Brown C, Myers J. Digital technology supports therapeutic singing for cognitive health & well being .HPHR. 2022;62. 10.54111/0001/JJJ9
Nearly 11% of Americans over age 65 are living with Alzheimer’s disease (AD) and this number is projected to triple over the next three decades.1 As a leading cause of disability, older adults with cognitive impairment are likely to spend twice as many days hospitalized as those without it.2 In addition to cognitive impairment, psychological conditions such as depression have also contributed to the increased rates of disability and decreased quality of life among older adults. Mental health conditions in general have an astronomical cost of over $225 Billion.3 Yet, over half (57%) of adults with a mental illness do not receive treatment.4 With psychological symptoms such as depression, apathy, and agitation recognized as core features of AD and predictors of cognitive decline and survival,5 interventions that address both cognitive and psychological symptoms are crucial for this population.
There are many interventions used to treat AD; however, they are not without limitations. Pharmacotherapy alone has limited clinical benefits with unclear long-term therapeutic efficacy, especially for non-cognitive outcomes.6 Over the past decade, there has also been a significant increase in severe adverse reactions (e.g., gastrointestinal issues) to conventional prescribed drugs for AD such as Donepezil and Galantamine.7 Non-pharmacological interventions including cognitive training, cognitive rehabilitation, and non-invasive brain stimulation have also been used to address cognitive decline in older adults. However, many do not directly treat mood6 and have limited research findings of their clinical significance.8
One solution to the ongoing challenges associated with current treatments is therapeutic music. Growing research on the many neurological benefits of therapeutic music provides one attractive option for promoting neuroplasticity and emotional health.9 In a recent study comparing the efficacy of an active group music intervention and group music listening in AD, 90 nursing home residents with AD were randomly assigned to receive either active music intervention, receptive music intervention, or their standard care (control). Results revealed a large effect size of active music intervention for cognitive (η2 = 0.62) and behavioral symptoms (η2 = 0.61) as well as a small—medium effect on functional state (η2 = 0.18).10 This highlights the superior benefits of active participation in music-making for those with AD over passive and traditional means of care.10
Singing stimulates areas of the brain responsible for cognitive processing, language, communication, coordination, motor timing, and movement while also positively regulating cortisol, dopamine, and endorphins that can elevate mood and reduce pain.11-14 Regular singing has been shown to help reduce anxiety, depression, agitation, and aggression in older adults with dementia.15, 16, 17 One meta-analysis found a medium effect size (d = 0.61) for music interventions reducing agitation in those with mild to severe dementia.18 Several studies have also shown an improvement in quality of life as well as reduced isolation and stress for both individuals with AD and their caregivers.15, 19,20
Despite the benefits of music therapy, with fewer than 10,000 board-certified music therapists, there are just not enough practitioners to meet the demand.21 Therefore, increased access to therapeutic music is critical for treating the millions with cognitive and mental health concerns. SingFit is a subscription mobile application for caregivers and rehab therapists (e.g., speech-language pathologists, occupational therapists) to use with individuals with dementia and other cognitive disorders regardless of severity. Designed by experienced music therapists and founded in current neuroscience and music research, SingFit addresses the treatment gap and provides support for individuals both in and outside traditional rehab therapy.
After training and downloading the app, a user selects a song playlist based on their client’s cognitive level, mood, and musical preference. Similar to a traditional music therapy session, both the user and client actively participates in music through singing and movement as well as meaningful conversations with guided prompts or trivia, which is also included in the platform. A user can also adjust various tracks of a song to meet the needs of a client. For example, if the client is easily distracted by the singer due to attention deficits, the singer’s voice can be reduced.
When compared with other music streaming platforms, SingFit aims to better meet the needs of older adults with cognitive decline by delivering music and therapeutic protocols designed specifically for those with cognitive impairment. SingFit delivers a tailored intervention by utilizing songs that have been tested for popularity, singability, and likability with older adults with cognitive decline to ensure songs are engaging prior to being used in playlists. One of the unique features of SingFit’s platform is the Lyric Coach technology (Figure 1) which provides an auditory lyric prompter just before each line of the song. The Lyric Coach removes the academic process and anxiety of trying to read lyrics and provides support for those with visual, speech, and cognitive impairments. The platform also provides standardized training to ensure that facilitators use specific engagement strategies to maximize social engagement and provide a standardized and replicable music intervention. SingFit systematically targets multiple domains of functioning (e.g., social, cognitive, physical) through the use of the proprietary lyric prompter to help facilitate language processing and production, trivia and reminiscent questions to stimulate social and cognitive engagement, and guided movement/exercise which helps promote physical activity.
Figure 1. Lyric Coach & Customizable Music Tracks
Research has shown that Singfit is a feasible method for motivating older adults to sing in order to improve cognitive function. In a singing and song learning study by Reid et al. (2017), 48 healthy musically inactive older adults (aged 65-84) were randomly assigned to a sing, listen, or no music activity group (control).22 For 5 weeks, participants in the sing group used SingFit daily as a “sing-along” aid to learn their favorite songs and the listen group used Singfit daily as a listening device to learn their favorite songs. Although the impact on cognitive function did not reach significance, which the authors suggested was due to the short duration of the protocol, they did find that a majority of the participants enjoyed the app and were compliant (70%).22 The authors concluded that based on attrition, compliance, and enjoyment among users, SingFit is a feasible option to promote regular singing for cognitive function in older adults.22
While more empirical research is needed to assess the therapeutic benefits of SingFit, it has been very well-received by current users. SingFit is currently in over 437 long term care communities, with a retention rate of 95% in 2020 and 94% in 2021, pointing to the feasibility and satisfaction with the digital platform.23 Additionally, 58 facilities have reported the use of SingFit approximately 2-3 times a week, and facilitators report the platform as making their job easier (84.5%), fulfilling (91.4%), and positively impactful on their residents/participants (98.3%) via a SingFit customer survey.23
The cognitive healthcare field needs novel treatment solutions that can be implemented easily and effectively across a broad range of settings. SingFit’s digital therapeutic music platform aims to provide an accessible response to the rising prevalence of cognitive impairments and associated healthcare costs. Currently, research is underway to determine the therapeutic efficacy of SingFit. However, SingFit’s evidence-based design shows promising utility for those with AD and other cognitive disorders.
There are also several federal hospital facilities specifically dedicated to mental health care including St. Elizabeth’s Hospital in Washington, D.C., which is now administered by the District of Columbia Department of Mental Health, and two Federal Medical Center facilities (FMC Devens in Massachusetts and FMC Lexington in Kentucky) that are now operated by the Federal Bureau of Prisons.
Congress should consider taking the following steps:
Dr. Yohanna found in 2013 that there were approximately 378,00 incarcerated individuals with SMI and many times that number of individuals suffering from SMI who were not incarcerated, including a significant portion of the unhoused and the unsheltered living on our city streets. The new and re-purposed Marine Hospital Service should aim to establish and maintain a minimum of 300,000 safe and sanitary psychiatric beds located in every state throughout the U.S., and to offer scientific and compassionate treatment to all individuals suffering from SMI.xv
Chelsea S. Brown and Jennifer R. Myers are paid employees of Musical Health Technologies. The authors have no other conflict of interest to disclose.
Chelsea S. Brown is a board-certified music therapist and product manager at a digital health company specializing in scalable music interventions. As a board-certified music therapist, her research focuses on music interventions for stress and anxiety, mindfulness, and digital mental health interventions.
Jennifer Rae Myers is a senior product manager at a digital health company. As a medical speech-language pathologist and neuropsychologist, her interests include the cognitive-communication impact of trauma, cognitive health disparities, and research inclusivity.