Introduction
The use of a standardized program, designed by a music therapist, for cognitively impaired adults to improve well-being and attenuate cognitive decline.
Methods
An experimental control group study with eight participants for 26 weekly sessions. Mental status, level of depression, quality of life, and caregiver burden were measured prior to and following completion of the study. Quality of life was achieved as measured by a process evaluation.
Results
The study participants experienced less cognitive decline and depression when compared to the control group. There was no difference in caregiver burden among both groups.
Discussion
Participation in a mutual support group using music therapy may diminish cognitive decline and depression.
At the present time, Alzheimer’s disease remains an incurable, fatal illness impacting 5.3 million people living in the United States and close to 48 million people worldwide [1]. In the early stages of the disease, most victims remain in the home and are cared for by family and/or friends. As the disease progresses, the need for care increases often resulting in the need for out of home care consisting of day care, assisted living, and nursing home care. As the need for care increases, the situation of placing the cognitively impaired adult at risk for harm increases.
The Java Music Club is the first standardized mutual support program addressing the critical rates of depression and loneliness across the senior living spectrum. It is a research-based wellness program for long-term care homes (including memory care), assisted living and retirement homes, adult day centers and community support centers. It was developed by Kristine Theurer, MA (Gerontology) MTA (Music Therapy), over a six-year period and implemented in 2010, in three nursing homes in British Columbia, Canada [37]. Ms. Theurer drew from her 20 years of experience as an accredited music therapist facilitating therapeutic groups. She found that a weekly discussion group centered around 52 themes, selected by participants, with carefully selected music related to the theme (142 songs in a songbook), along with pictures, affirmations, sayings and readings resulted in participants reporting benefits of reduced loneliness, understanding, mutual support, friendships, and increased coping skills [38]. Some of the theoretical foundation underlying this approach included Kitwood’s concept of personhood and Riessman’s helper therapy principle [39,40]. Personhood recognized a fundamental human drive to help others and, when inhibited, the person does not thrive. Helping not only helps the helped but also the helper. Those observing also receive benefits.
Some of the major objectives of the program are to:
• Develop mutual peer support
• Reduce loneliness and depression
• Increase social and emotional support
• Improve quality of life
• Prevent out of home placement
• Reduce caregiver burden
This project is an experimental designed, random assignment, assessment of the participation effects of eight (8) clients for 26, one hour sessions, in a facilitated group program consisting of music, songs, theme pictures, affirmations, sayings, poetry, and interaction that will provide an opportunity for the participants to offer social and emotional support, experience well-being, and increase their quality of life. The site is the Salvation Army’s Serendipity Adult Day Services located in Anchorage, Alaska. The research question is: Will participation in this program result in mutual support among the participants, increase their quality of life, and reduce the burden of their caregivers?
Hypothesis 1: Participation in the Java Music Club over a six-month period will result in mutual support.
Hypothesis 2: Participation in the Java Music Club over a six-month period will result in higher quality of life.
Hypothesis 3: Caregivers of participants in the experimental group will report less burden than caregivers in the control group.
Assignment to the control and experimental groups were random and drawn from the 55 clients who participate in the day care program. There were no major differences among both groups selected. This project is an assessment of the participation effects of eight (8) clients for 26, one hour sessions, in a facilitated group program consisting of music, songs, theme pictures, affirmations, sayings, poetry, and interaction that will provide an opportunity for the participants to offer social and emotional support, experience well-being, and increase their quality of life. Eight (8) clients were randomly selected for the control group.
Pre and post testing used the following instruments:
• Mini Mental Status Exam (MMSE)
• Reality Comprehension Clock Test (RCCT)
• Geriatric Depression Scale
• Alzheimer’s Disease Related Quality of Life Scale (ADRQL)
• Zarit Burden Interview
The following measures were conducted at the end of the group sessions:
• Client Interview Schedule
• Facilitators Interview Schedule
• Directed focus group with participants
After each session (26) the following instrument was completed
• Process Measure: Mather Life Ways Institute on Aging Observing Quality of Life Scale
The session format is as follows:
Preparation
• CD player with background music, table with tablecloth, drinks, treats, chairs, and songbooks arranged
• The facilitator invites a group member to be an assistant and to choose the theme for the meeting
Opening
• Welcome to our meeting preamble is read
• Opening Song and ringing of chimes
• Group guidelines read followed by “getting centered”
• A song related to the theme is sung by the group
Middle
Assistant is given “aboriginal talking stick” and asked to respond to one of the discussion questions related to the theme. The stick is passed from one member to the next
• A quote is chosen and the members are asked to take turns responding to it
• Another song is chosen and sung by the group using the song book
• A photograph is passed among the group, related to the theme, and members asked to respond to its meaning and collectively create a story
• Additional songs and quotes occur with members responding
Closing
• Closing affirmation read together
• Closing song “I will be there for you”
• Thank you handshake or hug offered
The results of this pilot study demonstrated the value of the Java Music Club Program in providing the participants, referred to as guests, with the opportunity of sharing their feelings and providing mutual support to one another, adding to their quality of life. The evidence was obtained primarily from the process and post measures from the participants and staff. The process measure (Figure 1) observing the quality of life that was present during each of the 26 sessions, demonstrated pleasantness scores representing a clearly pleasant experience with moderate to high levels of activity. The highest score was in response to the question “Did the guest appear to enjoy the Java Music Club”? This was an extremely pleasant experience with a high level of activity. Selected comments from participants during the focus group were: “An opportunity to express my emotions and thoughts and get it out of my system.” “I loved it, but wanted to meet more often.” “We get to know each other much better.” “It brought back a lot of different memories.” “To join in this group is to forget my worries. It eases your problems. This is different, something special. It takes the loneliness away.” A facilitator commented, “It has been an amazing and very rewarding experience. The approach has helped me know them better, and in a personal way, it has been a relaxing time with lots of fun.” Another facilitator stated “It’s my favorite group. I am amazed at how guests with dementia have responded… short, simple, yet profound answers”.
The experimental group demonstrated a slight decline in their MMSE post-test scores compared to the control group who demonstrated a significant decline in MMSE scores (Table 1). There also were noticeable differences in the Geriatric Depression Scale. The experimental group significantly lessened to the amount of depression, whereas the control group showed a slight increase in depression. The other scales did not demonstrate significant differences among the groups.
Experimental (8) Mean (sd) |
Control (8) Mean (sd) |
|
Age, years | 71(11.8) | 74(10.2) |
Female to male ratio | 6:02 | 6:02 |
Mini Mental Status Exam (MMSE) | ||
Pre-test | 19.3(6.9) | 21.1(3.6) |
Post-test | 18.8(5.6) | 17.9(5.9) |
t-test | 1.94 | 2.76* |
Reality Comprehensive Clock Test | ||
Pre-test | 2.6(1.3) | 3.1(1.2) |
Post-test | 2.2(.88) | 2.9(1.1) |
t-test | 1.42 | 1.54 |
Geriatric Depression Scale | ||
Pre-test | 2.8(1.3) | 1.7(.95) |
Post-test | 1.5(1.0) | 2.0(1.0) |
t-test | 1.12* | -1 |
Alzheimer’s Disease Quality of Life Scale | ||
Pre-test | 426.2(5.1) | 427.7(4.8) |
Post-test | 427.1(3.6) | 427.6(4.4) |
t-test | -0.715 | 0.008 |
Zarit Burden Interview | ||
Pre-test | 25.2(4.2) | 29.2(6.3) |
Post-test | 26.6(3.9) | 28.7(6.1) |
t-test | -0.728 | 0.323 |
The results of this pilot study demonstrated the value of the Java Music Club Program in providing the participants, referred to as guests, with the opportunity of sharing their feelings and providing mutual support to one another, adding to their quality of life. The evidence was obtained primarily from the process and post measures from the participants and staff. The process measure (Figure 1) observing the quality of life that was present during each of the 26 sessions, demonstrated pleasantness scores representing a clearly pleasant experience with moderate to high levels of activity. The highest score was in response to the question “Did the guest appear to enjoy the Java Music Club”? This was an extremely pleasant experience with a high level of activity. Selected comments from participants during the focus group were: “An opportunity to express my emotions and thoughts and get it out of my system.” “I loved it, but wanted to meet more often.” “We get to know each other much better.” “It brought back a lot of different memories.” “To join in this group is to forget my worries. It eases your problems. This is different, something special. It takes the loneliness away.” A facilitator commented, “It has been an amazing and very rewarding experience. The approach has helped me know them better, and in a personal way, it has been a relaxing time with lots of fun.” Another facilitator stated “It’s my favorite group. I am amazed at how guests with dementia have responded… short, simple, yet profound answers”.
Both mutual support among the participants and experiencing enhanced quality of life were observed during the 26 sessions to support hypotheses 1 and 2. The third hypothesis where the caregivers reported less of a burden was not supported by the data.
The 26 sessions were intended to be weekly, but there was a two-month break due to staffing shortage, with 17 sessions remaining. Also because the setting is a day treatment center, all eight of the members did not always attend each session. Caregiver burden measures may have also been affected by the break in session meetings.
This pilot study demonstrated the value of the Java Music Club Program in providing the participants with the opportunity of sharing their feelings and providing mutual support to one another, adding to their quality of life. The pre and post testing findings were limited with only two significant differences found between the participants and controls. Participant’s level of depression was less, as was increased cognitive impairment. Consistency in providing the program and attendance were also factors. The effects may have been greater if there wasn’t the two-month break. Group process, when experienced on a more consistent basis, creates a positive synergy. It would have been interesting to determine if there were any differences among the participants, if frequency of attendance was measured. The strength of the findings was from the process measures, demonstrating an increase of quality of life and mutual support. The facilitators also experienced an increase in well-being and satisfaction from the Program. Clients highly valued the Program and expressed a strong desire to continue it after the study was completed. Caregiver burden was anticipated to lessen because of the positive effects of the Program, but consistency in attendance may have been a factor, as well as the short duration of the pilot project.
The use of the Java Music Club with cognitively impaired participants may prove to be a useful intervention in responding to loneliness and depression, and encouraging mutual support and opportunity to improve quality of life resulting in well-being. Music therapy is beginning to be more recognized as an important psychosocial intervention to ameliorate a variety of symptoms in persons with cognitive challenges. Music and mutual support may decrease anxiety and agitation, thus reducing the need for psychotropic drugs for disruptive behavior.
This study demonstrated the effectiveness of using a structured, empathically designed music therapy program with cognitively impaired participants and achieving the goal of creating mutual support among the participants and improving their quality of life. The Day Care Center recognized the positive results obtained by the participants and have elected to include the Program in its regularly scheduled activities. Future research will be conducted in assisted living and nursing homes where resident participation is more consistent.
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Citation: Cunningham PM (2016) Java Music Club: A Standardized Mutual Support Program for Adults with Cognitive Change. J Alzheimers Neurodegener Dis 2: 006.
Copyright: © 2016 Patrick M Cunningham, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.