Quality of life (QOL) of older adult community choral singers in Finland

The Vocal Hygiene Treatment Programs for Singers: A Systematic Review

OBJECTIVES

This systematic review aims to explore the effectiveness of voice health education interventions among singers, particularly focusing on vocal hygiene treatment programs tailored for professional voice users.

STUDY DESIGN

Systematic review.

METHODS

Preferred Reporting Items on Systematic Reviews and Meta-Analysis guidelines were followed to conduct this systematic review. Comprehensive searches were conducted in PubMed, Web of Science, Scopus, Science Direct, and Cochrane Library databases. Four articles were selected for detailed review. The studies were evaluated using the Effective Public Health Practice Project tool for quality assessment.

RESULTS

The four reviewed studies primarily utilized the pretest-posttest design to examine the effectiveness of vocal hygiene interventions on singers' vocal health. Two studies investigated the effect of hydration as a treatment method, while the remaining two focused on vocal hygiene instruction. Significant improvements were observed in various vocal health parameters, including maximum phonation time, intensity, Dysphonia Severity Index, and number of daily vocal breaks taken.

CONCLUSION

This systematic review provides valuable insights into the efficacy of vocal hygiene treatment programs for singers. The positive outcomes observed in the reviewed studies underscore the importance of voice health education tailored to singers' specific needs. However, the limited number of eligible studies and the common limitation of small sample sizes highlight the need for further research in this area. Vocal health practitioners, educators, and researchers can utilize the findings of this review to develop evidence-based vocal hygiene interventions that promote the well-being and longevity of singers' vocal performance careers.

Longitudinal effects of choir singing on aging cognition and wellbeing: a two-year follow-up study

Introduction

While increasing evidence points toward the benefits of musical activities in promoting cognitive and emotional well-being in older adults, more longitudinal studies are needed to establish their long-term effects and uncover the mechanisms through which musical activities affect well-being. Most previous research has focused on instrumental musical activities, but little is currently known about the long-term effects of singing, even though neuroimaging evidence suggests that it is a versatile activity for the brain, involving a multitude of neural processes that are potentially beneficial for well-being.

Methods

We conducted a 2-year follow-up study to assess aging-related changes in cognitive functioning and emotional and social well-being with self-report questionnaires and standardized tests in 107 older adult choir singers and 62 demographically matched non-singers. Data were collected at baseline (T1), and at 1-year (T2) and 2-year (T3) follow-ups using questionnaires on subjective cognitive functioning, depression, social engagement, and quality of life (QOL) in all participants and neuropsychological tests in a subgroup of participants (45 choir singers and 41 non-singers).

Results

The results of linear mixed model analysis showed that in verbal flexibility (phonemic fluency task), the choir singers had higher scores already at T1 and showed no change over time, whereas the non-singers showed enhancement from T1 to T3. Furthermore, active retrieval of word knowledge (WAIS-IV Vocabulary task) showed significantly different changes from T1 to T2 between the groups (enhancement in choir singers and decline in non-singers), however lacking significant change within groups. Similar opposite trajectories of QOL related to social inclusion and safety of the environment (WHOQOL-Bref Environmental subscale) were significant from T1 to T3, but these changes were not significant within groups or at each timepoint. Within the choir singers, shorter experience in choir singing was associated with greater improvement in the vocabulary task over the follow-up period, suggesting that initiation of choir singing at older age induces some verbal benefits. There were no group differences in any other questionnaire or neuropsychological measure over time.

Discussion

In conclusion, our results suggest that choir singing at older age is associated with a sustained enhancement of phonemic fluency, while the effects on other verbal skills and quality of life are less clear.

How health-focused choirs adapted to the virtual world during the COVID-19 pandemic - An international survey

The COVID-19 pandemic significantly impacted the operation of choirs around the world due to the high-risk nature of group singing for disease transmission. These risks are even greater for people living with health conditions. This paper presents the results of an international, cross-sectional survey that asked health-focused choir facilitators if and how they adapted their choir to due to COVID-19 restrictions and the high-risk of transmission during group singing. Participants were recruited through searches of choir and music therapy networks, social media, and snowballing sampling methods. The anonymous online survey consisted of 17 multiple choice and 7 short answer questions. Data was analysed using descriptive statistics and thematic analysis. Sixty-five surveys were commenced (50 completed). Many respondents (63 %) took their choirs online, and neurological conditions were the most common populations served. Format and methods of online choirs are described, as are benefits and challenges of online choirs. Several respondents indicated they would continue online post-COVID-19 restrictions. Online choirs were seen as feasible and beneficial, despite challenges. Recommendations regarding facilitator skills, technology set up, accessibility and session structure for online facilitation of health-focused choirs are provided.

Can Singing in a Choir Be a Key Strategy for Lifelong Health? A Cross-sectional Study

INTRODUCTION

Singing in a choir can play a significant role in a strategy for lifelong health. This study aimed to assess the nutritional status and the quality of life of healthy adults singing in a choir.

METHODS

The cross-sectional study, carried out from August 2017 to June 2018, was preceded by a weekly pilot study. A total of 100 choristers (72 women, 72.0%) aged 19-70 years (mean age was 38.30 ± 15.99 years) were included in the study. The control group consisted of 100 healthy adults (68 women, 68.0%) aged 19-70 years (mean age was 38.48 ± 16.09).

RESULTS

Significantly lower body weight and body mass index and significantly lower results of selected body composition components (P< 0.05) were found in the study group in comparison with the control group. The choristers showed significantly lower values of basal metabolic rate (P= 0.004) and metabolic age (P< 0.001). In addition, a significantly higher quality of life was observed in the group of choristers in each of the domains tested (P < 0.05).

CONCLUSION

Singing in the choir may have effect on lifelong health, defined as better nutritional status and better perception of quality of life and health.

Intervention and mediation effects of a community-based singing group on older adults' perceived physical and mental health: the Sing4Health randomized controlled trial

ObjectiveTo examine short- and long-term effects of a group singing program on older adults' perceived physical and mental health levels, and also investigate subjective well-being (life satisfaction, positive/negative affect and hedonic balance), body balance and serum biomarkers (C-reactive protein and erythrocyte sedimentation rate) as putative mediating mechanisms, controlling for the cognitive status of the participants. Design: The randomized controlled trial included 149 participants (60 to 95 years), allocated to an immediate intervention group (IG) or a wait-list active control group (WLG). The intervention comprised 34 sessions of group singing during 4-months. Main outcome measures: Self-report measures of physical health, anxiety, stress, and depression. Blinded assessments were conducted at baseline, post-intervention (4 months) and follow-up (6 months). Results: Participants in the IG reported a lower decline in perceived physical health after the intervention, as compared to the WLG. These benefits were maintained at follow-up. Singing-related changes in physical and mental health outcomes were mediated via an increase in positive affect. Moderation results showed that participants with very low cognitive functioning reported more anxiety and depression symptoms after the intervention. Conclusions: These findings provide further understanding on the psychological and physical mechanisms and effects of group singing in older adults.

Factors Predicting Adherence to Artistic-Singing Groups for Older Adults and their Role as Moderators of the Intervention Outcomes

OBJECTIVES

Group singing (GS), as an art-based intervention, has demonstrated a wide range of biopsychosocial benefits in older adult participants. However, the factors that predict the adherence of older adults to these programs and that moderate the intervention outcomes were not yet studied, which is the aim of this study.

METHODS

A randomized controlled trial was developed to test the efficacy of a GS intervention, from which pre-post intervention data was collected and analyzed. Participants: 149 retired older adults (M = 76.66, SD = 8,79 years old) users of a social care institution.

RESULTS

Principal component analysis of responses to a pre-intervention assessment yielded 10 factors. General well-being (GWB), negative mood and loneliness, blood pressure, and the participants' years of formal education predicted the number of sessions attended by the participants. GWB moderated the intervention's outcomes on life satisfaction, social identification, and systemic inflammation.

CONCLUSIONS

Years of education, well-being, negative mood and loneliness, and blood pressure at baseline predicted participants' adherence to a singing group artistic intervention.

CLINICAL IMPLICATIONS

For future artistic interventions with older adults, screening for participants' characteristics such as formal education, health and well-being before the intervention is important as it allows predicting adherence and tailoring more adjusted and cost-effective interventions.

Comparative effects of music interventions on depression in older adults: A systematic review and network meta-analysis

BACKGROUND

The effect of different music interventions on depression in older adults is varied. We aimed to explore the comparative effect of different music intervention features on depression in older adults.

METHODS

We searched PubMed, EMBASE, CENTRAL, CINAHL, and ProQuest Dissertations&Theses from inception to October 2021 for randomized controlled trials (RCTs) of music interventions in participants aged ≥60 years. Music interventions were classified based on the TIP (theme, intensity, and provider/platform) framework. The theme was divided into: 1) active music therapy (ACT); 2) receptive music therapy (Recep); and 3) music medicine (MM). The intensity was classified as high (>60 minutes/week), and low (≤60 minutes/week). The provider was classified as a music therapist (MT) or a non-music therapist (NonMT). Summary standardized mean differences (SMD) of level of depression with 95% confidence interval (CI) were estimated using a frequentist framework with a random-effects model. The certainty of evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) approach. This study was registered with PROSPERO (CRD42021247165).

FINDINGS

Fifteen RCTs involving 1,144 older adults (mean age 67.9-86.6 years) were included. When compared with usual care, the most effective music intervention was active music therapy >60 minutes/week by music therapist (Act/High/MT) (SMD -3.00; 95%CI, -3.64,-2.35), followed by music medicine >60 minutes/week by non-music therapist (MM/High/NonMT) (SMD -2.06; 95%CI, -2.78,-1.35) with moderate and high certainty of evidence, respectively. Depression scores in older adults treated with ACT/High/MT was also significantly lower than all other interventions, except MM/High/NonMT. Low intensity music interventions other than Act/Low/MT had no impact on depression.

INTERPRETATION

Although active music therapy >60 minutes/week by music therapist is the most effective intervention to alleviate depression in older adults, music medicine by listening to music of older adult's own preference >60 minutes/week is an alternative approach in settings with limited resources.

FUNDING

None.

Effects of Choir Singing on Mental Health: Results of an Online Cross-sectional Study

OBJECTIVES

The study aims to quantify the impact of sociodemographic, personal, and choir-related characteristics on perceived singing well-being and mental health changes due to singing.

STUDY DESIGN

847 German adult choristers (233m, 614f, age 18-86 years) were interviewed in a cross-sectional online questionnaire study that included questions on singing well-being, vocal and choral characteristics, the adapted versions of the Bochum change questionnaire (BCQ2000), the Utrecht Work Engagement Scale (UWES-09), and the WHO-5 well-being index.

METHODS

Multiple regression models were calculated with singing related well-being or mental health changes as dependent variables and individual and choir-related characteristics as factors. Predictors of mental health benefits were analyzed in gender subgroups and in persons with a low or normal/high score on the WHO-5.

RESULTS

On average, participants rated the impact of singing on well-being and mental health changes positively. Subgroup analysis revealed smaller but significant positive mental health effects in men compared to women and in persons with a low WHO-5 score compared to those with a normal/high score. Education level and relationship status were not significantly related to subjects' perceptions of mental health benefits, whereas singing well-being increased with age in women and in participants with a low WHO-5 score. Larger improvements in mental health came along with longer choir membership, more singing hours per week, and a high engagement in choral activity. Significant positive associations of well-being with optimal singing behavior and vocal warm-ups were observed.

CONCLUSION

Results suggest that singers of all ages, genders, and educational backgrounds perceive the choral experience as beneficial to their well-being and mental health. Positive effects are related to WHO-5 scores, engagement in choral activity, and optimal singing conditions. On average, women rate singing benefits higher than men and singers with preexisting vocal pathologies or low WHO-5 benefit slightly less.

Exploring the impact of community-based choral participation on cognitive function and well-being for persons with dementia: evidence from the Voices in Motion project

OBJECTIVES

Music-based interventions are postulated to mitigate cognitive decline in individuals with dementia. However, the mechanisms underlying why music-based interventions facilitate cognitive benefits remain unknown. The present study examines whether a choral intervention can modulate patterns of cognitive change in persons with dementia and whether within-person variation in affect is associated with this change.

METHODS

Thirty-three older adults with dementia engaged weekly in the Voices in Motion (ViM) study consisting of 3 choral seasons spanning 18-months. Performance on the Mini-Mental State Examination (MMSE) and the Positive and Negative Affect Schedule was assessed monthly within each choral season using a longitudinal intensive repeated-measures design. Three-level multilevel models were employed to disaggregate between- and within-person effects across short- (month-to-month) and long-term (season-to-season) intervals.

RESULTS

ViM participants exhibited an annual MMSE decline of 1.8 units, notably less than the clinically meaningful 3.3 units indicated by non-intervention literature. Further, variability in negative affect shared a within-person time-varying association with MMSE performance; decreases in negative affect, relative to one's personal average, were linked to corresponding improvements in cognitive function.

CONCLUSION

Engagement in the ViM choral intervention may attenuate cognitive decline for persons with dementia via a reduction of psychological comorbidities such as elevated negative affect.

The health impacts of place-based creative programmes on older adults' health: A critical realist review

Place-based creative programmes can help alleviate the structural and place-related problems that affect older adults' health. However, it is unclear why these programmes achieve positive outcomes, and how these may vary across contexts. This critical realist review aimed to address these gaps. We were able to evidence why these programmes may work for older people's mental, social and physical health. Place-based creative programmes impact on health because they support social relatedness, motivation, self-continuity and self-efficacy. However, the circumstances under which and for whom these programmes work remain hidden since existing studies do not report sufficiently on context. We set out some of the general aspects of context that could form the basis of minimum standards for reporting.

Benefits of choir singing on complex auditory encoding in the aging brain: An ERP study

Aging is accompanied by difficulties in auditory information processing, especially in more complex sound environments. Choir singing requires efficient processing of multiple sound features and could, therefore, mitigate the detrimental effects of aging on complex auditory encoding. We recorded auditory event-related potentials during passive listening of sounds in healthy older adult (≥ 60 years) choir singers and nonsinger controls. We conducted a complex oddball condition involving encoding of abstract regularities in combinations of pitch and location features, as well as in two simple oddball conditions, in which only either the pitch or spatial location of the sounds was varied. We analyzed change-related mismatch negativity (MMN) and obligatory P1 and N1 responses in each condition. In the complex condition, the choir singers showed a larger MMN than the controls, which also correlated with better performance in a verbal fluency test. In the simple pitch and location conditions, the choir singers had smaller N1 responses compared to the control subjects, whereas the MMN responses did not differ between groups. These results suggest that regular choir singing is associated both with more enhanced encoding of complex auditory regularities and more effective adaptation to simple sound features.

Embodied Prevention

Evidence-based recommendations for lifestyles to promote healthy cognitive aging (exercise, education, non-smoking, balanced diet, etc.) root in reductionistic studies of mostly physical measurable factors with large effect sizes. In contrast, most people consider factors like autonomy, purpose, social participation and engagement, etc. as central to a high quality of life in old age. Evidence for a direct causal impact of these factors on healthy cognitive aging is still limited, albeit not absent. Ultimately, however, individual lifestyle is a complex composite of variables relating to both body and mind as well as to receiving input and generating output. The physical interventions are tied to the more subjective and mind-related aspects of lifestyle and wellbeing in the idea of the “embodied mind,” which states that the mind is shaped by and requires the body. The causality is reciprocal and the process is dynamic, critically requiring movement: the “embodied mind” is a “embodied mind in motion.” Hiking, playing musical instruments, dancing and yoga are examples of body–mind activities that assign depth, purpose, meaning, social embedding, etc. to long-term beneficial physical “activities” and increase quality of life not only as delayed gratification. The present motivational power of embodied activities allows benefiting from the side-effects of late-life resilience. The concept offers an access point for unraveling the mechanistic complexity of lifestyle-based prevention, including their neurobiological foundations.

Piano Training Enhances Executive Functions and Psychosocial Outcomes in Aging: Results of a Randomized Controlled Trial

Objectives

Preliminary evidence suggests piano training may enhance areas of executive functions and psychosocial outcomes in aging adults. However, little is known regarding specific cognitive outcomes affected and whether or not enhancements are sustainable. We conducted a randomized controlled trial to evaluate the effects of piano training on cognitive performance, psychosocial well-being, and physiological stress and immune-function, in older adults.

Methods

Older adults (N=155, 60-80 years) completed an initial three-hour assessment of standardized cognitive and psychosocial measures. Participants were randomly assigned to one of three groups: piano training, computer-assisted cognitive training, or a no treatment control group. Training groups completed a 16-week program with two group training sessions per week for 90 minutes each session. All participants completed a standard battery of executive functions (working memory, processing speed, verbal fluency), psychosocial measures (musical and general self-efficacy, mood), and physiological measures (cortisol and immune-function) at pretesting, posttesting, and at a three-month follow-up time point.

Results

Results showed that piano training and computer-assisted cognitive training enhanced working memory and processing speed as compared to controls. Piano training significantly increased verbal fluency skills in category switching, as compared to computer-assisted cognitive training and no treatment controls. Participants in piano training demonstrated enhanced general and musical self-efficacy post-training; however, no significant differences were found for physiological measures.

Discussion

Piano training resulted in a unique advantage in category switching as compared to computer-assisted cognitive training and no treatment controls. Music training programs may mitigate or prevent cognitive deficits in verbal skills.

Creative dance associated with traditional Portuguese singing as a strategy for active aging: a comparative cross-sectional study

Background

Multimodal forms of exercise can influence several physical and mental factors important for successful aging. In the present study, we introduce a new type of multimodal intervention, combining movement (creative dance) with traditional singing. This study aims to compare physical fitness, functional physical independence, depressive symptoms, general cognitive status, and daytime sleepiness among older adults participating in multimodal exercise, those participating in traditional physical exercise, and those not actively engaged in physical exercise.

Methods

This cross-sectional study included 112 people aged ≥ 65 years (75.3 ± 0.7 years) living independently in the community, divided into 3 groups: multimodal exercise (n = 34), traditional exercise (n = 41), and no physical exercise (n = 37).

Results

The multimodal exercise group showed greater flexibility of the lower limbs and upper limbs/shoulders and better general cognitive status than the traditional exercise group (p < 0.05). The traditional exercise group had better agility and dynamic balance, aerobic endurance, and strength of the lower and upper limbs than the no-exercise group (p < 0.05).

Conclusions

The results suggest that the two types of programs studied may have different impacts on some of the variables investigated and support the design of future experimental studies that include interventions based on the combination of creative dance and traditional Portuguese singing.

A Qualitative Exploration of Aged-Care Residents' Everyday Music Listening Practices and How These May Support Psychosocial Well-Being

Strategies to support the psychosocial well-being of older adults living in aged-care are needed; and evidence points toward music listening as an effective, non-pharmacological tool with many benefits to quality of life and well-being. Yet, the everyday listening practices (and their associated specific psychosocial benefits) of older adults living in residential aged-care remain under-researched. The current study explored older adults' experiences of music listening in their daily lives while living in residential aged-care and considered how music listening might support their well-being. Specifically, what might go into autonomous listening activities? 32 Australian residents (aged 73-98) living in two Australian care facilities participated in semi-structured interviews. The results of a qualitative thematic analysis revealed three themes pertaining to "previous music experiences and interest," "current music listening," and "barriers to listening." While an interest in and access to music did not necessarily result in everyday listening practices, of those participants who did listen to music, perceived benefits included outcomes such as entertainment, enjoyment, relaxation, and mood regulation. Drawing on Ruud's notion of music as a "cultural immunogen" supporting well-being and Self-Determination Theory, theoretical implications of the findings are addressed, relating to how to create and support music activities in aged-care facilities so that they are engaging, meaningful, and promote emotional regulation, community, and well-being.

Quality of life and associated factors amongst older adults in a remote community, Nepal

Purpose

The purpose of the study is to assess the quality of life (QOL) of older adults and explore factors associated with it.

Design/methodology/approach

A cross-sectional study was conducted in a remote community in Nepal. A total of 671 older adults aged 60 years were enrolled in the study. QOL was measured by WHOQOL-OLD questionnaire. Data were analyzed using multiple logistic regression.

Findings

Most participants were female (53.0%), illiterate (70.6%), married (64.2%) and living with family (59.3%). Among participants, 82.4% had fair QOL, and the autonomy domain received the lowest score (average = 10.98). After adjusting the model, the elderly aged <70 years had 11.07 times better QOL (aOR = 11.070; 95% CI = 2.546–48.123), elderly with high sufficient income had 2.73 times better QOL (aOR = 2.738; 95% CI = 1.183–6.337) and elderly free from depression had 9.45 times better QOL (aOR = 9.452; 95% CI = 3.466–25.773) compared to their counterparts. The elderly receiving social support had 9.97 times better QOL than those who did not (aOR = 9.976; 95% CI = 3.152–31.574), and those able to afford healthcare services had 4.69 times better QOL than those who could not afford it (aOR = 4.694; 95% CI = 1.046–21.063).

Originality/value

The five predictors – age, income sufficiency, depression, social support and healthcare service affordability – were found to significantly affect QOL. This study suggests special care strategies for vulnerable older adults addressing the issues that affect geriatric depression. This article provides relevant information to the government to consider increment of income, encourage family and community for social support and make health services affordable for older adults.

Beneficial effects of choir singing on cognition and well-being of older adults: Evidence from a cross-sectional study

Background and objectives

Choir singing has been associated with better mood and quality of life (QOL) in healthy older adults, but little is known about its potential cognitive benefits in aging. In this study, our aim was to compare the subjective (self-reported) and objective (test-based) cognitive functioning of senior choir singers and matched control subjects, coupled with assessment of mood, QOL, and social functioning.

Research design and methods

We performed a cross-sectional questionnaire study in 162 healthy older (age ≥ 60 years) adults (106 choir singers, 56 controls), including measures of cognition, mood, social engagement, QOL, and role of music in daily life. The choir singers were divided to low (1–10 years, N = 58) and high (>10 years, N = 48) activity groups based on years of choir singing experience throughout their life span. A subcohort of 74 participants (39 choir singers, 35 controls) were assessed also with a neuropsychological testing battery.

Results

In the neuropsychological testing, choir singers performed better than controls on the verbal flexibility domain of executive function, but not on other cognitive domains. In questionnaires, high activity choir singers showed better social integration than controls and low activity choir singers. In contrast, low activity choir singers had better general health than controls and high activity choir singers.

Discussion and implications

In healthy older adults, regular choir singing is associated with better verbal flexibility. Long-standing choir activity is linked to better social engagement and more recently commenced choir activity to better general health.

Multi-cultural perspectives on group singing among diverse older adults

Group choir singing has been shown to have health benefits for older adults. However, because most studies have included predominantly white participants, it is unknown whether findings generalize to older adults from more diverse backgrounds. This multi-site qualitative study assessed perceived benefits of group singing for socioeconomically and racially/ethnically diverse older adults. We interviewed 31 choir participants, 6 music professionals and 6 administrators involved in a large, cluster-randomized trial. We used content analysis to identify themes. Psychosocial engagement was most commonly reported, with six components: emotional well-being, self-esteem, self-confidence, social connection and support, decreased loneliness, and cultural identity and multi-cultural appreciation. A few reported cognitive and physical benefits. They also suggest that group singing among ethnically diverse older adults can have multiple psychosocial benefits and enhance a sense of cultural identity and appreciation of other cultures. These findings can help in selecting structured outcome measures for choir interventions.

Sing4Health: protocol of a randomized controlled trial of the effects of a singing group intervention on the well-being, cognitive function and health of older adults

Background

Singing is a multimodal activity that requires physical, cognitive and psychosocial performance, with benefits to various domains of well-being and health in older adults. In recent years, research has increasingly studied group singing as an important cost-effective intervention to promote active and healthy aging. However, the specific factors responsible for these benefits need further experimental support, as most studies do not allow for causal inferences. This study responds to the need for further randomized controlled trials (RCT), with follow-up measurement, on the benefits of group singing in older adults from a low socioeconomic background. Also, while most studies often focus on specific outcome measure dimensions, in this study, the conjoint effect of several physical, psychosocial, psychoemotional and cognitive dimensions are analyzed, testing mediation effects of psychosocial and psychoemotional variables on the well-being and health of the participants.

Methods

We implement and measure the effects of a singing group program for older adults, with an RCT crossover design study, in a natural context, before and after the intervention and in a follow-up, 6 months after the intervention.

Participants

140 retired older adults (> 60 years) users of a social support institution, will be invited to participate in a singing group program and randomly allocated to an experimental (n = 70) and a control (n = 70) group, which will enroll in the regular activities proposed by the institution. The intervention consists of 34 bi-weekly group singing sessions, of 2 h each, for 4 months. Measures on social and emotional well-being, cognitive function, and health indicators (e.g., blood pressure, glycemia, cholesterol, c-reactive protein, sedimentation rate, respiratory function, body balance, sleep quality, medication intake, and health services attendance) will be collected. Interviews will be conducted on the motivation and perceived benefits of participation.

Discussion

Significant improvements are expected in the outcome measures in the experimental group after the intervention, validating singing groups as a cost-effective intervention for healthy aging. Psychosocial and psychoemotional variables are expected to be mediators of the effects of the program in the cognitive function, well-being and health of the participants.

Trial registration

NCT03985917. Registered 14th June 2019 (retrospectively registered).

A Qualitative Exploration of Choral Singing in Community-dwelling Older Adults

Recent research has recognized the value of participatory arts, including choirs, as a strategy to engage older adults in the community. Less is known about the participation of minority older adults of low socioeconomic status (SES) in choirs. The purpose of this qualitative descriptive study was to explore the perceived benefits of choral singing among older adults from Program of All-Inclusive Care for the Elderly (PACE) day centers. We elicited perceptions from 19 choir participants from three focus groups, the majority of whom were Black or African American (N =17/19), each held at a different PACE center. One main theme emerged, "Something for us to do that we love," with two subthemes, "Joyful time together" and "Uplifting experience performing for others." These study findings have implications for promoting choir singing in older adults to serve as a place for engagement in social interactions in a lifelong activity they love.

Understanding Wellbeing Among College Music Students and Amateur Musicians in Western Switzerland

Musical performance requires the ability to master a complex integration of highly specialized motor, cognitive, and perceptual skills developed over years of practice. It often means also being able to deal with considerable pressure within dynamic environments. Consequently, many musicians suffer from health-related problems and report a large number of physical and psychological complaints. Our research aimed to evaluate and analyze the wellbeing of two distinct groups of musicians, college music students and amateur performers in the French-speaking part of Switzerland. A total sample of 126 musicians was recruited for the study (mean age ±SD = 22.4 ± 4.5 years, 71 male). Wellbeing was assessed through the World Health Organization Quality of Life-BREF questionnaire evaluating two general measures, quality of life (QoL) and general health, and four specific dimensions: physical health, psychological health, social relationships, and environment. For both groups, respondents’ QoL was high on each measure: median scores were higher than 4 for the two general measures and higher than 70 for the four specific dimensions. Among the dimensions, respondents had the highest mean score for environment (75.0), then social relationships and physical health (74.0 and 73.8, respectively), and finally, psychological health (70.3). Differences between groups of musicians emerged in terms of overall QoL and general health, as well as the physical health dimension, where college music students scored lower than the amateur musicians; conversely, college music students scored higher than the amateurs on social relationships. Our overview of musicians’ wellbeing in Western Switzerland demonstrates that, while music making can offer some health protective effects, there is a need for greater health awareness and promotion among advanced music students. This research offers insight into musicians’ wellbeing and points to the importance of involving different actors (teachers, administrators, support staff) in facilitating healthy music making.

The Voice-Related Quality Of Life: A Study on the Reliability and Validity of the Tamil Version

Objective

Voice serves as an identity and is one of the primary requisites of an individual, especially for singers who are extensive professional voice users with greater vulnerability to voice disorders. The aim of this study is to translate and validate the Tamil version of Voice-Related Quality of Life (T-VRQOL), a self-rating questionnaire that estimates the influence of voice disorders on quality of life. The study also intends to compare the T-VRQOL scores in singers (with and without voice complaint) and non-singers, and to correlate T-VRQOL and the Tamil Singing Voice Handicap Index-10 (TSVHI-10).

Method

In this cross-sectional study, 120 native Tamil speakers (40 classically trained Carnatic singers without voice complaints, 40 Carnatic singers with voice complaints and 40 normal non-singers) in the age range of 20 to 50 years, filled in the T-VRQOL and the TSVHI-10 rating scales, along with a demographic questionnaire.

Results

Reliability of T-VRQOL was established with Cronbach α coefficient (r = 0.9, P < .001) and good test-retest reliability (r = 0.98). The validity of T-VRQOL was confirmed by examining convergent and discriminant validity. T-VRQOL also demonstrated a good correlation with the TSVHI-10 (r = 0.838, P < .001). On comparing the T-VRQOL scores across the groups, singers (13.88 and 24.3) obtained higher values than the non-singers (11.63). Among the singers, those with voice complaints (24.3) scored higher than those without voice complaints (13.88) in the T-VRQOL.

Conclusions

The Tamil version of Voice-Related Quality of Life (VRQOL) questionnaire correlates well with TSVHI-10. It proves to be an effective clinical tool in effectively evaluating the VRQOL among the Tamil-speaking population.

Positive physical and mental outcomes for residents in nursing facilities using music: a systematic review

Objectives

The objective of this study was to investigate the applicability and effectiveness of the use of music in providing for positive physical and mental outcomes in nursing facilities.

Problem

Lack of quality of life (QOL) has been a significant issue within nursing facilities. With the rise in census due to Baby Boomers, it has become imperative to find ways to increase overall QOL.

Methods

The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate to collect data regarding the use of music to provide for positive physical and mental outcomes in nursing facilities.

Results

The most common facilitator mentioned was increased socialization or communication (18%), followed by reduced depression (12%), improved physical health (11%), and reduced agitation or behavior problems (9%). The most common barriers were as follows: cannot isolate effects of music (26%), cost prohibitive (11%), difficult to implement (11%), and no significant improvements in QOL or well-being (11%).

Conclusion

The use of music showed positive outcomes for residents in nursing facilities and should be considered for implementation as part of the normal culture within such facilities.

Creative Arts Interventions to Address Depression in Older Adults: A Systematic Review of Outcomes, Processes, and Mechanisms

Depression experienced by older adults is proving an increasing global health burden, with rates generally 7% and as high as 27% in the USA. This is likely to significantly increase in coming years as the number and proportion of older adults in the population rises all around the world. Therefore, it is imperative that the effectiveness of approaches to the prevention and treatment of depression are understood. Creative arts interventions, including art, dance movement, drama, and music modalities, are utilized internationally to target depression and depressive symptoms in older adults. This includes interventions led by trained arts therapists as well as other health and arts professionals. However, to date there has not been a systematic review that reports effects and examines the processes (why) and mechanisms (how) of creative arts interventions are used to address depression in this older age group. This systematic review of studies on creative arts interventions for older adults experiencing depression examined: outcomes of four creative arts modalities (art, dance movement, drama, and music); with particular attention paid to processes documented as contributing to change in each modality; and mechanisms considered to result from these processes. Our analysis of 75 articles (17 art, 13 dance, 4 drama, and 41 music) indicates mostly significant quantitative or positive qualitative findings, particularly for interventions led by creative arts therapists. Mechanisms of change gleaned from the studies that were common across modalities include physical (e.g., increased muscle strength; neurochemical effects, such as endorphin release), intra-personal (e.g., enhanced self-concept, strengthened agency and mastery; processing and communication of emotions), cultural (e.g., creative expression, aesthetic pleasure), cognitive (e.g., stimulation of memory), and social (e.g., increased social skills and connection), that were all considered to contribute to reduced depression and symptoms. Recommendations for future research includes stronger focus on testing of processes and mechanisms.

Music for the ageing brain: Cognitive, emotional, social, and neural benefits of musical leisure activities in stroke and dementia

Music engages an extensive network of auditory, cognitive, motor, and emotional processing regions in the brain. Coupled with the fact that the emotional and cognitive impact of music is often well preserved in ageing and dementia, music is a powerful tool in the care and rehabilitation of many ageing-related neurological diseases. In addition to formal music therapy, there has been a growing interest in self- or caregiver-implemented musical leisure activities or hobbies as a widely applicable means to support psychological wellbeing in ageing and in neurological rehabilitation. This article reviews the currently existing evidence on the cognitive, emotional, and neural benefits of musical leisure activities in normal ageing as well as in the rehabilitation and care of two of the most common and ageing-related neurological diseases: stroke and dementia.

Comparison of Well-being of Older Adult Choir Singers and the General Population in Finland: A Case-Control Study

Previous research suggests that singing in a choir as an older adult is associated with better quality of life (QOL). However, the degree to which sociodemographic variables and level of engagement in hobbies contribute to this relationship is largely unknown. The aim of the study was to compare quality of life (QOL) of older adult choir singers with a matched sample of older adults from the general population in Finland, taking into consideration sociodemographic, satisfaction with health, and level of engagement in hobbies (active, inactive). Case-control methods were used to match a sample of 109 older adult singers with a sample of 307 older adults from the general population. Tobit regression analysis with sociodemographic covariates was used to explore observed group differences in QOL as measured by two WHOQOL-Bref domains (psychological and physical). Probit regression analysis was used to examine the effect of sociodemographic variables and engagement in hobbies and on overall QOL and satisfaction with health. As expected, sociodemographic variables were strongly associated with physical and psychological QOL. After controlling for sociodemographic variables, the older choir singers reported significantly higher ratings on physical QOL, but not psychological QOL, compared to matched controls. Additional adjustment for satisfaction for health attenuated the results. When considering level of engagement in hobbies, older adult choir singers reported significantly higher overall QOL and satisfaction with health when compared to either controls who were either actively engaged in hobbies or not active in hobbies. These results suggest that singing in a choir as an older adult may promote well-being, even after accounting for sociodemographic and level of engagement in hobbies.

Cognitive, emotional, and neural benefits of musical leisure activities in aging and neurological rehabilitation: A critical review

Music has the capacity to engage auditory, cognitive, motor, and emotional functions across cortical and subcortical brain regions and is relatively preserved in aging and dementia. Thus, music is a promising tool in the rehabilitation of aging-related neurological illnesses, such as stroke and Alzheimer disease. As the population ages and the incidence and prevalence of these illnesses rapidly increases, music-based interventions that are enjoyable and effective in the everyday care of the patients are needed. In addition to formal music therapy, musical leisure activities, such as music listening and singing, which patients can do on their own or with a caregiver, are a promising way to support psychological well-being during aging and in neurological rehabilitation. This review article provides an overview of current evidence on the cognitive, emotional, and neural effects of musical leisure activities both during normal aging and in the rehabilitation and care of stroke patients and people with dementia.

Measurement equivalence across gender and education in the WHOQOL-BREF for community-dwelling elderly Taiwanese

BACKGROUND

The WHOQOL-BREF, a generic quality of life (QoL) instrument, has been widely used clinically and for research on older populations. However, its measurement equivalence/invariance (ME/I) has not been well examined for the elderly (≥ 65 years) across some different demographics.

METHODS

The data were derived from a cross-sectional study with a convenience sampling design in Taiwan. We enrolled 244 elderly participants: men = 143 (58.6%); educational level ≤ primary school = 121 (49.6%). The ME/I was examined using multiple group confirmatory factor analysis (MGCFA) across gender and educational level.

RESULTS

The fit indices were satisfactory for the configural models of gender and educational level (standardized root mean square residual [SRMR] = 0.0742 and 0.0770; root mean square error of approximation [RMSEA] = 0.0655 and 0.0686; comparative fit index [CFI] = 0.953). In addition, MGCFAs showed that ME/I was supported across gender (ΔSRMR = 0.001 to 0.019; ΔRMSEA = -0.003 to 0.001; ΔCFI = -0.003 to 0.000) and educational level (ΔSRMR = 0.002 to 0.006; ΔRMSEA = -0.002 to 0.004; ΔCFI = -0.007 to 0.000).

CONCLUSION

The WHOQOL-BREF Taiwan version is appropriate for combined use and for comparisons in older people across gender and different educational levels.

Intense piano training on self-efficacy and physiological stress in aging

The aim of this study was to evaluate the effects of an intense piano training program on general self-efficacy, musical self-efficacy, and physiological stress in older adults. Self-efficacy refers to perceived beliefs regarding the performance of domain-specific tasks or activities, which contribute to psychological and physical health. A key challenge is to identify activities that promote self-efficacy in the aging population. Seventeen healthy community-dwelling older adults (60-85 years) with little to no previous musical training participated in a within subjects experimental design. Measures of self-efficacy and cortisol levels were administered over three time points: an initial pre-testing session, a second pre-testing following a two-week no treatment control period, and a post-testing session upon the completion of piano training. Intense piano training consisted of 30 hours of training (3 hours per day) in which high levels of achievement were required. Results of a three-way Repeated Measures ANOVA over all time points with pairwise comparisons revealed significantly (p < .05) enhanced musical self-efficacy post-training, F (2, 32) = 11.5, p < .001, d = .79. No significant changes in general self-efficacy or cortisol levels were found. These results suggest that domain-specific self-efficacy may increase as a result of short-term intense music training; however, short-term music training may not be sufficient to transfer to general self-efficacy.

Study protocol for a cluster randomized trial of the Community of Voices choir intervention to promote the health and well-being of diverse older adults

Background

Older adults are the fastest growing segment of the United States population. There is an immediate need to identify novel, cost-effective community-based approaches that promote health and well-being for older adults, particularly those from diverse racial/ethnic and socioeconomic backgrounds. Because choral singing is multi-modal (requires cognitive, physical, and psychosocial engagement), it has the potential to improve health outcomes across several dimensions to help older adults remain active and independent. The purpose of this study is to examine the effect of a community choir program (Community of Voices) on health and well-being and to examine its costs and cost-effectiveness in a large sample of diverse, community-dwelling older adults.

Method/design

In this cluster randomized controlled trial, diverse adults age 60 and older were enrolled at Administration on Aging-supported senior centers and completed baseline assessments. The senior centers were randomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control). Community of Voices is a culturally tailored choir program delivered at the senior centers by professional music conductors that reflects three components of engagement (cognitive, physical, and psychosocial). We describe the nature of the study including the cluster randomized trial study design, sampling frame, sample size calculation, methods of recruitment and assessment, and primary and secondary outcomes.

Discussion

The study involves conducting a randomized trial of an intervention as delivered in “real-world” settings. The choir program was designed using a novel translational approach that integrated evidence-based research on the benefits of singing for older adults, community best practices related to community choirs for older adults, and the perspective of the participating communities. The practicality and relatively low cost of the choir intervention means it can be incorporated into a variety of community settings and adapted to diverse cultures and languages. If successful, this program will be a practical and acceptable community-based approach for promoting health and well-being of older adults.

Trial registration

ClinicalTrials.gov NCT01869179 registered 9 January 2013.

Social media users have different experiences, motivations, and quality of life

While the number of individuals participating in internet-based social networks has continued to rise, it is unclear how participating in social networks might influence quality of life (QOL). Individuals differ in their experiences, motivations for, and amount of time using internet-based social networks, therefore, we examined if individuals differing in social network user experiences, motivations and frequency of social network also differed in self-reported QOL. Two-hundred and thirty-seven individuals (aged 18-65) were recruited online using the online platform Mechanical Turk (MTurk). All participants completed a web-based survey examining social network use and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-Bref) to assess QOL. Individuals who reported positive associations with the use of social networks demonstrated higher QOL while those reporting negative associates demonstrated lower QOL. Moreover, individuals using social networks to stay connected to friends demonstrated higher QOL while those using social networking for dating purposes reported lower QOL. Frequency of social network use did not relate to QOL. These results suggest that QOL differs among social network users. Thus, participating in social networking may be a way to either promote or detract from QOL.

Music enrichment programs improve the neural encoding of speech in at-risk children

Musicians are often reported to have enhanced neurophysiological functions, especially in the auditory system. Musical training is thought to improve nervous system function by focusing attention on meaningful acoustic cues, and these improvements in auditory processing cascade to language and cognitive skills. Correlational studies have reported musician enhancements in a variety of populations across the life span. In light of these reports, educators are considering the potential for co-curricular music programs to provide auditory-cognitive enrichment to children during critical developmental years. To date, however, no studies have evaluated biological changes following participation in existing, successful music education programs. We used a randomized control design to investigate whether community music participation induces a tangible change in auditory processing. The community music training was a longstanding and successful program that provides free music instruction to children from underserved backgrounds who stand at high risk for learning and social problems. Children who completed 2 years of music training had a stronger neurophysiological distinction of stop consonants, a neural mechanism linked to reading and language skills. One year of training was insufficient to elicit changes in nervous system function; beyond 1 year, however, greater amounts of instrumental music training were associated with larger gains in neural processing. We therefore provide the first direct evidence that community music programs enhance the neural processing of speech in at-risk children, suggesting that active and repeated engagement with sound changes neural function.

Auditory learning through active engagement with sound: biological impact of community music lessons in at-risk children

The young nervous system is primed for sensory learning, facilitating the acquisition of language and communication skills. Social and linguistic impoverishment can limit these learning opportunities, eventually leading to language-related challenges such as poor reading. Music training offers a promising auditory learning strategy by directing attention to meaningful acoustic elements of the soundscape. In light of evidence that music training improves auditory skills and their neural substrates, there are increasing efforts to enact community-based programs to provide music instruction to at-risk children. Harmony Project is a community foundation that has provided free music instruction to over 1000 children from Los Angeles gang-reduction zones over the past decade. We conducted an independent evaluation of biological effects of participating in Harmony Project by following a cohort of children for 1 year. Here we focus on a comparison between students who actively engaged with sound through instrumental music training vs. students who took music appreciation classes. All children began with an introductory music appreciation class, but midway through the year half of the children transitioned to the instrumental training. After the year of training, the children who actively engaged with sound through instrumental music training had faster and more robust neural processing of speech than the children who stayed in the music appreciation class, observed in neural responses to a speech sound /d/. The neurophysiological measures found to be enhanced in the instrumentally-trained children have been previously linked to reading ability, suggesting a gain in neural processes important for literacy stemming from active auditory learning. Despite intrinsic constraints on our study imposed by a community setting, these findings speak to the potential of active engagement with sound (i.e., music-making) to engender experience-dependent neuroplasticity and may inform the development of strategies for auditory learning.

Participatory arts for older adults: a review of benefits and challenges

This article reviews the scientific literature on the enhancement of healthy aging in older adults through active participation in the arts. Methodologies and conclusions are described for studies of dance, expressive writing, music (singing and instrumental), theatre arts, and visual arts including documentation of mental/physical improvements in memory, creativity, problem solving, everyday competence, reaction time, balance/gait, and quality of life. In addition to these gains in measures of successful aging, the article also provides (in a Supplementary Appendix) some selected examples of arts engagement for remedial purposes. Finally, it offers suggestions for expanding inquiry into this underinvestigated corner of aging research.