Original Investigation 

Aging and Health

Slow-Tempo Music and Delirium/Coma-Free Days Among Older Adults Undergoing Mechanical Ventilation: A Randomized Clinical Trial

Babar A. Khan, Sikandar H. Khan, Anthony J. Perkins, et al

JAMA Intern Med Published Online: October 13, 2025

doi: 10.1001/jamainternmed.2025.5263

Key Points

Question  Among critically ill, mechanically ventilated older adults in the intensive care unit, does a music-listening intervention reduce delirium, pain, or anxiety?

Findings  In this randomized clinical trial of 158 mechanically ventilated older adults, a twice-daily music intervention delivered via noise-canceling headphones and tablets for up to 7 days did not demonstrate a statistically significant decrease in delirium duration, delirium severity, pain, or anxiety.

Meaning  A music-listening intervention did not improve delirium, pain, or anxiety among critically ill older adults.

Abstract

Importance  An estimated 70% to 80% of older adults develop delirium in the intensive care unit (ICU).

Objective  To determine if a slow-tempo music (60-80 beats/min) listening intervention decreases delirium duration, delirium severity, pain, or anxiety in older adults undergoing mechanical ventilation.

Design, Setting, and Participants  This multicenter randomized clinical trial with concealed outcomes assessments was conducted in older adults undergoing mechanical ventilation from February 2020 to December 2023. Patients were enrolled from the ICUs of 2 hospitals affiliated with the Indiana University School of Medicine and from the Mayo Clinic in Rochester, Minnesota.

Intervention  A music intervention comprising classical and contemporary tracks, delivered twice daily through noise-canceling headphones and tablets for up to 7 days, was compared to active control listening to a silence track delivered under identical conditions.

Main Outcomes and Measures  The primary outcome was delirium/coma-free days during the 7-day intervention period assessed by the Confusion Assessment Method for the ICU (CAM-ICU) and the Richmond Agitation-Sedation Scale. The secondary outcomes were delirium severity assessed by the CAM-ICU-7, pain assessed by the Critical Care Pain Observation Tool, and anxiety assessed by the visual analog scale for anxiety (VAS-A).

Results  A total of 158 patients were randomized (mean [SD] age, 68 (9.2) years; 72 [45.5%] female and 86 [54.4%] male). In an intention-to-treat analysis, no differences were found in the number of delirium/coma-free days in the music intervention group compared with control (median [IQR] days, 2.5 [0-5] vs 3 [0-5]; P = .66). There were also no statistically significant differences in the mean CAM-ICU-7 scores, mean pain scores, or mean VAS-A scores over the 7-day intervention period. By end of the 7-day period, both music intervention and control groups had similar mean (SD) CAM-ICU-7 scores (2.72 [2.80] vs 2.56 [2.72]), Critical Care Pain Observation Tool scores (0.20 [0.55] vs 0.61 [1.29]), and VAS-A scores (43.6 [24.7] vs 28.8 [38.4]).

Conclusions and Relevance  In this randomized clinical trial among older adults undergoing mechanical ventilation, a slow-tempo music intervention did not demonstrate a statistically significant decrease in delirium duration, delirium severity, pain, or anxiety symptoms.

Trial Registration  ClinicalTrials.gov Identifier: NCT04182334