Merton Music Therapy Community-based Dementia Project

Dementia represents one of the most significant and growing challenges facing adult social care in England, with increasing numbers of people living longer with complex and progressive needs. Alongside cognitive decline, people living with dementia often experience anxiety, agitation, communication difficulties, and social isolation, particularly during key transition points such as diagnosis, changes in care arrangements, hospital admissions, and end-of-life care. These challenges also have a substantial impact on informal carers, many of whom experience stress, reduced wellbeing, and difficulty sustaining their caring role without additional support.

National policy and clinical guidance emphasise the importance of non-pharmacological, person-centred approaches to dementia care, particularly those that promote wellbeing, maintain independence, and reduce distress. Music-based interventions are increasingly recognised within this landscape for their potential to support emotional regulation, communication, identity, and connection. However, despite a growing body of academic research, access to structured and evaluated music interventions which are integrated into adult social care provision remains limited and inconsistent, particularly at a local level. As this project will recruit from a client group that are already known to adult social care or via a community provider commissioned by and within the Borough of Merton, it provides a unique opportunity both to gather data around use of and contact with adult social care services and those who may be on the cusp of needing adult social care services, and to provide access to music therapy which is integrated into existing provision.

Merton has an ageing population and the number of people living with dementia is estimated to increase, as older age is one of the main risk factors for dementia. 12.6% of people living in Merton are aged 65 years and over (Merton Story 2025) and its over 80s population is estimated to increase by nearly a quarter (24%) between 2025 and 2035 (GLA 2025). There is an identified need for Merton to support people living with dementia and their families and carers from diagnosis to end of life. There is also a need as partners to better align our dementia activity around prevention, diagnosis, social care, healthcare and support for carers across Merton's health and care system. The Merton Health and Wellbeing Strategy 2025 to 2030 includes an existing action to explore service models enabling the needs of individuals, families and communities to be more empowered and better supported, starting with dementia.

Local analysis by external consultants (Newton, 2024) who were working in Merton in late 2024 for Merton Adult Social Care showed that the number of residents in receipt of long-term care with memory and cognition as the primary support reason has been increasing; with care packages increasing from 62 in 2019/20 to 91 in 2023/24. Newton also estimated that the "rates of dementia rise in line with the aging population, we can expect the average number of adults with dementia to rise by 500 in the next ten years".

Merton are currently developing a 5 year action plan on dementia (for April 26 - March 31). This project will contribute to work activity under the plan by supporting people with dementia and their carers when they are at or approaching points in the dementia journey where they are likely to need more support. It is anticipated that the availability of timely, appropriate psychosocial support in the form of tailored group music therapy sessions will help participants to accept their diagnosis, experience peer support, navigate changes in their relationship, ultimately leading to improved outcomes.

This project responds directly to the need for preventative, community-based interventions that can support people living with dementia and their carers while aligning with adult social care priorities. By focusing on key stages of need and generating locally relevant evidence, the project will help address both service pressures and gaps in provision.

Aims

• To assess the feasibility of delivering music therapy sessions and conducting research in two different community settings
• To evaluate the impact of music therapy upon the people who take part directly in sessions, as well as its wider impact on the settings, staff and carers of people with dementia
• To compare differences between the two settings, in terms of the participants, the content of sessions, the effects of music therapy, and the resources required to deliver session and collect data.

Main Research Question

How does the feasibility and impact of group music therapy sessions for people with dementia compare between two different community settings?

Subsidiary research questions:

1. What is the impact of the music therapy groups upon attendees (people with dementia and informal carers) and does this differ between the two settings?
2. What is the impact of the music therapy groups upon staff and culture in the settings (day centre and memory hub staff)?
3. Is it feasible to conduct the study in these two settings? (recruitment, retention, attendance, delivery, data collection)
4. What are the barriers and facilitators to implementation in each setting?

Study design

This is a single arm, pre-post feasibility study using mixed methods, which investigates the effects of music therapy concurrently in two different groups of participants.

Setting

The study will take place under the umbrella of Adult Social Care/Public Health Services within Merton Council. Within this context, the music therapy groups will take place in two different settings:

1. Merton Memory Hub, a service run by the Alzheimer's Society and commissioned by Merton Council Public Health, providing services, support and activities to people who have been diagnosed with dementia and their families and carers
2. Eastways Day Centre, a day centre operated by Merton Council (Adult Social Care) providing support to older people with eligible needs for day care in the local area.

In each of these settings, music therapy groups will take place in dedicated rooms which will be arranged to provide an appropriate space, supported by Memory Hub/Day Centre staff in agreed ratios.

Participants

In both settings, the participants will be people who have been diagnosed with dementia. At the Memory Hub, we will also recruit the informal carers of people with dementia to take part in the music therapy group, though we will not exclude any person with dementia who wishes to take part but does not have a carer who can attend with them. At the day centre, carers do not usually attend as this is respite time for them, but they will be included in the study as we will collect data from them. We will involve them in the group by holding a sharing session towards the end of the programme, and by providing simple music activities which they can try at home if they wish.

It is anticipated that due to the different profiles of services users accessing Memory Hub and day centre provision, these two music therapy groups will include people at slightly different stages of their dementia journey, with the day centre participants expected to be more advanced in their dementia. Also, because the Memory Hub group will include informal carers (that are usually partners or family members), the music therapy group may have an impact on the relationship between them. Consequently, we have selected slightly different measures for assessing the impact of these two music therapy groups.

Inclusion and Exclusion Criteria

Inclusion criteria

• Be aged 18 or over - carers and people with dementia
• With a diagnosis of dementia (or the informal/family carer to someone with a diagnosis of dementia who is participating in the study)
• Able to provide informed consent to take part in the study, or with a consultee who knows the person well and is able to provide a judgement about whether they would want to take part in the study
• Able to speak and understand English, or with a supporter who can act as translator for research methods
• Be willing in principle to take part in a music therapy group and attend weekly

Exclusion criteria

• Lacking capacity to provide informed consent and no consultee available
• Having an uncorrected hearing impairment which would significantly impact upon their ability to engage with the music therapy group
• Already receiving music therapy in a different context (they may participate if they are participating in other music activities that are not music therapy)
• Concurrently participating in another trial of a psychosocial intervention (or ceased participation within the past 6 weeks)
• Anticipated not to be able to attend at least 50% of sessions

Recruitment

The target sample size is approximately 26 participants across the two groups. The Council will help promote the project in terms of engaging with people living with dementia and their carers and recruitment through a number of mechanisms including Community Dementia Services, Merton Dementia Action Alliance partners, promotion to health partners (such as GP newsletter, secondary healthcare teams, St Georges Hospital dementia team) and engagement with community and voluntary sector groups in Merton. The council will also work with day centres and adult social care teams to promote the study to their clients. In total, the study will aim to recruit up to 16 participants for the Dementia Hub group, and up to 10 participants for the day centre group, but group sizes will be informed by the clinical judgement of the music therapist.

We will also conduct interviews with hub, day centre and social care staff who have been involved with the project.

Intervention

The intervention in this study will be attendance at one of the music therapy groups weekly for a period of 10 weeks. The music therapy sessions in this study will be delivered by a fully qualified, HCPC registered music therapist with experience in working with people with dementia, who will be engaged on a freelance basis for one day per week. CIMTR academics and Merton Council partners will meet with the Music Therapist engaged for the project to discuss the needs of participants and the aims of the intervention. Following this, the Music Therapist and researchers will plan a music therapy programme which promotes engagement, social connection, enjoyment, and personal identity, with the aim of supporting quality of life, emotional regulation, and the relationship between person with dementia and care partner. The programme will include accessible musical resources and activities which participants can integrate into their daily lives, allowing the benefits of music therapy to be sustained longer-term, and potentially beyond the duration of the intervention itself. Session activities will include some combination of the following: singing familiar songs, receptive music listening, improvised music making, music-based games (such as rhythmic copying or turn taking), movement to music, and songwriting, as well as time for sharing, discussion and reflection. The Memory Hub sessions will also include time for refreshments and socialising between the attendees (this is already included within the time that participants spend at the day centre).

Data collection

The study will collect both quantitative and qualitative data, as well as feasibility data relating to recruitment, attendance, attrition and acceptability of study methods.

The follow demographic and descriptive data will be collected from participants:

People with Dementia: Age, Gender, Diagnosis, time since diagnosis, level of musical experience Carer: Age, Gender, Relationship to person with dementia Staff: Role, Years of experience working with dementia care

Quantitative data will be collected using standardised scales for quality of life, wellbeing, relationship quality, engagement, and caregiver sense of competence at baseline and after completing the course of sessions. A self-reported measure of mood and engagement will be used to collect data on immediate response to the sessions on the day. Data will also be collected via Merton Council about the participants' use of adult social care services.

Qualitative data will be collected through informal feedback and interviews with participants in the music therapy groups and/or their care partners, through interview with the music therapist and the observational records of music therapy sessions, and through interviews with staff at the Hub and day centre.

Quantitative measures

People with dementia

Short Warwick-Edinburgh Mental Wellbeing Scale - 7-item version

ICECAP-O

EQ-5D-5L

QCPR - Quality of the Caregiver-Patient Relationship Scale

3 item loneliness scale

MIDAS - Music in Dementia Assessment Scale

Carers

Short Warwick-Edinburgh Mental Wellbeing Scale - 7-item version

ICECAP-O

EQ-5D-5L

QCPR - Quality of the Caregiver-Patient Relationship Scale - better SSCQ

CES - Carer Experience Scale

Qualitative data

Participants in the music therapy groups and their carers, where appropriate, will be invited to attend an interview following their attendance at the sessions. This will last approximately 20-30 minutes and use a semi-structured format, with questions focusing on participants' experiences of the music therapy group and any impact they have noticed it having on their wellbeing, relationships or daily life. Visual and audio prompts may be used as appropriate to help participants with dementia recall the sessions. Any informal feedback about the music therapy sessions which arises spontaneously will also be noted.

The music therapist will be asked to complete a structured pro-forma after each session to collect data about the session content and participants' responses in the moment. The music therapist will be interviewed following the end of the sessions, using a semi-structured interview format, with questions focusing on their observations about the responses of participants individually and as a group, changes over the course of the sessions, and their opinions about the format and delivery of the sessions.

Day centre and hub staff who have supported the sessions will also be invited to be interviewed following the completion of the sessions. Again, a semi-structured format will be used, with questions focusing on their experiences of the sessions, participants' responses, the impact on their own practice, and any changes they have observed in participants following the sessions.

All interviews will be audio recorded if participants give consent, otherwise the interviewer will make notes during the interview.

Data analysis

Quantitative data will be analysed using descriptive statistics with exploratory analysis to detect signals of benefit within this non-randomised study. Data will be summarised with mean and standard deviation for normally distributed variables, and median and inter-quartile range for skewed variables. Recruitment, retention and attrition rates will be calculated.

Recordings of interviews will be transcribed as necessary. The software package NVivo 14 will be used to conduct the thematic analysis.

Ethics

Recruitment of participants will not commence until the study has received ethical approval from Anglia Ruskin University and from a Health Research Authority Research Ethics Committee (due to the study including people recruited from Adult Social Care Services).). The researcher who has direct contact with participants will have a DBS check and Safeguarding Training (Level 2) and any causes for concern will be reported to the relevant Designated Safeguarding Lead.

Consent

Participants will provide informed consent before they participate in the study. Written information sheets will be provided for people with dementia and their carers, for the music therapist, and for any day centre and memory hub staff who participate in interviews. An easy-read information pamphlet will be provided for people with dementia. Once participants have expressed an interest in the study, they will receive copies of the information sheets and have the opportunity to discuss these with a member of the study team. If they agree to participate in the study and the researcher is satisfied that they have capacity to provide informed consent to do so, they will be requested to sign a consent form.

If someone is judged not to have capacity to provide informed consent, we will seek a consultee who knows the person well to make a judgement about whether they would have wanted to take part in the study. The consultee will be provided with an information sheet explaining about the study and the role of the consultee. If, according to their judgement, the person would have wanted to take part, they will be asked to sign a consultee declaration to indicate that this is their opinion. Participants will always be asked for their assent to proceed with any of the study activities, and these will be immediately discontinued if there is any sign of discomfort or stress.