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Introduc>on
Demen/a refers to a group of disorders that affect memory
and thinking.1 As of 2016, the es/mated prevalence of demen/a
for Canadians was 564,000; by 2031, this number is projected to
grow to 937,000 Canadians.1 As demen/a progresses, persons
with demen/a (PwD) experience worsening disability which has a physical, psychological, social and economic impact on both the
PwD and their family caregivers (CGs).2-‐3 Non-‐pharmacological
interven/ons for PwD have been able to maintain or improve func/on in ADLs and cogni/on, reduce behavioural symptoms
and reduce CG burden.4-‐7
Choral singing is a new approach to non-‐pharmacological
therapy and is garnering increased interest as a result of several
pilot studies.8-‐10 As PwD and CGs par/cipate in choirs, they have
the opportunity to engage in a meaningful ac/vity and benefit
from social engagement.8-‐10 In addi/on, choral singing is a
physical ac/vity that involves the whole body (e.g.,
musculoskeletal, respiratory) as well as the senses (vision,
hearing, balance and touch).11 Interven/ons that include mild to
moderate physical exercises have also shown improvements in behavioural symptoms, performance of daily living ac/vi/es, quality of life, and reinforced posi/ve sense of self, as well as
reducing CG burden. 4,12-‐14
Purpose
The purpose of this study was to describe exis/ng community-‐ based choirs for PwD and their CGs. Although there is growing interest in choirs for PwD and a number of publica/ons, to our knowledge there has been no effort to compare and contrast these choirs in terms of their structure, programs, and other factors. Thus it is /mely and important to gather informa/on
about these choirs and their perceived benefits as well as lessons learned
Objec>ves
1) Describe the key characteris/cs of the choirs (e.g. purpose,
program structures, sources of support/funding).
2) Explore the challenges and successes, as well as the benefits
to par/cipants.
Methods
Sample. A convenience sample of 6 community based choirs for
PwD and their family CGs were recruited using email contacts from an internet search. Eligibility criteria included: 1)
professionally organized choir (i.e., not music therapy); 2) program targe/ng PwD and CGs; 3) community based (i.e.,
par/cipants are living at home) and 4) english Speaking.
Data Collec>on. Semi-‐structured phone interviews were
conducted with administrators of the choirs. Conversa/ons were audio recorded and transcribed. Ethics approval was received
from the University of Victoria and all par/cipants provided
wriaen consent prior to par/cipa/on in the study.
Analysis. Transcrip/ons of the interviews were coded in a
Microsoc Excel database and descrip/ve analyses were
completed to address the objec/ves of the study.
Results
Table 1. Summary of choir loca/ons and size
*Ra/o of CGs to PwD is 1:1
Table 2. Summary of program structures
Table 3. Summary of program structures
* are CGs/previous choir members whose loved one with demen/a passed away ** annual cost $380
• The majority (n=5) of the choirs offer a public performance at
least once per choir season.
• The majority (n=4) of the choirs rely on volunteer choir
administrators. The larger programs (n=2) have paid choir administrators with a volunteer board of directors.
Results
Challenges:
Common challenges of running a choir for PwD and their CGs included: 1) keeping sessions engaging; 2) selec/ng music that works well for the group (i.e., challenging yet familiar or simple and energe/c); 3) having a large enough song repertoire; 4)
working within a limited budget; 5) dealing with demen/a progression; 6) distance and transporta/on.
Common Success:
Structured Social Time. Many (n=4) of the choirs noted the
importance of a planned break /me/social /me which provides valuable /me for peer support and rela/onships to develop. The social /me also offers an opportunity for the CG to relax and
interact with others since volunteers help to ensure a safe and suppor/ve environment for the PwD.
Benefits:
Purpose. Choir directors report the PwD and CG find the choir
a significant source of meaning and purpose, as well as being relaxing and fun.
“The choir changed their lives. It’s what they get up for. It gives them something to work on. Something was expected of them and
they could do it.”
“One care partner says that his wife talks about the program all week long when it is in session because it is the thing she looks
forward to during the week.”
“When things are really tough at home with my partner (PwD), I just think about next Thursday and coming to choir and that helps
me get through.”
Empowerment. The choir offered opportuni/es to learn, to
engage and to communicate with others.
“One of the men that takes part in the choir can really not make himself understood with words because of his aphasia and he can
sing. He can sing beauIfully. It gives him an opportunity to contribute, be successful and be good at something”
“Once someone gets diagnosed society writes them off as ‘This person isn’t going to be able to think any more or be part of things
anymore.’ Through singing they can be part of things, they can learn, they can be engaged.”
Enjoyment. The choir provides a suppor/ve sehng that allows
par/cipants to interact with others and have fun together.
“One caregiver said that she doesn’t remember the last Ime her husband smiled before he came to the choir and started singing”
“They celebrate something they are sIll able to do. They are
happy to be engaged and happy to interact with people that know what they are going through.”
Caregiver Support. Social networks have expanded and
informa/on is shared informally between caregivers.
“When the care partners are talking to each other, they are likely to give referrals or insights in to other resources in the community
that they are using (i.e. in home help, assisted living,
transportaIon services). It means a lot more to the people when they talk to someone that has had personal experience with it.”
Discussion
Findings from our interviews suggest that choral programs
improve the quality of life of PwD and CGs and can be ini/ated at a low cost with volunteer support. Our findings fit well with the limited studies available, showing that PwD have the capacity to be engaged, learn new songs, and find enjoyment in choir
par/cipa/on.8-‐10 From these results we see that PwD are able to
contribute to a professionally led choir and par/cipate in public performances. The benefits of the choir extend to CGs by offering respite that may allow them to con/nue in their role for longer
and allow them to develop connec/ons with other CGs who
understand their experience. The benefits for CGs was also seen
in the literature.9-‐10
Limita>ons. This is a descrip/ve pilot study with a small sample
size. There are addi/onal programs which we were not able to contact due to /me and resource limits.
Conclusion
A community-‐based choir provides a valuable opportunity for both PwD and CGs to share an enjoyable ac/vity in a suppor/ve sehng. Sugges/ons for future research include using a
randomized control trial that will allow comparison of the impact and benefits of the choir versus other interven/ons (e.g.,
exercise) for PwD and their CGs.
Acknowledgements
This research was supported by the Jamie Cassels Undergraduate Research Award, University of Victoria.
Bibliography
1. Canada AsS. Latest informa/on and sta/s/cs. 2016; hap://www.alzheimer.ca/en/
About-‐ demen/a/What-‐is-‐demen/a/Demen/a-‐numbers
2. Dugeon S. Rising Tide: The impact of demenIa on CAnadian Society. Alzheimer Society
of Canada; 2010.
3. Dassel KB, Carr DC. Does demen/a caregiving accelerate frailty? Findings from the
health and re/rement study. The Gerontologist. 2016;56(3):444-‐450.
4. Sampath P, Forbes D, Barton S, Blake C. A systema/c review of the effec/veness of
interven/ons for persons living with demen/a based in teh home or community. PerspecIves. 2015;38(2):6-‐19.
5. Wall M, Duffy A. The effects of music therapy for older people with demen/a. Br J Nurs.
2010;19(2):108-‐113.
6. Beard RL. Art therapies and demen/a care: A systema/c review. DemenIa. 2012;11(5):
633-‐656.
7. Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. 2008.
8. Bannan N, Montgomery-‐Smith C. 'Singing for the brain': reflec/ons on the human
capacity for music arising from a pilot study of group singing with Alzheimer's pa/ents. J R Soc Promot Health. 2008;128(2):73-‐78.
9. Camic PM, Williams CM, Meeten F. Does a 'Singing Together Group' improve the quality
of life of people with a demen/a and their carers? A pilot evalua/on study. DemenIa (London). 2011;12(2):157-‐176.
10. Unadkat S, Camic PM, Vella-‐Burrows T. Understanding the Experience of Group Singing
for Couples Where One Partner Has a Diagnosis of Demen/a. The Gerontologist. 2016.
11. Kivnick HQ. Personal communica/on. 2016.
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of pa/ents with late-‐stage demen/a. Alzheimer's care today. 2009.
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for demen/a that informal carers might try or access: a systema/c review. InternaIonal journal of geriatric psychiatry. 2010;25(7):756-‐763.
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healthy older adults. CMAJ. 2013;185(10):881-‐885.
Name (n=6) Loca>on(s) Year program started
Choir Size
When Created
Current Size PwD*
Circle of Music Waterloo, ON (Canada) 2016 30 n/a 10 Intergenera/onal Singers Woodstock, ON (Canada) 2013 23 n=23 1 choir 3 The Alchemy Chorus Canberra (Australia) 2016 50 n=60 1 choir 30
Sing Here Now Choir Portland/ Beaverton, OR (USA) 2011 20 n=36 2 choirs 18 Giving Voice Chorus Minn/St. Paul, MN (USA) 2014 30 n=174 3 choirs ~74 Forget-‐Me-‐Not Chorus Cardiff/Newport, South Wales (UK) 2011 40 n=125 3 choirs ~62 Name Singing
Dura>on Structured Social Time Weeks/yr Prac>ce Loca>on(s) Prac>ce Loca>on Fees
Circle of Music 40 min. 40 min. 30 Church Donated Intergenera/onal
Singers 60 min. 0 min. 16 Re/rement Home Donated The Alchemy
Chorus 90 min. 30-‐40 min. 40 Community Centre Rented Sing Here Now
Choir 75 min. 25 min. 16 Alz Assoc Office; Church Donated Giving Voice
Chorus
90 min. 30 min. 40 Community Centre;
Music School Donated
Forget-‐Me-‐Not
Chorus 100 min. 15 min. 36 Community Centre; Church; School Rented
Name Song
Structure Volunteers Volunteer training Choir membership fees
Funding
Circle of Music Unison High school students; Church members
yes None none
Intergenera/onal
Singers Mul/part/Unison Elementary students yes None Alz Soc and free will dona/on at concerts **
The Alchemy
Chorus Unison Support/singing volunteers from other choirs
n/a $5/person/
week None
Sing Here Now
Choir Mul/part Support volunteers n/a None Alz Assoc fund raising Giving Voice Chorus Mul/part/
Unison Support/singing volunteers
Yes $50/person/
16weeks Community charity founda/ons and private donors
Forget-‐Me-‐Not
Chorus Mul/part Support Volunteers No* None Forget-‐Me-‐Not Chorus Founda/on: community charity founda/ons and private donors.
Zach Anderson and Debra Sheets, Ph.D, FAAN
A Descrip/ve Study of Community-‐Based Choirs for Persons with Demen/a and their Caregivers
Musical Connec>ons
Zach Anderson, School of Nursing March 8, 2017
This research was supported by the Jamie Cassels Undergraduate Research Award, University of Victoria.
Supervised by Dr. Debra Sheets.
