By: Melissa Heffner, MT-BC
A group of researchers from Taiwan wanted to test the effectiveness of music therapy in a group setting in maintaining cognitive function and improving depression in elderly persons with dementia. Their article, “The Impact of Group Music Therapy on Depression and Cognition in Elderly Persons With Dementia: A Randomized Control Study,” appeared in Biological Research for Nursing in 2014. Previous research has shown music therapy to be an effective way to delay cognitive deterioration and reduce depression and anxiety in elderly persons with dementia. These researchers wished to include participants who were more than 82 years old as well as use both biochemical and psychosocial measures. In this study, cortisol was the biochemical marker for depression, and the cognitive functions on which the researchers focused were orientation to place, orientation to time, short-term memory, registration, calculation, attention, and language.
The participants included in the study were 100 elderly adults between the ages of 65 and 97, the mean age being 82. Forty-nine individuals were in the experimental group that received group music therapy. Fifty-one individuals were in the control group that received usual care, including watching television, taking walks, and afternoon tea. Out of the 100 participants, 62 had moderate dementia, 21 had severe dementia, and 17 had mild dementia.
The participants were asked about their music preferences, past musical experience, and interest in participating in the music therapy group. This information was used to create the music therapy intervention. It involved music-cued reminiscence, song choice, music listening, singing, and instrument playing. More specifically it included listening to popular music, rhythm playing to music, using fine and gross motor movements to music, singing with instrumental accompaniment, and rhythm playing with instrumental accompaniment. The group music therapy occurred over a six-week period, with two 30-minute sessions per week. The following table outlines the themes and activities of the 12 total sessions:
| Session | Music Therapy Intervention Theme |
| Sessions 1 and 2 | Musical instrument activity using clappers, maracas, triangles, tambourines, and handbells |
| Sessions 3 and 4 | Therapeutic singing activity allowing for broad participation |
| Sessions 5 and 6 | Music listening |
| Sessions 7 and 8 | Color sound bell, hand function, and attention rehabilitation in which the music therapist encouraged participants to name a color out loud and then press the bell of that color |
| Sessions 9 and 10 | Music activity and traditional festival in which the therapist played music related to traditional festivals and encouraged participants to accompany the music briefly with an instrument to demonstrate their sense of celebration |
| Sessions 11 and 12 | Music creators in which the therapist asked each participant to choose an instrument that represented himself or herself and take a turn initiating a group improvisation |
Based on the results of the measures taken, this study showed that group music therapy can decrease depression in elderly persons with dementia. Reasons for this may be because participant-preferred and familiar music was used, the use of musical instruments provided opportunities for emotional expression, and the auditory stimulation in music may have served as a distraction from unpleasant feelings and provided a pleasant stimulus on which to focus.
The researchers found that no significant differences existed between the cortisol levels of the control and experimental groups immediately following the music intervention. This means that from a biochemical standpoint, group music therapy did not significantly affect levels of depression in the elderly with dementia. Suggestions were made for future studies in order to see consistent outcomes.
Group music therapy did, however, delay the deterioration of cognitive functions in elderly adults with dementia, and these effects were still evident one month after the intervention had ended. The individuals who benefited the most were those with mild and moderate dementia, rather than severe dementia. It was suggested that those with severe dementia seek individual music therapy. The cognitive function with the most improvement over the course of the study was the recall function. This may be because music stimuli may enhance cognitive functions, musical elements (like rhythm, temporal sequences, and form) may aid in organizing and reintegrating recall, the music therapy intervention themes were designed specifically to target cognitive functions, and therapeutic singing which allowed for broad participation may have helped participants orient to reality.
Overall, the researchers concluded that group music therapy had a positive impact on depression and delayed the deterioration of cognitive functions, especially recall, in elderly persons with dementia. Group music therapy may be most effective for those with mild and moderate dementia. The researchers suggested that, in order to maintain the treatment effect, group music therapy should be part of the daily activity program for these elderly adults.
Chu, H., Yang, C.-Y., Lin, Y., Ou, K.-L., Lee, T.-Y., O’Brien, A. P., & Chou, K.-R. (2014). The impact of group music therapy on depression and cognition in elderly persons with dementia: A randomized controlled study. Biological Research for Nursing, 16(2), 209-217.