Abstract
Objectives: Music offers a promising nonpharmacological alternative for managing agitation in people with Alzheimer's disease and other dementias (ADRD). We report resident and nursing home (NH) characteristics associated with uptake of a personalized music intervention. Design: Post hoc analysis of a cluster-randomized embedded pragmatic clinical trial (ePCT) involving delivering resident-preferred music to manage agitated behaviors. Setting and Participants: A total of 463 residents with ADRD in 27 NHs randomized to receive the intervention. Methods: We obtained resident and NH characteristics from Minimum Data Set and Long-Term Care FocUS data. In addition, we created a study-specific engagement measure, which describes the proportion of enrolled residents in a given NH with any nursing staff use of the intervention. We used hierarchical models to estimate associations between resident and NH characteristics and (1) any exposure to the personalized music intervention and (2) minutes of music received per study day. Results: This post hoc analysis included 463 residents from 27 NHs (mean age: 80 years (standard deviation, SD: 12.2), 68.5% female, and 25.3% Black or African American). Resident characteristics associated with a greater likelihood of any exposure to the music included being Black or African American (p=0.02). NH characteristics were associated with greater likelihood of any exposure included higher quality star ratings (p=0.01) and nursing staff engagement with the intervention (p=0.01). Among those exposed to the music, younger residents (p=0.02), Black residents (p=0.03), and those with less health instability (p=0.03) received greater doses. Residents living in NHs with high nursing staff engagement also received higher doses (p ≤ 0.001). Conclusions and Implications: Black race was associated with a greater probability of exposure and more use of a personalized music intervention, after controlling for NH quality. Nursing staff engagement with a personalized music intervention increased uptake. These findings are useful for future ePCTs of behavioral interventions in NHs. Trial Registration: Clinicaltrials.gov Identifier: NCT03821844.