Combining Music And Reminiscence Therapy Interventions For Wellbeing In Elderly.pdf

Accepted Manuscript Combining music and reminiscence therapy interventions for wellbeing in elderly populations: A systematic review Lauren Istvandity, Dr PII:

S1744-3881(17)30060-9

DOI:

10.1016/j.ctcp.2017.03.003

Reference:

CTCP 715

To appear in:

Complementary Therapies in Clinical Practice

Received Date: 8 February 2017 Accepted Date: 28 March 2017

Please cite this article as: Istvandity L, Combining music and reminiscence therapy interventions for wellbeing in elderly populations: A systematic review, Complementary Therapies in Clinical Practice (2017), doi: 10.1016/j.ctcp.2017.03.003. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

ACCEPTED MANUSCRIPT TITLE PAGE – Submission to Complementary Therapies in Clinical Practice Combining music and reminiscence therapy interventions for wellbeing in elderly populations: A systematic review

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Dr Lauren Istvandity Griffith Centre for Social and Cultural Research

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Griffith University 170 Kessels Rd Nathan Queensland 4111

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Tel: +61 07 3735 7317 Email: [email protected]

ACCEPTED MANUSCRIPT Combining music and reminiscence therapy interventions for wellbeing in elderly populations: A systematic review

Abstract

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Both music therapy and reminiscence therapy are currently being used to increase aspects of wellbeing in older people, including those with memory diseases such as dementia, as alternatives to pharmacological treatments. There is growing evidence that combining these therapies in a focused way would provide unique wellbeing outcomes for this population. This review aims to report on the existing intervention studies that utilise both music and reminiscence activities in equal measure in elderly adult populations. A systematic review of intervention-based studies published between 1996 and 2016 was carried out: five studies were included in this review. Included studies were predominantly carried out in aged care facilities with aged populations affected by a range of conditions; all studies assessed aspects of mental well-being. The review found music reminiscence therapy to have positive effects for participants in four out of five studies. Further research incorporating qualitative methods and mapping of intervention procedures would complement existing findings.

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Keywords: reminiscence, music therapy, memory, wellbeing, older adults, systematic review

ACCEPTED MANUSCRIPT Introduction

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The past decade has seen a great increase in research that theorises, applies and evaluates the use of alternative wellbeing therapies employing aspects of the arts, especially for the elderly. Music in particular, has been used to induce health and wellbeing benefits for various age groups. Often considered separate to music therapy, music, health and wellbeing activities, or “health musicing” (Bonde, 2011), can manifest in a range of modes including music-making, such as singing (Clift et al., 2010; Skingley and Bungay, 2010); listening (Ware, 2013); and combined with dance (Davidson and Emberly, 2012; Quiroga Murcia, Kreutz, Clift, and Bongard, 2010). Like other modes of arts-based stimuli, music can be found embedded in numerous alternative wellbeing therapies for older people, including reminiscence therapy.

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Reminiscence therapy is a group activity that involves the conversational discussion of autobiographical memory, which is usually triggered by given topics, tangible items such as photographs or artefacts, or recordings of music. The activity is often used with older populations, frequently in dementia care, and has been shown to most positively affect cognition (Wang, 2007), mental health, especially depression (Chiang et al., 2010; Watt and Cappeliez, 2000; see also meta-analysis by Bohlmeijer, Smit and Cuijpers, 2003), and selfesteem (Chao et al., 2006), alongside other factors. The therapy has been found to be more effective when conducted in group settings, over individualised therapy for its socialisation benefits (Haslam et al., 2010), despite its evolution from individual “life review” interventions as conceived by Butler (1963).

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Previous systematic reviews describe past studies of reminiscence therapy as producing mixed outcomes. A Cochrane review conducted by Woods, Spector, Jones, Orrell and Davies (2005) indicates some positive effects are evident, however the small number of studies and the variety of approaches limits generalised appraisal. A more recent review by Westerhof, Bohlmeijer and Webster (2010) describes theoretical and practical progress in reminiscence interventions designed to support mental health outcomes. This review suggests an increasing strength in the positive effect of the therapy in more recent studies, which are scaffolded by developments in understanding of reminiscence functions and definitions. Neither review evaluates the efficacy of stimuli used in interventions, which are only mentioned in passing. While music may be used within reminiscence activities to prompt the recall of memories, it has also been used for a similar purpose within music therapy. Music therapy has also been shown to have some positive effects in varied populations, including older people (Hanser and Thompson, 1994; Lai and Good, 2005) and those with dementia (Svansdottir and Snaedal, 2006; Wall and Duffy, 2010) and may integrate elements of reminiscence into its practice with these target groups. Music therapy currently has a greater evidence base and an established theoretical infrastructure as compared to reminiscence therapy, though systematic reviews produce mixed conclusions about its efficacy (McDermott, Crellin, Ridder & Orrell, 2012; Ueda, Suzukamo, Sato & Izumi, 2013; Vink, Bruinsma & Scholten, 2003). Though

ACCEPTED MANUSCRIPT recall of memories may become part of a particular music therapy protocol, it is just one of a raft of tools used in the broader applications of music therapy.

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The overlap of the use of music and reminiscence between these two therapies is rather germane. Studies across the domains of psychology and sociology demonstrate that music can effectively trigger autobiographical memories with strong emotional content (Cady, Harris & Knappenberger, 2008; Janata, Tomic & Rakowski, 2007; Schulkind, Hennis & Rubin, 1999), and that an individual’s personal memories of music are closely tied to their self-identity (Bennett, 2013; DeNora, 2000; Frith, 1996) and life story (AUTHOR, A; B). In a qualitative study of older people’s use of music, Hays and Minichiello (2005) underscore the importance of music to this demographic, stating that it can connect them to “others who may no longer be living, and may also validate memories, give meaning to live, and bring a greater sense of spirituality” (p. 274). Further to this, preliminary studies suggest that even the autobiographical recall of those experiencing cognitive decline such as dementia can be enhanced by music listening (El Haj, Postal and Allain, 2012). Summarily, this evidence points to the potential for a focussed, combined application of music and reminiscence in a structured setting to produce positive wellbeing outcomes for older populations, with and without cognitive diseases such as dementia.

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Methods

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At present, there are no published literature reviews that provide an adequate overview of studies that integrate both music and reminiscence based activities for therapeutic gain with older populations. Similarly, a standardised protocol for the delivery of a music-reminiscence therapy was not found at the time of this review. Hence, the aim of this systematic review is to determine the extent to which music and reminiscence activities have been empirically assessed as interventions with older people in published studies. Further, the review sought to describe how such activities were carried out, which aspect/s of health or wellbeing were targeted, and how outcomes were evaluated within studies meeting the criteria. The findings of the review will provide insight into the current state of research, with the view to generating standardised frameworks and procedures for the practice of music-reminiscence therapy.

Literature Search Strategy

The author systematically searched academic databases relating to public health and aged care using a pre-determined search string. The databases included: EBSCOhost, PubMed, Proquest, CINAHL Plus, Informit Health, MEDLINE, Scopus, Google Scholar, and Wiley Online Library. The search string allowed for the broad collection of research encompassing both music or reminiscence interventions in elderly populations: music OR arts AND aged care OR elderly OR seniors OR ageing OR older people AND reminiscence therapy OR therapy AND intervention AND wellbeing OR health. Due to the lack of established terminology for therapeutic activity that includes both music and reminiscence, a broad search enabled the detection of relevant studies that may not use similar lexicons. The

ACCEPTED MANUSCRIPT database search was restricted to include only full-text, peer-reviewed articles written in English and published between 1996 and 2016 at the time of the search. Study Selection Process

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In the first stage of inquiry, several key exclusion criteria also applied in line with the search string. The review was narrowed in terms of co-morbidity via the exclusion of research incorporating diseases or conditions other than forms of dementia, depression or anxiety (e.g. cancer, Parkinson’s disease, disability, suicide). This review is focused on the current state of intervention procedures involving music, reminiscence, and elderly populations and so theoretical articles and reviews of literature were excluded. Studies that utilised participants that were under the age of 65 years were excluded. Abstracts were reviewed for the presence of keywords in line with these parameters; potentially relevant articles were downloaded for full review (see Figure 1).

Data Extraction

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The second stage of the review involved examination of full-text articles, and application of further exclusion criteria. The first of these was the use of concepts of memory and reminiscence. This review is concerned with the inclusion of reminiscence activities as part of the intervention, however, many studies in the areas of cognitive and psychological science take measures for levels of memory function as a result of a particular intervention, but do not include a reminiscence component in their intervention: such studies were excluded from the review. Similarly, studies were excluded if reminiscence was listed as an outcome of an intervention (e.g. increased verbalisation of past experiences, thoughts and feelings), but did not form an integral part of the intervention itself.

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During the second stage of the review, the author populated tables that detailed aspects relevant to the review such as year of publication, sample size and description, type of intervention, frequency and length of intervention and whether it was conducted with groups or individuals, country of study, and facility type. This method allowed the author to overview a large amount of studies with ease, and to determine common characteristics. Articles selected for review were read several times each for familiarity and study characteristics were extracted in further detail (see Table 1). The studies’ commonalities and differences were synthesized by the author, and appear below. Results

Of the 1, 658 studies recovered in the database search, five studies were found to exclusively utilize an intervention combining music and reminiscence therapies: these are the focus of this review. Presented in Table 1 (see Appendix), these studies comprise Ashida (2000), Haslam et al. (2014), Mohammadi, Shahabi and Panah (2011), Rawtaer et al. (2015), and Takahashi and Matsushita (2006).

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A further seven studies were found to use music and reminiscence as part of a wider array of activities designed to stimulate aspects of participants’ wellbeing in some way. These include study designs in which music and reminiscence therapy was used in combination with other leisure activities within one cohort, e.g. gardening (Han et al. 2011; Jo and Song 2015), or where music was only one source of stimulation for reminiscence, and where outcomes related specifically to music-based reminiscence were not measured (Cook 1998; Jo and Song 2015; Kirkland et al. 2014; O’Rourke et al. 2011; Wang 2004). Further to these, a study by Wang (2007) includes music as just one of the series of topics in a reminiscence-based intervention. These studies have been excluded from extended review as the extent to which the impact of reminiscence on wellbeing was influenced by stimuli other than music is unclear.

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Research Aims of Selected Studies

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The five studies meeting the criteria principally aimed to improve one or more aspects of mental health among elderly subjects, including anxiety, depression, or stress, in different combinations. One study additionally included measures of cognition and life satisfaction (Haslam et al. 2014). The study by Ashida (2000) sought to evaluate the use of reminiscence activities in a music therapy context, focussed exclusively at reducing symptoms of depression in older adults with dementia. Mohammadi et al. (2011) were also interested in exploring the effects a music-based therapy may have on depression levels, in addition to feelings of stress and anxiety in older adults affected by various conditions of cognitive and physical health, including dementia in Iran. Particularly, the researchers wish to understand the degree to which traditional Persian music can be used to achieve the same positive effects found in music therapy studies using Western music. In a different approach, four psychosocial interventions (Tai Chi exercise, mindfulness awareness practice, musicreminiscence therapy, and art therapy) were implemented by Rawtaer et al. (2015) in a community context with the aim of improving levels of anxiety and depression in Singaporean elderly. The study carried out by Takahashi and Matsushita (2006) included a focus on physiological indications in measuring the long-term effects of a music-based therapy on stress and blood pressure levels of older adults affected by moderate or severe dementia. The further two identified studies looked at mental health outcomes in more complex ways. Haslam et al. (2014) extend on previous research that suggested improvements in cognition and wellbeing arise via the development of a shared sense of group identification that is encouraged by reminiscence activities (Haslam et al. 2010). The authors note the limitations of verbal discussion and the recognition and particular treatment of individual identity within traditional reminiscence therapy. To counter this, the 2014 study incorporates song-based simple reminiscence in secular and religious music groups. The aim of the study was to examine whether personal identification with the assigned group improved health outcomes, which included cognition, anxiety, and also life satisfaction.

ACCEPTED MANUSCRIPT Interventions

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All selected studies relied on music that was familiar to participants to stimulate reminiscence activities. Mohammadi et al. (2011) describe their intervention as “music therapy”, however, it also involved a significant reminiscence component. Participants (n=19, mean age 69 years) were recruited within a residential facility, and were split between intervention and control groups. The intervention group participated in Persian music-making with traditional instruments, movement, and reminiscence following music listening. The control group did not participate in this activity. Ninety-minute sessions were held once per week, for ten weeks.

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Similarly, Takahashi and Matsushita (2006) carried out an intervention they predominantly describe as music therapy, which included substantial reminiscence activities. Of 43 recruited participants (mean age 83 years), 24 were selected for the intervention group which participated in singing familiar song, playing instruments, and reminiscing as led by the group facilitator. The remainder of participants formed a control group that did not participate in music-reminiscence activities. Sessions were carried out once per week for six months. Intervention group participants reportedly also met separately to the sessions of their own volition, to talk about their recollections from the session, contributing to their emotional stability and socialisation.

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In a much shorter intervention, 20 aged care residents (mean age 86 years) in Ashida’s study (2000) participated in a three-week study. The intervention was carried out in the third week, in which groups attended five daily 45-minute sessions. The Cornell Scale for Depression in Dementia was filled out by nursing staff for each participant at the end of each week – the first two weeks therefore created baseline data against which the results from the third week could be compared. Sessions began and ended with a drumming activity to allow interaction between the facilitator and each participant. The facilitator led the reminiscence section of the activity by singing familiar songs related to the theme of the day accompanied by guitar. Questions relating to the lyrical content were then asked of each participant, enabling sharing and conversation. In a point of different to the above-mentioned studies, Haslam et al. (2014) included a traditional story-based reminiscence group using set themes as a baseline measure for the music-based intervention. Participants were forty elderly adults of mixed levels of independence living in two residential aged-care communities (mean age of 87 years). Participants were randomly assigned to one of three activity groups – story-based, secular song, or religious song reminiscence, in which they participated for two thirty minute sessions per week, for six weeks comprising 12 sessions in total. In both the song-based groups, facilitators played recorded music from the 1920s to the 1970s, one decade per week, and encouraged participants to sing along, and to strike up conversations in response to salient songs. The only difference between the groups was the theme of the music – popular music or music with religious themes.

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Participants in the study by Rawtaer et al. (2015) were affected by anxiety or depression, and were screened for cognitive decline, which would result in exclusion from the intervention stage. Ninety-nine participants that completed the study were recruited from public housing blocks in the Singaporean community (mean age 71 years). These people were given a choice of which of the four interventions they would like to take part in (Tai Chi exercise, mindfulness awareness practice, music-reminiscence therapy, or art therapy). Participants then undertook this activity with facilitators for ten weeks. After this point, the researchers changed their procedure to include all four interventions within one session, at the request of participants. Along with this change, the session frequency was lessened to fortnightly for the following 18 weeks, and then once per month for the rest of the year. The musicreminiscence element, which is of most interest to this review, comprised guided group singing to popular songs, followed by conversations of experiences and events.

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Evaluation and Measures

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All studies used predominantly quantitative measures based on pre-determined scales or physiological symptoms. All studies employed pre- and post-test levels except for Haslam et al. (2014), in which a group using traditional reminiscence therapy acted as a baseline. This study engaged several quantitative scales and inventories to examine elements of cognition, anxiety, and quality of life. Aspects of identity (social and religious) were also measured via five point scales. The choice of measures used by Haslam is the most complex of the selected studies. Rawtaer et al. (2015) screened participants for inclusion using anxiety and depression inventories, as well as the score on a Mini Mental State Exam (MMSE). The outcomes of the study were measured via two self-rated anxiety and depression scales filled out by participants at the first week of activities, and then at the fourth, tenth, twenty-fourth, and fifty-second week after the commencement of the interventions.

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Both Mohammadi et al. (2011) and Ashida (2000) confined their evaluation to a single scale. Mohammadi et al. (2011) utilized a 21-item questionnaire to obtain data on stress, anxiety, and depression levels of participants before and after the intervention, while Ashida’s study (2000) was carried out with particular reference to outcomes on the Cornell Scale for Depression in Dementia. In addition, patient behaviour and participation during the session was captured and later analysed via video camera, contributing a qualitative dimension to the analysis. The use of physiological well-being measures was most prominent in Takahashi and Matsushita (2006) who measured blood pressure, and cortisol levels via saliva samples from the intervention group participants before and after each music therapy session for six months, then again at one and two years after the commencement of the first music therapy session. Cortisol levels of the control group were recorded before the first music therapy session, then again at one and two years after the intervention. All participants were also given an intelligence test at the same intervals.

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Outcomes Ashida (2000) found participants’ depressive scores significantly decreased immediately after the intervention activity. Observation revealed an increase in participation over the course of the sessions. There was some indication from staff members that improvements in participants’ moods were not long lived after the sessions. Mohammadi et al. (2011) found statistically significant differences in pre- and post-test results, suggesting improvements in levels of stress, anxiety, and depression were experienced by participants. Given the long term nature of their study, Takahashi and Matsushita (2006) were able to use the data of 18 out of 24 participants who participated for the full two years. The researchers found positive results in both cortisol levels and blood pressure for those participating in the intervention, as opposed to the control group, although the changes in cortisol were mitigated in individuals with lower intelligence test scores.

Discussion

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The results of the study conducted by Haslam et al. (2014) showed no significant improvement in health as a result of the interventions, however, the research did reveal that a stronger sense of personal identification with the reminiscence group was connected to improved cognition and life satisfaction after story-based reminiscence, and improved life satisfaction and reduced anxiety after religious song reminiscence. These patterns did not apply to the secular song activity. In contrast, Rawtaer et al. (2015) noted amongst other outcomes that at the end of the fourth week, music-reminiscence therapy and art therapy were the only groups to show a significant improvement in levels of depression and anxiety. In the combination phase of interventions (after week 10), the analysis suggested improvements continued to week 52 relevant to baseline information.

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While only a small number of studies fit the criteria for this review, they nonetheless reveal a great deal about the current state of research into pairing music and reminiscence therapies. The focus of these studies collectively is on mental well-being, predominantly the reduction of anxiety, depression and stress, the levels of which are measured almost solely through quantitative methods. Notably, there is little emphasis on other types of well-being, such as social or emotional well-being, save for the use of a life satisfaction scale by Haslam et al. (2014). Much of the evaluation processes involved carers or researchers gathering information on participants, except within Rawtaer et al. (2015), in which participants undertook self-assessment. Three out of the five studies utilised populations affected by dementia (Ashida, 2000; Mohammadi et al., 2011; Takahashi and Matsushita, 2006), while one study screened exclusively for elderly participants with diagnosed anxiety or depression (Rawtaer et al., 2015); participants in all of these studies were gathered from aged care facilities. The remaining study (Haslam et al., 2014) used participants of varied mobility who were residing in communities. The details of how the intervention sessions are carried out are frequently omitted, or vaguely described, within all studies. Interventions across the studies often encouraged a range of interaction with music, such as singing, moving, and listening, before moving on to

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reminisce. The exception to this appears to be the design by Ashida (2000), who describes a therapist singing songs while participants listened in order to promote reminiscence; it is unclear whether participants also sang in this intervention, or only listened. A great deal of variance was apparent in the design of delivery intervention between studies. The frequency of sessions, length of individual sessions between studies were widely different, varying for example from five consecutive days of 45-minute sessions (Ashida, 2000), to weekly 30 minute sessions once per month (Rawtaer et al., 2015). The duration of interventions aligned with study aims - three of the studies looked to short-term outcomes (Ashida, 2000; Haslam et al., 2014; Mohammadi et al., 2011), while two considered effects over longer periods of time. In light of the outcomes, it is useful to note that both long- and short-term studies validated the effects of a music-reminiscence therapy. The exception is the result of Rawtaer et al.’s study, in which no quantifiable health benefits were found. The data does however suggest that psycho-social aspects of identity and quality of life were positively affected, suggesting that quantitative measures alone may be insufficient for assessing the ways in which music-reminiscence therapies may be helpful for older people.

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Limitations There are several limitations that could be seen to effect the outcome of this review. The review only includes published studies written in English and with full-text availability within major databases. Similarly, the review only sort peer-reviewed articles to ensure a baseline standard of research, and did not include research published in books or conference proceedings. It is possible that further studies that are currently unavailable in this format or language may contribute to an understanding of music and memory interventions. In addition, the design of this systematic review to specifically seek studies combining music and reminiscence may have excluded music-based studies in which reminiscence is only mentioned in passing. In an effort to review and consolidate this niche area, the review excluded studies in which the activity of reminiscence was not purposeful, or was a result of the therapy interaction, rather than part of the intervention itself. In this way, the review is limited to a view of reminiscence as an intervention tool, and does not waver from this scope.

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There were numerous limitations evident in the studies matching the review criteria. Leading these limitation is the lack of detail provided in all selected studies in describing the processes of the intervention itself. Rather, brief overviews of the types of activities are given, but examples of how facilitators connected memory and music for participants was not apparent in any of the studies. This reduces the ability for the studies to be replicated, but also does little to aid the production or legitimation of future research in the area. Further to this, there is little assessment of the content of memories that were recounted by participants, and no reflection on the success of some conversation topics or genre of music over others. This is likely related to the predominant use of quantitative methods that focus on measurable outcomes of the intervention, but do not assess the process of the intervention itself. The lack of qualitative measures employed besides observation, which did not seem to play a significant role in these studies’ findings, is at odds with the qualitative nature of the activity – listening, singing, remembering, and talking.

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The samples populations are described by most researchers as small in size for statistical purposes, and can be seen as a product of aged care environments. Four out of the five studies were conducted in aged care facilities; Rawtaer et al. (2015) were the only researchers to focus on participants situated within an urban community. This highlights a clear gap in the literature, in which further research could seek to know more about the effects a music and memory program might have for elderly people living in the community. Another limitation regarding participant pools is that the demographic information gathered on participants appears to be limited. For the most part there is minimal information provided on the cultural, ethnic or religious background of participants, and few connections made between these aspects and the intervention outcomes. The exception here is the research by Mohammadi et al. (2011) that looks specifically at Persian participants and traditional music. There are studies outside the scope of this review that consider these factors such as Chong (2000; reminiscence with Chinese elderly) and Wray (2012; life review with female UK immigrants). These inquiries that suggest ethnicity and culture may play a part in how aspects of music, memory, and wellbeing are perceived and expressed by individuals, indicating that further consideration of these factors could result in more nuanced findings.

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Conclusions The studies included in this review reveal the developing nature of empirical testing and theoretical rationale of therapies combining music and memory. These studies utilised elderly populations, some affected by cognitive decline, and incorporated aspects of music therapy (singing, playing and listening to music) while also drawing a focus to the act of reminiscing and conversation. The review demonstrates the outcomes of existing research predominantly positive effects of such therapies upon the mental well-being of participants, especially stress, anxiety, and depression, though there is a gap in the effect on other aspects of well-being (emotional, social). Such findings were achieved principally through quantitative methods, with only one study using self-reporting mechanisms. There is a clear need for further use of qualitative research methods to complement the existing research. Research that concentrates on the reported effects of therapies via interviews, surveys, and documented observation could provide further insights regarding the way the therapy may or may not be perceived as having benefits for participants. The key aspects of successful delivery of the therapy cannot be effectively determined from these studies. While there was some consistency in the use of singing and familiar songs, there is little information given on the delivery process, and the efficacy of session facilitation is not evaluated in any of the included studies. This highlights a focus on measuring outcomes, rather than developing protocol strategies, which are not currently standarised. Future research should incorporate description and reflection of their practices, to further legitimise research via possible replication, but also in a concerted effort to work towards an aligned practice method. The small number of existing studies indicates that there is broad scope for further research in music and reminiscence therapy that looks into both long and short term outcomes, working with elderly people who are both affected and unaffected by physical and mental ailments and disease. It is possible that the use of music and reminiscence together is already occurring informally as a recreational activity in aged

ACCEPTED MANUSCRIPT care centres; however, the documentation of this is yet another direction for future research. In recent times, there has been an increased call for interventions in aged care that are neither invasive nor costly: further research into arts-based therapies such as music-reminiscence is therefore a rational area of focus in contributing to global healthcare solutions, with a firm foundation of empirical and theoretical research still developing.

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Acknowledgements Research leading to this publication was supported by St Vincent’s Aged Care, Brisbane, Australia.

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Hanser, S. B., & Thompson, L. W. (1994). Effects of a music therapy strategy on depressed older adults. Journal of Gerontology, 49(6), 265-269. doi:10.1093/geronj/49.6.p265 Haslam, C., Haslam, S. A., Jetten, J., Bevins, A., Ravenscroft, S., & Tonks, J. (2010). The social treatment: The benefits of group interventions in residential care settings. Psychology and Aging, 25(1), 157. doi:10.1037/a0018256 Haslam, C., Haslam, S. A., Ysseldyk, R., McCloskey, L. G., Pfisterer, K., & Brown, S. G. (2014). Social identification moderates cognitive health and well-being following story-and song-based reminiscence. Aging & Mental Health, 18(4), 425-434. doi:10.1080/13607863.2013.845871 Janata, P., Tomic, S. T., & Rakowski, S. K. (2007). Characterisation of music-evoked autobiographical memories. Memory, 15(8), 845-860. doi:10.1080/09658210701734593

ACCEPTED MANUSCRIPT Lai, H. L., & Good, M. (2005). Music improves sleep quality in older adults. Journal of Advanced Nursing, 49(3), 234-244. doi:10.1111/j.1365-2648.2004.03281.x McDermott, O., Crellin, N., Ridder, H. M., & Orrell, M. (2013). Music therapy in dementia: a narrative synthesis systematic review. International journal of geriatric psychiatry, 28(8), 781-794. doi:10.1002/gps.3895

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Mohammadi, A. Z., Shahabi, T., & Panah, F. M. (2011). An evaluation of the effect of group music therapy on stress, anxiety and depression levels in nursing home residents. Canadian Journal of Music Therapy, 17(1). Retrieved from: http://search.proquest.com.libraryproxy.griffith.edu.au/docview/1030389753?accountid=145 43

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Quiroga Murcia, C., Kreutz, G., Clift, S., & Bongard, S. (2010). Shall we dance? An exploration of the perceived benefits of dancing on well-being. Arts & Health, 2(2), 149-163. doi:10.1080/17533010903488582 Rawtaer, I., Mahendran, R., Yu, J., Fam, J., Feng, L., & Kua, E. H. (2015). Psychosocial interventions with art, music, Tai Chi and mindfulness for subsyndromal depression and anxiety in older adults: A naturalistic study in Singapore. Asia‐Pacific Psychiatry, 7(3), 240250. doi:10.1111/appy.12201

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Sakamoto, M., Ando, H., & Tsutou, A. (2013). Comparing the effects of different individualized music interventions for elderly individuals with severe dementia. International Psychogeriatrics, 25(5), 775-784. doi:10.1017/s1041610212002256

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Schulkind, M. D., Hennis, L. K., & Rubin, D. C. (1999). Music, emotion and autobiographical memory: They're playing your song. Memory & Cognition, 27(6), 948-955. doi:10.3758/bf03201225

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Skingley, A., & Bungay, H. (2010). The Silver Song Club Project: Singing to promote the health of older people. British journal of Community Nursing, 15(3), 135-40. doi:10.12968/bjcn.2010.15.3.46902 Svansdottir, H. B., & Snaedal, J. (2006). Music therapy in moderate and severe dementia of Alzheimer's type: A case–control study. International Psychogeriatrics, 18(04), 613-621. doi:10.1017/s1041610206003206 Takahashi, T., & Matsushita, H. (2006). Long-term effects of music therapy on elderly with moderate/severe dementia. Journal of Music Therapy, 43(4), 317-333. doi:10.1093/jmt/43.4.317

ACCEPTED MANUSCRIPT Ueda, T., Suzukamo, Y., Sato, M., & Izumi, S. I. (2013). Effects of music therapy on behavioral and psychological symptoms of dementia: a systematic review and metaanalysis. Ageing Research Reviews, 12(2), 628-641. doi:10.1016/j.arr.2013.02.003

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Vink, A. C., Bruinsma, M. S., & Scholten, R. J. (2003). Music therapy for people with dementia. Cochrane Database of Systematic Reviews, 4, Art. No.: CD003477. doi:10.1002/14651858.CD003477.pub2 Wall, M., & Duffy, A. (2010). The effects of music therapy for older people with dementia. British Journal of Nursing, 19(2), 108-113. doi:10.12968/bjon.2010.19.2.46295

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Wang, J. J. (2007). Group reminiscence therapy for cognitive and affective function of demented elderly in Taiwan. International Journal of Geriatric Psychiatry, 22(12), 12351240. doi:10.1002/gps.1821

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Ware, A. (2013). The emerging field of harp therapy and its clinical applications. Journal of the Australasian Rehabilitation Nurses Association, 16(2), 15-17. Retrieved from: http://search.informit.com.au/documentSummary;dn=487906908410843;res=IELHEA Watt, L. M., & Cappeliez, P. (2000). Integrative and instrumental reminiscence therapies for depression in older adults: Intervention strategies and treatment effectiveness. Aging & Mental Health, 4(2), 166-177. doi:10.1080/13607860050008691

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Westerhof, G. J., Bohlmeijer, E., & Webster, J. D. (2010). Reminiscence and mental health: A review of recent progress in theory, research and interventions. Ageing and Society, 30(04), 697-721. doi:10.1017/s0144686x09990328

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Wray, S. (2012). “This is your life you have to live with the memories”: Older migrant women’s reflections on living with the past. The International Journal of Aging in Society, 1 (3), 35-48. doi:10.18848/2160-1909/cgp/v01i03/35159

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Woods, B., Spector, A., Jones, C., Orrell, M., & Davies, S. (2005). Reminiscence therapy for dementia. Cochrane Database Syst Rev, 2. doi:10.1002/14651858.cd001120.pub2

Appendices [Figure 1] [Table 1]

ACCEPTED MANUSCRIPT

Table 1: Studies matching inclusion criteria Study Aim

Population; sample size / setting /country

Intervention; length / frequency / group or individual delivery

Methods and measures

Ashida / 2000

Examines use of reminiscence groups and music therapy techniques to decrease symptoms of depression

20 elderly people with dementia (3 males, 17 females; 73-94 years)

Drumming; guided reminiscence with therapist performing familiar songs.

Cornell Scale for Depression in Dementia (pre-/post-tested)

SC

Video-recorded (observation)

Group delivery

Significant decrease in depressive symptoms and improvement in mood and social interaction reported immediately after the intervention

40 elderly people of mixed mobility (mean age 87 years) Residential aged care, country unknown

1) Story reminiscence: guided group reminiscence on set themes (baseline) 2) Secular song reminiscence: participants shared and sang familiar popular songs and conversed 3) Religious song reminiscence: participants shared and sang familiar religious songs and conversed

EP

Investigates the health effects of shared sense of group identification via song- and storybased reminiscence

AC C

Haslam et al. /2014

TE D

M AN U

Residential aged care, USA

45 mins daily x 5 days

Findings

RI PT

Author / date

2 x 30min sessions/week for 6 weeks Group delivery

Self-Administered Gerocognitive Examination Geriatric Anxiety Inventory Satisfaction with Life Scale Aspects of identity (social, religious) were also measured

Limitations

This study uses a small sample size and acknowledges it does not control for variables that may have affected the outcome such as participant’s health, change of medication, group size and level of normal social interaction. The intervention is protracted to only occur within one week, making it an unusual addition to participants’ schedules. Additionally, this study only looks at very short term outcomes.

No effects found on measures of cognition, anxiety, or life satisfaction. A stronger sense of group identification as a result of the story reminiscence impacted positively upon cognition and life satisfaction; group identification following religious song resulted in increased life satisfaction and reduced anxiety. No positive effect was found for secular song.

This study has a small sample size. The authors acknowledge it does not include a measure of depressive symptoms and that a more narrative-style approach in the songbased sessions could have resulted in different outcomes.

ACCEPTED MANUSCRIPT

Study Aim

Population; sample size / setting /country

Intervention; length / frequency / group or individual delivery

Methods and measures

Findings

Limitations

Mohammadi et al. / 2011

To test whether Iranian music therapy will reduce stress, anxiety and depression in elderly aged care residents

19 elderly people over 65 years (9 female, 10 male, mean age 69 years) with a range of cognitive or physical disease or decreased mobility

Music therapy techniques incl. playing instruments, singing traditional songs, rhythmic movement, and reminiscing after listening

Depression Anxiety Stress Scale (DASS-21) – pre-/posttesting

Intervention group showed significant improvement in anxiety, depression, and stress scales as compared to control group

This study used a small sample size; does not control for cognitive decline, or separate affected participants in analysis.

Group delivery

Community – public housing, Singapore

Tai Chi Exercise: guided Tai Chi movements for total 30 minutes

Art therapy: participants shown art and asked to reflect on thoughts and feelings

TE D

99 older adults with depression or anxiety (25 males, 76 females, mean age 71 years)

Mindfulness Awareness Practice: Instructors guided meditation with focus on body sensations, feelings, and thoughts.

EP

To evaluate the short- and longterm effects of a community-based psyschosocial intervention on mental health of older adults

Music Reminiscence Therapy: Instructor guided discussion of past events or experiences after group singing of popular songs. Music was main medium for reminiscence, though photos and pictures were also used.

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Rawtaer et al. / 2015

M AN U

Residential aged care, Iran

SC

1 x 90 minute sessions/week for 10 weeks

RI PT

Author / date

Single intervention 30mins weekly for 10 weeks; mixed intervention 30 minutes per fortnight for 18 weeks; 30 minutes once a month for the

Geriatric Depression Scale (GDS) Geriatric Anxiety Inventory (GAI) Mini Mental State Exam (MMSE) Zung Self-Rating Depression Scale (SDS) Zung Self-Rating Anxiety Scale (SAS) Measures taken at baseline, 4 weeks, 10 weeks, 24 weeks and 52 weeks.

The guidance given to the group/individuals to facilitate reminiscence is unclear. 4th week: only MRT and AT treatment groups recorded significant decrease in SDS and SAS scores. This was maintained for MRT by week 52

This study has a small sample size and does not incorporate a control group. Use of self-rating scales may introduce some bias. Intervention chosen by participants, not randomised. Participants did not remain in single intervention for more than 10 weeks.

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Population; sample size / setting /country

Methods and measures

Intervention; length / frequency / group or individual delivery remainder of the year (24 weeks) Group delivery

Aged care, Japan

MT group: facilitator lead singing of familiar songs; led group reminiscence; playing instruments in concert context Control group: did not participate in music therapy activities

1x 60 minute session weekly for 6 months

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Group delivery

Music therapy group: saliva sampling & blood pressure (pre- and post-session for 6 months, plus 1 and 2 years after first session)

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43 elderly people with various types of dementia (5 men, 19 women; mean age 82.7)

EP

Investigated the long term physiological and psychological effects of music therapy with elderly dementia patients

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Takahashi & Matsushita / 2006

Findings

RI PT

Study Aim

SC

Author / date

Non-music therapy group: saliva sampling & blood pressure before start of first MT session (baseline), then at 6 months, 1 and 2 years after therapy began. Both group given HDS-R intelligence test before therapy session, 6 months, 1 and 2 years after sessions began.

Individuals who scored highly on the intelligence test were found to have improved cortisol levels compared to the control group after two years. Participants in the music intervention group were found to have lower blood pressure levels after two years than those in the control group.

Limitations

Uses only physiological measures; small sample size; it was difficult to obtain clear results through use of salivary cortisol levels.

ACCEPTED MANUSCRIPT Figure 1. Selection process

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Databases searched: EBSCOhost, PubMed, Proquest, CINAHL Plus, Informit Health, MEDLINE, Scopus, Google Scholar, and Wiley Online Library (n = 1658)

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Excluded based on initial criteria (n = 1580)

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Full-text articles obtained (n = 76)

Excluded (n= 71)

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Reasons: Reminiscence interventions that did not include music; music interventions that did not refer to reminiscence or memory

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Studies included in review (n = 5)