Music Interventions for Dementia and Depression in Elderly care

INTERVENTION: Group Music Therapy (GMT) will be provided for participants allocated to the first intervention. Groups will comprise of between 7‐10 participants. Sessions will be 45 minutes in length, led by a registered music therapist, and the groups will be closed groups (group membership will be fixed throughout the 6‐month intervention period). Participants allocated to this condition will partake in 13 weeks GMT held twice per week for the first 13 weeks followed by a further 13 weeks of GMT once per week. Each participant will first receive an individual music therapy assessment delivered by a registered music therapist. This will involve the music therapist sourcing information about the participant’s preferred music via staff and relatives. The music therapist will then explore playing a range of these songs to identify the types of responses the participant gives to each. Music that the participant is particularly responsive to will be noted and used in subsequent music therapy sessions. Groups in the second intervention, Recreational Choir Singing (RCS), will comprise of at least 10 participants (i.e. 15 – 20). Each session will be 45 minutes in duration and will be led by a musician with choir leading skills and a music degree. In contrast to GMT, the RCS groups may be open (i.e. participants not eligible to enrol in the study but who wish to participate in the choir may join the group). Participants allocated to the RCS group will partake in 13 weeks of recreational choir singing twice per week followed by a further 13 weeks of group recreational choir singing once per week. RCS focuses on singing participant‐selected songs akin to a choir context but without the expectation of preparing for a performance. The core principle of RCS is to sing familiar songs in a quasi choir setting, which provides a familiar musical environment for people to experience connectedness with others and enjoyment of music making in a group. The third intervention combines GMT and RCS, and participants allocated to this condition will partake in 13 weeks of GMT twice per week and RCS twice per week followed by a further 13 weeks of GMT once per week and RCS once per week. Each session of GMT and RCS will be 45 minutes in duration. CONDITION: dementia depression PRIMARY OUTCOME: Montgomery–Åsberg Depression Rating Scale SECONDARY OUTCOME: Adverse events: ; No adverse effects of music interventions are known from earlier trials. Intervention providers are trained to work closely with and adapt their interventions to the needs of participants in order to avoid adverse reactions. Because little knowledge exists about what the potential adverse events could be, all types of adverse events and serious adverse events (e.g. unexpected worsening of symptoms), whether related or unrelated to the interventions, will be reported. All‐cause mortality (time to death) ; Care staff from the residential care facilities (those involved in the daily care of residents), will report on participant deaths on a monthly basis. Costs of the interventions: ; Total and component costs of the interventions will be assessed from a societal perspective, including the cost of the intervention as well as statutory health and social care services used, using a tailored version of the Client Socio‐Demographic and Service Receipt Inventory (CSSRI). Days on sick leave of care staff (those involved in the daily care of residents), as recorded monthly by the employer Disease‐specific quality of life assessed using the Quality of Life in Alzheimer's Dementia scale (QOL‐AD; Logsdon et al., 2002) ; Generic quality of life assessed using the EuroQoL questionnaire (EQ‐5D) Medication use: INCLUSION CRITERIA: 1) Cognitive impairment or dementia, as indicated by a Clinical Dementia Rating (CDR) score of at least 0.5 and a Mini‐Mental State Examination (MMSE) score of 26 or less ; Data on type (ATC Codes N065, N06) of medication used and any increase or decrease over time will be collected from care staff using the 'medication profile' section of a tailored version of the Client Socio‐Demographic and Service Receipt Inventory (CSSRI), or from available databases. Neuropsychiatric Inventory Questionnaire (NPI‐Q; Kaufer et al., 2000) Subjective perceived burden of care staff (those involved in the daily care of residents) assessed using the Professional Care Team Burden Scale 2) at least mild depressive symptoms, as indicated by a Montgomery‐Åsberg Depression Rating Scale (MADRS) score of at least 8; 3) a clinical diagnosis of dementia according to ICD‐10 research criteria; 4) at least 65 years of age 5) living in residential care facilities