Understanding the Effects of Music Care on the Lived Experience of Isolation and Loneliness in Long-Term Care: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Overview
2.2. Study Setting
2.3. Design
2.4. Music Care “Initiative” Intervention
2.5. Participant Selection and Recruitment
2.6. Interviews
2.7. Data Analysis
3. Results
3.1. Participants
3.2. Themes
“Resources can be an issue….”
“So we realized we needed to order a second set of bells. They were ordered eight days after the first set, and they have not arrived.”
“Are we gonna pay them to stay an extra hour every day or something like that? So we ended up not getting any of the staff.”
“[Getting the nurses on board] was a little bit more difficult to achieve. They, at first, look at it as a recreation job. Like you guys are the ones who program so you guys do it.”
“[The music system] does have some problems. Sometimes it charges and takes like ten to fifteen minutes to get it going. So it’s a little bit different.”
“Ideally like there should be a different space in which we can practice but there is just limited spacing here.”
“Yeah, because some people are really struggling, just maybe, either cognitively or physically, in ringing the bell properly.”
“Well, it’s verbal, and it’s different. But it doesn’t mean that like it… That’s why I think reports and that’s why my notes I think are really important. Yeah. Because if I can start noticing somebody’s foot tap, right. And I can see somebody’s hand starting to go to a beat, right? Like things like that. But then I have to see that and write that down in order for that… because that is a piece of information important.”
“And the third floor has a higher level of functioning. Right. So I think this kind of a program has kind of automatically morphed to this floor, simply because of level of ability. You’re going to get more response.”
“Day to day, it’s different in long-term care, you can have moment to moment differences. I had a gentleman who was really animated and contributed wonderfully last week. He had a bad night. Didn’t have a good morning, halfway through, he had to use the washroom. He just wasn’t himself and fell asleep a lot. That’s just the nature of long-term care, right? And then I had a lady who this morning felt very sad, didn’t want to come out of her bed, and I can’t force someone to come.”
“There’s a particular resident on one of the units, every time there is a behaviour, I use the same music. So it’s actually one of the Christmas ones, the holiday season. I guess she kind of connects with and is familiar with the Christmas songs.”
“Because they’ve said it themselves that this brought back memories… thinking either about the war or when they were younger.”
“He brought in a picture one time of his family band when he was younger.”
“Yes, we chatted about what it was, why it was their favourite song and what we liked about it. Some people would share some things that happened to them.”
“[Prior to the start of the program] I don’t have to be playing music I don’t have to have anything in my hands but they’re excited.”
“We sing songs that we like at the table (me and my tablemate). It gets our mind off of things.”
“Another resident, she’s kind of on the angry side a lot of the time and I’ve noticed that she will listen to Elvis or Bobby Darin on the iPod and sing and dance.”
“I also include music in the background so the music to release to decrease muscle tension and to help it to stay calm to motivate them to do the exercise.”
“I’ve noticed a lot of changes in the residents over time. I think they’re more relaxed [during] meals.”
“You know myself, my supervisor and the rest of the people participating in it… You just we all love music. We express the same reaction to music; we just get engaged right away. Music is bonding.”
“If the staff is included that will help the residents to feel more connected to the staff as well as other residents.”
“For example, I have one gentleman who loves music, and every time I see him, our connection with each other is talking about music. Which is awesome. And for him, music can be a daily thing. But someone who, music wasn’t part of their lives, or was just on Sunday at church, which is a reality for this age group and this demographic as well. [Music] was a good thing and a joyful thing and something that brought happiness and a comfort level for sure. But they didn’t necessarily go to dances and [music] wasn’t taught. And then I have a lady who danced ballroom dance since she was three years old and loves all kinds of music and music is naturally a part of her life. Not because I brought it or because I brought her to music appreciation, simply because music always was for her.”
“Communication becomes a barrier from time to time, and I think at this home it was.”
“Um, I think the communication piece, maybe we fell short on that a little bit, is trying to help the staff who weren’t trained, to at least come in for a mini thing and see what it’s about. I don’t know whether that was done. I wasn’t called into it. I think that would have been a beneficial piece.”
“Our [program] is very approachable. We don’t put a restriction on them, we tell them that it’s fun. So it’s not necessarily all regimented we just let loose and we just play.”
“I feel like I didn’t really get really good learning and direction on what was expected. From my understanding, I sort of turned it into this because this was the only way that I could figure out how I could do music appreciation in a group.”
“[The music care trainer] was absolutely wonderful and I loved how passionate she is about music, and how she opened my eyes to I just loved some of her ideas like, like using a familiar song changing the words to try to motivate somebody I thought was just divine and, and fun…Some of the tools that were taught to us were fabulous.”
“I think that was the most exciting thing is [that] you can probably do more of this even after the project is over.”
“One said she only liked classical music, but she was coming out and she was willing to listen to other music.”
“Above and beyond this initiative we’ve tried to just include a lot more music around the home in our common areas.”
“Sometimes in 35 to 40 min, the resident can go from having behaviours to sleeping.”
“We’re hoping to continue it and we will, eventually, but we can’t get all the people together at the same time to do much with it, you know?”
“[A resident who is otherwise] secluded, and doesn’t come out, he’s coming to listen, he’s going to the social hour on Thursday night…”
“He kind of said that he’s a little bit of a loner…it’s been great that music has really been a way to open the door with him.”
“I get hyper at one minute and then it makes me laugh and joke with others.”
“It’s making a difference. The residents who are coming out even if they’re not coming out regularly I think it’s getting some of them to open up more talk share more in a group.”
“Music is good for us, and it increases the social aspect.”
“[My table mate and I] sing songs that we like at the table. It gets our minds off things.”
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Ontario Long Term Care Association (OLTCA). This Is Long-Term Care. 2019. Available online: https://www.oltca.com/OLTCA/Documents/Reports/TILTC2019web.pdf (accessed on 19 June 2020).
- Statistics Canada. 2016 Census Topic: Age and Sex. 2017. Available online: https://www12.statcan.gc.ca/census-recensement/2016/rt-td/as-eng.cfm (accessed on 21 June 2020).
- Gibbard, R. Sizing Up the Challenge: Meeting the Demand for Long-Term Care in Canada. 2017. Available online: https://www.cma.ca/sites/default/files/2018-11/9228_Meeting%20the%20Demand%20for%20Long-Term%20Care%20Beds_RPT.pdf (accessed on 17 June 2020).
- Boscart, V.M.; Sidani, S.; Poss, J.; Davey, M.; d’Avernas, J.; Brown, P.; Heckman, G.; Ploeg, J.; Costa, A.P. The associations between staffing hours and quality of care indicators in long-term care. BMC Health Serv. Res. 2018, 18, 750. [Google Scholar] [CrossRef] [PubMed]
- COVID-19 Death Rates in Ontario Long-Term Care Homes Significantly Higher and Increasing in For-Profit Homes vs. Non-Profit and Publicly-Owned Homes: New Data Analysis. Ontario Health Coalition. 2020. Available online: https://www.ontariohealthcoalition.ca/index.php/death-rates-in-long-term-care-by-ownership-release/ (accessed on 20 June 2020).
- Hsu, A.; Lane, N. Impact of COVID-19 on Residents of Canada’s Long-Term Care Homes—Ongoing Challenges and Policy Response. 2020. Available online: https://ltccovid.org/wp-content/uploads/2020/04/LTCcovid-country-reports_Canada_Hsu-et-al_updated-April-14-2020.pdf (accessed on 19 June 2020).
- Canadian Armed Forces. OP LASER—JTFC Observations in Long Term Care Facilities in Ontario. 2020. Available online: https://www.macleans.ca/wp-content/uploads/2020/05/JTFC-Observations-in-LTCF-in-ON.pdf (accessed on 23 June 2020).
- Ryman, F.V.M.; Erisman, J.C.; Darvey, L.M.; Osborne, J.; Swartsenburg, E.; Syurina, E.V. Health effects of the relocation of patients with dementia: A scoping review to inform medical and policy decision-making. Gerontologist 2018, 59, e674–e682. [Google Scholar] [CrossRef] [PubMed]
- Kerns, J.W.; Winter, J.D.; Winter, K.M.; Kerns, C.C.; Etz, R.S. Caregiver perspectives about using antipsychotics and other medications for symptoms of dementia. Gerontologist 2018, 58, e35–e45. [Google Scholar] [CrossRef] [PubMed]
- Flamm, H. They Want Docile: How Nursing Homes in the United States Overmedicate People with Dementia. 2018. Available online: https://www.hrw.org/report/2018/02/05/they-want-docile/how-nursing-homes-united-states-overmedicate-people-dementia (accessed on 12 June 2020).
- Smetanin, P.; McNeil, D.; Burger, C. Modelling of CFHI’s Reducing Antipsychotic Medication Use Program. 2016. Available online: https://www.cfhi-fcass.ca/docs/default-source/about-us/corporate-reports/ap-riskanalytica-e.pdf?sfvrsn=3e8c5ca1_2 (accessed on 2 June 2020).
- Health Quality Ontario. Measuring Up 2018: A Yearly Report on How Ontario’s Health System is Performing. 2018. Available online: https://www.hqontario.ca/Portals/0/Documents/pr/measuring-up-2018-en.pdf (accessed on 4 June 2020).
- Jansson, A.; Muurinen, S.; Savikko, N.; Soini, H.; Suominen, M.; Kautiainen, H.; Pitkälä, K. Loneliness in nursing homes and assisted living facilities: Prevalence, associated factors and prognosis. J. Nurs. Home Res. 2017, 3, 43–49. [Google Scholar] [CrossRef]
- Palmer, A.D.; Newsom, J.T.; Rook, K.S. How does difficulty communicating affect the social relationships of older adults? An exploration using data from a national survey. J. Commun. Disord. 2016, 62, 131–146. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Cacioppo, J.T.; Cacioppo, S. Social Relationships and Health: The toxic effects of perceived social isolation. Soc. Personal. Psychol. Compass 2014, 8, 58–72. [Google Scholar] [CrossRef] [PubMed]
- The National Senior’s Council. Report on the Social Isolation of Seniors. 2017. Available online: https://www.canada.ca/en/national-seniors-council/programs/publications-reports/2014/social-isolation-seniors.html (accessed on 17 June 2020).
- Mileski, M.; Brooks, M.; Kirsch, A.; Lee, F.; LeVieux, A.; Ruiz, A. Positive physical and mental outcomes for residents in nursing facilities using music: A systematic review. Clin. Interv. Aging 2019, 14, 301–319. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Foster, B.; Bartel, L. Understanding music care in Canadian facility-based long term care. Music Med. 2016, 8, 29. [Google Scholar] [CrossRef]
- Foster, B.; Pearson, S.; Berends, A. 10 domains of music care: A framework for delivering music in Canadian healthcare settings. Music Med. 2016, 8, 199–206. [Google Scholar] [CrossRef]
- Tymoszuk, U.; Perkins, R.; Fancourt, D.; Williamon, A. Cross-sectional and longitudinal associations between receptive arts engagement and loneliness among older adults. Soc. Psychiatry Psychiatr. Epidemiol. 2020, 55, 891–900. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hanser, S.B. Music-based interventions for people with Alzheimer’s disease and related dementias: A review of the research. Music Med. 2021, 13, 156–161. [Google Scholar] [CrossRef]
- Ihara, E.S.; Tompkins, C.J.; Inoue, M.; Sonneman, S. Results from a person-centered music intervention for individuals living with dementia. Geriatr. Gerontol. Int. 2018, 19, 30–34. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- King, J.B.; Jones, K.G.; Goldberg, E.; Rollins, M.; MacNamee, K.; Moffit, C.; Naidu, S.R.; Ferguson, M.A.; Garcia-Leavitt, E.; Amaro, J.; et al. Increased Functional Connectivity After Listening to Favored Music in Adults With Alzheimer Dementia. J. Prev. Alzheimer’s Dis. 2018, 6, 56–62. [Google Scholar] [CrossRef] [PubMed]
- Thomas, K.; Kosar, C.; Mor, V.; Baier, R. Individualized Music Program Improves Outcomes For U.S. Nursing Home Residents With Dementia. Innov. Aging 2017, 1, 1045–1046. [Google Scholar] [CrossRef] [Green Version]
- Odell-Miller, H. Embedding Music and Music Therapy in Care Pathways for People with Dementia in the 21st Century—A position paper. Music Sci. 2021, 4, 1–10. [Google Scholar] [CrossRef]
- Udo-Akang, D. Theoretical Constructs, Concepts, and Applications. Am. Int. J. Contemp. Res. 2012, 2, 89–97. [Google Scholar]
- Foster, B.; Pearson, S.; Berends, A.; Mackinnon, C. The expanding scope, inclusivity, and integration of music in Healthcare: Recent developments, research illustration, and future direction. Healthcare 2021, 9, 99. [Google Scholar] [CrossRef] [PubMed]
- Amano, T.; Hooley, C.; Strong, J.; Inoue, M. Strategies for implementing music-based interventions for people with dementia in long-term care facilities: A systematic review. Int. J. Geriatr. Psychiatry 2022, 37, 1–13. [Google Scholar] [CrossRef] [PubMed]
- Chevalier, J.M.; Buckles, D.J. Participatory Action Research: Theory and Methods for Engaged Inquiry; Routledge: London, UK, 2019. [Google Scholar] [CrossRef]
- Kambaru, A. Qualitative research and a modified grounded theory approach. Tsuru Univ. Rev. 2018, 88, 47–58. [Google Scholar]
Home-Specific Intervention Description | Music Delivery | Frequency of Intervention |
---|---|---|
Participating residents play percussive instruments (such as djembes, shakers, drums) along to recorded music. Located in the hallway to invite others to join. | Live & recorded | 10–20 min, 2–3 x/wk |
Residents gather in a common space to listen to culturally or personally important music. Discussions about why the music is important to each participant follows the music listening. | Recorded with video (YouTube) | 45 min, 1 x/wk |
Spontaneous musical conversations, musicking, chimes, and sing-alongs facilitated by staff and volunteers. | Live & recorded | 5 min, 3–5 x/wk |
Music care plans were created for participating residents and integrated into the care planning system for use during 1:1 visits with recreation staff. | Live & recorded | 10–20 min, 1–3 x/wk |
A bell choir was created with 16 participating residents, and facilitated by a community volunteer. A coffee social followed each practice to enhance socialization between residents. | Live | 60 min, 1–2 x/wk |
Person-specific 1:1 visit plans that incorporated music were developed and implemented for at-risk isolated residents. Group music events building upon the individual sessions were offered. | Live & recorded | 10–20 min, 2–4 x/wk |
Every resident in the building (>275) contributed songs to a curated home-wide playlist to be used during mealtimes to create positive experiences and interactions in the dining rooms. | Recorded | 20 min, 7–14 x/wk |
Individual music care plans were created for at-risk residents. The care plans were implemented by members of the recreation staff team and include creating playlists, a musical knitting group, etc. | Live & recorded | 10 min, 2 x/wk |
A resident choir was created to increase resident:resident socialization and to create a unique community experience. | Live | 30 min, 2 x/wk |
Isolated residents were visited by recreation staff members to engage through music. Over time, staff and residents formed relationships and multiple residents would engage in each staff-led visit. | Live & recorded | 15 min, 1–3 x/wk |
Ideas for musical moments were placed in a jar and staff were invited to spontaneously pull the ideas out and execute them throughout the day. | Live & recorded | 5 min, 3–10 x/wk |
The Pathways Singing Program (a sing-along DVD set with associated recreation programs) was implemented in one area of the home. | Recorded | 20 min, 2 x/wk |
Musical activities were designed for residents who otherwise struggle to participate in daily life at the LTC home. Music interactions were focused on maximizing accessibility and inclusivity for participants. | Live & recorded | 10 min, 2–3 x/wk |
The “Singing Social” involves karaoke-style sing-alongs for residents and staff in a common area of the home. Participants may sing in a group or as individuals; they may accompany themselves, sing acapella or to a recording. | Live & recorded | 45 min, 1 x/wk |
Staff were taught three strategies to use in the morning, which has been identified as a difficult time at this LTC home: a wake-up song (written by the team), a familiar song, and musical activities. | Live | 10 min, 2–7 x/wk |
Participant Category | Percentage of Interviewees |
---|---|
Female | 59% |
Male | 41% |
Residents | 34% |
Staff members or volunteers | 66% |
Groups of 2 | 19% |
Groups of 3 | 9% |
Staff Position | Frequency |
---|---|
Activation Facilitator | 1 |
Programs Managers | 2 |
Spiritual Care | 1 |
Therapeutic Recreationist | 1 |
Student Volunteer | 2 |
Life Enrichment Manager | 1 |
Life Enrichment Team | 2 |
Program Therapist | 2 |
Recreation Therapist | 2 |
Dietary Team | 1 |
Registered Practical Nurse | 1 |
Physiotherapist | 1 |
Activation Manager | 1 |
Activities Team | 1 |
Director of Programs | 1 |
Theme | # of Codes | # of Interviews |
---|---|---|
Limited Resources | 35 | 17 |
Distinct Experiences | 96 | 14 |
Life Enrichment | 82 | 19 |
Dynamic Relationships | 56 | 10 |
Program Flexibility | 55 | 15 |
Potential Continuity | 29 | 7 |
Enhanced Socialization | 28 | 15 |
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Cheetu, S.; Medeiros, M.; Winemaker, L.; Li, M.; Bartel, L.; Foster, B.; Mackinnon, C. Understanding the Effects of Music Care on the Lived Experience of Isolation and Loneliness in Long-Term Care: A Qualitative Study. Healthcare 2022, 10, 457. https://doi.org/10.3390/healthcare10030457
Cheetu S, Medeiros M, Winemaker L, Li M, Bartel L, Foster B, Mackinnon C. Understanding the Effects of Music Care on the Lived Experience of Isolation and Loneliness in Long-Term Care: A Qualitative Study. Healthcare. 2022; 10(3):457. https://doi.org/10.3390/healthcare10030457
Chicago/Turabian StyleCheetu, Sheetal, Mara Medeiros, Lauren Winemaker, Maggie Li, Lee Bartel, Bev Foster, and Chelsea Mackinnon. 2022. "Understanding the Effects of Music Care on the Lived Experience of Isolation and Loneliness in Long-Term Care: A Qualitative Study" Healthcare 10, no. 3: 457. https://doi.org/10.3390/healthcare10030457
APA StyleCheetu, S., Medeiros, M., Winemaker, L., Li, M., Bartel, L., Foster, B., & Mackinnon, C. (2022). Understanding the Effects of Music Care on the Lived Experience of Isolation and Loneliness in Long-Term Care: A Qualitative Study. Healthcare, 10(3), 457. https://doi.org/10.3390/healthcare10030457