Merton Music Therapy Community-based Dementia Project

Dementia represents one of the most significant and growing challenges facing adult social care in England, with increasing numbers of people living longer with complex and progressive needs. Alongside cognitive decline, people living with dementia often experience anxiety, agitation, communication difficulties, and social isolation, particularly during key transition points such as diagnosis, changes in care arrangements, hospital admissions, and end-of-life care. These challenges also have a substantial impact on informal carers, many of whom experience stress, reduced wellbeing, and difficulty sustaining their caring role without additional support.

Merton are currently developing a 5 year action plan on dementia (for April 26 - March 31). This project will contribute to work activity under the plan by supporting people with dementia and their carers when they are at or approaching points in the dementia journey where they are likely to need more support. It is anticipated that the availability of timely, appropriate psychosocial support in the form of tailored group music therapy sessions will help participants to accept their diagnosis, experience peer support, navigate changes in their relationship, ultimately leading to improved outcomes.

This project responds directly to the need for preventative, community-based interventions that can support people living with dementia and their carers while aligning with adult social care priorities. By focusing on key stages of need and generating locally relevant evidence, the project will help address both service pressures and gaps in provision.

Aims

• To assess the feasibility of delivering music therapy sessions and conducting research in two different community settings
• To evaluate the impact of music therapy upon the people who take part directly in sessions, as well as its wider impact on the settings, staff and carers of people with dementia
• To compare differences between the two settings, in terms of the participants, the content of sessions, the effects of music therapy, and the resources required to deliver session and collect data.

Main Research Question

How does the feasibility and impact of group music therapy sessions for people with dementia compare between two different community settings?

Subsidiary research questions:

1. What is the impact of the music therapy groups upon attendees (people with dementia and informal carers) and does this differ between the two settings?
2. What is the impact of the music therapy groups upon staff and culture in the settings (day centre and memory hub staff)?
3. Is it feasible to conduct the study in these two settings? (recruitment, retention, attendance, delivery, data collection)
4. What are the barriers and facilitators to implementation in each setting?

Study design

This is a single arm, pre-post feasibility study using mixed methods, which investigates the effects of music therapy concurrently in two different groups of participants.

Setting:

The study will take place under the umbrella of Adult Social Care/Public Health Services within Merton Council. Within this context, the music therapy groups will take place in two different settings:

1. Merton Memory Hub, a service run by the Alzheimer's Society and commissioned by Merton Council Public Health, providing services, support and activities to people who have been diagnosed with dementia and their families and carers
2. Eastways Day Centre, a day centre operated by Merton Council (Adult Social Care) providing support to older people with eligible needs for day care in the local area.

In each of these settings, music therapy groups will take place in dedicated rooms which will be arranged to provide an appropriate space, supported by Memory Hub/Day Centre staff in agreed ratios.

Participants

In both settings, the participants will be people who have been diagnosed with dementia. At the Memory Hub, we will also recruit the informal carers of people with dementia to take part in the music therapy group, though we will not exclude any person with dementia who wishes to take part but does not have a carer who can attend with them. At the day centre, carers do not usually attend as this is respite time for them, but they will be included in the study as we will collect data from them. We will involve them in the group by holding a sharing session towards the end of the programme, and by providing simple music activities which they can try at home if they wish.

It is anticipated that due to the different profiles of services users accessing Memory Hub and day centre provision, these two music therapy groups will include people at slightly different stages of their dementia journey, with the day centre participants expected to be more advanced in their dementia. Also, because the Memory Hub group will include informal carers (that are usually partners or family members), the music therapy group may have an impact on the relationship between them. Consequently, we have selected slightly different measures for assessing the impact of these two music therapy groups.

Intervention:

The intervention in this study will be attendance at one of the music therapy groups weekly for a period of 10 weeks. The music therapy sessions in this study will be delivered by a fully qualified, HCPC registered music therapist with experience in working with people with dementia, who will be engaged on a freelance basis for one day per week. CIMTR academics and Merton Council partners will meet with the Music Therapist engaged for the project to discuss the needs of participants and the aims of the intervention. Following this, the Music Therapist and researchers will plan a music therapy programme which promotes engagement, social connection, enjoyment, and personal identity, with the aim of supporting quality of life, emotional regulation, and the relationship between person with dementia and care partner. The programme will include accessible musical resources and activities which participants can integrate into their daily lives, allowing the benefits of music therapy to be sustained longer-term, and potentially beyond the duration of the intervention itself. Session activities will include some combination of the following: singing familiar songs, receptive music listening, improvised music making, music-based games (such as rhythmic copying or turn taking), movement to music, and songwriting, as well as time for sharing, discussion and reflection. The Memory Hub sessions will also include time for refreshments and socialising between the attendees (this is already included within the time that participants spend at the day centre).

Data collection:

The study will collect both quantitative and qualitative data, as well as feasibility data relating to recruitment, attendance, attrition and acceptability of study methods.

The follow demographic and descriptive data will be collected from participants:

People with Dementia: Age, Gender, Diagnosis, time since diagnosis, level of musical experience Carer: Age, Gender, Relationship to person with dementia Staff: Role, Years of experience working with dementia care

Quantitative data will be collected using standardised scales for quality of life, wellbeing, relationship quality, engagement, and caregiver sense of competence at baseline and after completing the course of sessions. A self-reported measure of mood and engagement will be used to collect data on immediate response to the sessions on the day. Data will also be collected via Merton Council about the participants' use of adult social care services.

Qualitative data will be collected through informal feedback and interviews with participants in the music therapy groups and/or their care partners, through interview with the music therapist and the observational records of music therapy sessions, and through interviews with staff at the Hub and day centre.

Data analysis:

Quantitative data will be analysed using descriptive statistics with exploratory analysis to detect signals of benefit within this non-randomised study. Data will be summarised with mean and standard deviation for normally distributed variables, and median and inter-quartile range for skewed variables. Recruitment, retention and attrition rates will be calculated.

Recordings of interviews will be transcribed as necessary. The software package NVivo 14 will be used to conduct the thematic analysis.

Ethics:

Recruitment of participants will not commence until the study has received ethical approval from Anglia Ruskin University and from a Health Research Authority Research Ethics Committee (due to the study including people recruited from Adult Social Care Services).). The researcher who has direct contact with participants will have a DBS check and Safeguarding Training (Level 2) and any causes for concern will be reported to the relevant Designated Safeguarding Lead.