A recent study published in JAMA Internal Medicine has examined the potential benefits of slow-tempo relaxing music as a therapeutic intervention for critically ill older adults experiencing delirium. This multi-center randomized controlled trial involved patients aged 50 years and older who were admitted to intensive care units (ICUs).

Study Overview

The research, titled “Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation: A Randomized Controlled Trial,” aimed to determine if listening to slow-tempo music (60 to 80 beats per minute) could effectively shorten the duration of delirium or coma, alleviate delirium severity, pain, or anxiety, compared to a control group that experienced silence.

While the trial did not exhibit significant improvements in the primary outcomes, it revealed a trend indicating that patients who received at least seven doses of slow-tempo music experienced fewer days of delirium and coma. Additionally, a noteworthy trend was observed among patients who had received benzodiazepines—these medications are known to heighten the risk of delirium.

Delirium in the ICU

Delirium is a serious condition characterized by confusion, which can have profound short- and long-term health consequences, including an augmented risk of developing post-ICU dementia. Approximately 75% of older adults admitted to ICUs are reported to develop delirium.

Trial Design

The trial took place across multiple sites, including Indiana University School of Medicine-affiliated hospitals and Mayo Clinic. A total of xx participants were enrolled, and the study featured a two-arm trial design that included:

  • A carefully curated selection of slow-tempo music.
  • A control group that listened to silence tracks.

Listening sessions were meticulously delivered twice daily for up to seven days utilizing computer tablets and over-the-ear active noise-canceling headphones. This approach demonstrated the feasibility of maintaining intervention fidelity in the busy environment of an ICU.

Findings and Implications

Despite the intuitive belief that calming music would yield benefits in the critical care setting, the results indicated that prescribed slow-tempo playlists did not significantly reduce delirium, pain, anxiety, or affect the length of ventilation or hospital stay. Dr. Babar Khan, co-lead author of the study, stated:

“Despite the intuitive appeal of calming music in the ICU, our rigorously conducted multi-center trial shows prescribed slow-tempo playlists did not reduce delirium, pain or anxiety, nor change length of ventilation or stay.”

Dr. Linda L. Chlan, also a co-lead investigator, noted the importance of considering individual music preferences. She remarked:

“It is possible that a prescribed selection of music was not meaningful to patients, which highlights the importance of music preferences in designing future clinical trials.”

Exploratory Analyses

Post hoc analyses indicated promising trends towards greater coma-free days for patients who received a full course of music sessions, particularly in those who were exposed to benzodiazepines. This raises intriguing questions regarding the interactions between sedation and the effects of slow-tempo music.

Future Directions

The findings of this study suggest that further research should focus on:

  • Evaluating longer durations and targeted subgroups to identify specific patient needs and responses.
  • Investigating the use of personalized, therapist-guided music interventions rather than a standardized approach.
  • Exploring optimal timing for music interventions post-ICU stay.

Despite the lack of significant efficacy, this trial established a scalable model for music intervention delivery and tracking, confirming that the approach is safe and feasible for implementation in ICU settings.

Conclusion

The study makes significant contributions to the understanding of non-pharmacologic interventions aimed at mitigating delirium in critically ill older adults, emphasizing the complexity and individuality of therapeutic responses in clinical settings.

References

1. Khan, B., Chlan, L. L., & Egan, R. (2025). Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation: A Randomized Controlled Trial. JAMA Internal Medicine.

2. Medical Xpress. (2025). Retrieved from https://medicalxpress.com/news/2025-10-effect-tempo-music-delirium-critically.html