Study participant Lily Robillard reads a music sheet. She’s part of a research project headed by UCSF’s Julene Johnson, PhD, that studies whether singing in a community choir can improve a senior’s physical and mental health. Photo by Noah Berger

An innovative San Francisco program of community choirs for older adults found that singing in a choir reduced loneliness and increased interest in life, but did not improve cognition or physical function, according to a study by researchers at UC San Francisco.

The program – Community of Voices – was a collaboration between UCSF and the nonprofit San Francisco Community Music Center (CMC), as well as the San Francisco Department of Aging and Adult Services (DAAS), that aimed to assess whether art-based social interventions could substantively improve quality of life for older adults.

“Our current health and social systems are not prepared to help support our rapidly increasing population of older adults,” said lead author Julene Johnson, PhD, associate dean for research and professor in the UCSF School of Nursing. “There’s a high percentage who experience loneliness and social isolation, and depression also is relatively high. There’s a need to develop novel approaches to help older adults stay engaged in the community and also stay connected.”

The nearly 50 million Americans aged 65 and older represented 15.2 percent of the total U.S. population in 2016, according to the U.S. Census Bureau, and are increasingly diverse, with nearly 22 percent currently from racial/ethnic minority backgrounds – increasing to almost a third by 2030 – and at increased risk for poor health outcomes. Previous studies have shown that social isolation and depression can exacerbate poor health.

A potential novel approach is to engage them in the arts, as they can be offered in the community, are relatively low cost to deliver, are engaging, and can be culturally tailored. One option is community choirs, as about 32.5 million U.S. adults regularly sing in choirs.

“Thanks to the vision and leadership of UCSF and Julene Johnson, we now have evidence-based research to support the value of choirs for older adults,” said Sylvia Sherman, CMC program director.

In the Nov. 9, 2018, Journal of Gerontology: Psychological Sciences study, 12 federally supported senior centers in San Francisco were randomized into a weekly group choir program designed to engage adults age 60 and older cognitively, physically and socially. Over a three-year period (February 2012 to August 2015), 390 English- and Spanish-speaking participants were enrolled into either a group that started choirs immediately (208 members), or another group that initiated choirs six months later (182 members). Two-thirds of the participants were from diverse backgrounds, 20 percent reported financial hardship, and 60 percent had two or more chronic medical conditions.

The Community of Voices choirs were led by professional choir directors and accompanists. They identified music repertoire that was culturally tailored for each site, appropriate for older adults with various singing abilities, and challenging enough to facilitate growth and mastery over time. The 90-minute choir sessions included informal public performances.

Dana Pounds (left), project manager for the Community of Voices research study, tests Ruth Aviles following choir rehearsal. Photo by Noah Berger

During the study, singers completed memory, coordination and balance tests, and completed questionnaires about their emotional well-being. Researchers assessed outcomes at six months, along with the health care costs.

Overall, the researchers found that older adults who sang in a choir for six months experienced significant improvements in loneliness and interest in life. However, no substantial group differences occurred in the cognitive or physical outcomes or for health care costs. The overall six-month retention rate was 92 percent.

Each of the 12 choirs created for the UCSF trial program continues to sing as part of CMC’s Older Adult Choir Program.

“We were a little surprised not to see improvements in cognitive and physical function, especially because the literature, although small, suggested there should be improvements,” Johnson said. “However, our study is one of the first randomized controlled trials of a choir intervention, whereas the others were cross-sectional or did not randomly assign the participants.”

More research is needed on how choirs improve well-being and the potential long-term health impacts, said Johnson, who served on a 25-person panel of the National Institutes of Health and John F. Kennedy Center for the Performing Arts on music and the brain, with results published in March 2018 in Neuron.

“Besides being one of the first arts-based randomized trials for older adults, our trial represents a new direction in translational research designed to address health disparities, in which interventions are designed and evaluated in community settings from the outset,” Johnson said. “These study methods can be a model for future trials to engage and retain diverse older adults in research.”

Co-Authors: Senior author Steven Gregorich, PhD, Anita Stewart, PhD, Michael Acree, PhD, Jason Flatt, PhD, MPH, Wendy Max, PhD, of UCSF; and Anna Napoles, PhD, MPH, National Institutes of Health.

Funding: The study was supported by the National Institute of Aging (R01AG042526, P30AG15272) and National Center for Advancing Translational Sciences (UL1 TR000004). Napoles was partly supported by the Intramural Research Program of the National Institute on Minority Health and Health Disparities.

Disclosures: The authors report no conflicts of interest.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals – UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – as well as Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. UCSF faculty also provide all physician care at the public Zuckerberg San Francisco General Hospital and Trauma Center, and the SF VA Medical Center. The UCSF Fresno Medical Education Program is a major branch of the University of California, San Francisco’s School of Medicine.