A large-scale multi-centre randomised controlled trial examined whether listening to slow-tempo music could reduce the duration or severity of delirium and coma among critically ill older adults admitted to intensive care units (ICUs). The study included patients aged fifty years and older and compared the effects of twice-daily sessions of slow-tempo music—played at sixty to eighty beats per minute—with a silence-track control. Results showed that the music intervention did not significantly shorten the length of delirium or coma, nor did it reduce delirium severity, anxiety, or pain levels. Despite its calming qualities, the prescribed slow-tempo music failed to produce measurable clinical improvements when compared with silence, challenging assumptions about the direct therapeutic effects of music in critical care settings.
Although the primary outcomes were neutral, secondary findings revealed an interesting trend. Patients who received at least seven doses of the slow-tempo music appeared to experience fewer days of delirium or coma, suggesting a possible cumulative or dose-related effect. Moreover, among patients who had been administered benzodiazepines—a class of sedatives known to increase delirium risk—there was also a trend toward fewer days spent in delirium or coma when exposed to the music intervention. These observations, while not statistically definitive, highlight potential interactions between sedative medications and non-pharmacological interventions such as music therapy. The findings invite further exploration of how auditory stimulation might serve as an adjunctive therapy, particularly for vulnerable populations of older adults requiring mechanical ventilation or prolonged ICU stays.
Delirium, a common and serious complication in hospitalised older adults, manifests as acute confusion, disorientation, and fluctuating levels of consciousness. It carries both immediate and long-term consequences, including increased mortality, prolonged hospitalisation, and a heightened risk of post-ICU cognitive decline or dementia. Estimates suggest that up to seventy-five per cent of older adults in the ICU experience delirium at some point during their admission. This alarming statistic underscores the urgency of identifying effective, low-risk interventions to mitigate delirium’s impact. While pharmacological treatments have shown limited efficacy and often carry side effects, music therapy represents a promising, non-invasive alternative that could be integrated into routine care if its benefits are confirmed through further research.
The Decreasing Delirium through Music in Critically Ill Older Adults (DDM) Trial was carried out across several prominent institutions, including hospitals affiliated with the Indiana University School of Medicine—such as Indiana University Health and the Sidney and Lois Eskenazi Hospital in Indianapolis—as well as the Mayo Clinic in Rochester, Minnesota. The research team brought together experts from Indiana University, the Mayo Clinic, the Regenstrief Institute, Anglia Ruskin University, and Area 10 Labs. This collaborative effort ensured rigorous trial design and methodological precision, making it one of the most comprehensive studies to date examining the effects of music in critical care. The two-arm trial used concealed outcome assessments and standardised delivery of both music and control conditions. Sessions were administered twice daily for up to seven days using computer tablets and over-the-ear noise-cancelling headphones, ensuring consistency and minimising environmental interference.
The DDM Trial also demonstrated the feasibility of a centralised, app-based system for delivering music interventions in the demanding ICU environment. By leveraging digital technology, the research team could standardise the ‘dose’ of music across multiple sites, track adherence, and maintain data integrity. Such infrastructure has broader implications for the future of personalised digital therapeutics in healthcare. The study, entitled “Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation: A Randomised Controlled Trial,” was published in JAMA Internal Medicine, a journal of the American Medical Association. Despite the lack of significant outcome changes, the research contributes valuable insights by delineating the limits of standardised, non-personalised music interventions and highlighting the need for more individualised approaches.
Co-lead author Dr Babar Khan emphasised that while the idea of calming music in the ICU is intuitively appealing, empirical evidence must guide practice. He noted that the trial’s findings refine current understanding, suggesting that future research should prioritise personalised, therapist-guided approaches rather than standardised playlists. Dr Linda L. Chlan of the Mayo Clinic, another co-lead investigator, echoed this sentiment, highlighting that music’s therapeutic potential depends on personal meaning and patient preference. She pointed out that a prescribed set of songs may lack emotional relevance for individual patients, thereby diminishing its effectiveness. Dr Sikandar Khan, also a co-lead author, added that the study successfully demonstrated the practicality of tracking the “dose” of music through app-based delivery. He further remarked that exploratory analyses revealed promising trends among patients who remained in the ICU long enough to receive seven days of intervention, particularly those who had received benzodiazepines. This observation opens new avenues for investigating how sedation levels and personalised auditory stimuli may interact to affect brain function and recovery trajectories in critically ill older adults.
More information: Babar Khan et al, Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation, JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2025.5263
Journal information: JAMA Internal Medicine Provided by Regenstrief Institute
