• Danielle Ní Chróinín, Sandra Wang, Guruprasad Nagaraj, Shiquan Ren, Paul M Middleton, and Alison Short.
• South Western Sydney Clinical School, UNSW Sydney, Sydney, New South Wales, Australia.
• Emerg Med Australas. 2025 Feb 1; 37 (1): e70004e70004.

ObjectiveTo assess potential feasibility of a targeted music intervention trial in older ED patients and association with clinical outcomes.MethodsProspective pragmatic trial of adults aged ≥65 years in the ED, with prevalent delirium or increased risk of incident delirium, receiving either 2-h music intervention via headphones or usual care. The primary outcomes were (i) feasibility as assessed by actual use of the intervention (target 70% of offered patients) and (ii) incident delirium in delirium-free patients.ResultsAmong 211 initially screened patients, 44 were included. The initially planned randomised controlled trial proved difficult due to poor intervention adherence, resulting in a move to patient self-selection to routine care or 2-h music intervention. There were 19 control (13 prevalent delirium) and 25 intervention participants (20 prevalent delirium); 2-h target intervention duration was achieved in 17/25 (68%) patients (8/25 achieving <2 h). Among those without prevalent delirium, incident delirium occurred in 1/6 of control and 4/5 of intervention (P = 0.08). There were no between-group differences in terms of improved or resolved delirium, pain scores or agitation/sedation scores (all P > 0.1).ConclusionsSelf-selected use of a targeted music intervention was feasible in a cohort of older ED patients. While we were likely underpowered to detect associations between intervention and outcome, collection of selected outcome measures proved feasible; these may be helpful in larger scale studies. Exploration of barriers and facilitators to use, as well as preferred delivery methods, are likely to be helpful in wider investigations of music therapy in this high-risk cohort.© 2025 The Author(s). Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

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