Impact of a Group-Singing Program on Older Adult Health and Its Feasibility in Retirement Communities

Abstract

Background: Given an anticipation of enormous demands in older adult care in the next several decades, there is a need to continue developing knowledge in gerontology and discovering effective, economic, and innovative ways to promote older adult health. Recently, there is an increased interest in integrating music interventions into healthcare. Participating in a group-singing program may be beneficial to healthy aging through engaging in active music-making activities and breathing exercises. This dissertation is composed of two papers. The purpose of the first paper is to evaluate the impact of a group-singing program on older adults’ cognitive function, pulmonary health, and quality of life (QoL). The purpose of the second paper is to determine the group singing program’s feasibility (facilitators, barriers, attendance) and acceptability (participant satisfaction). Methods: A pre and post-test quasi-experimental design was used to evaluate the impact of a group-singing program on older adult health. The intervention consisted of pre-singing exercises, song-singing and learning, and socialization. Classes were 75 minutes/week for 12 weeks. Inclusion criteria were age ≥ 60, no self-reported diagnosis of dementia, and able to hear conversations within 2 feet. Participants were recruited from 3 senior living communities. Outcome measures included cognition, lung function, QoL, and program feasibility and acceptability. In the first paper, descriptive statistics and a paired t-test with 2-sided alpha level at 0.05 were used to report primary findings of the impact of a group-singing program on health outcomes and its feasibility. In the second paper, we analyzed attendance sheets, weekly post-session logs and a satisfaction survey to identify the group-singing program facilitators and barriers and to evaluate program acceptability with participant satisfaction. Results: We enrolled 49 participants (mean age 83.6). Forty-two (86%) completed the posttests and exit survey. At the 12th week there was significant improvement in phonological (p<0.0001) and animal (p=0.0004) Verbal Fluency Tests, immediate Word Recall Test (p<0.0001), Maximum Inspiratory Pressure (p=0.0001), and Maximum Expiratory Pressure (p<0.0001). Participants reported they were satisfied or highly satisfied with the group-singing program (on average, 9 on a 10-point scale). They reported enjoying singing and preparing for a performance and improving their singing skills. They appreciated the interventionists’ professionalism and experience in working with older adults. At the individual level, barriers to implementing a group-singing program were participant health conditions and physical limitations, schedule conflicts, and lack of agreement on song selection and use of music scores. At the organizational level, consistent and effective communication, comfortable environment for the group, available equipment for group-singing and community commitments to promoting healthy aging facilitated the program success. The implementation barriers included communication gaps, schedule conflicts with routine community meetings and events, competing for the location with other activities, and failing to follow through with a commitment to the program. Conclusion: A group-singing program with deep breathing training and song-learning may promote memory, language, speech information processing, executive function, and respiratory muscle strength in older adults. The group-signing program was feasible and well-accepted as demonstrated by high participant retention, high satisfaction, and participant interests in continuing the program after the study completion. The program facilitators and barriers were identified at both individual and organizational levels. The program can be improved by accommodating participants with different levels of music proficiency and modifying song keys to fit lower voice ranges in older adult. Optimizing scheduling and reinforcing communication may facilitate the implementation. A future clinical trial with a larger sample with culturally diversity is indicated.