“Music in Mind” and Manchester Camerata: an exploratory qualitative evaluation of engagement in one care home in Northwest England

A qualitative systematic review of the experiences of sharing music for people living with dementia and their family care partners: the thread of connection

BACKGROUND

There is a global need for interventions that support the wellbeing of people living with dementia and their family care partners. Studies show that shared musical activities may achieve this. Our systematic review aimed to synthesise existing research exploring dyads' experiences of shared musical activities across a range of contexts.

METHOD

From 31 October 2020 we searched PubMed, PsycInfo, CINAHL Complete, EMBASE, RILM, Web of Science Core Collection, Google Scholar and ProQuest Dissertations & Theses for studies published up to 14 April 2021, and hand searched five music therapy journals plus citation lists. Thirteen qualitative studies reporting on dyads' experiences and perspectives of shared musical activities across a range of settings were included. Studies with mixed populations or mixed modality interventions were excluded. We analysed the final studies using thematic synthesis, engaging in reflective discussions and reflexivity throughout. The quality of included studies was assessed using the CASP qualitative checklist. This study is registered on PROSPERO: CRD42020169360.

RESULTS

Six themes were identified from 13 studies: 1) shared musical activities support wellbeing for people living with dementia, 2) music groups become ecological systems, 3) shared musical activities are experienced differently over time, 4) shared musical activities are experienced by me and as we, 5) music is a supportive structure, and 6) the thread of connection (an overarching theme). A GRADE-CERQual assessment found moderate to high confidence in these findings. Findings informed the development of the Contextual Connection Model of Health Musicking.

CONCLUSION

Shared musical activities foster experiences of connection for people living with dementia and their family care partners. Experiences of connection are supported through professional facilitation and the structural aspects of music, and are influenced by the setting and changes over time. These experiences of connection play a central role in supporting dyadic and individual wellbeing. These findings are largely relevant to a western cultural context; future research should seek to include more diverse cultural experiences.

Analysing the use of music to facilitate social interaction in care home residents with dementia: Narrative synthesis systematic review

INTRODUCTION

Individuals with dementia residing in care homes can rely heavily on care staff to access activities and meaningful interactions. Previous research suggests that care home interactions can be short, fragmented and task-orientated due to staff workload and residents' language impairments. However, music has the potential to be an alternative communication form that remains intact in the later stages of dementia. This systematic review aims to explore how care home music interventions can facilitate social interactions.

METHODS

A narrative synthesis was conducted to explore the mechanisms behind how and why care home music intervention facilitate social interactions. The four-element framework guided analysis; (1) Developing a theory, (2) Developing a preliminary synthesis, (3) Exploring relationships, (4) Assessing robustness.

FINDINGS

The final synthesis included 23 articles. The studies consisted of music therapy sessions, personalised music listening, structured music singing or instrument playing sessions and music therapeutic care. Despite the difference in music interventions, most studies reported an increase in residents' sociable verbal and non-verbal communication and a decrease in unsociable communication. Music interventions allowed residents to reminisce, express themselves, focus and connect with others.

DISCUSSION

The studies highlighted music interventions are accessible to all residents with dementia despite their impairments. The adaptability allows individuals to continue to connect and express themselves even when language deteriorates. More research is needed into the enablers and barriers to implementing interventions into practice, as this systematic review has highlighted that some form of music intervention for all residents can be highly beneficial. Care homes use of music could increase social interactions and meaningful activities.

Music-making in the community with people living with dementia and care-partners - 'I'm leaving feeling on top of the world'

Evidence exists relating to music-based initiatives and positive health outcomes for people living with dementia who can access them. Yet, knowledge about the impact of 'music-making' on the well-being of community-dwelling people with dementia is limited. Much of the existing evidence about the benefits of music is focused on care home settings where initiatives can be readily applied as part of a weekly schedule of activities. Therefore, this initiative aimed to provide opportunities to participate in music-making, to increase social interaction and ultimately well-being in a community environment. Ten music-making session were scheduled for community-dwelling people living with dementia and care-partners, once a month between September 2019 and March 2020. Three sessions did not take place due to Covid19. Eighteen participants consented to take part including seven people living with dementia, five care-partners and six former care-partners. Baseline semi-structured interviews explored the lived experience of music and expectations of the upcoming music-making cafes. Self-report questionnaires captured 'in the moment' experiences of each music-making cafe. Follow-up semi-structured interviews explored the impact of music-making on participants' self-reported well-being. Interviews were transcribed verbatim and analysed thematically. The findings demonstrate that participating in the music-making café benefitted the self-reported well-being of participants in three ways: first, a sense of camaraderie that enabled the facilitation of connections with others; second, creating opportunities to 'level the playing field' by always assuming a person's strengths and abilities; and third, group participation in music-making meets a need for meaningful musical experiences. We conclude that participating in music-making is a powerful medium to promote well-being for community-dwelling people living with dementia and care-partners.

Broadening the debate on creativity and dementia: A critical approach

In recent years there has been a growing interest in person-centred, ‘living well’ approaches to dementia, often taking the form of important efforts to engage people with dementia in a range of creative, arts-based interventions such as dance, drama, music, art and poetry. Such practices have been advanced as socially inclusive activities that help to affirm personhood and redress the biomedical focus on loss and deficit. However, in emphasizing more traditional forms of creativity associated with the arts, more mundane forms of creativity that emerge in everyday life have been overlooked, specifically with regard to how such creativity is used by people living with dementia and by their carers and family members as a way of negotiating changes in their everyday lives. In this paper, we propose a critical approach to understanding such forms of creativity in this context, comprised of six dimensions: everyday creativity; power relations; ways to operationalise creativity; sensory and affective experience; difference; and reciprocity. We point towards the potential of these dimensions to contribute to a reframing of debates around creativity and dementia.