Abstract
BackgroundOur population is ageing. In Australia, 16% of the total population are aged 65 years or over, and this is projected to grow rapidly over the next 10 years. Focusing on living and ageing well is essential to slow or mitigate cognitive decline and reduce long-term healthcare needs. Early intervention and prevention, especially for older adults identified as at risk of dementia, provides proactive measures to delay cognitive decline, minimise disability, maintain independence, and reduce the associated social and economic implications. Investing in programs to enhance older adults' cognitive health and well-being can lessen the burden on healthcare systems and society and support healthy ageing.
Active participation in music-based activities has cognitive benefits for older adults and cognitive training programs evidence the benefits of piano training for cognitive health. However, there is a lack of research regarding which music program design is best. Additionally, no music-based studies have demonstrated the benefits of learning a musical instrument as a cognitive training program for participants with subjective cognitive decline (SCD), a self-reported decline in memory and thinking. SCD may precede a formal diagnosis of mild cognitive impairment (MCI) in older adulthood and potentially indicate a risk of dementia.
Music therapy is a clinical practice that supports people's health, functioning and well-being across the lifespan. Music improvisation is effectively used in music therapy programs for cognitively impaired older adults, yet the benefits of this practice for healthy older adults are not known. Engaging in musical improvisation demands self-directed musical output in the simultaneous creative thinking and production of musical sounds. The autonomy and creativity inherent in the musical improvisation process could be health-enhancing however, how far the practice enhances older adults’ cognitive abilities remains underexplored.
Method
This doctoral thesis examines the benefits of music improvisation as a method of piano training compared to traditional piano instruction. A rapid systematic review of the cognitive training literature (Study 1) informed the design of the music-based cognitive training program within this research. Two further empirical studies, using a mixed-methods embedded sequential design, examined group piano training for healthy older adults aged 60 and above who were novice musicians. Older adults in the study reported whether they had SCD. Study 2 was a feasibility study with older adults (n=39) engaged in a music improvisation piano training program. Study 3 was a randomised controlled trial (RCT). Participants (n=111) in the RCT were randomly assigned to either group piano training using music improvisation techniques (experimental intervention group), group piano training using traditional piano instruction (active control), or an inactive waitlisted control group. The RCT group piano training programs were delivered online via Zoom.
Results
The results demonstrated that piano training using both music improvisation and traditional music instruction methods enhanced global cognition and spatial working memory, particularly for those who entered the program with lower cognitive scores and SCD. Participants in the music improvisation group demonstrated improved self-efficacy and a transfer of creative confidence to their everyday lives. These improvements in well-being among older adults who engaged in music improvisation were not observed for participants who completed the traditional piano instruction program. The overall results indicated that increasing participant autonomy and self-directed input within music-based programs for older adults is health-enhancing.
Conclusion
In conclusion, using music improvisation to support musical instrument learning is feasible and beneficial for older adults’ cognitive health and general well-being. Piano training using music improvisation as the method offers well-being advantages over traditional piano instruction, particularly in terms of older adults' creative self-efficacy. Music improvisation and traditional instruction as piano training methods can be offered as cognitive training programs and prescribed as arts-for-health interventions to support healthy ageing. These music-based programs can also support cognitive health as part of a dementia prevention strategy.
| Date of Award | 2023 |
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| Original language | English |
| Awarding Institution |
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| Supervisor | Sandra Garrido (Supervisor), Genevieve Steiner-Lim (Supervisor), Jennifer MacRitchie (Supervisor), Andrew Milne (Supervisor) & Caroline Smith (Supervisor) |