Choir Singing for People With Dementia and Their Care Partners: Exploring the Role of Bonding Social Capital

Abstract

In this paper, we present the findings from a study of Voices in Motion, an intergenerational community choir program involving persons living with dementia, care partners, and high school students in Victoria, British Columbia, Canada. Using the concept of social capital, we examine the role Voices in Motion plays in generating trustworthy social relationships, reducing feelings of social isolation, and improving subjective well-being among choir members. Data came from interviews with 23 dyads, each consisting of a person living with dementia and their care partner; additionally, five focus groups with 29 high school students across two Voices in Motion choirs were conducted. Choir rehearsals and concerts were also observed. The study sought to identify factors in Voices in Motion that facilitate the emergence of supportive social relationships among choir members, the way members characterize the nature of these relationships, and the benefits they see in the context of everyday life. The analysis revealed that the two choirs in the Voices in Motion program served as a source of bonding social capital for persons living with dementia, care partners, and students. Care partners and persons living with dementia spoke of a sense of togetherness that united choir members as they shared a similar journey with dementia, along with a profound joy in singing and pride at performing at well-attended concerts and advocacy events. Care partners in particular saw Voices in Motion as a source of emotional support in the context of increasing caregiving burden, while students reported gaining a deeper understanding of the everyday experiences of dementia through their involvement in Voices in Motion.

Keywords

intergenerational choirs singing dementia relationships bonding social capital

Introduction

An estimated 771,939 Canadians currently live with dementia and by 2050, this number is expected to increase to more than 1.7 million (Alzheimer Society of Canada, 2024). The syndrome of dementia consists of a group of progressive symptoms which interfere with memory and cognitive function and negatively impact performance in daily life (Wetzels et al., 2010). The syndrome originates from a number of diseases, either singly or in combination with Alzheimer’s disease which is the most common form of dementia. The physical, psychological, social, and economic impact of dementia on care partners is significant and often overwhelming as symptoms progress. In the later stages of dementia, the need for supervision and assistance increases and admission into long-term care is often required to meet the complex needs of persons living with dementia (Schulz et al., 2004). Dementia is also socially stigmatized with diagnosed individuals encountering social rejection from others which increases the risk of social isolation (Behuniak, 2011). Social isolation is strongly associated with elevated stress hormones and inflammation which impact health and well-being along with an elevated risk for anxiety and depression (Cacioppo & Cacioppo, 2014).

Existing pharmaceutical interventions offer limited and temporary benefits and, while research is ongoing, there are few if any promising advances in the development of medications to treat dementia (Zhang et al., 2024). However, community-based interventions such as aerobic exercise, arts-based activities, and programs facilitating social engagement offer promise in mitigating the impact of dementia symptoms, improving quality of life for both persons living with dementia and their care partners, and delaying entry into long-term care (Sampath et al., 2015). The use of music as an intervention is also garnering increased interest as a result of encouraging research results (Bannan & Montgomery-Smith, 2008; Camic et al., 2011; Unadkat et al., 2016). Studies have shown that those with moderate dementia symptoms can engage in musical activities as they retain abilities like perceiving pitch and melody (Vanstone & Cuddy, 2010) and continue to recognize familiar songs (Johnson et al., 2011) and lyrics (Prickett & Moore, 1991). Music therapy where persons living with dementia listen to music in a quiet place has a small-to-moderate effect in decreasing agitation, disruptive behavior, and anxiety (Tsoi et al., 2018) although several meta-analyses report that music therapy has limited to non-existent benefit in reducing dementia symptoms and incapacity (Chang et al., 2015; Pedersen et al., 2017; Ueda et al., 2013; Zhang et al., 2017).

With older adults, singing in a group or fully-fledged choir is known to improve self-esteem (Johnson et al., 2013), enhance mood, reduce stress, and foster social interactions (Dingle et al., 2012; Harris & Caporella, 2014). Research indicates that persons living with dementia benefit from this activity in similar ways. Bannan & Montgomery-Smith (2008) found that following participation in three weekly group singing sessions, persons with Alzheimer’s disease could learn and perform a repertoire of songs; additionally, singing helped improve communication with their care partners which enhanced their relationships. Camic et al. (2011) report that choir participation for persons living with dementia helped maintain a stable quality of life despite deterioration in their condition. An intergenerational choir for people with Alzheimer’s disease and college students lessened stigma and decreased social isolation for both people with Alzheimer’s disease and their family care partners (Harris & Caporella, 2014). Social involvement in a choir has also been found to improve cognitive functioning and depressive symptoms (Dingle et al., 2012; Kivipelto et al., 2013; McDowell et al., 2022; Osman et al., 2016). In a randomized controlled trial using two interventions, singing or listening to familiar songs, Särkämö et al. (2014) found that both interventions produced important improvements in mood, episodic memory, and orientation while the singing group also experienced improvement in physical signs of depression. In studying the effects of choir-singing in persons living with dementia, Dawudi et al. (2024) noted increases in emotional well-being, reductions in cortisol levels in saliva as an indicator of lower stress, and improved emotional and communication behavior. In a recent systematic review of the literature, Thompson et al. (2021) analyzed quantitative, qualitative and mixed-methods studies using a systematic mixed-studies synthesis and found that individuals involved in group singing experienced joy, positivity, and personal well-being and concluded that meaningful social engagement through singing helps support people living with dementia through the various stages of dementia. Several qualitative studies have also reported benefits for choir participation or group singing for persons living with dementia, including increased confidence, enjoyment, consistency and a sense of empowerment (Mabire et al., 2023), along with personal and social benefits such as social connections and a deep sense of belonging (Thompson et al., 2023). Further documented benefits include feelings of happiness and joy, social inclusiveness and developing a sense belonging, along with improvements in the care partner and cared-for relationship (Lee et al., 2022; Osman et al., 2016).

Overall, the literature indicates that singing can serve as an effective non-pharmacological intervention for those living with dementia, with potential to enhance cognitive functioning and emotional well-being, bring enjoyment and happiness, and strengthen relationship with care partners. There is, however, insufficient information on the social dynamics of choir participation and, more specifically, how persons living with dementia and their care partners develop social connections and a sense of belonging in the choir. More information is needed on the nature of social engagement in dementia choirs and the factors that facilitate communication among choir participants, particularly in the context of intergenerational choirs. This study addressed this gap in knowledge by investigating Voices in Motion, an intergenerational community choir program for persons living with dementia, their care partners, and high school students in Victoria, British Columbia, Canada. The intent is to examine social engagement as an aspect of choir membership, consider the nature and extent of social relationships in an intergenerational context, and the factors that facilitate their emergence in the Voices in Motion program.

Theoretical Framework

The framework of social capital serves as the theoretical framing for this study. Social capital may be defined as resources that people access as a result of their membership in a supportive social network or a trusted group of individuals who share similar norms and values (Kawachi & Berkman, 2014). The framework emphasizes the value and benefits of reciprocal and trustworthy social relationships among individuals, i.e., where people have confidence in each other and believe that others will do what is perceived to be right (Coleman, 1988; Paxton, 1999). Putnam (2000) divides social capital into three types: bonding, bridging, and linking. Bonding social capital is “found among densely connected groups with strong, affective ties connecting group members to each other, and is important in providing social support and increasing in-group solidarity” (Agnitsch et al., 2006, p. 39). In contrast, bridging social capital comes from social relationships among individuals who belong to heterogeneous groups, while linking social capital occurs between people of unequal wealth, power, and status.

This study considers the nature of social relationships among Voices in Motion choir members, including persons in the early to moderate stage of dementia, and whether such relationships progress to the extent to which they constitute a form of bonding social capital. Findings from research on choirs for individuals without dementia lends support to this idea although there is no evidence that this process occurs in choirs for persons living with dementia and their care partners. In particular, Pearce et al. (2015) found that singing more quickly led to the development of bonding social capital when compared to other artistic activities. Lamont et al. (2018) report that the desire to access social relationships in a supportive community was the most important reason for why older adults join a community choir. Several studies have found that singing in a choir results in improved social support and psychological well-being, and reduced feelings of isolation and loneliness (Clift & Morrison, 2011; Pérez-Aldeguer & Leganés, 2014; Stewart & Lonsdale, 2016; Teater & Baldwin, 2012). These findings provide indirect evidence of choirs being a catalyst for the development of bonding social capital. This study has important implications given that bonding social capital has protective effects against social isolation and cognitive decline (Kuiper et al., 2015).

Methods

Study Design

This qualitative study investigated how the Voices in Motion program engages persons living with dementia, their care partners, and high school students in two separate community-based choirs. Funded by the Alzheimer Society of Canada and the Pacific Alzheimer Research Foundation, the study spanned a period of 18 months and used qualitative methods to examine the nature, evolution, and characteristics of social relationships in Voices in Motion, how choir participants experienced them, and the impact these had on their daily life. Four questions guide the study: (1) How do social relationships develop among Voices in Motion participants? (2) What are the characteristics of the social relationships in Voices in Motion? (3) Are social relationships in Voices in Motion intergenerational in nature? And (4) Do social relationships in Voices in Motion lead to the emergence of bonding social capital?

Sample

The sample consisted of 23 dyads of persons living with dementia and care partners across two choirs, (Voices in Motion 1 & Voices in Motion 2). The mean age for those with dementia was 80 years with a range of 69 to 98 years while the mean age for care partners was 68 years with a range of 49 to 89 years. There were 12 female and 11 males with dementia and 19 female and 4 male care partners. The care partners’ relationship included: 13 spouses, 7 daughters/sons, 2 friends, and 1 sister. Among those with dementia, 88% were diagnosed with Alzheimer’s disease (n = 20), with Vascular (n = 2), and Lewy Body dementia (n = 1) accounting for the remaining subtypes of dementia in the sample. Twenty-nine high school students from grades 8 through 12 were also part of the study. They consisted of 21 female students and 8 male students from two local high schools. Students were asked to only commit to one choir season, but most participated in two seasons. Participation rates and numbers changed slightly over time as students in grade 12 graduated while others became increasingly busy with academic requirements.

Structure of the Choirs and Repertoires

Participants in the study attended up to three 3.5-month choir seasons involving weekly rehearsals, with each season ending with a concert performance at a local church. There were three choir seasons for the first choir (Voices in Motion 1) and two seasons for the second choir (Voices in Motion 2) which started later than Voices in Motion 1. As a number of persons living with dementia and care partners joined throughout the intervention, some dyads participated in three seasons, while others joined for only the second and third season. More specifically, five Voices in Motion 1 dyads in the study participated in all three choir seasons while 9 dyads took part either in one or two seasons only. With Voices in Motion 2, 6 dyads participated in two seasons and 3 dyads participated in one season only. Dyads who participated in fewer seasons did so either because they joined the choir at a later date or withdrew due to worsening symptoms of the relative or friend living with dementia.

Weekly rehearsals were held at two local community churches and a professional choir director (Bachelor of Music, Diploma in Education, Master of Music) with 30 years of experience conducted the choirs while a professional pianist accompanied both choirs in rehearsals and at the concerts. The director made the songs available to choristers either in binders with lyrics only or full score (music notes with lyrics) to accommodate the varying abilities of choristers in reading music. The choirs sung in 3-part harmony (soprano, alto, and baritone) and most songs had verses and a chorus. The director also provided choristers with compact discs of the songs for them to practice at home. She created repertoires for each season with an uplifting theme (e.g., “Songs of Love and Friendship; ” “Living in Technicolor,” “People Who Need People”). Each repertoire featured a mix of recent songs and older songs choristers likely knew from their childhood, teenage or young adult years. For example, one Christmas concert themed “Living in Technicolor” included songs such as: “What a Wonderful World,” “La Vie en Rose,” “Colour My World,” and “Yellow Submarine,” along with traditional Christmas carols. Each concert included a Master of Ceremonies who introduced the songs and medleys with anecdotes and stories.

Data Collection

Data came from in-depth interviews with choristers living with dementia and their care partners, focus groups with students, and observation of three choir seasons for the first choir (Voices in Motion 1) and two seasons for the second choir (Voices in Motion 2). Two trained research assistants conducted interviews with choristers living with dementia and care partners dyads for both choirs. The research assistants also conducted focus groups with 29 high school students across the two Voices in Motion choirs at the end of each choir season to learn about their experiences of interacting with care partners and their relatives or friends living with dementia. They used interview guides to ensure consistency in how participants were prompted with regard to their experiences of participating in the Voices in Motion choirs. All interviews and focus groups were recorded with permission from the participants and a professional transcriber transcribed the recordings verbatim. Finally, the research assistants observed the rehearsals and concert performances in the first season of the Voices in Motion 1 and Voices in Motion 2 choirs and documented their observations with field notes. They focused on how participants interacted with each other and the ways in which socialization was facilitated through ice-breaking exercises.

Data Analysis

The interviews and focus groups recordings were transcribed verbatim and inputted into NVivo 12 (Lumivero, 2025) for data management and analysis. The research assistants followed the procedures of thematic analysis outlined by Braun & Clarke (2006). This involved reading the transcripts multiple times to familiarize themselves with their content and assigning descriptive codes to segments of text that reflected meaningful and salient aspects of the participants’ experiences with Voices in Motion. Coded segments were grouped into categories on the basis of their shared meaning. The research assistants compared codes and categories throughout the analysis until the data yielded no additional information pertaining to the properties of the identified categories. Occasional disagreements over codes and/or categories were resolved with further discussion and involvement of the investigator overseeing the study (first author). This analytical process also involved memo writing, reflecting on the data, codes and categories, and making comparisons between them to gain a full understanding of the data and the relationships between categories which were then synthesized into themes that reflected the nature of the participants’ experiences in Voices in Motion. The research assistants also analyzed observational field notes using a similar set of procedures with the aim of identifying important moments pertaining to the nature and level of interactions in both choirs. While this analytical process was inductive and emergent, we used the concept of bonding social capital to guide the final interpretation of the data and in reviewing themes for their conciseness and relevance. We relied on the following strategies to enhance the trustworthiness of the findings: ensuring coherence between research questions, methodological approach and interpretations, and maintaining a log of methodological and analytic decision making (Thorne, 2000).

The analysis revealed four themes capturing the evolution of social relationships among participants in the two Voices in Motion choirs and the factors that facilitated this process which led to the development of bonding social capital among choir members. In the results section, all quotes from participants living with dementia and their care partners are identified by pseudonyms and a number to maintain anonymity while students who participated in the focus groups are identified by the choir and season in which they participated.

Ethical Considerations

The Voices in Motion study was approved by the Human Research Ethics Review Board at the University of Victoria (#20-0329, 8 December 2017). All participants provided written assent at the outset of data collection, which was confirmed on an ongoing basis. Participants were provided sufficient opportunities for questions regarding their participation before consenting. Written informed consent for publication was provided by all participants.

Results

Initiating and Nurturing Social Relationships in Voices in Motion

The Voices in Motion’s choir director took an active role in creating an environment that fostered social relationships among the choristers. She enthusiastically welcomed choristers and made them feel appreciated and valued during the rehearsals. In describing her, the choristers used terms such as “wonderful,” “patient,” “a great teacher,” “approachable,” “friendly,” “warm,” “encouraging,” “animated,” “enthusiastic,” and “delightful.” As one care partner remarked, the director brought together “… a bunch of elderly people with dementia and a bunch of young people to sing together…it sounds like a crazy idea that somebody had. And so, it’s amazing that we did anything!” (Liam 11). Choristers with dementia felt inspired by her: “She makes you want to sing because it’s in her.” (Olivia 01) and “You look forward to going because she is such a… she’s a very positive person.” (Kristin 08). The director’s husband, who also sang in the choir, likewise warmly greeted choristers and readily chatted with them during rehearsals. One wife of a chorister living with dementia recalled how, “He’s a good support… when Fred (her husband) arrives, it’s a big hello and he sits next to Fred, you know… ‘I’ll get your coffee’… and the second Wednesday Fred was so overwhelmed by the joyful experience that he had tears on the way home.” (Lena 06).

The director introduced several exercises designed to help choristers to get to know each other on a more personal basis. At the beginning of the choir season, she ran a “getting to know you” activity during rehearsal breaks, where dyads of choristers living with dementia and care partners and dyads of students shared information about themselves. Later on, she introduced conversation groups and encouraged participants to chat about current events, a process students found helpful in relating to the choristers living with dementia and their care partners. As the choir season progressed, choristers started to interact in a joyful and spontaneous manner at the start of rehearsals and during breaks and many stayed behind to chat with each other. In both choirs, care partners also spoke of a bond that emerged among them as they learned more about each other and their specific caregiving circumstances. As one care partner put it, “there’s a lot of personalities there and love…lots of lovely people and a lot of warmth. Yeah, it does feel very at home.” (Kate 08). To which her friend living with dementia chimed in, “I love it. I just love it.” (Kristin 08). Several choristers living with dementia underlined the benefit of Voices in Motion as a venue for socializing as suggested by this comment: “I would have a hard time saying which is more important. They’re both kind of equally important to me – the social and the singing.” (Helen 09).

The choristers also appreciated strategies used to manage forgetfulness. One example is the customized name buttons that everyone wore to assist with memory loss and help the choristers living with dementia feel more comfortable and connected during the rehearsals. One care partner commented: “I like the fact that they have name tags every week and people really make an effort to address you by name and get to know you and it’s not just about the choir and about the singing. It’s about the personal side as well.” (Emily 01). One chorister living with dementia said that being able to banter with others without worrying about his faltering memory and forgetting names gave him “a little lift.” (Alan 18).

In the focus groups, high school students discussed at length the interactions they had with the choristers living with dementia and their care partners and how, over time, these became casual and comfortable:

They made us all call each other by our first name…So, we didn’t have to call them Mr. and Mrs. and then their last name and that helped a lot and it made things so much easier cause then the people with Alzheimer’s wouldn’t have to be concerned with remembering last names and we wouldn’t be so formal when talking to them. It became way more personal, and I appreciated it. Even with the choir director, we had to call her by her first name as well and that made it a lot more comfortable around her. (Voices in Motion 1_Spring 2018)

The director’s approachability and friendliness along with the ice-breaking exercises thus played a key role in fostering interactions among choristers and instilled in them a sense that they belonged to a caring community. Particularly important was the deep connection the choristers living with dementia developed with Voices in Motion and their appreciation of being accepted by others without having to worry about memory loss or confusion.

“We Are all on the Same Path:” Singing and Sharing the Dementia Journey

Choristers talked about a sense of togetherness that emerged in Voices in Motion which they felt was rooted in a shared joy of singing and the common purpose of performing well in concerts. As one chorister living with dementia remarked, “We are all on the same path” (Alan 18) while another said, “If you’re in a group and you’re liking the same things like music and songs, you enjoy it and you’ve got like that feeling that we’re working together and that really makes it important because we’re trying to really do our best. (Olivia 01). This chorister added, “I feel very welcome you know, and I think if the people are there, and they want to be in a choir that they’re outgoing…they’re easy to talk to. And we’re all enjoying the same thing and…we’re working together.” One care partner similarly singled out music as a catalyst uniting the choristers: “It’s great that our group has very specific needs, to come together in a very fun way. Just put us all in a room, with nothing specific to do, it might be a little more strained or challenging because we don’t really have anything in common, but music has brought us together” (Kate 08).

Several care partners talked of the benefit of belonging to a group of peers with first-hand experience of dementia, as suggested by this comment: “The big thing with the choir is realizing that you’re not alone…. Because other people are in the same situation, almost identical and we’re able to swap stories and do silly things as if nothing’s happened. It’s great. It’s really good.” (Hugh 07). One care partner talked of a sense of trust and mutual understanding that developed among choir members, “This is a place where people with dementia and their caregivers can meet each other, talk about what’s going on… They see themselves reflected in other people. There’s a sense of understanding going on and when you add in the students it just brings a whole different energy and that it’s fun.” (Miriam 04). Another pointed to how sharing the same journey with dementia united care partners, “It’s kind of nice to socialize with people and we’re all kind of on the same journey…everyone accepts everyone for the way they are.” (Judi 18). One more care partner echoed this point: “Just knowing that other people have similar experiences. I get a lot of support from others, from the other partners and supporters. And it’s not as though we delve into details of each other’s experiences, but it’s just a sense of community, that yeah, you’re not on your own. (Sally 09). This comment from a person living with dementia also points to this sense of a shared journey: “We have a chance to talk to other people who are the same as us basically. But when you’ve got the whole group there it makes it a lot easier to handle and you feel like okay I’m here because I want to be here.” (Diana 07). One husband talked of the mutual understanding care partners had over living with someone with dementia and gave an example of one care partner who shared concerns over her husband’s memory loss, “I could sense because I was dealing with it, she knew that I would understand what she was dealing with.” (Hugh 07).

Care partners appreciated that no one in Voices in Motion seemed bothered by the foibles of dementia as illustrated by this comment: “This choir is fantastic really. You get that feeling that we’re not all worrying because of Alzheimer’s. We’re there because we’re having fun. We’re enjoying things and meeting other people.” (Hugh 07). One chorister living with dementia appreciated not worrying about people reacting to his diagnosis unlike in other circumstances: “When people hear that you’re living with Alzheimer’s, they sort of say, ‘This guy’s a little different.’ And you’ve got to get over that…” (Alan 18). One care partner underlined the way people supported the choristers living with dementia without judging, “We all help each other out turning pages, finding the music. And nobody is embarrassed about it. Everybody just does it.” (Judi 18). Another chorister noted that being with other people with memory loss like herself was kind of reassuring: “If my brain decided to take a holiday, I wasn’t going to be the only one with it doing that.” (Helen 09).

Voices in Motion as an Antidote to Loneliness and Isolation

Care partners spoke of how Voices in Motion played a crucial role in reducing the social isolation they had been experiencing as a result of their spouse’s reluctance to attend social gatherings due to memory loss.

One care partner explained her situation: “What happens is with your friends you don’t kind of fit in with other couples… And sometimes family don’t know how to deal with it also. So, it’s a bit isolating.” (Lena 06). She added, “We were feeling left out of everything and so this gave us an opportunity to do something we haven’t done in a long time. And from a social standpoint it was good for both of us.” She felt that the choir helped them reconnect socially: “The more that we can do from a social standpoint and challenge ourselves I think that’s what’s good.” Even care partners who had maintained strong social connections still appreciated connecting with people with similar experiences: “We’re blessed with some lovely friends, and we have a pretty good social life. I’m not always on the lookout to increase my social circle but having said that, these are folks who are going through similar challenges so it would be important to reach out.” (Sally 09). One care partner bemoaned the lack of time allocated to socializing and pointed to the importance of Voices in Motion as a social hub: “It would be nice if we had a little bit more time to do the social and the sharing of information.” (Colin 02).

The choristers living with dementia similarly valued Voices in Motion as a place to socialize as reflected in this comment: “I don’t see a lot of people because I don’t work and I don’t go anywhere, so I like that.” (Patrick 06). Another chorister described the choir as a “…good support group for all aspects. It’s a nice activity that’s engaging. It’s a good program for engagement.” (Anthony 21). One more chorister emphasized how “Music brings people together. Even if you can’t sing too well, they’re enjoying it, they’re humming with the music.” (Olivia 01). A daughter expressed gratitude for how other choristers engaged with her mother, “The people are nice to her. It’s not patronizing.” (Emma 23). One husband similarly commented, “So, we always make an effort to talk to them, draw them into some kind of conversation.” (Hugh 07). The choristers living with dementia pointed to the concerts being beneficial to their relationship with family and friends as illustrated by this comment: “It was good for my grandchildren to see me doing something else.” (Alan 18). One student similarly underlined the importance of family members attending the Voices in Motion concerts: “A lot of their families came and that really like gave them a boost and they were really putting in the effort to do this because they were looking forward to the concert where they could perform in front of their family to prove that they could really do something.” (Voices in Motion 1_Fall 2018).

Another key aspect of Voices in Motion is the way choristers connected with concert audiences. One care partner reflected: “I find it very moving to… connect spiritually with a group of people around me. It’s very special. And you could tell by the audience reaction because there was a pause before they applauded, you know.” (Miriam 04). She continued to speak about this powerful way of relating to the audience: “When you finish a song and the audience is quiet, and you just feel that you’ve gotten through to them. And that’s usually in the more profound songs. You can just feel when they get it.” Another care partner similarly said: “I feel the love. I do honestly. You finish a song, and I feel the love. I feel like there’s a really good feeling at the concert that the audience really appreciates the music.” (Kate 08).

Voices in Motion as an Intergenerational Community

In the focus groups, students described being in Voices in Motion as an experience that helped them understand and communicate with persons living with dementia. One student remarked, “It’s just having fun and having a good conversation with them brought joy to me, and I think it brought joy to them as well.” (Voices in Motion 1_Fall 2018). Another student highlighted the mutual benefits of having students and persons living with dementia talking with each other in a choir:

It’s an experience where you can interact with people with Alzheimer’s and it’s in a relaxed and casual manner because you share the experience of making music together and people with Alzheimer’s don’t always get a lot of time to interact with people socially, especially young people. So, it means a lot to them as much as it means to us to have that experience and to be exposed to that.” (Voices in Motion 1_Spring 2018)

Along the same lines, other students said relating to the older adults in Voices in Motion was like interacting with grandparents. Some were international students from the Philippines who lived away from family. As one student put it:

It means a lot to a lot of people who aren’t exactly that close with their grandparents or don’t get to see them often, because for a lot of foreign students, our grandparents don’t live here and so we never see them. And so, being in a community choir with a bunch of I’d say elderly people who are really sweet and nice… the relationship between them became kind of like having them as our grandparents… Like having a ton of grandparents. (Voices in Motion 1_Spring 2018)

Students also reflected on how relationships among choir members strengthened over time. As one student noted, “It’s a choir but it’s so much more than a choir at the same time. It’s almost a family of just people, like people of all ages, and you can just chat with whoever you want to.” (Voices in Motion 2_Spring 2019). Another likewise commented that Voices in Motion was about much more than singing, “It isn’t just a choir. It wasn’t created for this like specific purpose of making phenomenal music…it was meant to bring people together and teach people about one another.” (Voices in Motion 1_Spring 2018). Several students also discussed various ways in which Voices in Motion made people feel they belonged to a unique community as astutely articulated by this participant:

I think everyone deserves to be part of a community and when you’re excluded from things like that, it can be really hard to keep going. If you’re going through something like that, I think if you’re part of a community, that can really lift your spirits and make things a bit better. (Voices in Motion 2_Fall 2018)

Care partners and their relatives or friends enjoyed having high school students in Voices in Motion. One chorister living with dementia noted, “I am enjoying the kids. I think it’s a beautiful addition and I think it’s really good for them as well… That’s my highlight.” (Kristin 08). One care partner characterized including young people in Voices in Motion as “a brilliant idea.” (Maggie 15) while another stated, “It wouldn’t have worked without the kids.” (Colin 02). Moreover, care partners appreciated the students’ youthful enthusiasm and strong voices: “It’s just impressive that kids that age are even interested in doing something like that. Never mind being enthusiastic about it and gentle with everybody and they’re just lovely kids.” (Minnie 22). One care partner even guiltily admitted, “I just relish that time with them even more than I do with the other caregivers” (Lena 06).

Discussion

The study examined the process by which two Voices in Motion choirs served as a source of bonding social capital for a very diverse group—persons living with dementia, care partners, and high school students. The focus was on the social dimensions of choral singing and the perceived benefits of this activity from the perspective of participants. Choir participation for individuals without dementia is associated with enhanced social support, the development of positive relationships, and a lowering of feelings of loneliness and social isolation (Bailey & Davidson, 2005; Lamont et al., 2018). It is not known if such benefits occur to the same extent in a choir involving persons living with dementia and their care partners. This study sought to address this question using the concept of bonding social capital as its theoretical framework.

Voices in Motion as a Source of Bonding Social Capital

Analysis of the interviews with choir members and observations of the choir rehearsals and concerts suggests that bonding social capital emerged with both choirs by the end of their respective first seasons. As Kawachi et al. (2004) note, bonding social capital is rooted in social relationships among people who share similar backgrounds and sense of identity. Both care partners and choristers living with dementia spoke of a sense of togetherness that united choir members, in part because they shared a similar journey with dementia, and a profound joy in singing. The choir director played an integral role in this process by introducing socializing exercises during the rehearsals and putting together repertoires that resonated with the choristers— songs from the 1950s and 60s that older choristers had enjoyed as younger individuals while more recent songs appealed to students. Choristers were united not only by a shared awareness of the stigmatized nature of dementia, but by the pride they took at performing at well-attended concerts and advocacy events. These concerts were joyful events although many care partners noted that they also challenged the nihilistic notion of people living with dementia as too incapacitated to perform.

A concerted effort to involve the choristers living with dementia equally in all choir activities and performances further contributed to the emergence of bonding social capital. Two factors facilitated this process. First, the choristers seemed to retain an embodied ability to learn lyrics and perform songs despite being forgetful and having moments of confusion. This is likely because, as Jacobsen et al. (2015) note, resilient areas of the brain that are involved in musical memories are less affected by neurodegeneration and remain relatively intact throughout the progression of dementia. Thus, as a type of embodied self-expression, choir singing may serve as a unique opportunity for mutual engagement with others that exists separately from cognition and which manifests itself corporeally as a pre-reflective form of agency (Smith et al., 2022). The second factor was pairing choristers and students who provided assistance whenever needed to support participation. This involved, for example, helping them find the right page in their music book or assisting with negotiating stairs on and off the stage. In both Voices in Motion choirs, we observed students readily providing this kind of assistance. One beneficial consequence was that students started to engage in conversations with the choristers and learned to appreciate them as unique individuals thus challenging any preconceived notions they might have had about persons living with dementia.

Reciprocity, Trust, and a Sense of Togetherness

As a crucial aspect of bonding social capital, reciprocity is a type of social duty characterized by mutual support and trust that fosters cohesion in social networks (Putnam, 2000). With reciprocity, group members tend to respond to each other’s social cues and behaviors in a give-and-take manner resulting in deeper social ties as well as long-term cooperation (Coleman, 1988). Social ties within the Voices in Motion choirs grew stronger over time, while reciprocity was evident from the start of the program. Care partners talked of feeling comfortable right away in the choirs and described having conversations that were personal and involved sharing about important moments in their lives and family stories. Several care partners also felt Voices in Motion had become an important source of emotional support as they bonded over respective caregiving burden. In rehearsal breaks, we observed care partners talking with students on topics of personal interest and retelling activities they had engaged in during the week. Several choristers living with dementia spoke of their relief at being in a group where they did not have to worry about memory lapses or bouts of confusion. While not necessarily fully participating in conversations, they nonetheless appreciated being included and enjoyed taking part in the ice-breaking activities. Over time, students felt more comfortable taking the initiative to chat with them during rehearsals and at breaks.

Care partners and persons living with dementia expressed relief that dementia and memory loss were not a source of concern in Voices in Motion. Without this worry, they were able to concentrate on learning the songs, doing the exercises the choir director introduced to improve singing performance, and preparing for the concerts. Several care partners described this accepting atmosphere as playing an important role in instilling a sense of trust and comfort among choir members. This finding echoes earlier research by Phinney et al. (2016) on a neighbourhood walking club for persons living with dementia. The authors found the lack of attention paid to dementia in the club as crucial in helping build trust and connections among participants. This is exemplified by a promotional flyer describing the walking club as a place where “the diagnosis is left at the door” (p. 386). This effort helped foster a distinctly non-medicalized culture within the club, with walking seen not as a therapeutic intervention but instead as a normal enjoyable everyday life activity.

Care partners spoke in different ways about a sense of togetherness that united choir members. Several pointed to a feeling of unison that occurred as choristers sung in harmony. They also described the concerts as a collective endeavor that reflected the trust they had for each other as people and performers. Several care partners valued the close friendships they developed within Voices in Motion while students talked of befriending care partners and persons living with dementia and characterized the choir as being surrounded by “many grandparents.” This finding resonates with Thompson et al.’s (2023) phenomenological study of a community-based choir in Victoria, Australia, where people living with dementia and care partners were able to establish social connections meaningful enough to give them a sense of belonging to a supportive community. In a similar manner, Langston and Barrett (2008) report solidarity developing in a choir they observed as a result of its members’ commitment and loyalty to the choir, their shared love of music, the respect given to those willing to perform in solos, duets or quartets, and their appreciation of the choir participating in community or civic events. The authors saw these factors as essential in fostering social capital within the choir.

Social Ties and Emotional Sustenance

Emotional sustenance is an important feature of social support and facilitated by participation in joyful and fulfilling activities (Lamont et al., 2018; Umberson et al., 2010). Emotional sustenance in Voices in Motion took many forms, a central one being the support and encouragement provided by the choir director and the positive and encouraging feedback she gave choir members. Care partners said they felt validated, understood, and valued by the director and described the rehearsals as “joyful” and “happy” events. Care partners saw Voices in Motion as an essential aspect of their lives and emphasized looking forward to the weekly rehearsals. Several noted how choir members actively listened to each other and found their newly developed friendships to be a source of emotional support.

Several wished more time could have been devoted to socializing during rehearsals. Care partners underlined the joy of singing together, and the pride they experienced in how well-attended concerts and performances in advocacy events helped challenge the negative stereotypes of individuals living with dementia. The involvement of high school students provided Voices in Motion with a distinctly intergenerational culture. Students actively engaged with Voices in Motion and their presence fostered positive feelings among care partners and those living with dementia. Many looked forward to their interactions with students while students expressed a deep appreciation for the ties they had built as part of their involvement with Voices in Motion. A benefit of these connections was that students overcame their initial fears of being with the choristers living with dementia. In the focus groups, many students spoke of how they had come to appreciate them as unique individuals with their own histories and personalities. These personal stories helped create stronger bonds between the participants.

Limitations

The transferability of the findings to other choirs for individuals living with dementia is limited by the qualitative nature of the study and its convenience sampling. There is a lack of racial diversity in the sample of care partners and relatives or friends living with dementia. The sample is also potentially skewed with most care partners being women. While data were collected longitudinally over an 18-month period, it is not known whether the benefits of the Voices in Motion choirs extend to a longer period of time.

Implications

This study has several implications. Bonding social capital has been shown to improve health and well-being, reduce social isolation for individuals with illness and their care partners (Eriksson, 2011; Ferlander, 2007), decrease rates of depression (Salehi et al., 2019; Simons et al., 2019), and lower care partner distress (Horsfall et al., 2012; Papastavrou et al., 2015). Our study adds to this evidence by underlining the value of intergenerational choral singing in fostering social engagement and increasing social connectivity among participants living with dementia and their care partners. Our findings also complement a previously published study on Voices in Motion where we found choral singing and social engagement to be linked to declining care partner distress, improvement in cognition for both choristers living with dementia and care partners, and a decline in depressive symptomatology (McDowell et al., 2022).

Further, Voices in Motion served as a safe space for people living with dementia and their care partners to socialize and develop a sense of trust with one another—this helped reduce social isolation, a risk factor with memory decline and worsening physical well-being (Villalonga-Olives et al., 2018). The benefits of the Voices in Motion program are significant in the context of an aging population with the increasing number of dementia cases and need for long-term care services (Kuiper et al., 2015; Prince et al., 2013). The widespread availability of dementia choirs like Voices in Motion could potentially result in those living with dementia staying in the community longer, thereby delaying entry into long-term care, and thus reducing the overall costs associated with their care (Middleton & Yaffe, 2009). This is particularly important given the lack of cure for dementia and current pharmaceutical treatments offering limited symptomatic relief (Thangwaritorn et al., 2024).

Conclusion

The study underscores the value of choral singing as an intervention fostering social engagement and the emergence of bonding social capital among choristers living with dementia, their care partners, and high school students. Crucial to this process is the intergenerational nature of Voices in Motion which helped diversify social relationships and gave high school students the opportunity to gain a deeper appreciation of dementia as lived experience as they interacted with the choristers. Also fundamental is the common purpose choristers shared in preparing for and performing in well-attended public concerts. The benefits of choral singing highlighted in this study point to the value of community-based intergenerational dementia choirs as a therapeutic intervention based on the principle of social capital. By fostering positive social relationships, such choirs enable those with the diagnosis, and their care partners to engage together in an enjoyable activity, while being part of a powerful catalyst for challenging nihilistic social views of dementia.

Supplemental Material

Supplemental Material - Choir Singing for People With Dementia and Their Care Partners: Exploring the Role of Bonding Social Capital

Supplemental Material for Choir Singing for People With Dementia and Their Care Partners: Exploring the Role of Bonding Social Capital by André P. Smith, Ruth Kampen, Debra J. Sheets, Stuart W. S. MacDonald in Dementia.

Footnotes

Acknowledgements

The authors wish to acknowledge the people with dementia, family members, students, and community volunteers who gave their expertise and time so generously. The authors would also like to extend their deepest appreciation to Erica Phare-Bergh (Choir Conductor/Director) and Rick Bergh for their incredible efforts in making the Voices in Motion project a reality that to this day gives singers an opportunity to belong to a community where they experience love, connection and support.

ORCID iD

André P. Smith

Ethical Considerations

The Voices in Motion study was approved by the Human Research Ethics Review Board at the University of Victoria (#20-0329, 8 December 2017).

Consent to Participate

All participants provided written assent at the outset of data collection, which was confirmed on an ongoing basis. Participants were provided sufficient opportunities for questions regarding their participation before consenting.

Consent for Publication

Written informed consent for publication was provided by all participants.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported the Alzheimer Society of Canada [Quality of Life grant number 18–20]; with supplementary funding from the Pacific Alzheimer Research Foundation [Internal grant number 37070].

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Due to the nature of this research, participants in this study did not agree for their data to be shared publicly, so the generated and/or analyzed data during the current study are confidential. *

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

André P. Smith, PhD, is Professor in the Department of Sociology at the University of Victoria with research interests in the areas of aging, mental health, and the lived experience of dementia. His research program reflects a desire to understand the intersectionality of health and health-related behavior and their wider socio-cultural, institutional and familial contexts.

Ruth Kampen, MA, is a sociologist in the Department of Sociology at the University of Victoria and one of the project coordinators for the Voices in Motion project.

Debra J. Sheets, PhD, is an Emeritus Professor in the School of Nursing at the University of Victoria. Her research interests focus on gerontology and geriatric nursing—and in particular dementia and caregiving, technology in home care, and creativity and aging.

Stuart W.S. MacDonald, PhD, is Professor and Mohr Chair with a research focus on cognitive aging and the cognitive neuroscience of aging. Recent avenues of investigation include the early identification of those at risk for cognitive and functional decline, paying particular attention to lifestyle interventions that may delay or prevent memory changes with increasing age.

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