strategy
on depressed older adults. J Gerontol 1994;49:265—9.
14. Hirokawa E. Effects of music listening and relaxation instruc-
tions on arousal changes and the working memory task in older
adults. J Music Ther 2004;41(2):107—27.
15. Huang YC. Physiological and psychological effects of music
therapy among nursing home residents. Fu-Jen J Med
2003;11:47—57 [in Mandarin].
16. Song MY. The improvement of activity in nursing home: music
therapy and others. J Long-Term Care 2003;7:205—16 (in Man-
darin).
17. Lin HC, Chen SL. Using focus groups to explore the group music
therapy experience of long-term care elderly. Hu Li Za Zhi
2007;54(2):38—46 [in Mandarin].
18. O’Callaghan C, Hiscock R. Interpretive subgroup analysis
extends modified grounded theory research findings in onco-
logic music therapy. J Music Ther 2007;44(3):256—81.
19. Whitehead-Pleaux AM, Zebrowski N, Baryza MJ, Sheridan RL.
Exploring the effects of music therapy on pediatric pain: phase
1. J Music Ther 2007;44(3):217—41.
20. Johnson RA, Schwiebert VB, Rosenmann PA. Factors influencing
nursing home placement decisions: the older adult’s perspec-
tive. Clin Nurs Res 1994;3:269—81.
21. Tse MM. Nursing home placement: perspectives of community-
dwelling older persons. J Clin Nurs 2007;16:911—7.
22. Kwok T, Luk JKH, Lau E, Woo J. Attitudes of old people
towards old age homes in Hong Kong. Arch Gerontol Geriatr
1998;27:89—96.
23. Iwasiw C, Goldenberg D, MacMaster E, McCutcheon S, Bol N.
Residents’ perspectives of their first 2 weeks in a long-term
care facility. J Clin Nurs 1996;5:381—8.
24. Schopp A, Leino-Kilpi H, Välimäki M, Dassen T, Gasull M,
Lemonidou C, et al. Perceptions of privacy in the care of elderly
people in five European countries. Nurs Ethics 2003;10:39—47.
25. Wilson SA. The transition to nursing home life: a com-
parison of planned and unplanned admissions. J Adv Nurs
1997;26:864—71.
26. Lee DTF. Residential care placement: perceptions among
elderly Chinese people in Hong Kong. J Adv Nurs
1997;26:602—7.
Perceptions of group music therapy among elderly nursing home residents in Taiwan
27. Zelazny CM. Therapeutic instrumental music playing in hand
rehabilitation for older adults with osteoarthritis: four case
studies. J Music Ther 2001;38:97—113.
28. Kramer MK. A trio to treasure: the elderly, the nurse, and
music. Geriatr Nurs 2001;22:191—5.
29. Guzzetta CE. Music therapy: hearing the melody of the soul.
In: Dossey BM, Keegan L, Guzzetta CE, Kolkmeier LG, editors.
Holistic nursing: a handbook for practice. 2nd ed. Gaithers-
burg, MD: Aspen Publishers; 1995. p. 669—98.
30. Sung HC, Chang AM. Use of preferred music to decrease agi-
tated behaviours in older people with dementia: a review of
the literature. J Clin Nurs 2005;14:1133—40.
31. Aldridge D. An overview of music therapy research. Comple-
ment Ther Med 1994;2:204—16.
32. American Music Therapy Association. Available at:
http://www.musictherapy.org/faqs.html; 2005 [accessed
May 15, 2007].
33. Lai HL, Good M. Music improves sleep quality in older adults. J
Adv Nurs 2005;49:234—44.
34. Remington R. Calming music therapy and hand massage with
agitated elderly. Nurs Res 2002;51:317—23.
35. Clark ME, Lipe AW, Bilbrey M. Use of music to decrease aggres-
sive behaviors in people with dementia. J Gerontol Nurs
1998;24:10—7.
36. Gray-Vickrey P. Gerontological research: use and application of
focus groups. J Gerontol Nurs 1993;19(5):21—7.
195
37. Loeb S, Penrod J, Hupcey J. Focus groups and older
adults: tactics for success. J Gerontol Nurs 2006;32(3):
32—8.
38. Brown JB. The use of focus groups in clinical research. In: Crab-
tree BF, Miller WL, editors. Doing qualitative research. 2nd ed.
Thousand Oaks, CA: Sage; 1999. p. 109—24.
39. Krueger RA. Focus groups: a practical guide for applied
research. 2nd ed. Thousand Oaks, CA: Sage; 1994.
40. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-Mental State’’. A
practical method for grading the cognitive state of patients for
the clinician. J Psychiatr Res 1975;12(3):189—98.
41. Morse JM, Field PA. Qualitative research methods for health
professionals. 2nd ed. Thousand Oaks, CA: Sage; 1995.
42. Lincoln YS, Guba EG. Naturalistic inquiry. Beverly Hills, CA:
Sage; 1985.
43. Nyamathi A, Shuler P. Focus group interviews: a research
technique for informed practice. J Adv Nurs 1990;15(11):
1281—8.
44. Gerdner LA. Effects of individualized versus ‘‘relaxation’’
music on the frequency of agitation in elderly persons with
Alzheimer’s disease and related disorders. Int Psychogeriatr
2000;12:49—65.
45. Hupcey JE, Clark MB, Hutcheson CR, Thompson VL. Expecta-
tions for care: older adults’ satisfaction with and trust in health
care providers. J Gerontol Nurs 2004;30:37—45.