Music in Care Home Settings: Guidelines for Implementation and Evaluation Based on the Music Interventions for Depression and Dementia in ELderly Care (MIDDEL) Study in the UK

Context: Music-based interventions are widely acknowledged to promote the wellbeing of care home residents, particularly those whose communication is impaired, such as through stroke or dementia. Yet in such settings the use of music is limited for reasons that are not entirely clear. Objectives: The Music Interventions for Depression and Dementia in ELderly care (MIDDEL) trial in 16 English care homes was used as a case study to highlight key issues which appear to affect the successful implementation and evaluation of music-based interventions. Methods: The fidelity data from the MIDDEL trial was used to develop inferences in consultation with interventionists and researchers. Based on the literature about implementing psychosocial interventions in care homes and data from this study, a checklist was developed to enhance implementation and research pertaining to music-based interventions in care homes. Findings: New insights were found on the adherence of interventionists to the fidelity criteria. Pragmatic issues relevant to conducting a trial immediately after a pandemic are highlighted, including: the difficulties of maintaining engagement with care home personnel and the practicalities of delivering an intensive intervention to a population who have depression and dementia. We derive recommendations for improving future interventional studies in care homes. Limitations: The participating care homes may not be representative of the industry. The Covid pandemic complicated the study in numerous ways documented here. Implications: The lessons learned offer guidance for future implementation and research on music-based interventions in residential care settings.