Exploring the impact of live music performances on the wellbeing of community dwelling people living with dementia and their care partners

ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;">Dementia is an international priority accordingly with the current estimates of around 50 million people living with the condition, predicted to reach 82 million in 2030 and 152 million in 2050 WHO(2018), Policy recommendations  World Alzheimer's Report promote the development and also sustainability of groups to enhance wellbeing post diagnosis for people living with dementia and their care partners. According to research, In 2012 the UK Prime Minister posed the challenge of how to ‘promote individual and community-based activities for people with dementia and their carers…and increase their social contacts within their community and thereby promote wellbeing.

• The concept of well-being has attracted many definitions. The Department of Health states that: ‘Well-being is about feeling good and functioning well and comprises an individual's experience of their life and a comparison of life circumstances with social norms and values.
• Furthermore, the Department of Health's description of well-being posits that it exists in two dimensions, with a subjective or personal perspective, based on life satisfaction and an objective perspective, based on assumptions about fundamental human needs and rights.
• In contrast, identified well-being to have personal, cultural and social dimensions. Psychosocial approaches to dementia provide humanistic explanations that consider psychological and social factors as influential in the maintenance of well-being. Kitwood conceived well-being and personhood differently from previous models which adopted a medical and behavioural focus.
• Kitwood stressed the importance of personhood and person-centred care as fundamental to achieving well-being and defined personhood as a standing or status that is bestowed upon one human being, by others, it implies recognition, respect and trust.
• Using this definition of personhood ‘well-being’ is enhanced by the presence of recognition and respect received from others.
• An increasing number of non-pharmacological interventions have emerged to enable people to live as well as possible with dementia; one particular area is the potential of music as an effective way to enhance well-being.
• However, a distinction is helpful between music provision for people living with dementia and music therapy which are considered two different approaches to delivering music. For example, music-based interventions with a therapeutic goal may need to draw on the skills of both musicians and therapists to apply musical parameters, tailored to an individual's needs to address physical, emotional, cognitive, and social needs.
• Music therapy is a psychological intervention, delivered by Health and Care Professions Council (HCPC) registered music therapists and has been applied to people living with dementia to support their psychological, emotional, cognitive, physical, communicative and social needs. Much evidence exists about music therapy including data from systematic reviews.
• it has undertaken a Cochrane Review to assess whether music therapy (MT) can diminish behavioural and cognitive problems or improve social and emotional functioning for people with dementia. Ten studies were included in this review although the authors report that the methodological quality of these small, short‐term studies was generally poor, as was the presentation of results; no useful conclusions could be drawn.
• This review was updated by those who aimed to assess the effects of music-based therapeutic interventions for people with dementia on emotional well-being including quality of life, mood disturbance or negative affect, behavioural problems, social behaviour and cognition at the end of therapy and four or more weeks after the end of treatment. 22 studies with 1097 randomised participants were included and the authors reported that the quality of the evidence was moderate for depression, overall behavioural problems and agitation or aggression at the end of treatment. For all other outcomes, it was low or very low. The authors also commented that the quality of reporting for some trials was poor.
• All of the reviewed trials were undertaken in nursing homes or hospitals. A further systematic review to determine the effect of music therapy (MT) on cognitive functions in people living with dementia was undertaken. Of 1089 potentially relevant records, 110 studies were assessed for eligibility, and 7 met the inclusion criteria, of which 6 contained appropriate data for meta-analysis (330 participants, mean age range 78.8–86.3).
• Overall, random-effects meta-analyses suggested no significant effects of MT on all outcomes. Critiques of therapeutic approaches relate to the quality of studies involved in the Cochrane Reviews undertaken to date, although some evidence also highlights the benefits of prescribed therapy that can be personalised to meet the needs and skill level of the individual.

Music provision that is not considered music therapy (MT), in contrast, may be considered a leisure activity to contribute to individual well-being in dementia and an activity that can be enjoyed in its own right without the therapeutic connotations or indeed a focus on ‘behaviours that challenge. The potential impact of music and well-being in dementia has mainly materialised in response to the increasing acknowledgement of the accessibility and applicability of music in various settings with people experiencing dementia in different ways. The Commission on Dementia and Music and the International Longevity Centre UK (ILC-UK) examined the existing landscape and future potential of using music-based initiatives concluding that ‘Music can promote a range of hugely beneficial outcomes for people with dementia….and when it is used appropriately and in a meaningful way, the use of music has no known negative impacts. One possible explanation is that music can be more accessible for people with dementia when compared to non-musical forms of activity: enabling opportunities for ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;">reminiscence and positive expressions of well-being. A further explanation would implicate the person's Procedural Memory (PM) which despite the level of impairment caused by dementia, enables certain activities to remain preserved and relatively resistant to decline including engagement with music. However, caution is required when assuming that music has no known negative effects, as music may incite unwanted memories as well as positive memories.

Recent reviews on ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;">psychosocial interventions in dementia concluded that there was evidence for enhanced well-being via music-based approaches as well as the potential of music to address declining cognition, anxiety, depression and quality of life (QOL) in dementia. In addition, the sharing of music within a group can have a beneficial psychosocial impact on the person with dementia and their care partners. A critical review of the participative arts in dementia suggests that music-based interventions may have higher benefits when compared with alternate art practices.  found increased happiness in residents and staff exposed to music interventions and intimate live music performances have been shown to have a positive effect on human contact, care relationships, positive emotions and negative emotions in persons living with dementia in nursing homes reported on the positive impact of concert performances on the wellbeing of people living with dementia showing increased levels of cooperation, interaction, and conversation.

Yet, much of this evidence relates to residential, nursing and hospital settings despite estimations that two-thirds of people living with dementia in the UK continue to live in their own homes (Wittenberg, Hu, and Barraza-Araiza, 2019), a desire that has been the penned as ‘ageing in place. Service developments are driven by commitments to enabling ageing in place resulting in increasing quantities of community-based dementia support services. There is somehow evidence of community-based music initiatives including the BUDI  from Bournemouth University and a community-based group singing intervention with people with early-stage dementia and their family carers. Nevertheless, despite the growing quantity of evidence on the benefits of exposure to music, much of the research has occurred in residential care or nursing homes. The importance of music for people remaining in their own homes and attending community groups is under-represented. This paper contributes to knowledge of the benefits of a live music café involving people living with dementia who remain in the community and care partners. Our work directly responds to contemporary policy recommendations of enhancing well-being post-diagnosis, while also addressing the current gap in knowledge about the benefit of live music for people living with dementia in the community.