Part of the Aging Well Through Arts Special Report
Twenty years ago, when academic researcher Julene Johnson wanted to study how music might help the aging process, she couldn’t get funding. Johnson, a professor at the Institute for Health & Aging at the University of California, San Francisco, suspected that music might improve memory, mood and even physical function.
And, she thought, what could be more perfect than choral music? Your instrument is already in your body, and you are bathed in beautiful sound by fellow musicmakers. Singing in a group is fun, so there’s plenty of reason to come back week after week: You get to see your friends and exercise your vocal cords and brain all at once.
Fast forward to 2010, when Johnson won a Fulbright scholarship to study the impact of singing in the quality of life of older adults in Finland.
Johnson hypothesized that music participation is a cost-effective way to promote health, independence and well-being.
Because there, children study arts, but they don’t stop when they get older, as so many people do in the United States. They keep singing or making music throughout their lives. In fact, in one city (population 125,000) there were more than 50 choirs — six of which were dedicated to older adults. Because of its emphasis on cradle-to-grave musical expression, Finland seemed the perfect place to study the effect of music on aging.
Music as a Force for Good
In Finland, Johnson saw the effects up close, including how making music together can build group cohesion toward a common goal.
Vocal music even played a pivotal role in Finnish history, Johnson notes. “Music was used as a political force,” she says. When Finland was ruled by Russia, citizens would meet and talk about politics. They planned how to change the future at singing festivals, which eventually led to the country’s independence.
When Johnson returned to the U.S., she was determined to learn more. So when the National Institutes of Health called for proposals to identify novel ways to promote independence and well-being in older adults, she applied for, and receive, a grant founding her Community of Voices study, the largest of its kind.
Johnson hypothesized that music participation is a cost-effective way to promote health, independence and well-being to help an increasingly diverse population of older people remain active and independent. Other studies have found that older adults who sing in choirs tend to have high rates of well-being and mood, but they didn’t address whether those effects can be attributed to choral singing or to the self-selection of the participants.
The Community of Voices Study
Johnson’s study — large, rigorous and randomized — would really put the hypothesis to the test. Involving 390 participants from 12 senior centers in the San Francisco Bay area, the Community of Voices study is unique in a few ways.
For starters, it is the first to test the effects of an arts-based intervention for older adults on improving key measures of health and well-being: cognitive health, physical functioning, emotional well-being and social connectedness.
Another difference is the deliberate recruitment of ethnically-diverse older adults. By 2030, nearly half of people over 65 are expected to come from diverse racial and ethnic backgrounds.
After participants were recruited, they were screened and given assessments that would be remeasured at six and 12 months. Participants needed to be 60 or older and have adequate vision and hearing and fluency in English or Spanish. People with significant cognitive impairment were excluded. Of the nearly 400 participants, 55 percent had not sung in a choir as an adult.
Serious About Singing in a Choir
The Community of Voices program also was different from the passive singalong approach to choruses that you might expect to see in senior centers because it was designed to include physical, social and cognitive components as well as performances.
Professional choir conductors and accompanists designed the musical program. Directors made certain adjustments for age, such as changing the key to allow for aging voices to sing without strain. But the 90-minute rehearsals involved learning new songs, paying attention to the conductor and synchronizing personal singing parts with the rest of the choir. The repertoire included Latin, African-American and Filipino music, show tunes that were tailored to each choir.
Rather than sitting the whole time, choir members stood or moved to different parts of the room. A 15-minute warm-up at the beginning of each session included vocal work, breathing and stretching movements. There was also a 10-minute refreshment break.
Each choir met once a week for a year, and performed three to four times in public. The average age was 71, females represented 76 percent of participants,and two-thirds were non-white. Researchers collected data about falls and the use of health care services every three months, and focused on three primary outcomes:
- Cognitive function Attention and executive function were tested.
- Lower body strength Participants were given a timed sit-to-stand test to assess their ability.
- Emotional well-being Participants were rated on the frequency of depressive symptoms including feeling down, having little interest in things, trouble sleeping, being tired, having poor appetite, feeling bad about themselves, having trouble concentrating or moving slowly.
Participants were also tested for verbal learning and memory, social engagement, social support, loneliness, walking speed, balance and falls.
Another key attribute was measured — self-efficacy — which Johnson defined as “people feeling like they have the power to do things for themselves.” In addition to literally building strength to sing louder, Johnson notes that singing can help people find their voice metaphorically speaking.
“The voice is a way of self-expression,” she says. “They can speak up to their landlords.”
The last Community of Voices choir is soon to finish its run for the study, and the data is still being collected and tabulated. One thing is for sure, though: The choirs were a hit. Once they finished participation in the study, all the previous choirs have continued to sing.