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thesis entitled

The Effect of Music Therapy Sessions
On Perceived State of Affect Among

Residents of A Retirement Center

presented by
Michiko Kato

has been accepted towards fulfillment
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Master of Music , Music Therapy
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May 15, 1986

 

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THE EFFECT OF MUSIC THERAPY SESSIONS
ON PERCEIVED STATE OF AFFECT
AMONG RESIDENTS OF A RETIREMENT CENTER

BY

Michiko Kato

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF MUSIC, MUSIC THERAPY

School of Music

1986

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ABSTRACT
THE EFFECT OF MUSIC THERAPY SESSIONS
ON PERCEIVED STATE OF AFFECT
AMONG RESIDENTS OF A RETIREMENT CENTER
BY

MICHIKO KATO

The purpose of this study was to examine the effects
of music therapy sessions on perceived state of affect among
residents of a retirement center.

Each of twenty subjects was randomly assigned to either
an experimental group or a control group. The Affect Balance
Scale was individually administered to each of them as a pre-
test prior to the first music therapy session. Subjects
from the experimental group attended one to seven weekly
sessions. One experimental subject withdrew from the pro-
ject. The remaining nine experimental subjects and ten
control subjects completed the Affect Balance Scale as a
posttest after seven sessions had been completed. Four
experimental subjects were eliminated from the statistical
analysis due to their poor attendance in sessions.

No significant difference was found between the changes
from the pretest scores to the posttest scores of the experi-
mental and control groups. In addition, no significant
difference was found between the two scores of pretest and

posttest in the experimental group.

ACKNOWLEDGEMENTS

Grateful appreciation is expressed to Professor Robert
F. Unkefer and Dr. Dale Bartlett for their support, guidance
and help throughout this research study.

Thanks and acknowledgement are extended to Professor
Alicia C. Gibbons, Ann Rose and Lori Strom for their indi-
vidual help and contributions.

A very special thank is given to the residents of the
retirement center, in which this study was conducted, for

their cooperation and participation in this study.

ii

TABLE OF CONTENTS

LIST OF TABLESIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII V

LIST OF FIGURES. I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I Vi
CHAPTER

I I THE PROBLEMI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1

IntrOdUCtiono I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I

Purpose Of the StUdYo I I I I I I I I I I I I I I I I I I I I I I

Research Hypotheses........................

LimitationSIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
overVieWIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

CD wanna-i

II. REVIEW OF RELATED LITERATURE...............

Theories and Findings in Social Geron-
tology..................................... 8
Psycho—social theories of aging
Definitions
Measuring psychological well—being
Correlates of well-being
Activity and well-being
L/Mfigic Therapy for Elderly People........... 18
eatment goals
LResearch findings
eatment approach
bsdmmary.................................... 31

III. METHODOLOGYIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII 33

Sample..................................... 33
Selecting the subjects
The experimental group
The control group
Setting.................................... 36
Materials and Equipment.................... 36
Procedure.................................. 37
The Pretest
Measurement properties
Use in this study
The experimental group
The control group

iii

IV.

APPENDICES

A.

I.

Music therapy sessions

The posttest
Analysis..................................
Summary...................................

RESULTSI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
FindingSI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Review of Hypotheses......................

Interpretations...........................

SUMMARY AND CONCLUSIONSIIIIIIIIIIIIIIIIIII

ummarYIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

COnCluSionSI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
DiSCUSSionI I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I
Recommendations for Future Research.......

List of Cassette Tapes Used in Sessions...
List of Songs Used in Sessions............
Example of a Song Sheet...................

Questions and Scoring Sheet Used in
Pretest and Posttest......................

Example of Scoring........................
Example of a Session......................

Raw Data and Demographic Information:
Experimental Group........................

Raw Data and Demographic Information:
contrOl GroupIIIIIIIIIIIIIIIIIIIIIIIIIIIII

Raw Scores of the Affect Balance Scale....

REFERENCESIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII

iv

42
42

44
44
47
49
51
51
53

53
58

62
63
64

65
67

68

69

71

72

LIST OF TABLES

Pretest and Posttest Mean Scores from the
Affect Balance scaleIIIIIIIIIIIIIIIIIIIIIIIIIIII 4S

Pretest-Posttest Gain Scores from the
Affect Balance Scale............................ 48

LIST OF FIGURES

1. Changes of Raw Scores from Pretest to Posttest.. 46

vi

CHAPTER I

THE PROBLEM

Introduction

 

The growing population of elderly people is one of the
most serious issues in today's society and will draw more
attention in the near future. In 1980, there were more
than 35 million persons over age 60 in the United States.
While the population as a whole increased by 11 percent
during the period of 1970 to 1980, the population 65 and
over increased by 28 percent. Furthermore, the latest
population projections indicate that the proportion of those
over 75 will be rising in the next few decades (Siegel &
Davidson, 1984). Society, therefore, will have to face
many problems on how to meet the needs of elderly people
in a sufficient way.

Aging is a very complex process. It is biological,
psychological, and sociolagical in nature. From the bio—
logical view, one looks for signs of aging in the loss or
decline of functional efficiency of bodily organs. Changes
in neuromuscular skills, learning ability, judgment, memory,
and sensory acuity are important for the psychological view
of aging. In addition, behavioral scientists and sociologists

look for signs of aging in the individual's changing roles

in society and growing dependence in life (Cox, 1983; Siegel
& Davidson, 1984). Disengagement of an aging individual
from the society can occur due to organic diseases and
disabilities related to age-typical diseases such as arthri-
tis, brain damage or heart disease. As well, it can occur
following retirement from work. Thus, old age is a time
when many persons experience personal and social losses.
Since all these factors are interrelated, it is important
for people working with aging persons not only to treat
the disease or the problem, but also to give consideration
to the whole person with his or her multiple needs (Ford,
1962). In other words, elderly people need assistance to
learn, in the best sense, to grow old instead of merely
becoming old (Boxberger & Cotter, 1968).

The first part of the present study focuses on the
area of social gerontology. Gerontology is the scientific
study of aging, while geriatrics involves the application of
gerontological knowledge. Social gerontology is defined as
the study of the effect of aging upon individuals and society,
as well as the resulting reactions of individuals and society
to aging (Koller, 1968). Though the field of gerontology in
genral is still young with very few theories of aging that
are established scientifically (Watts, 1980), there has been
a dramatic increase in the number of published reports in
gerontological research (Hoyer, Raskind & Abrahams, 1984).

Particularly, much attention has been paid to older persons'

psychological well—being in recent years (Markides & Martin,
1979).

Psychological well-being includes the concepts of ad-
justment, morale, satisfaction with life, and happiness which
have been dealt with interchangably in earlier research. Re-
cently, researchers have been attempting to separate each
term from the others, and to establish more sophisticated,
scientific measurement techniques of these concepts along
with formulation of theories.

The second part of this study deals with utilization of
music with elderly people. Many programs have been estab-
lished to improve life quality for the elderly, including
music (Gibbons, 1980 & 1983a). The number of articles
describing the use of music therapy in geriatrics has, how-
ever, been scarce, especially articles of a scientific nature,
though the need for more scientific study has already been
recognized (Boxberger, 1960). Except for a few articles and
unpublished master's theses or doctoral dissertations, most
publications are of a descriptive nature.

Only a few studies have dealt directly with the effects
of music therapy on psychological aspects of the elderly such
as morale (Gibbons, 1980). personal adjustment (Binford,
1982), depression (Ramsay, 1982), and self-esteem (Ice,

1984).

Purpose of the Study

It has been widely recognized that the growing popu-
lation of older people demands more extended, multiple care.
Music has been used in many institutions for the elderly.
However, specific studies regarding the use of music therapy
for elderly people and these people's musical characteristics
have been extremely limited (Riegler, 1980a; Ramsay, 1982;
Hylton, 1983; Gibbons 1983a).

On the other hand, in the field of social gerontology
studies of life satisfaction or psychological well-being
have increased in the last few decades, and more scientific
measurements have been developed. The Affect Balance Scale,
conceived by Bradburn in 1969, was one of these measurement
techniques. This self-report scale was developed to measure
short term state of affect. Using a revised form of this
scale, suggested by Beiser (1974), as a pretest and posttest
measurement, the present study attempted to examine the effect
of music therapy sessions on perceived state of affect among
residents of a retirement center. There were two reasons
for the choice of the term of "perceived state of affect."
First, the term of psychological well-being or mental well-
being seemed to be so broad that it might have been inappro—
priate in such a study using a very small sample and a scale
with ten items as the measure. Second, terms such as life
satisfaction, morale, or happiness have been assumed to

underlie the Affect Balance Scale, but this writer felt that

the use of one of these terms could also be misunderstood.
On the other hand, a person's perceived state of affect is
what this scale actually measures since it assesses both
positive and negative affects as well as the balance of

these affects.

Research Hypotheses

The Affect Balance Scale (Bradburn, 1969) has been
recognized as one of the most effective instruments available
to assess psychological well-being. It was devised to mea-
sure with sensitivity fluctuations of positive and negative
affects over a period of a few weeks. The scale was appro—
priate for this study because of its use with elderly popu—
lations and its ability to measure affective changes over
the period required. More details will be presented in the
following chapters.

Using a population from a retirement center, a living
facility for elderly persons in East Lansing, Michigan, the
following null-hypotheses were formulated.

1. The eight weekly music therapy sessions will result in
no statistically significant difference between the
experimental and control groups in their changes from
the pretest scores to the posttest scores as measured by
the Affect Balance Scale.

2. There will be no statistically significant difference

between the pretest and posttest scores in the experi-
mental group as measured by the Affect Balance Scale.

Limitations

 

This study limited its experimental and control sub-
jects to higher functioning residents who were living in an
independent living unit of the retirement center. The rea—
son for choosing this population was to avoid the wide range
of mental and physical functioning levels of residents in
the health care center and the intermediate living unit
from the same retirement center. It would have been diffi—
cult or impossible for most residents from both these units
to understand the questions of the Affect Balance Scale.

Due to the available room and the number of musical
instruments, the number of the participants was limited to
ten in the experimental group and ten in the control group.
Moreover, music therapy sessions were held only once a week
because of the regular weekly programs at the center as well
as the different personal schedule of each participant.

Statistical analysis was limited to determining the
difference between two groups in their changes from pretest
to posttest and the difference of pretest and posttest in
the experimental group. Some studies have attempted to
correlate variables such as health state, mental alertness,
or activity level to the perceived psychological well—being.
Such was not attempted in this study because of the small

size of the sample.

Overview

In Chapter II, theoretical and empirical background of
this study is presented in a review of related literature.
The first part of the review focuses on the theories and
research findings in social gerontology. Definitions of
psychological well—being and related terminologies are pre-
sented. The relationship between activity and well—being
concludes the first part of the literature review. The
second part deals with music therapy for elderly people.
Treatment goals, research findings and treatment approach
are presented in this section.

Chapter III includes the methodology of the present
study. The sample, setting, materials and equipment, pro-
cedure, and statistical analysis of data are described. In
Chapter IV, the data collected are presented in relation to
the relevant research hypotheses investigated, and the re-
sults are interpreted. Chapter V includes a summary of the
study, discussion of conclusions and recommendations for fu-
ture research. Appendices include a list of cassette tapes
and a list of songs used in sessions, an example of a song
sheet, the revised form of the Affect Balance Scale, an
example of scoring procedure, and tables of raw data and

demographic information.

CHAPTER II

REVIEW OF RELATED LITERATURE

Theories and Findings in Social Gerontology
Psycho-social Theories of Aging

As stated by Maddox and Wiley (1976), recognition of
aging as a social problem is new. Studying this issue
scientifically is even more recent, and there exists no
single theoretical perspective yet which organizes substan-
tive research on the social aspects of aging. However, the
amount of research publication on psycho-social aging has
increased dramatically in the recent few decades.

The activity theory is one of the major theories which
have dominated gerontological research in the United States.
This theory states that the maintenance of social activities
is the most effective way to age optimally, even though
some reduction in social roles is inevitable as one ages
(Havighurst, 1963). According to this theory, an active
rather than a passive role is important for mental health
and satisfaction with life. Therefore, substitutes should
be found when a person has to give up certain roles or activi—

ties (Butler & Lewis, 1982).

Definitions

 

It is important to know who belong to an older popula-
tion. Siegel and Davidson define the older population as
persons aged 55 and over, the elderly as persons of 65 and
over, the aged 75 and over, and the extreme aged 85 and
over. They also use the term of the frail aged for the
age group 80 and over (1984). Butler and Lewis (1982) refer
to the concept of two groups among older people: early old-
age between 65 and 74 years and advanced old-age 75 and above.
One must, however, be aware of the fact that age itself is
not an indicator of a person's physical, mental, and psycho-
logical status.

The major concern of researchers, regardless which
theory they represent, has been so-called successful aging.
There has been conceptual confusion in terminology related
to successful aging. One prefers the term of psychological
well-being or mental health; another uses the concept of
adjustment or adaptation; and still others choose morale,
life satisfaction, or happiness. The literature review re-
veals that some authors have used these terms interchangably,
while others have attempted to differentiate them from each
other.

Psychological well-being, sometimes called subjective
well-being, is assumed to be one's subjective evaluation
of the overall quality of one's inner experience (Lawton,

1983). Campbell (1981) interprets mental well-being as the

10

entirely subjective experience of individuals and their
feelings of being happy and content. However, these de-
finitions are so global that there have been attempts to
define particular characteristics of psychological well-
being more precisely. For example, life satisfaction,
morale, and happiness have drawn much attention as such
major characteristics underlying psychological well-being.

Life satisfaction refers to the degree to which one
is presently content or pleased with his or her general
life situation (Lemon, Bengston, & Peterson, 1972). Many
researchers agree that life satisfaction has played an im—
portant role in social gerontology (Maddox & Wiley, 1976;
Peppers, 1976; Lohmann, 1977; Larson, 1978; Cutler, 1979;
George & Bearon 1980; Kausler, 1982).

Morale refers to the emotional component of a person's
attitude toward his or her own life, a reflection of his or
her feelings about the past, present, and future (Chown,
1977).

Happiness sometimes is used as a synonym for life satis-
faction, but more precisely reflects the affect people feel
toward their current state of affairs. Bradburn defined
happiness as the extent to which positive feelings outweigh
negative feelings (1969).

Measuring Psychological Well-being
Psychological well-being has been the subject of many

researchers in the last few decades. Although a clear

11

concept, especially regarding the causal relationships
between biological, environmental and psychological fac-
tors influencing one's feeling of satisfaction with life,
has not been established yet, a review of the literature
reveals sufficient insights to enable investigators to mo—
del causal networks and to test their model (Berghorn,
Schafer, Steere, & Wiseman, 1978). This writer will first
review the most frequently used measurement instruments of
psychological well—being for elderly people, and then pre-
sent the findings regarding the correlates of well-being.

Neugarten and her team attempted to establish a short,
easily-administered instrument as a measure of old people's
well—being (1961). The Life Satisfaction Ratings and In-
dices A and B are the results of their efforts. The Rat-
ings and Indices have been revised, and are recognized as
probably the most widely used instrument for assessing sub—
jective perception of well-being among the older population
(George & Bearon, 1980). The basic concept of these instru-
ments is the assumption that there are five underlying dimen-
sions of psychological well-bing: zest, resolution and forti—
tude, congruence between desired and achieved goals, positive
self-concept, and mood tone (Neugarten, Havighurst, & Tobin,
1961). In general, the Life Satisfaction Indices are re—
commended for use with healthy older persons.

Next, extensive studies have been done regarding the

Philadelphia Geriatric Center Morale Scale, which was

12

designed by Lawton and his team in 1972. This scale was
developed for use with very old, institutionalized persons,
and, after revisions, now consists of 17 items with three di-
mensions. The dimensions are agitation, attitudes toward
one's own aging, and lonely dissatisfaction (Lawton, 1975).

Unlike the Life Satisfaction Indices and the Philadel-
phia Geriatric Center Morale Scale, both of which measure
long-term perception of well-being, the Affect Balance Scale
was developed to measure short-term state of affect by
Bradburn (1965, 1969). He postulated that overall psycho—
logical well-being depends on person's recent perception of
two independent dimensions which are the positive affect
and the negative affect. In this scale, each dimension has
five questions, and the difference between the scores of
both affects is suggested to be a good predictor of a per-
son's current level of psychological well-being. Bradburn
stated that happiness can be defined as the extent to which
positive feelings outweigh negative feelings, using the time
referent of a few weeks.

Although the original scale had been developed with a
sample of younger subjects, several authors have used this
scale with older persons. Gaitz and Scott (1972), for exam-
ple, examined whether there were age related differences in
responses of 1441 subjects in six age groups, including a

group of persons 75 years and over, to several instruments

used to measure meantal health. Among other findings, they

13

concluded that the Affect Balance Scale scores showed no
significant pattern of relationship to age. However,
older groups reported less positive and less negative
affects than younger and middle-age groups did. Moriwaki
(1974) attempted to validate the Affect Balance Scale
using eight psychiatric out-patients and 19 normal per-
sons aged 60 years and over. She employed several other
instruments such as the Comprehensive Role Index, the
Rosow Morale Scale, the Nine-Item Mental Health Scale and
self-reports of avowed happiness. Results indicated that
the Affect Balance Scale was the best over-all measure of
psychological well-being, and Moriwaki concluded that this
scale was applicable to the elderly as well as to younger
populations. She added, however, that differential age
norms should be developed to accommodate the lowered affect
associated with age.

This writer found the Affect Balance Scale as a suitable
instrument in the present study because of its sensitivity
to current affective fluctuation within the preceding few
weeks, and its brief administration form. More details will
be discussed in the Chapter III.

Correlates of Well-being

 

First, one should consider the fact that not only the
objective factors determine the level of well-being, but also
one's subjective perception of these factors are very impor-

tant as correlates of well-being (Fengler, 1981). The

14

focus of the review of correlates of psychological well—
being and related concepts in this study was the causal re-
lationship of activity and social interaction to the level
of perceived well-being among older people.

Among other correlates, perceived health has been widely
found to be by far the most important one (Palmore & Luikert,
1974; Palmore & Kivett, 1977; Larson, 1978; Barresi, Ferraro,
& Hobey, 1984; Dillard, Campbell, & Chisolm, 1984). Other
significant variables are education, socioeconomic status,
housing conditions and social activities (Palmore & Luikert,
1974; Palmore & Kivett, 1977; Birren & Schaie, 1977; Larson,
1978; Barresi et al., 1984; Dillard et al., 1984).

Activity and Well-being

The research findings of how the level of activities
and social interaction will affect one's well-being have
been somewhat controversial. First of all, activity is de—
fined as any regularized or patterned action or pursuit be-
yond routine or personal maintenance (Lemon et al., 1972).

In addition, Lemon et al. divided activity into three cate—
gories: informal, formal, and solitary activities. It is
also important to note that many aged persons have limita-
tion in activity due to a chronic condition. For example,
in 1981, 45 percent of persons aged 65 years and over were
limited in their activity, compared with only 10.5 percent
of younger persons (Siegel & Davidson, 1984).

The initiators of the activity theory, Tobin and

15

Neugarten (1961), found supporting evidence of this theory
in their longitudinal study with two age groups of the
older population. According to the study results, social
interaction was positively associated with life satisfac—
tion. Neugarten (1977), Pfeiffer (1977), and Markides and
Martin (1979) also confirmed the strong association of
activity and life satisfaction. Pepper (1976) concluded
from the study of the effects of leisure types on life
satisfaction among retirees that social and/or physical
activities had the most positive effect on life satisfac-
tion. Lemon et al. (1972), however, stated that only in—
formal activities such as interaction with friends, rela-
tives, and neighbors were directly associated with life
satisfaction. Using the Affect Balance Scale, Graney (1975)
found a direct relationship between happiness and social
activity among elderly epople. He emphasized that passive
activities such as watching television or reading were not
related to happiness while activities involving face-to-
face interaction were positively related to happiness.

An interesting finding was reported by Wylie (1970)
in the study of life satisfaction as a program impact
criterion. Wylie examined the effects of a three-year
demonstration program on the lives of an aged population.
Results indicated that higher morale scores were registered

in the experimental group after participation in the program

of social activities. This finding, however, was a contra—

diction to the finding of the survey by Toseland and Sykes

16

(1977). In their investigation examining the relationship
between senior citizen center participation and life satis-
faction, they concluded that senior citizen center partici-
pation was not related significantly to life satisfaction,
but that activity level was by far the best predictor among
other variables of life satisfaction. In this writer's
opinion, the contradictory results of both studies might
come from the difference in the nature of the studies: The
first included an experimental treatment; the other was a
form of survey. In spite of the difference in the results,
both studies indicate the importance of program planning

in senior citizen centers to improve participants' activity
level.

On the other hand, some gerontologists have warned
against making a causal relationship between the activity and
well-being. For example, Wolk and Telleen (1976) compared
living conditions of retirees from two different populations
in order to study the relationship of health and economic
sufficiency to life satisfaction. Their study populations
were from a nursing home and from a retirement type village.
They concluded that the components of life satisfaction are
affected differently by the living arrangements. According
to Wolk and Telleen, activity level may be of limited and
secondary importance to successful and satisfying experi-
ences of older people. In another study, the relative im-

pact of personality factors and social status variables

17

upon levels of activity and psychological well-being among
middle-aged and older persons was examined in a five-year
period (George & Bearon, 1978). Findings suggested that
psychological well-being could be predicted better by person-
ality factors than by social status factors, while activity
levels were better predicted by social status variables.
Between levels of activity and psychological well-being,
however, there existed only a weak correlation. Markides
and Martin (1979) maintained that not activity itself, but
health and socioeconomic status determine the degree of both
activity and life satisfaction. In other words, a person who
is healthy and has abundant resources for living is more
likely to engage in activities than a person with poor
health and limited resources.

From the review of literature, it is apparent that
concepts of psycho-social aging and causal relationships
of well-being and various factors of a living situation
still need much more investigation in future. There are a
few possible explanations for this need. First, the dimen-
sion of a person's psychological well-being is so complex
that a clearcut study of causal relationships is very diffi—
cult to conduct. Second, the population of elderly people
is not a homogeneous group, but a very heterogeneous group
with a wide range of age. Third, gerontology itself is a
quite new social science though it has grown dramatically

since the 1950's. Finally, study findings regarding the

18

impact of activities and social participation upon a per-
son's well-being have been, to a certain degree, contra-
dictory. It might be a great challenge for future research-
ers to approach these problems. In this writer's opinion,
however, there is enough positive evidence to support the
concept of maintaining the activity level of elderly per—
sons at as high a level as possible. Ford (1962), for
example, defined the individual use of leisure time as one
of the most important features in preparing older people

for successful aging. Pfeiffer and Davis (1974) stated that
middle-aged people should get more training for leisure to
avoid serious degrees of dissatisfaction in old age. Simi-
larly, Moran (1979) suggested that it is essential to find
substitute companions and activities for an aging person

in order that he or she can maintain healthy mental outlooks
by filling his or her day—time in a meaningful way.

Music can provide opportunities for improving leisure-
time skills and enhancing social interaction among partici—
pants in all ages. Musical activities can be adapted to
the decreased abilities of elderly people and to their spe-
cific needs. The following part of the literature review

focuses on music therapy as it relates to this population.

Music Therapy for Elderly People
Music activities have been incorporated into many

recreational programs for elderly people to enhance life

19

quality (Williams, 1953; Gibbons, 1983a). With increasing
numbers of elderly people, music therapy, both in geriatric
residential institutions and community settings, is becoming
more important. For the first population, arresting senility
and deterioration is one of the major treatment goals, while
helping people to prepare for productive and enjoyable life
is essential for the latter population (Gilliland, 1953).

According to recent data, about five percent of per-
sons aged 65 years and over were living in institutional
settings in 1981. Moreover, those 65 years and over may
generally expect to spend about one year, on the average,
in an institution sometime in their remaining life span.
Third, among the institutionalized residents, there are
far more women than men, and a higher number of non-married
people and persons over 75 years compared with non-institu-
tionalized persons (Siegel & Davidson, 1984). Finally,
other major factors affecting the nursing home population
are the high prevalence of chronic diseases, mental im—
pairment and severe physical limitations (Moran, 1979).
All these factors mentioned above should be taken into
account when planning a music therapy session since the
majority of music therapists in the geriatric field will
probably be working with institutionalized persons.
Treatment Goals

The overall goal of music therapy for elderly people

should be to achieve and to maintain these people's mental,

20

physical, and psychological levels of functioning as high as
possible. There seem to be general treatment goals which
are common and essential among all age populations, and
goals which are set to meet specific needs of elderly peo-
ple. This writer briefly describes general goals, then
moves on to more age-specific goals, and last, focuses on
goals which are strongly related to the present study's
topic.

To begin with, music can be used as a tool to provide
opportunities for stimulating creativity. Donahue (1953)
suggested that music therapy should be applied as an out-
let for the creative impulses which are still present in
elderly persons. Creative activity also is suggested to
enhance the feeling of self—esteem (Toombs, 1968). Having
an opportunity for a successful experience might lead to an
enhanced self-concept or increased self-esteem (Palmer,
1977; Gibbons, 1980). In addition, music is an excellent
tool for providing group experiences to improve social
and communication skills. Liederman (1967) indicated that
the promotion of the feeling of organization within a group
is probably the most important therapeutic effect. Many
authors agree on the importance of facilitating sociali—
zation through musical activities and sharing common experi-
ences among older people (Toombs, 1968; Palmer 1977; Hylton,
1983; Hennessey, 1984; McGraw, 1985). Finally, self-ex-

pression and expression of feelings are common treatment

21

goals. Since many elderly people might have experienced
various kinds of loss and grief in their lives, it is
essential for them to release tension, repressed feelings,
anxiety, depression, aggression or negative self-concern.
I Music may be helpful to facilitate such processes (Toombs,
1968; Browne & Winkelmayer, 1968; Shapiro, 1969; Bright,
1972; Tanner & O'Briant, 1980).

Among the more age-specific goals, it is important to
motivate elderly persons to engage in physical activities,
and, when necessary, to exercise for better physical function-
ing in spite of some possible chronic limitations. The
literature review indicated that many therapists have
recognized the importance of utilizing music in conjunction
with physiotherapy and general physical activities. (Toombs,
1968; Palmer 1977; Mason, 1978; Hennessey, 1984). Along with
improving physical functioning, Palmer (1977) and Hylton
(1983) pointed out the importance of providing mental stimu-
lation. This is particularly true for institutionalized
people, because the high prevalence of mental deterioration,
in many cases, is the reason for placing aging individuals
in an institution (Butler & Lewis, 1982). In conjunction
with a reality orientation program, a way of recognizing the
social structure of the institutional environment so that
residents are encouraged and allowed to behave in a more
rational fashion, music therapy has proved to be a useful

tool (Citrin & Cixon, 1977; Riegler, 1980a).

22

Lastly, there are goals which seem to be of particular
interest for this study. Musical activities can be adapted
at each person's individual functioning level so that every-
one can have a successful experience. This, in turn, may
lead to enhanced elevation of mood, and the feeling of
well-being and better quality of life. The research team
at University of the State of New York in Albany suggested
that rhythm and sound stimulate physical and emotional well-
being, and satisfaction in accomplishment might lead to
personal enjoyment and confidence (1968). Satisfaction
and a sense of well—being may be a result of well estab-
lished group feeling (Toombs, 1968). Shapiro (1969) empha-
sized giving a new zest for living as one of the treatment
objectives. According to Bright (1981), the sense of enjoy—
ment is essential to successful rehabilitation for elderly
people.

All these treatment goals, however, have been suggested
based on theoretical speculations or empirical observations
during music therapy sessions. Very little scientific re-
search has been done to examine and evaluate specific musi-
cal characteristics of elderly people, and the effect of
use of music on these people. This writer strongly felt a
need for reviewing the literature which has attempted to

cover these neglected areas.

23

Research Findings

First, some auditory characteristics typical for aged
people must be examined since music is primarily of an
auditory nature. Rees and Botwinick (1971) studied psycho-
logical factors which might influence older people's lower
audiometric scores in addition to age-related sensory de-
cline. They concluded that older people are more cautious
in decision making in a test situation than younger people
are, and the magnitude of auditory deficits in later life
may be overestimated due to this factor. This view was
confirmed by Potash and Jones (1977) and Moran (1979).
Regarding auditory ability of elderly people, Riegler
investigated the most comfortable loudness level for a
geriatric population (1980b). In her experiment, after
ascertaining hearing acuity of a pure tone of 440 Hz at
50 dB, 28 residents from a group home and from a nursing
home were asked to set the most comfortable loudness level
while listening to a pure tone or recorded music. The
results showed that the mean most comfortable loudness
for the pure tone of 440 Hz was 58.8 dB, and the mean most
comfortable loudness for the recorded music with an average
frequency of approximately 440 Hz was 67.6 dB. She further
stated that the subjects preferred soft music to loud mu-
sic. It was, however, unclear in this study whether the
most comfortable loudness level of elderly subjects was

significantly different from that of younger persons.

24

More research is needed in this area.

An extensive study was done by Gibbons (1980) to
examine musical aptitudes in relation to age in an inde—
pendently living elderly population sample. Using Gordon's
Musical Aptitude Profile, Gibbons compared its scores with
self-esteem, morale scores and other attribute variables.
Study results indicated that no significant differences
were found when correlation coefficients were computed for
age and the Musical Aptitude Profile Scores. Moreover,
the following variables were slightly related to the Musical
Aptitude Profile Scores: musical activity level, musical
experience, frequency of music listening, and monthly in-
come. General morale was a rather weak predictor of the
composite Musical Aptitude Profile Scores. In a later study,
she investigated musical aptitudes of an institutionalized
elderly population (1983a), using Gordon's Primary Measures
of Music Audiation. Results revealed no significant correla-
tion between the test scores and the age groups in the sam—
ple. She concluded that this finding suggests that the
musical aptitude of her study subjects was maintained beyond
age 65 to later years. Unlike the results of her study in
1980, no correlation among selected attribute variables
and the test scores was found. In another study in the same
year, she conducted an additional experiment to analyze the
musical discrimination response of an institutionalized

elderly sample by administering the Tonal and Rhythm Subtests

25

of the Primary Measure of Music Audiation Test (1983b).
Her finding seems to be important for practicing music
therapists since it implies that the institutionalized
elderly have problems in learning or performing music which
requires discrimination of subtle musical changes and complex
rhythm patterns. Gibbons recommended the use of music
with marked changes in pitch or duration and with simple
rhythm patterns for facilitating successful experiences.
Another important objective for a more effective utili-
zation of music for elderly people seems to be the study of
musical preference of these people. Many authors agree
that the popular music in young adult years is preferred
to other kinds of music, and, as a result, the use of such
music is effective in music therapy sessions. However, only
a few studies have been done to examine systematically this
widely held assumption. Gibbons (1977) conducted such a
study, and found that music of young adult years was, in
fact, significantly preferred to music of later life periods
by her study subjects aged 65 to 95 years from various resi-
dential settings. In addition, another assumption that
older people prefer sedative music to stimulative music
could not be confirmed. Concerning the preference of musi-
cal activities, Ives (1980) examined the preference order
among singing, Orff—Schulwerk, kitchen band and dancing

in two groups of senior citizens. Most of the songs sung

26

in the sessions were popular between 1900 and World War II.
Singing was the most preferred activity, followed by Orff-
Schulwerk and kitchen band, and dancing was the least pre-
ferred activity. She suggested that singing might be the
least threatening activity for participants, or might have
special meaning for them from young years. In addition,
she mentioned that singing might facilitate a successful
experience in a relatively short amount of time.

A significant change which is related to singing and
accompanies the aging process is lowered voice range. Since
singing is suggested to be one of the prominent activities
of music therapy sessions with elderly people, it is essen-
tial to understand what is the most comfortable voice range
for this population. Greenwald and Salzberg (1979) con—
cluded from their study with nursing home residents that
the functional vocal range of this population sample was
far more limited than the average range of young adults.
Implication for practitioners is to transpose songs into
lower keys so that elderly people can enjoy the singing
activity more and for a longer period of time.

Last and most important for this study's topic, no
published articles concerning the effect of music on elderly
people's various psychological status could be found. Only
a few master's theses have attempted to provide information
in this specific area. Ramsay (1982) focused in his study

on music therapy and depression in the elderly, but could

27

not obtain a statistically significant difference in pre-
depression level and post-depression level of a nine—week
period of music therapy sessions. He indicated, however,
that music therapy was more effective in lowering depres-
sion levels on the care home residents with a relatively
high level of depression than those with a lower level of
depression. Binford (1982) examined the effect of early
life music on reminiscence, self-report of ability for
change and personal adjustment. As music selections, she
chose songs popular between 1916 and 1941. An adjective
check list describing subject's perception about himself
or herself was used as one of the dependent variables.
While the experimental group had the reminiscence part
prior to filling the check list, the control group first
completed the check list prior to the reminiscence. In
spite of nonsignificant findings, Binford concluded that
the use of music as a tool for recalling past memories
may effectively be applied in the clinical approach to
explore the curative process. In this writer's opinion,
however, the reminiscence part was too poorly designed to
have more impact on the adjective check list since the
subjects had the opportunity to listen to the music only
once. The effect of music and guided imagery on self-
esteem of female carehome residents was examined by Ice
(1984). Six semiweekly sessions yielded nonsignificant

difference in the self-esteem scores of the pretest and

28

posttest among the experimental group as well as between
the posttest scores of the experimental group and the control
group which had poetry instead music for guided imagery
sessions.

In conclusion, research in the elderly populations'
musical characteristics and the effect of music on them
has just begun. At this moment it is too early to draw
any general conclusions in all the specific areas. Studies
previously done have limitations in their experimental de-
signs which hinder generalization, as all the investigators
consciously admitted. The amount of research already done
is also far too small. However, the first step has been
done, and there are already some useful suggestions for
future research. Music therapy in general has been criti-
cized for its lack of studies in a more scientific manner.
The area of geriatric populations particularly needs fur-
ther investigation since the effectiveness of music therapy
with these populations has been apparent and encouraging
based on general observations. The last part of the litera-
ture review will describe the treatment approach.
Treatment Approach

Selecting appropriate types of music is a key for a
successful music therapy session. Many practitioners agree
that the music from the young adult years is particularly
effective. For example, well-known familiar and favorite

recreational home songs, patriotic songs, folk songs and

29

hymns were especially enjoyed by the participants on a
geriatric ward (Hall, 1956). Liederman (1967) recommended
as criteria for music selections the following: music with
simple and repetitive rhythmic patterns and with prominent
beats, and music of short duration and in familiar tunes.
Mason (1978) suggested that the use of slower music with a
firm thythm might be a good choice.

There seem to be some particularly popular types of
musical activities. First, singing is by far the most fre-
quently chosen activity for elderly people. Graham (1977),
for example, stated that songs from the early years associated
with religious training and the courtship period are the
most motivating music for geriatric patients. Group sing—
ing is supposed to facilitate group interaction and expres-
sion of feelings. In addition, group singing is a powerful
tool to encourage reminiscing (Hennessey, 1976). Bright
(1972) suggested that music can recall the past to one's
mind, and such association can help participants relate one
person's memories of a particular period of time with other
persons through group discussion. According to Byrne (1984),
reminiscing involves the reliving, re-experiencing, or
savoring of past events, and one's immediate reactions to
music can be used as material in group discussion.

Next, playing instruments is another popular activity
among programs for elderly people. It can be in the form

of accompaniment to singing (Boxberger, 1960; Moore, 1978)

30

or rhythm band or kitchen band (Williams, 1953; Merril,
1967; Toombs, 1968; Douglass, 1978). However, Moore (1978)
warns that some rhythm instruments have poor tone quality,
and can cause association with kindergarten characteristics,
an important point in this writer's opinion when planning

a successful session, especially with higher functioning
persons.

Third, music can be incorporated in movement exercise
(Mason, 1978; Hennessey, 1984) and dance activities (Merril,
1967; Toombs, 1968).

Fourth, there are some scattered activities such as
individual lessons for learning instruments (Eberly, 1953;
Jeanette, 1966) and listening to music (Hall, 1956; Merril,
1967; Douglass, 1978).

Finally, music has been used in combination with other
therapy programs. Boudreault (1975) reported a successful
integration of music therapy as a part of a milieu therapy,
and Needler and Baer (1982) suggested that music and move-
ment were combined with the techniques of remotivation
therapy for stimulating and maintaining the functioning
level of regressed elderly people.

To conclude this part of the literature review, some
general guidelines for planning successful music therapy
sessions should be added. Awareness of elderly persons'
physical and mental limitations is important in order to

modify activities to their functioning levels (Toombs, 1968).

31

Bright (1981) further referred to the importance of learning
an extensive repertoire of music from the appropriate periods
and asking the patient what music selection he or she would
like to hear. In addition, participants should have plenty

of time during discussions.

Summary

Study of aging as a psycho-social phenomenon has in-
creased recently in the area of social gerontology. There
have been many debates concerning theoretical formulations
and the causal relationships of psychological well-being,
and various factors in a person's living situation. The
recent trend in research has been to determine some under—
lying characteristics of the rather broad terminology of
psychological well-being. Life satisfaction, morale, and
happiness have been given particularly much attention as
they relate to psychological well-being. At the same time,
more sophisticated instruments for measuring psychological
well—being have been developed and used in the elderly
population samples.

Some factors in one's aging process have been defined
as strong predictors of psychological well-being, while
there have been different findings regarding other variables.
The relationship between the level of activity/social inter—
action and psychological well-being has been, to a certain

degree, contradictory; however, there has been sufficient

32

evidence to support the importance of increasing activity
levels of older persons as a means for a more enjoyable

and successful aging. Music has been incorporated in many
programs to facilitate such process. Despite the paucity
of scientific studies, the positive effect of music therapy
upon elderly persons has been apparent, and it seemed to be
very important to try to fill this gap in the literature.
The present study attempted to examine the relationship
between the effect of music therapy sessions and the degree
of the perceived state of affect among residents of a re-

tirement center.

CHAPTER III

METHODOLOGY

Sample

The sample studied in this investigation consisted of
residents from a retirement center in East Lansing, Michi-
gan. The subjects of the study were living in the inde—
pendent living unit of this center. The residents of this
unit were considered to be suitable for the present study
because of its use of a self—report scale as the experi-
mental measurement.

Selecting the Subjects

 

First, a letter was sent to the director and the
activity therapy director of the center asking them for
permission to conduct a research project. Next, two sets
of a letter and consent form were prepared in large print.
One set was for the control group and the other for the
experimental group. The letter asking for a consent form
of the control group included the purpose of the study,
an approximate schedule of the project, and the nature of
the scale as pretest and posttest. The other letter for
the experimental group included the same description above,
and a brief explanation about music therapy sessions. It
was also mentioned that no musical background was required.

The consent form for the control group indicated that the

33

34

persons had read the explanation about the project, and that
he or she was willing to participate in two administrations
of the scale. The consent form for the experimental group
had an additional explanation that the person was willing

to participate in eight music therapy sessions, but was free
to withdraw from the study at any time without penalty.

Subjects were then randomly drawn from the telephone
directory of the center. Since there were about 180 resi—
dents living in the unit, every eighth person was drawn
to form two groups of ten persons each. They were randomly
assigned to either group.

Upon a suggenstion by the music therapist working at
the center, each person was contacted personally by this
experimenter accompanied by the music therapist. The pre-
sence of the therapist was helpful during the initial inter-
views because most of the persons contacted had no experi-
ence with a research project and did not know the experi-
menter. It was important to avoid unnecessary caution and
possible fear or rejection by contacting them through someone
they already knew. Each interview lasted about 10 to 15 mi-
nutes, in some cases longer, and included an introduction
of this experimenter, an oral explanation of the project,
and completion of the consent form. Out of the 26 persons
contacted, 20 agreed to participate in the study. Almost
two thirds of them required or preferred an oral presenta-

tion of the letter and the consent form due to poor vision.

35

Collecting the subjects and completing the consent forms
took a total of five days.

All subjects were Caucasian, and their average age
was 83.9 years. None of them had any regularly scheduled
music therapy programs except an occasional sing-a-long
group, music appreciation group, movement group, and talent
shows provided by the activity program of the center.
The Experimental Group

There were eight women and two men in the experimental
group. Their ages ranged from 71 to 91 with an average age
of 82.1 years and a median age of 83 years. One person was
living with her spouse, and others were living alone in
their apartments. Six persons had significant visual prob-
lems which interfered with the ability or the motivation to
read even large print. Two subjects had hearing impair-
ment, but could understand enough to communicate when they
were approached with a slow and firm voice in close proximity.
Five subjects needed an aid to walk. One had had professional
musical training.
The Control Group

There were seven women and three men in the control
group. Their ages ranged from 65 to 97. The average age
was 85.6 years and the median age was 84. Two of them were
living with their spouses, while the others were living alone.
Five persons had significant visual problems, and two had

hearing problems. Two subjects needed ambulatory aid, and

36

one person was confined to wheelchair.

Setting

The initial interviews as well as the administration
of pretest and posttest were done individually in the living
room of each subject. Each living room was furnished with
the subject's own belongings. The room was well-lighted,
air-conditioned, carpeted, and quiet. The level of noise
from outside was minimal.

The music therapy sessions were conducted in a private
dining room of the center. The room was located apart from
the living areas, but was easily accessible. It accommodated
a large dining table, which was removed during the sessions,
and 12 chairs. It was well-lighted, air-conditioned, car-
peted, and very quiet. The room was furnished in a luxurious
way like the other parts of the unit, and the whole atmos-

phere was comfortable.

Materials and Equipment

 

The following items were used for the administration of
the pretest and the posttest.

1) Two pages of the Affect Balance Scale in large print

2) A pen.

Further materials were used for the music therapy ses-
sions.

1) An autoharp

2)
3)
4)

5)

6)

7)

37

A guitar

A cassette recorder

Cassette tapes (See Appendix A)

Song sheets selected from various songbooks and
typed in large print (See Appendices B and C)

A set of rhythm instruments including rhythm
sticks, maracas, bells, woodblocks, hand drum and
tambourine

A set of tone bars.

Procedure

 

The Pretest

 

The Affect Balance Scale was administered as the pretest

in the present study. The scale consists of five items in

the Positive Affect Scale and the Negative Affect Scale,

respectively. The following questions are included in the

scale:

During the past few weeks did you ever feel:
Positive feelings:

1.
2.
3.

4.
5.

Pleased about having accomplished something?

That things were going your way?

Proud because someone complimented you on something
you had done?

Particularly excited or interested in something?

On top of the world?

Negative feelings:

1.
2.
3.
4.
5.

So restless that you couldn't sit long in a chair?
Bored?

Depressed or very unhappy?

Very lonely or remote from other people?

Upset because someone criticized you?

38

Measurement properties.

Bradburn (1969) reported a test-retest correlation of
.76 with measurements three days apart. According to Larson
(1978), the test-retest reliability with adults of age 18
years and over within 10 months was .74 for men and .71 for
women.

As to validity, George and Bearon (1980) reported that
the scale was significantly related to the Rosow Morale
Scale (r = .61) and to the Life Satisfaction Index A (r = .66).
Both validities were gathered with elderly samples.

Use in this study.

To avoid possible skewed scores toward a too positive
or too negative direction, the questions were rearranged in
a random order. The words of positive and negative feelings
were eliminated, also. In the original scale, a dichotomous
forced choice with "Yes" or "No" was used for responses.
However, this writer felt that a trichotomous forced choice
with "Often," "Sometimes," or "Never", suggested by Beiser
(1974), might reflect more frequency and intensity of affec—
tive states. Therefore, a trichotomous response farm was
substituted for the original answer form. The reordered
questions and altered answer sheets were typed in large print
(See Appendix D).

As a result of the altered response form, the scoring
was also changed. In the original scale, one point was given

for each "Yes" response, and zero points were given for "No"

39

responses. The sum of the scores of the negative feelings
was subtracted from the sum of the scores of the positive
feelings, yielding a range of -5 to +5. A constant of five
was added to this score for more convenient computations,
resulting in a range from 0 to 10. In the present study,
two points were given for each "Often" response, one point
for each "Sometimes" response, and zero points for "Never"
responses. A constant of ten was added to the subtracted
sum of negative feeling scores from the sum of positive
feeling scores. The final score ranged from 0 to 20, With
higher scores reflecting more positive affective states.
An example of scoring is included in Appendix E to illust-
rate the scoring procedure.

After the initial interviews which required five days
to complete, the pretest was administered individually.
Testing in a group was not possible due to many subjects'
visual, auditory or comprehension problems. The pretest
procedure required four days to complete.

The experimental group.

Seven subjects required or preferred an oral presen—
tation of the scale. The examiner then recorded the answers
for them. Three were able to complete the scale on their
own.

Seven subjects had no major problems in completing
the scale while two others needed some repeats and different

explanations to understand some questions. One subject added

40

extended associations to each question, making the procedure
very difficult.

The control group.

Six subjects required or preferred an oral presen-
tation. Five subjects finished the testing without major
problems. Three talked voluntarily about their associations
with some questions or about their personal matters during
the testing, but were able to focus on the task with some
reminders. Two subjects had extreme difficulties remaining
on task. Instead, they constantly talked about something
else. One of them seemed to be not only talkative but also
disoriented, and had problems understanding longer questions.
Music Therapy Sessions

The actual sessions started later than originally
planned because of the extended period spent on the initial
interviews and the pretest procedure. Due to the delay,
subjects of the experimental group participated in seven
group music therapy sessions once a week instead of eight
originally planned sessions.

Sessions consisted of several activities: singing,
listening to music, exercising to music in their chairs,
playing instruments as accompaniment to songs, and dis-
cussion about the content of the songs as well as other
seasonal events. An example of a session is included in
Appendix F.

Despite the visual problems, six subjects were able

41

to read song sheets in large print. Therefore, all songs
except a few introduction and goodbye songs were typed in
large print, and every person who wished could have his or
her own song sheets. For the two subjects with hearing
problems, the words of each song were clearly and slowly
read before singing. In addition, these two sat next to
the therapist to enable them to hear well.

Out of ten subjects, only five participated more than
four times in sessions. One never came to the session and
dropped completely from the study during the seven-week
period. One was seriously sick during the first five weeks.
One complained about the side effects of the medication and
could not attend the 9:30 a.m. sessions. The fourth had
scheduling problems and withdrew from the sessions after
two participations. The last subject was unable to partici-
pate due to reality disorientation.

Among the remaining subjects, only two seemed to be
fully alert. The other three had to be reminded of the
session every week and had to be escorted to the room be-
cause of their poor short-term memory about time and place.

The Posttest

 

The Affect Balance Scale was administered to both
groups as a posttest four days after the completion of seven
music therapy sessions. Again, testing was done individually
and required four days to complete. For some subjects, there

were similar problems in following the procedure and

42

understanding the questions. In addition, it became obvious
this time that at least two subjects had some disorientation
with time. They talked about the same topics they had
discussed during the pretest procedure, indicating that for
some questions they did not relate to the concept of "during

the past few weeks".

Analysis

Of the nine experimental subjects who completed the
posttest, four had to be eliminated from the statistical
analysis because of their poor attendance in the sessions.
Therefore, a Mann Whitney U Test, a non-parametric test,
was performed on the changes of the scores from the pretest
to the posttest to determine if there was a statistically
significant difference in these changes between two groups.

A Wilcoxon Matched-Pairs Signed-Ranks Test was then
computed to determine if there was a statistically signifi-
cant difference between the pretest scores and the posttest

scores of the experimental group.

Summary

Twenty subjects, averaging 83.9 years in age, were ran-
domly assigned to either an experimental group or a control
group. The Affect Balance Scale was individually administered
to each of them as a pretest prior to the beginning of music

therapy sessions. Nine subjects from the experimental group

43

attended one to seven weekly sessions. After the comple-
tion of the seventh session, the same scale was used as a
posttest to all the subjects except one who had dropped
from the study. Four more subjects from the experimental
group had to be eliminated from the statistical analysis
because of their infrequent attendance to the sessions. A
Mann Whitney U Test was computed to determine the difference
between two groups in their changes from the pretest scores
to the posttest scores. A Wilcoxon Matched-Pairs Signed:
Ranks Test was used to determine the difference between the
pretest scores and the posttest scores of the experimental

group.

CHAPTER IV

RESULTS

Findings

The present study attempted to determine the effect of
participation in weekly music therapy sessions on a person's
affective state. The Affect Balance Scale was used as pre—
test and posttest prior to and after seven music therapy ses-
sions. The raw data and demographic information for each
subjects of both groups are included in Appendices G through
I. Table 1 represents mean scores of ten raw items, positive
affects and negative affects, and the total score of the
Affect Balance Scale in a revised form. Figure 1 illustrates
changes from the pretest to the posttest in each group's mean
scores from Table 1. The direction of the arrow indicates
the change from the pretest to the posttest. It can be
observed that there were no changes on four occasions. All
positive affect scores except the item of "On top of the
world" range from 0.8 to 1.4, indicating that these affects
were experienced sometimes or more frequently by most of the
subjects. All negative affect scores range from 0.1 to 0.8,
indicating that these affects were felt less frequently than
sometimes. In the experimental group, the scores of "Pleased

about having accomplished something," "Proud because someone

44

45

Table 1

PRETEST AND POSTTEST MEAN SCORES
FROM THE AFFECT BALANCE SCALE

 

 

“4'0 '0

OH (I) m G) G.)
'U >‘ 'U )4 >0) U) U) >07
U) 3 '0 H 03 #0 H 'U (D H -l-J 4J0 HQ)
(0 :3 "-1 -l-J «40) JJ 0) H a) Q) (00) (OH
0) C: O U Q) (DH-l U) H C: C (0 UNH 4J0
r-1 3 H X CE 0'44 0) O (D O Q: (D‘H CU
Oa O Q. 0.) 04-) GNU H .0 'U H :3 CM 4J0)

Experimental Group

Pretest
Scores 1.4 1.0 1.4 1.2 0.8 5.8 0.2 0.8 0.4 0.6 0.6 2.6 13.2

Posttest
Scores 1.2 1.0 0.8 1.4 0.4 4.8 0.4 0.6 0.4 0.6 0.4 2.4 12.4

Control Group

Pretest
Scores 1.4 0.9 0.8 1.0 0.4 4.5 0.1 0.5 0.8 0.4 0.4 2.3 12.2

Posttest
Scores 1.3 1.1 1.1 0.9 0.9 5.3 0.4 0.6 0.5 0.4 0.2 2.1 13.2

 

'* For computation of the total score, see Appendix E.

46

Positive Affects Negative Affects

often ——9
Zn

._.__..,.
y

sometimes

 

NC

0

I

\l
————.————>

 

NC NC

0
I
N
h- --
+_—q

 

é—- never

 

pleased
own way
proud
excited
on top of
the world
restless
bored
depressed
lonely
upset

NC = no change
Pretest .___9. Posttest Pretest ....._). Posttest
Posttest <____.. Pretest Posttest 4--.. Pretest

Experimental Group Control Group

Figure 1
CHANGES OF RAW SCORES FROM PRETEST TO POSTTEST

47

complimented you on something you had done,"

and "On top of
the world" were lower in the posttest while the score of
"Particularly excited or interested in something" was slightly
higher. In the control group, scores of "Things were going
your way," "Proud because someone complimented you on some—

' and "On top of the world" were higher

thing you had done,‘
in the posttest while others of positive affects slightly
decreased. As to the negative affects, subjects in the ex—

perimental group had lower scores in "Bored, and "Upset

because someone criticized you" in the posttest. Subjects

in the control group scored lower in "Depressed, and "Up-
set because someone criticized you" in the posttest. Two
statistical tests were applied to determine if these changes

were significantly different.

Review of Hypotheses

 

1. The eight weekly music therapy sessions will result in
no statistically significant difference between the
experimental and control groups in their changes from
the pretest scores to the posttest scores as measured
by the Affect Balance Scale.

The reader should be reminded that seven instead of
eight music sessions were held due to the delay during the
initial procedure of the project. To test the first hypo-
thesis, the change from the pretest score to the posttest
score of each subject was determined (Table 2).

Because five subjects had to be eliminated from the

statistical analysis due to their poor attendance in music

48

Table 2

PRETEST-POSTTEST GAIN SCORES
FROM THE AFFECT BALANCE SCALE

 

 

Experimental Group Control Group
Pretest Posttest Pretest Posttest
Score Score Change Score Score Change
7 7 0 8 12 +4
17 16 -1 11 11 0
15 13 —2 12 16 +4
13 11 -2 12 13 +1
14 15 +1 6 13 +7
15 18 +3
18 16 -2
13 1O -3
14 14 0

13 9 -4

 

49

therapy sessions, there were five remaining subjects in

the experimental group while all ten subjects remained in

the control group. Therefore, a Mann Whitney U Test was

computed because of the uneven numbers of subjects in the
two groups. It determined whether the changes from the
pretest to the posttest scores were significantly different

between the two groups. The obtained U value of 11.5 did

not reach the criterion U value for a two-tailed test with

n1 = 5 and n2 = 10 at .05 level of confidence. Therefore,
the first null-hypothesis that there will be no significant
difference between changes from the pretest to the posttest
of the experimental and control groups was accepted.

2. There will be no statistically significant difference
between the pretest and posttest scores in the experi-
mental group as measured by the Affect Balance Scale.

A Wilcoxon Matched-Pairs Signed—Ranks Test was computed

to test this hypothesis. The computed 2 value of —1.21 did

not reach the criterion 2 value required for a two-tailed

test at .05 level of confidence. Therefore, the second null-
hypothesis that there will be no significant difference bet—

ween the two testing scores of the experimental group was

accepted.~

Interpretations
Since there was no significant difference between the
changes from the pretest scores to the posttest scores of

the experimental and control groups, it has been concluded-

50

that the experimental treatment of weekly music therapy
sessions had no effect on the person's perceived state of
affect. This conclusion has been further supported by the
fact that there was no significant difference between the

two scores of pretest and posttest in the experimental group.

CHAPTER V

SUMMARY AND CONCLUSIONS

Summary
With the growing population of elderly people, the

study of aging as a psycho-social phenomenon has become
increasingly important in today's society. Many researchers
have attempted to identify major factors which might contri-
bute to the psychological well—being of these people. Among
factors which surround an elderly person's life, much atten-
tion has been given to the relationship between a person's
engagement in activity and psychological well-being. Although
there are some contradictory study findings, many authors
and clinicians agree that being engaged in activities is
very important for elderly persons in order to be satisfied
with life. Since many old people become more limited in
activities because of physical, social, financial or other
reasons, it has been strongly recommended that maintaining
or increasing the level of activities as much as possible,
and finding some new meaningful activities can increase
the quality of life for these people.

Music has been recognized as a powerful medium in
stimulating elderly persons mentally, emotionally, and/or

physically. It is supposed to help people develop new

51

52

skills, particularly those for leisure time, as well as to
enhance enjoyment of activities. It has also been observed
that music can facilitate socialization and group activi—
ties. However, not very much research has been done to
examine the effectiveness of music therapy as a therapeutic
tool for elderly populations. The present study attempted
to determine how participation in music therapy sessions
would affect the perceived state of affect among resi-
dents of a retirement center.

Twenty subjects from a retirement center in East Lansing,
Michigan, were randomly assigned to either an experimental
or control group. Ten subjects of the experimental group
agreed to participate in seven weekly sessions. All twenty
subjects completed the Affect Balance Scale, developed by
Bradburn (1969), as pretest prior to the first music session.
Out of ten experimental subjects, only five participated in
more than four sessions. After seven sessions had been
completed, the Affect Balance Scale was again administered
to 19 subjects. However, four experimental subjects who
did not participate in sessions frequently, had to be
eliminated from the statistical analysis. One subject
completely dropped from the project.

A Mann Whitney U Test was used to determine the differ-
ence between the two groups in the changes from the pretest
scores to the posttest scores. The result indicated that

there was no significant difference between both these

53

groups. A Wilcoxon Matched-Pairs Signed-Ranks Test was
computed to examine the difference between the pretest
scores and the posttest scores of the experimental group.

No significant difference was found between the two scores.

Conclusions

 

From the results of this study, the following conclu—
sions were reached to the stated null-hypotheses.

1. The seven weekly music therapy sessions resulted in
no significant difference between the experimental
and the control groups in their changes from the pre—
test scores to the posttest scores.

2. There was no significant difference between the pre-
test and posttest scores in the experimental group.

Lack of significant results has lead to the following
conclusion: The participation in music therapy sessions
over seven weeks produced no significant effect on per-
ceived state of affect among the residents of a retire-

ment center under the conditions used in this study.

Discussion
There is a need to discuss several factors which might
have influenced the outcome of the present study. These are
the limitations which were related to subjects, the measure-
ment instrument, research design and the experience of the
researcher.
First, there were problems with subjects. Although

all of them were living in an independent unit of the

54

retirement center, many of them were limited in their mental,
as well as physical, capabilities. The average age of all
subjects was 83.9 years. Siegel and Davidson (1984) re-
ferred to a term of the frail aged as an age group 80 and
over. Most of the subjects from the present study would
fit this description, not only because of their age but also
of their frail appearance. Most of them could at least
carry on daily routines around the unit such as dressing,
going to the dining room and taking care of other personal
matters. It was apparent, however, that many of them had
considerable difficulty remembering something new and
adjusting to a new situation, as evidenced by problems in
the initial procedure as well as by having needed reminders
and escorts to the session every week. Some of them still
missed the session because they could not remember the
place or time in spite of reminders about 30 minutes be-
fore the session start. Three of the experimental subjects
who participated more than four times exhibited extremely
poor short-term memory.

Chronic disease was another hindrance in this project.
Subject No. 6 only attended the last two sessions because
of illness. Subject No. 9 was recovering from a major
surgery. Although he appeared to be physically and mentally
active, he had problems in the morning because of medi-
cation.

Next, scores of the Affect Balance Scale were obviously

55

influenced by the aforementioned problems of some subjects.
Observation during the pretest and particularly during the
posttest indicated that some subjects seemed not to have
fully understood the longer questions. Repetition or
rephrasing of the questions was sometimes necessary. Although
the researcher frequently repeated the sentence of "During
the past few weeks", some subjects talked about their ex—
periences from the past months or even years. The items of
"Pleased about having accomplished something?", "Proud be-
cause someone complimented you on something you had done?"
and "Upset because someone criticized you?" seemed to cause
some distant associations in the past. Problems in adminis-
tering the scale were also represented in the time spent

on the administration. While some could complete it within
a few minutes, three needed almost an entire hour to finish
it because of extreme distractability.

The Affect Balance Scale itself showed certain limi-
tations under the current experimental condition. The re—
vision itself seemed to be helpful in many occasions. Al—
though there were many spontaneous answers with "Yes" or
"No", having had the choice of "Sometimes" seemed to have
made decisions easier for many subjects when they were un-
sure of the answers. How utilization of the original scale
with dichotomous answers would have affected the results
remains beyond the scope of this study. Besides the prob-

lems with the longer questions mentioned above, the question

56

of "On top of the world?" seemed to be less reflective of
what this study was looking for. Many subjects reacted to
this item with confusion, a chuckling or a comment on it

as being silly. The result indicated that average scores
of this item (See Table 1) were lower than any of the other
scores in the positive affect scale. Beiser (1974) could
observe in his longitudinal study over five years that this
item confirmed the impression that it was a meaningless
idiom in his setting with three age groups including per-
sons over 65.

Another consideration with the scale is its applica-
bility to elderly populations. The item of "So restless
that you couldn't sit long in a chair?" seemed to be less
suitable for elderly persons because many of the subjects
indicated that they spend most of their time in their chairs
any way. Although the Affect Balance Scale has been suggested
to be applicable to older populations, studies previously
done indicate that there was a discrepancy between the
functioning levels of subjects in their studies and those
in the present study. Moriwaki's validity study (1974)
with two aged samples did not indicate the average age of
subjects. From the statement that the subjects were over
60 years and that one group was drawn from a normally
functioning community population, one can suspect.that at
least subjects of this group were younger and much higher

functioning than those in the present study. Gaitz and

57

Scott (1972) included an age group of subjects over 75
years in their study. However, all subjects were non—
institutionalized community residents. Graney (1975)
also studied with community residents who were in good
health at the beginning of the study.

A significant problem in the experimental design was
that the posttest could not be done immediately after the
last session because of the upcoming weekend. Since three
subjects from the experimental group had extremely poor
short-term memory, the relapse of three days between the
last session and the posttest was surely too long of a
period for them to sustain some effects if there were any
related to the sessions. Another consideration is that
seven weekly sessions were possibly not frequent and long
enough to cause significant effects on subjects' perceived
state of affect. It took at least a few weeks to get to
know each other since experimental subjects were not socia-
lizing very much outside the sessions.

Last, there were certain limitations which were in-
herent to this researcher. Coming from a different cultu-
ral background was certainly a handicap when working with
very old people in order to recognize subtle details in
ongoing sessions. Despite the eight-month volunteer work
in the music therapy programs at the same retirement center,
mostly in the health care unit, prior to the project, she

failed to estimate accurately the functioning level of many

58

residents from the independent unit. Certain criteria
for choosing subjects instead of assigning randomly from
the entire unit would have helped to reach a more signifi-

cant result.

Recommendations for Future Research

Selecting a suitable sample for a study is a difficult
task when working with geriatric populations. The age
ranges widely from approximately 60 to sometimes over 100
years. Observation over the entire project confirmed that
age alone does not necessarily correlate well with how
people function and how they feel about themselves as
suggested in the literature. It seems to be important to
set certain criteria before selecting subjects. When using
a self-report as a measurement tool as in this study, mental
alertness should be checked in terms of orientation with
time and reality. In this study, it was unclear how well
the subjects in the control group were functioning mentally
because of the limited interactions with them. Problems
with some experimental subjects became obvious as weeks
passed by. It is, therefore, strongly recommended to have
some information about the target population in regard to
mental capabilities. If there is no written information
available, a discussion with staff members at the institution
would be valuable. The researcher, however, should defi-

nitely indicate the need and reason for limiting the target

59

population.

A researcher should also be prepared for some un-
expected obstacles. For example, at least 45 minutes were
needed to remind all subjects and escort some of them to
the session room before each session. At the same time,

45 minutes were too long for others to remember the time
and place. It is recommended that one have help getting
people together before the session.

Limiting subjects to those who exhibit mental alert-
ness would increase the usability of the Affect Balance
Scale. Use of this scale also should be carefully examined.
A pilot study may be helpful in eliminating unsuitable per—
sons from the study. At the same time, future researchers
should look for revisions of this scale adapted for elderly
persons, or use another instrument which might be more power-
ful in detecting the perceived state of affect. Another
suggestion is to track each person's state of affect more
frequently during a research project since the administra-
tion of this scale takes just a few minutes when persons
are alert and able to read.

Practical session periods should be extended. Since
it takes at least three to four sessions until everyone
feels comfortable with other participants as well as the
leader of the group, at least ten sesSions are recommended.
Two sessions a week might be more desirable if such schedul-

ing is possible. The size of the group should be bigger

60

because of the fragility of this population. If the ses-
sions occur beyond ten weeks, it is likely some subjects
will drop from the study.

A helper would be valuable for organizational reasons,
as well as for offering more variety in activities which
require more detailed attention for each person such as
movements or playing instruments. It would also add more
stimulation to activities.

To have experience in working with elderly people seems
to be a must in order to conduct a research project with
them. It helps to know typical problems that these people
show, to know how to cope with them, and to develop a confi-
dence in dealing with them. It will also help elderly per-
sons develop trust in the researcher when the face is already
familiar to them before participating in a project.

Based on the study findings and observations over the
whole project, it is recommended that further research be
conducted to study the effects of music therapy on elderly
person's affective state with the following suggestions.

1. Narrow the population sample with some criteria

such as mental, sensory, or physical functioning

level.

2. When using the Affect Balance Scale, apply it more
frequently.

3. Look for an alternative instrument to measure a
person's perceived state of affect when there is
evidence of limited mental capability in the
study sample.

61

4. Study the relationships of quality and intensity
of activity to person's perceived state of affect.

5. Study the relationship of other variables such as
health, socioeconomic states, or living conditions
to quality and intensity of activity.

6. Use a larger sample size.

7. Use an aid or co-therapist.

8 Plan a longer period for the project.

9. Allow a warming up period for a few weeks until
everyone feels comfortable in the new setting.

10. Know the population as much as possible prior to
the study and have basik skills and strategies
in dealing with elderly people through volunteer
works, etc.
Studies which can increase understanding of the effects
of music therapy activities on old people's perception of
their affects will be valuable so that more effective treat-

ment programs can be developed in effort to improve these

people's quality of life.

APPENDICES

APPENDIX A

LIST OF CASSETTE TAPES USED IN SESSIONS

62

LIST OF CASSETTE TAPES USED IN SESSIONS

Singalong Songfest
Hal Leonard Publishing Corporation, Winona, MN, 1983.
Familiar Singalongs
Hal Leonard Publishing Corporation, Winona, MN, 1983.
Shenandoah
From an unpublished cassette tape with a recording
of a choir concert of the State Singers at Michigan
State University, November 1984.

Available from the school of music, Michigan State
University, East Lansing, MI.

APPENDIX B

LIST OF SONGS USED IN SESSIONS

63

LIST OF SONGS USED IN SESSIONS

Agay, D. (1975). Best loved songs of the American people.
Garden City, NY: Doubleday.

Shenandoah
Brown, F., & Ptack, D. (1984). Come join the Geri-Tones.

(Available from Geritones, 287 W. Laurel Ave., Lake
Forest, IL 60045).

 

America the beautiful

I've been working on the railroad

Let me call you sweetheart

My wild Irish rose

She'll be comin' round the mountain

Take me out to the ballgame

The good old summer time

When Irish eyes are smiling

While strolling through the park one day

Johnson, C. (Ed.). Happiness is a song. Burnsville, NC:
World Around Songs.

 

Make new friends
Shalom Chaverim

Miller, M. (1961). With Mitch. NY: Random House
Let the rest of the world go by
Personal arrangements
Hi there, hello there - adapted by this author from
"Twinkle"
Introduction song - adapted by A. Rose from "Clemen-

tine"

Tent and trail songs. (1979). Burnsville, NC: World Around
Songs.

 

Row your boat.

APPENDIX C

EXAMPLE OF A SONG SHEET

64

EXAMPLE OF A SONG SHEET

IN THE GOOD OLD SUMMER TIME

 

IN THE GOOD OLD SUMMER TIME. IN THE GOOD OLD SUMMER TIME.
STROLLING THRO' THE SHADY LANES WITH YOUR BABY MINE.
YOU HOLD HER HAND AND SHE HOLDS YOURS.

AND THAT'S A VERY GOOD SIGN.

THAT'S SHE'S YOUR TOOTSEY WOOTSEY

IN THE GOOD OLD SUMMER TIME.

TAKE ME OUT TO THE BALLGAME

 

TAKE ME OUT TO THE BALLGAME.

TAKE ME OUT TO THE CROWD.

BUY ME SOME PEANUTS AND CRACKER JACK.

I DON'T CARE IF I NEVER GET BACK.

SO IT'S ROOT TOOT TOOT FOR THE HOME TEAM.
IF THEY DON'T WIN IT'S A SHAME.

FOR IT'S ONE. TWO. THREE STRIKES YOU'RE OUT
AT THE OLD BALLGAME.

APPENDIX D

QUESTIONS AND SCORING SHEET
USED IN PRETEST AND POSTTEST

65

QUESTIONS AND SCORING SHEET
USED IN PRETEST AND POSTTEST

PLEASE CHOOSE ONE ANSWER FOR THE FOLLOWING QUESTIONS AND
MAKE AN X-MARK FOR EACH OF THEM.

DURING THE PAST FEW WEEKS DID YOU EVER FEEL:
DEPRESSED OR VERY UNHAPPY?
.__ OFTEN
__ SOMETIMES
.__ NEVER
SO RESTLESS THAT YOU COULDN'T SIT LONG IN A CHAIR?
__ OFTEN
__ SOMETIMES
__ NEVER
ON TOP OF THE WORLD?
__ OFTEN
__.SOMETIMES
.__NEVER
PROUD BECAUSE SOMEONE COMPLIMENTED YOU ON SOMETHING
YOU HAD DONE?
___OFTEN
__ SOMETIMES
__ NEVER

66

UPSET BECAUSE SOMEONE CRITICIZED YOU?
__ OFTEN
__ SOMETIMES
__ NEVER
PLEASED ABOUT HAVING ACCOMPLISHED SOMETHING?
__ OFTEN
__ SOMETIMES
__ NEVER
VERY LONELY OR REMOTE FROM OTHER PEOPLE?
.__ OFTEN
__ SOMETIMES
__ NEVER
BORED?
__ OFTEN
__ SOMETIMES
__ NEVER
THAT THINGS WERE GOING YOUR WAY?
__.OFTEN
__ SOMETIMES
__ NEVER
PARTICULARLY EXCITED OR INTERESTED IN SOMETHING?
__ OFTEN ’
__ SOMETIMES
__ NEVER

APPENDIX E

EXAMPLE OF SCORING

67

EXAMPLE OF SCORING
Questions Answers Scores given

During the past few weeks did
you ever feel:

Pleased about having
accomplished something? sometimes 1

that things were going
your way? often 2

proud because someone
complimented you on some-

thing you had done? often 2

particularly excited or

interested in something? sometimes 1

on top of the world? never 0
Sum of thegpositive affect scores 6

 

so restless that you

couldn't sit long in a

chair? never 0
bored? sometimes 1

depressed or very
unhappy? often 2

very lonely or remote
from other people? never 0

upset because someone
criticized you? never 0

Sum of the negative affect scores 3

Computation of the total score of the Affect Balance Scale
in a revised form

sum of positive affect scores - sum of negative affect
scores + a constant of 10 = affect balance score

Scoring of the example above
6 - 3 + 10 = 13 affect balance score = 13

APPENDIX F

EXAMPLE OF A SESSION

68

EXAMPLE OF A SESSION

Singing

"Hi there, hello there"

"Introduction song"

"The good old summer time"
Exercise in chair to music

"Red River Valley"
Playing instrument (tone bars)

"Row your boat"

"Make new friends"

"She'll be comin' round the mountain"
Singing

"Farewell, good friends" (Shalom Chaverim)

APPENDIX G

RAW DATA AND DEMOGRAPHIC INFORMATION
EXPERIMENTAL GROUP

69

RAW DATA AND DEMOGRAPHIC INFORMATION

NF

mP
FF

NP
FF

FF
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wr

m—
vr

PF
mr

me
mr

@—
hr

5
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EXPERIMENTAL GROUP

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$9398 Hmowumflmum may 8km 8090.6 9.83 or nmooufi m DUMB—.5 a.

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ONO‘Q) mmmmmm 03051.0 NM 00““

m

gzr'OIV—CV r-Olt—(V F'hlt-CV F'OOt—‘V r-oai—‘V
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N

F

N

P

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P

N

N

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N

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N

N

N

F

r

P

m

P

mm

mm

Fm

mm

mm

mm

Pb

Fm

mm

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N

F

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N

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APPENDIX H

RAW DATA AND DEMOGRAPHIC INFORMATION
CONTROL GROUP

- score total

Dif Adm Vis Hear Amb Mar Test + score

Sex Age

jects's No.

S

83

11

12

11

82

12

RAW DATA

11
12
16
12
13

N 1'—
m r-
I— v-
N ‘—

m N
I\ In
ox C!)
N N
m V
v- v-

70

AND DEMOGRAPHIC INFORMATION
CONTROL GROUP

1— ‘— !— N ‘— N
‘— r- t— N N s—
N \— s— N v- \—
N t— \— N 1— 1—

91
65
82
92
96
83

15
16
17
18
19
20

APPENDIX I

RAW SCORES OF THE AFFECT BALANCE SCALE

71

RAW SCORES OF THE AFFECT BALANCE SCALE

Test

Subject No.

Experimental Group

 

35

00

12

01

22

00

01

00

00

01

10

00

00

01

21..

12

22

21

22

00

10

00

00

21

21

00

21

11

11

21

22

21

00

00

10

00

22

10

12

11

Control Group

 

24

00

01

O1.

02

01

01

11

01

12

01

00

25

00

11

01.

12

12

+4

12
16
12
13

00

00

01

00

02

01

22

21:

13

+1

00

11

01

00

O1

11

01

01!

21

14

84

241

20

21-

11

15

10

10

00

00

22

22

11

22

16

00

00

00

00

86

11

12

21

21.:

17

01

20

10

00

61

110

20

20

11

18

10

11

01

11

21

11

1.2

22

19

.01

00
00
00
00

O1

20

00

00

10

20

REFERENCES

72

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Beiser, M. (1974). Components and correlates of mental
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Berghorn, F. J., Schafer, D., Steere, G., & Wiseman, R.
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Bright, R. (1972). Music in geriatric care. NY: St.
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