In an intensive care unit filled with mechanical rhythms and restless sleep, scientists tested whether slow-tempo music could calm the mind of critically ill older adults. The answer, for now, appears to be no. A new multi-center trial led by the Regenstrief Institute and published in JAMA Internal Medicine found that twice-daily playlists of relaxing music did not shorten delirium or coma duration, nor reduce pain or anxiety compared to silence.
A Rigorous Test of a Simple Idea
Delirium, a sudden state of confusion that affects up to three-quarters of older ICU patients, can have lasting effects including post-ICU dementia. With its gentle pace of 60 to 80 beats per minute, the intervention music was designed to entrain calm brain states. Patients listened through noise-cancelling headphones twice a day for up to a week, while the control group heard nothing but quiet. Both interventions were delivered through a tablet app called Soundese, allowing precise tracking of each music “dose.”
The Decreasing Delirium through Music in Critically Ill Older Adults (DDM) Trial included participants from Indiana University Health hospitals in Indianapolis and Mayo Clinic in Minnesota. It tested the hypothesis that structured slow music could substitute or complement pharmacologic sedation, potentially minimizing drug-induced confusion. Yet despite its feasibility and patient adherence, the data told a more sobering story.
“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,” said Babar Khan, M.D., M.S., co-lead author.
There were, however, intriguing signals. Patients who completed at least seven sessions of slow-tempo listening showed a trend toward more delirium-free days. The same was true for those who had received benzodiazepines, a sedative known to increase delirium risk. Although these findings did not reach statistical significance, they hint at a possible interaction between music exposure, duration, and sedation state.
Personal Meaning May Matter More Than Tempo
Music therapy has long been explored as a tool for emotional regulation, cognitive stimulation, and pain reduction in hospitals. But this trial suggests that tempo alone may not unlock its therapeutic potential. The researchers suspect that personal musical preference—what the patient finds familiar or emotionally resonant—may be critical.
“We conceptualized music as a meaningful, complex stimulus to activate the brain among ICU patients. 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,” said Linda L. Chlan, Ph.D., R.N., of the Mayo Clinic.
The trial was also the first to demonstrate that an app-based system can reliably deliver and record therapeutic music exposure in the complex ICU environment. No adverse events were reported, confirming that music interventions are safe even among ventilated patients.
Still, the study refines clinical assumptions. Early, one-size-fits-all playlists may not be enough to shift the delicate neurochemistry of delirium. Future research, the authors write, should consider longer exposure times, personalized selections, and subgroups such as patients on certain sedatives.
As Dr. Khan summarized, the DDM trial did not find the hoped-for harmony between slow-tempo rhythms and the restless minds of the critically ill—but it did compose a new framework for how to study music as medicine.