The Power of Group Singing in Enhancing the Well-being of Dementia Caregivers: A Program Evaluation of the Gleeful Choir

The cognitive decline caused by Alzheimer's disease and related dementias can lead to loss of independence, decreased communication, and social isolation (Alzheimer's Association, 2023). Over 57 million people are living with dementia, and the numbers are growing with an estimated tripling by 2050 (World Health Organization (WHO), 2021). There are an estimated 68 million family caregivers in the United States who go unpaid and endure high levels of stress (AARP, 2023). Currently 11 million caregivers care for a family member with Alzheimer's disease (Alzheimer's Association, 2024). In Utah, an estimated 112,000 family members provide care for individuals living with Alzheimer's disease (Alzheimer's Association, 2024). Those caring for a person with dementia (PWD) face a long and demanding journey that often leads to caregiver burnout (Hiyoshi-Taniguchi et al., 2018). Musical activities can be beneficial for both persons with dementia (PWD) and their caregivers, offering cognitive, emotional, and social benefits (Davidson & Faulkner, 2010). Participation in community music program interventions can enhance social connections and reduce caregiver burden, fostering a sense of shared experience and emotional support (Camic et al., 2011). The Gleeful Choir, facilitated by Emily Christensen at Jewish Family Service of Salt Lake City, welcomes older adults and their caregiver (care dyads) in the community to take part in structured intergenerational singing activities and performances. The Gleeful Choir is a free choir for dementia clients and their caregivers ("The Gleeful Choir," 2025). The aim of the choir is to support family caregivers and uplift the lives of PWD. The purpose of this project is to evaluate the effectiveness and impact upon caregivers of the Gleeful Choir. This evaluation assessed the program's outcomes, identified strengths, and provided recommendations for enhancing its effectiveness. Using a mixed methods design, this project examined participant experiences, program implementation, and overall success in achieving its intended goals. The findings will contribute to the ongoing development of the program and inform future community-based programs for caregivers and people living with dementia.

The Power of Group Singing in Enhancing the Well-being of Dementia Caregivers: A Program Evaluation of the Gleeful Choir By Suzette McArthur-Shepherd A non-thesis graduate project submission in partial fulfillment of the requirements for the Degree of Master of Science In Gerontology College of Nursing The University of Utah July 28, 2025 Supervisory Committee: Alycia Bristol, PhD, Chair Jacqueline Eaton, PhD Brenda Luther, PhD 1 The Power of Group Singing in Enhancing the Well-being of Dementia Caregivers: A Program Evaluation of the Gleeful Choir Introduction The cognitive decline caused by Alzheimer’s disease and related dementias can lead to loss of independence, decreased communication, and social isolation (Alzheimer’s Association, 2023). Over 57 million people are living with dementia, and the numbers are growing with an estimated tripling by 2050 (World Health Organization (WHO), 2021). There are an estimated 68 million family caregivers in the United States who go unpaid and endure high levels of stress (AARP, 2023). Currently 11 million caregivers care for a family member with Alzheimer's disease (Alzheimer’s Association, 2024). In Utah, an estimated 112,000 family members provide care for individuals living with Alzheimer’s disease (Alzheimer’s Association, 2024). Those caring for a person with dementia (PWD) face a long and demanding journey that often leads to caregiver burnout (Hiyoshi-Taniguchi et al., 2018). Musical activities can be beneficial for both persons with dementia (PWD) and their caregivers, offering cognitive, emotional, and social benefits (Davidson & Faulkner, 2010). Participation in community music program interventions can enhance social connections and reduce caregiver burden, fostering a sense of shared experience and emotional support (Camic et al., 2011). The Gleeful Choir, facilitated by Emily Christensen at Jewish Family Service of Salt Lake City, welcomes older adults and their caregiver (care dyads) in the community to take part in structured intergenerational singing activities and performances. The Gleeful Choir is a free choir for dementia clients and their caregivers (“The Gleeful Choir,” 2025). The aim of the choir is to support family caregivers and uplift the lives of PWD. The purpose of this project is to evaluate the effectiveness and impact upon caregivers of the Gleeful Choir. 2 This evaluation assessed the program’s outcomes, identified strengths, and provided recommendations for enhancing its effectiveness. Using a mixed methods design, this project examined participant experiences, program implementation, and overall success in achieving its intended goals. The findings will contribute to the ongoing development of the program and inform future community-based programs for caregivers and people living with dementia. Literature Review To support this program evaluation, a focused review of recent literature was conducted using databases such as PubMed, PsycINFO, and Google Scholar. Search terms included “dementia caregiving,” “group singing,” “music intervention,” and “caregiver well-being.” The review prioritized peer-reviewed studies from over 30 articles over the last 15 years, including both qualitative and quantitative research. The key themes that emerged include the impact of musical engagement on caregiver well-being, the unique benefits of group singing, caregiver empathy for their family members, and gaps in existing research that this evaluation seeks to address. Caregiver Well-being and Musical Engagement Caregivers of PWD often experience stress, social isolation, and emotional burden, which can negatively impact their health and quality of life (Brodaty & Donkin, 2009). Music interventions can decrease frustration and burden for caregivers tending to their family members with dementia (Raglio et al., n.d.). Group singing may enhance emotional well-being and strengthen social networks for caregivers. Many families facing a dementia diagnosis may be looking for interventions that can be enjoyed by both the caregiver and the person living with dementia. Music programs are becoming increasingly recognized for enhancing cognitive awareness, fostering social 3 interaction, and emotional well-being for the care dyad and the broader family system (Särkämö et al., 2013). Other recent studies have explored the benefits of group singing for the dementia care dyad, reporting positive outcomes such as shared enjoyment, improved mood, enhanced relationship quality, increased self-esteem, and a greater sense of support (Blazek et al., 2024; Dowson et al., 2023). As the person with dementia declines, the caregiver may continue to find stability through shared music interventions. Research has increasingly pointed to the value of music-based activities, including singing, in supporting the emotional and social health of family caregivers of PWD (Anderson & Sheets, 2017; Bufalini et al., 2022). One review of several studies focused on how music and singing can affect caregivers' well-being and found that these types of interventions may offer meaningful support to those living a caregiving role (Lee et al., 2022). Group singing refers to people coming together to sing in a shared setting, such as a choir. It offers more than musical expression; it fosters connection, shared purpose, and emotional uplift (Bourne et al., 2021). For caregivers, group singing can be a meaningful way to engage with others and experience moments of joy alongside their family members. The article showed that group singing not only helped caregivers feel more socially connected and emotionally supported but also gave them tools to manage the stress of caregiving. Another study, which focused on older adults in general, adds to this understanding by showing how regular choir participation can positively impact mood, social engagement, and certain cognitive functions (Pentikäinen et al., 2021). While Pentikäinen et al., (2021) is not directly focused on caregivers, it is important to note that caregivers are often older adults themselves, and benefits like increased social connection and improved mood can lead to better coping and overall well-being. These studies, along with many others (Falth et al., 2022; Tamplin et al., 2024; Thompson et al., 2023; 4 Unadkat et al., 2017; Young et al., 2019), suggest that group singing may offer an accessible and enjoyable way to improve life for caregivers, not just by reducing stress, but by strengthening their sense of community and resilience. Group singing offers unique benefits beyond those of individual singing by combining musical expression with social connection and shared emotional experience. Unlike individual singing, group singing creates opportunities for emotional synchrony and collective joy, which can help caregivers reconnect with their family members in meaningful, non-caregiving roles (Thompson et al., 2023). The communal nature of choral music allows caregivers to participate without performance pressure while benefiting from a peer environment that uplifts and validates their experience (Pentikäinen et al., 2021). According to results from a pilot study by Mittelman & Papayannopoulou (2018), people in the early to middle stage of dementia and their family members and friends can enjoy and learn from rehearsing and performing in concerts that also engage the wider community. Increased Caregiver Empathy for the PLWD Researchers have found that caregivers' participation in dyad singing helps them remember the positive qualities of the ones they tend to, which leads to more empathy and helps them better meet the needs of their family member with dementia (Bourne et al., 2021; StuartRöhm et al., 2023). In their study, Skingley et al., (2021) observed that shared musical engagement in a choral setting fostered emotional closeness, mutual enjoyment, and a sense of shared achievement between caregivers and people living with dementia. Caregivers described moments of genuine connection that helped them see their family member or friend in a new light - as partners. Similarly, Stuart-Röhm et al., (2023) highlighted how singing together created space for positive emotions and meaningful interactions that 5 contrasted with the often-stressful routines of caregiving. These experiences helped caregivers reframe their roles and reconnect with their family members' identities, strengthening both their empathy and emotional resilience. With so many benefits associated with this type of activity, taking a closer look at similar community-based music interventions can both raise awareness and build on an already promising foundation for caregiver support. Literature Gaps Gaps exist in understanding how structured intergenerational music programs can provide sustained benefits for caregivers and enhance the caregiving experience. One gap to be addressed by this evaluation is to assist in providing a better understanding of how shared choral music programs can potentially lighten the load of the caregiver and promote joy as the mood of the care recipient is lifted through singing. While studies listed above highlight the benefits of shared singing for people with dementia, there tends to be less focus on caregivers and how they balance their own enjoyment with the continual demands of caregiving. Few studies qualitatively explore how participation in shared music activities impacts caregiver well-being, stress levels, and sense of identity as a caregiver. Little research exists on how long-term participation in such programs supports caregiver resilience, and how peer connection and mutual support may emerge in these settings. This evaluation of the Gleeful Choir helps fill that gap by exploring caregiver perspectives and outcomes, offering insights for both practice and future research. Gleeful Choir Background The Gleeful Choir was born out of Emily Christensen’s years of experience as a music therapist working in dementia and hospice care. Inspired by stories of dementia choirs around the 6 world, she had long envisioned creating a similar program in her own community. While participating in the Music and Memory coalition hosted by Jewish Family Service (JFS), Christensen connected with Ronnie Daniel, the former director of the Alzheimer’s Association Utah chapter, who encouraged her to approach JFS about a partnership. Recognizing the potential for the choir to be a natural extension of their existing music and memory programming, JFS Executive Director Ellen Silver enthusiastically supported the idea and secured funding. The program officially began in 2018, with Christensen initially contracting as the choir director before joining JFS as an employee in 2022. Significance of the Study As the aging population grows and dementia diagnoses increase, families seek resources and affordable interventions where the care dyad can enjoy enriching and therapeutic activities together (Alzheimer’s Association, 2023). It is important to understand how group singing enhances the lives of older adults and their families in our communities. Evaluating the impact of music programs on dementia caregivers can bring to light the value of holistic interventions that may contribute to the formation of new policies (Mabire et al., 2023). Understanding the benefits of caregiver participation in group singing and the Gleeful Choir program can help other community-based programs develop strong intergenerational music interventions. Among the most immediate benefits in studying the impact of singing together is the promotion of fun, meaningful and self-expressive outlets for respite and self-care for care families, as well as cognitive increase and emotional well-being for the care dyad (Li et al., 2015). Participation in the Gleeful Choir may provide social, emotional, and cognitive benefits for the caregiver. The choir offers community-based engagement that can assist in 7 improving quality of life for older adults with dementia and help alleviate burden for the caregiver. Theory This program evaluation is based on the Stress Process Model (Pearlin et al., 1990), which explains how stress develops in caregivers and how interventions can decrease caregiver burden. Caregiving for a person with dementia can cause increased emotional, physical, and psychological strain, often leading to burden and depression (Brodaty & Donkin, 2009). Engaging in meaningful shared activities, such as singing together in the Gleeful Choir, may serve as a stress-buffering mechanism, enhancing positive emotions and reducing the weight of the perceived burden. By helping the caregiver focus on shared enjoyment, rather than stress management, the program may help reduce emotional distress and enhance overall well-being. Additionally, this study draws from the Broaden-and-Build Theory of Positive Emotions (Fredrickson, 1998), which argues that positive emotions expand an individual’s coping resources over time. The choir experience may create joyful experiences, connection and resilience, decreasing the toll of caregiving. These benefits go beyond the choir moments, as caregivers may enjoy continued fulfillment and well-being with their family members as they reminisce and share choir experiences with others. These theories shaped the program evaluation by guiding measurement and interpretation. The Stress Process Model (Pearlin et al., 1990) focuses the assessment on whether the Gleeful Choir reduces caregiver burden by fostering positive shared experiences. Observational data and caregiver surveys tracked emotional distress, well-being, and stressbuffering effects. 8 The Broaden-and-Build Theory (Fredrickson, 1998) informed the evaluation of the influence of choir participation on emotional resilience. By tracking joy, engagement, and social interaction, the evaluation explored how positive emotions extended beyond the sessions. Together, these theories helped explain the program’s impact and provided insights for improvement. Aims 1. Modify the existing Gleeful Choir evaluation tools for use in a program evaluation. 2. Implement a program evaluation to identify the key strengths and challenges of the Gleeful Choir. In evaluating the Gleeful Choir, this project provided beneficial information on the role of interactive singing interventions and their impact on caregivers. This program evaluation may help improve future music-based programs; support individuals living with dementia and encourage those who care for them. Advocacy for social music programs for family dementia caregivers is of utmost importance to the well-being of our aging society. Methods This program evaluation utilized a mixed-method approach to gather quantitative and qualitative data. The University of Utah’s Institutional Review Board determined this project did not meet the definitions set by Federal regulations for Human Subjects Research. Sampling The Gleeful Choir has about 20 members, which includes about ten caregivers and ten PWD. This evaluation included nine caregivers and two program staff, Emily Christensen, the choir founder and director, and Rosemary Quatrale, the Jewish Family Service older adult care manager. One caregiver was absent during observations. Similar community-based music 9 program evaluations have been successful with comparable sample sizes (Harris & Caporella, 2014). Input from key stakeholders (staff, Emily and Rosemary) provided information on program implementation and outcomes. Involvement of caregivers helped provide input on ways to improve the program and the overall benefits of music interventions. Recruitment Through purposive sampling, caregiver choir members and staff were asked to participate. All consenting choir members were observed three times, each for a one-and a halfhour session, during regularly scheduled rehearsals on randomly selected dates. Their engagement and interactions were then evaluated, and feedback was gathered to assess the program’s impact. After observations ended, participants completed paper surveys. Caregivers who did not understand English were excluded, as the survey materials were delivered in English. Prior to beginning the project, during a regularly scheduled Gleeful Choir rehearsal, researcher introductions were made, the purpose and procedures of the study were explained, and verbal consent was obtained from caregiver choir participants. Time was provided for participants to ask questions and consider their participation. Choir members were assured that if they chose not to participate, their involvement with the choir would not be jeopardized in any way. Also, if they selected not to participate, no observational data would be collected. Consent was solidified prior to any data collection to ensure that participants were fully informed and voluntarily agreed to take part in the evaluation. All caregiver choir members agreed to participate in the evaluation. The survey responses were stored securely to ensure confidentiality and analysis efficiency. No identifiable participant information was collected. Regular meetings 10 with the project committee members and chair ensured data collection and analysis procedures accountability, validity, transparency, and fidelity. Monetary compensation was not planned for caregiver's participation; however, appreciation for their time and input was acknowledged, and sweet treats were offered during the last meeting. Approach To evaluate the effectiveness of the Gleeful Choir and its impact on dementia family caregivers, a structured program evaluation was conducted over a 5-week period (May 2025) at a local library, during the choir’s regular Thursday sessions from 1:00–2:30 PM. Only one evaluation session was at the regular location. The first meeting was in a local church building due to the library parking lot resurfacing, and the final meeting took place at a multicultural community center in preparation for the summer concert. The evaluation focused on caregiver experience, program quality, and participant engagement to evaluate if the choir was meeting its intended goals. Goals of the Gleeful Choir, (E. Christensen, personal communication, March 31, 2025) are to: 1. Create Meaningful Experiences - to provide an enjoyable and engaging activity for people with dementia (PWD). 2. Foster Connection – strengthen social bonds between (PWD) and their caregivers, offering a shared space for contribution and success. 3. Support Caregivers – offer emotional uplift, normalization, and respite through the joy of choral singing. 11 4. Encourage “Couple-hood” - give caregivers a chance to step away from their caregiving role and simply be a spouse, child or partner. These goals were considered during observations and survey collection and addressed during the feedback provided to the choir directors at the end of the program evaluation. This project was conducted in three phases: Phase 1: Development of Observation Instruments During this phase, an observation checklist was developed to document caregiver engagement, emotional responses, and interactions during choir rehearsals (Appendix A). Additionally, a caregiver survey was adapted from existing forms used by the Gleeful choir. The survey used scaled and open-ended questions to assess caregiver experience, social connection, and overall impact of the music program (Appendix B). Interview questions were created for the choir director and program care manager with a focus on gathering insights on program strengths, outcomes, and needed improvements (Appendix C). Committee feedback was sought to support adaptation of materials for this program evaluation. Phase 2: Data Collection: surveys, observations, and interviews Three one-and-a-half-hour observation periods occurred on randomly selected choir rehearsal dates over a five-week period. Focused two-column field notes were taken based on the observation check list to assess program effectiveness, as well as caregiver's well-being. At the end of the evaluation cycle, caregiver participants completed a short questionnaire survey rating overall program strengths and weaknesses. Finally, program leaders, including the director and care manager, were interviewed to assess whether planned activities were completed, any modifications made, and what worked well or needed improvement. Interviews with the director 12 and care manager provided further qualitative insights into program strengths and areas for enhancement. Phase 3: Data Analysis & Reporting Survey and observational data were analyzed to identify trends in caregiver engagement, well-being, and program effectiveness. The results were shared with program leaders to guide future improvements, ensuring the Gleeful Choir continues to provide a meaningful and joyful experience for caregivers and their family members. Measures and Analysis Plan For this program evaluation, three main data tools were used to measure caregiver outcomes. Observation Checklist and Field Notes An observation checklist was used to document caregiver engagement, emotional responses, and interactions during choir rehearsals (see Table 1). Field notes were recorded during observations to include any other significant events or behaviors not captured in the checklist. Table 1 Observation Checklist Scale Engagement Level Not Engaged = 1 Minimally Engaged = 2 Moderately Engaged = 3 Fully Engaged = 4 Emotional Response Sad = 1 Neutral = 2 Smiling = 3 Joyful = 4 Social Interaction None = 1 With Partner = 2 With Partner & Facilitator = 3 With Group = 4 Observational data was analyzed to track engagement, identifying changes in participation, such as increased singing, smiling, and social interaction. Attendance and retention patterns were also assessed to determine consistency in participation and overall program appeal, 13 as well as facilitator engagement. Additionally, session structure, accessibility, attendance, and retention trends were tracked to assess overall program consistency and appeal. Surveys Surveys included both six Likert scaled items (scaled from 1 to 5) and four open-ended questions to assess perceived benefits and burdens of choir participation (see Table 2). Through open-ended questions, such as “What was most meaningful about participating in the choir?” caregivers were asked to identify favorite aspects of the program and provide suggestions for improvement. Survey questions were chosen and updated based on common measures of caregiver support program outcomes, such as enjoyment, engagement, emotional well-being, and overall satisfaction. New items were developed to capture choir-specific experiences, including shared musical engagement, emotional connection, and the identified goals of the program. Table 2 Part I: Likert-Scale Caregiver Survey Questions (1strongly disagree -5 strongly agree) Question Number Q1 Q2 Q3 Q4 Q5 Q6 Survey Item Participation in the choir is enjoyable to me The choir setting feels inclusive and welcoming I feel a sense of connection with other choir members I feel supported by the choir staff Participating in the choir provides me with a sense of emotional uplift or joy Overall, I am satisfied with my experience in the choir program Part II: Open-Ended Questions Q7. In what ways has participating in the Gleeful Choir affected your well-being as a caregiver? Q8. Are there any challenges or difficulties in program participation? Q9. Do you have any suggestions for improving the choir experience for caregivers and their family members? Q10. Are there any other comments you would like to share? 14 Survey data was analyzed by using both quantitative and qualitative responses. Scores were analyzed using descriptive statistics, with average scores computed to identify overall trends. Open-ended survey responses were analyzed using thematic analysis (Braun & Clarke, 2006) to identify common themes, highlighting key areas for program enhancement based on recurring suggestions. Interview Guide A semi-structured interview guide was used at the end of the observations period to conduct interviews with program staff to gather their individual perspectives on caregiver experiences and areas for program improvement. Qualitative interviews with the director and care manager were transcribed and analyzed using thematic analysis (Braun & Clarke, 2006), to identify recurring themes, providing deeper insights into program strengths and areas for refinement. Additionally, findings were compared with existing program data to evaluate whether the choir's structure and activities align with past successes or require adjustments. Results To assess the effectiveness of the Gleeful Choir and gather valuable feedback for program improvement, three choir sessions were observed; there were four caregivers in session one, nine caregivers in session two, and six caregivers in session three. A total of nine caregivers participated in the program evaluation of the Gleeful Choir, some attending all three observation days, others just one or two days. Rosemary shared that participants were primarily spouses or adult children of individuals living with dementia and ranged in age from 50 to 80 years old. All participants identified as active caregivers and attended at least one choir rehearsal during the evaluation period. Of the nine caregivers, all agreed to be observed during rehearsals and completed the caregiver survey. 15 Caregivers represented a mix of long-term and newer choir members, with participation ranging from recent joiners to those involved since the choir’s founding in 2018. Their musical experience varied as well; some had no prior singing background, while others had experience singing or playing instruments such as piano or ukulele at varying levels. Most attended alongside their family members with dementia, while one attended as a professional caregiver with their client with dementia. Participants were engaged in multiple aspects of the evaluation, including direct observation, a caregiver well-being survey with both quantitative and openended questions, and informal conversations captured through field notes. Observational Results Observations of three Gleeful Choir sessions revealed consistent demonstrations of joy, engagement, and meaningful social connection among caregivers and their family members with dementia (see Table 3). Across all locations, whether in a church classroom, community arts center, or library, participants were greeted with warmth, smiles, and enthusiasm. Caregivers and care recipients alike appeared at ease, with many joining in song, laughter, and playful interactions. Facilitator energy was notably high, with Emily Christensen leading sessions that were structured yet flexible, combining vocal warm-ups, familiar songs, and humor that encouraged participation and connection. Visual cues such as toe-tapping, snapping, and deep sighs of relief were common indicators of enjoyment and emotional release. 16 Table 3 Observation Results Across Sessions Measure Engagement Emotional Response Social Interaction Session 1 2 3 1 Scale 1 (%) 0 0 0 0 Scale 2 (%) 0 11 0 0 Scale 3 (%) 25 33 50 0 Scale 4 (%) 75 56 50 100 2 3 1 0 0 0 11 17 25 33 17 0 56 67 75 2 3 0 0 0 0 22 33 78 67 Note. Engagement Level Emotional Response Social Interaction Not Engaged = 1 Sad = 1 None = 1 Minimally Engaged = 2 Neutral = 2 With Partner = 2 Moderately Engaged = 3 Smiling = 3 With Partner & Facilitator = 3 Fully Engaged = 4 Joyful = 4 With Group = 4 The physical environment posed no observed barriers to participation, and the inclusive, welcoming atmosphere supported a sense of belonging and equality. Sessions were well-paced, with clear instructions and large-print materials to aid accessibility. Caregivers often assisted with transitions or lyrics, stepping into informal roles that supported both their family members and the overall group dynamic. Notably, caregivers frequently remarked, verbally or through expressions, on the emotional uplift and community spirit the choir offered (see Table 4). These observations suggest that the Gleeful Choir fosters not only musical engagement but also a nurturing, low-pressure space for caregivers to experience connection, relief, and joy. 17 Table 4 Caregiver Observation Field Note Quotes Caregiver Caregiver 1 Caregiver 4 Caregiver 2 Caregiver 6 Caregiver 3 Observation Field Note Quote "I always leave happy." "This is the most uplifting thing ever!" "I don’t feel invisible anymore being in this group" "It feels like we belong to something." "For a good time, call Emily Christensen!" Emily's leadership style was consistently noted as enthusiastic, responsive, and encouraging. Through clear directions, engaging song selections, and adaptive pacing, she was able to meet the diverse needs of participants. This responsiveness was key to maintaining engagement and promoting a sense of safety and inclusion. Survey Results In their survey responses, caregivers overwhelmingly reported that they strongly agreed with the positive impact of participating in the Gleeful Choir. Interestingly, participant responses varied when asked about having a connection with other choir members (see Table 5). Table 5 Caregiver Survey Results Survey Query 1 - Strongly 234 - 5 - Strongly Disagree Disagree Neutral Agree Agree 1. Participation in the choir is 0% enjoyable to me 2. The choir setting feels inclusive 0% and welcoming 3. I feel a sense of connection with 0% other choir members 4. I feel supported by the choir staff 0% 5. Participating in the choir provides 0% me with a sense of emotional uplift 6. Overall, I am satisfied with my 0% experience in the choir program 0% 0% 0% 100% 0% 0% 0% 100% 0% 11% 33% 56% 0% 0% 0% 100% 0% 0% 11% 89% 0% 0% 11% 89% 18 Open-ended results In the open-ended questions, caregivers described the Gleeful Choir as a source of joy, emotional relief, and meaningful connection both with their family members and with a wider community of peers (see Table 6). The opportunity to engage in a shared musical activity created a sense of normalcy, offering moments of laughter and comfort amidst the challenges of caregiving. While a few respondents noted difficulties related to their family member’s cognitive or physical decline, these were framed more as natural caregiving barriers rather than program shortcomings. The repeated expressions of gratitude suggest that the program is meeting a significant unmet need. One caregiver's use of choir songs at home to soothe their mother indicates the choir's potential as not just a recreational outlet, but a practical caregiving tool. Taken together, these findings highlight the choir’s unique ability to support caregiver wellbeing in ways that are both emotional and functional. Table 6 Caregiver Survey Quotes Caregiver Open-Ended Survey Quotes "I love the joy, laughter and community." (Caregiver 8) "It gives us something fun to do together that is fun for both of us." (Caregiver 6) "It gives me joy every week." (Caregiver 3) "The choir is the highlight of our week." (Caregiver 2) "A great way to spend time together while doing something that feels normal." (Caregiver 8) "I will often play the songs we are focusing on in choir to soothe my mom at home." (Caregiver 6) "It encourages me to keep going." (Caregiver 1) "I love to hear my [family member’s] voice and see how much she enjoys it." (Caregiver 2) "It gives me joy, laughter and friendship with people…who understand…" (Caregiver 4) "It gives me great pleasure to participate." (Caregiver 5) 19 Interview Results The individual interviews with Gleeful Choir staff, including founder and director Emily Christensen (via Zoom) and older adult care manager Rosemary (in-person), provided rich insights into how the program supports dementia caregivers. Three primary themes emerged from the interviews: emotional release, social connection, and shared joy. Both staff members emphasized that the choir offers a uniquely supportive, low-pressure environment where caregivers and their family members can simply enjoy being together. While challenges like cognitive decline and occasional difficulty attending were acknowledged, these were seen as part of the caregiving journey and addressed with flexibility and compassion. In addition, both Emily and Rosemary approved the use of identifying information, sharing their perspectives on the overall success and future potential of the program. Emotional Release Emily noted that many caregivers arrive expecting to “do something nice” for their person with dementia but are surprised to discover that they themselves feel renewed by the experience. “Caregivers often leave feeling uplifted and personally supported,” she shared. Music becomes a form of emotional release - allowing caregivers to let go of the constant responsibilities of their role, even if just for a little while. Rosemary echoed this, explaining that caregivers benefit from “an hour of singing, where no one is asking anything of them, and no one is judging.” Emotional relief often continues beyond the session, with caregivers sharing stories of how they use choir songs at home to soothe or connect with their family members. Social Connection The choir is designed to encourage authentic connection, not just between the caregiver and their family member, but among caregiver peers as well. “Caregivers like the social part of 20 it,” Rosemary explained, adding that “sometimes it’s hard to get them to leave after rehearsal, they’re talking, laughing, sharing.” Emily described how she intentionally checks in with caregivers before and after practice, helping to build a sense of community and trust. She explained that “many of the friendships formed in the choir continue outside of it.” Both emphasized the importance of the choir’s culture of equality, where people with dementia and their caregivers are treated with equal dignity. “I talk to both the caregiver and the person with dementia the same,” Rosemary said. “We’re just here to sing and have fun together.” Shared Joy Joy was a theme interwoven throughout both interviews. Emily described the program as “a ray of sunshine,” saying, “I hope caregivers come to experience it as just something happy in their week.” Rosemary noted that singing familiar songs, especially those from earlier eras, creates opportunities for shared joy. “You see the person with dementia light up when they recognize a song, and the caregiver lights up too,” she said. That shared moment of joy is powerful, creating a memory rooted not in illness but in connection. Caregivers often reported that these moments gave them strength to continue caregiving. View of the Current Program Both Emily and Rosemary expressed confidence in the current structure of the program, describing it as inclusive and deeply needed in the community. Emily shared that the decision to use the term “memory challenges” rather than “dementia” in the choir was intentional: “We wanted everyone to feel like they belonged, regardless of their diagnosis.” Informal feedback collected by both leaders reinforced the choir’s positive impact. “Some caregivers tell me their person starts singing the moment they recognize the building,” Emily said. Rosemary added that “100% of the caregivers tell me they love it.” The recent choir summer performance was 21 described by both as a huge success, with every seat filled and every face smiling. Both Emily and Rosemary expressed a strong desire to see the choir grow, particularly given the long course of dementia and the ongoing need for meaningful community-based caregiver support. Discussion The observational field notes gathered during Gleeful Choir rehearsals revealed meaningful and consistent themes that strongly support the program's positive impact on caregiver well-being. One of the outstanding themes was the creation of a joyful and welcoming atmosphere. Across all three observation locations, caregivers and their family members were greeted with warmth, laughter, and smiles. The facilitator, Emily, played a crucial role in establishing this tone, bringing consistent energy and enthusiasm that was also shared by the participants. The environment was inclusive, inviting, and uplifting, highlighting the importance of emotional tone in caregiver-centered programming. Rosemary’s presence and participation in the choir offered valuable support to Emily and the choir members. Caregivers were not passive attendees; they actively participated in music-making, assisted one another, and shared moments of humor and connection. This peer interaction reflected a shared understanding of the caregiving experience and contributed to a sense of belonging. These findings are consistent with literature describing how music interventions can provide emotional relief and connection for caregivers of people with dementia (Lee et al., 2022; Raglio et al., n.d.). Similar to Blazek et al., (2024) and Dowson at al., (2023) reported, caregivers in this evaluation frequently described the choir as a space of joy, laughter, and shared understanding which are experiences essential to improving caregiver well-being. Accessibility and clarity in each session also emerged as strengths. The physical spaces used for rehearsals were barrier-free and easy to access, and the materials provided (e.g., large 22 print songbooks) supported participation for individuals with varying needs. The clear pacing and structure of sessions helped caregivers relax and engage, especially given the often-chaotic experience of just getting out the door to rehearsal. These inclusive elements are also supported in literature as crucial for successful music-based interventions (Särkämö et al., 2013). A particularly touching finding was the opportunity for meaningful engagement and emotional expression. The caregivers were observed humming, toe tapping, smiling, and sometimes expressing visible sighs of relief. Statements like “This is the most uplifting thing ever!” and “I don’t feel invisible anymore being in this group,” reflected a deep sense of validation and connection. These observations reinforce findings by Lee et al. (2022), that highlight how group singing can help caregivers reconnect with themselves and others through music. This also mirrors the conclusions of (Skingley et al., 2021), who noted the ability of shared music experiences to enhance mood and social bonds among caregivers. Some expected barriers were noted, particularly as caregivers managed the progressing decline of their family members. Participants reported that worsening symptoms sometimes made attendance challenging, though many still expressed strong appreciation for the program and a desire to stay involved. These findings align with Pentikäinen et al., (2021), who found that increasing caregiving demands can limit community participation. During the interview, Emily, the choir director, explained that program leaders are already making thoughtful adjustments to better support both caregivers and care recipients as dementia progresses, ensuring the experience remains flexible, low-pressure and meaningful for all participants, regardless of where they are in their caregiving or dementia journey A unique finding from this evaluation centered on the variability in caregiver responses regarding how effectively the choir fostered meaningful connections among caregiver 23 participants. While most respondents reported strong feelings of camaraderie and support, others did not experience the same level of connection. This suggests that although the choir may help most caregivers build relationships, due to varying comfort level, the social benefits may not reach everyone equally. Program leaders may wish to continue to examine what aspects promote group bonding and where there may be missed opportunities. While the social benefits of group singing are well-documented (Dowson et al., 2023), this nuance appears underexplored in the literature and offers a fresh insight for future program development. Suggestions for improving group connection could include gently introducing new members during their first few sessions or creating small group breakout opportunities which might be useful in a program where attendance may vary from week to week. These different experiences show the importance of designing music programs, such as the Gleeful Choir, that are not just engaging but also help everyone feel included and connected. Alignment with Program Goals The findings from this program evaluation strongly support the Gleeful Choir’s stated goals: to create meaningful experiences, foster connection, support caregivers, and encourage a return to couple-hood. Caregivers described the choir as a joyful, meaningful activity they could share with their family member, fulfilling the goal of creating enjoyable, engaging experiences for both members of the care dyad (See Table 6). The emotional uplift, moments of laughter, and shared musical memories reported in surveys and interviews reinforce the program’s success in providing opportunities for positive connection. Caregivers and program staff emphasized how the choir helped strengthen relationships by offering a low-pressure space for side-by-side participation, allowing caregivers to step out of a clinical caregiving role and reconnect as partners, children, or spouses. This directly reflects 24 the goal of encouraging “couple-hood.” As reflected in the program’s goal to encourage “couplehood,” (Unadkat et al., 2017) emphasize the importance of preserving relationship identity within the caregiving dyad, noting that shared musical activities like choir participation can help couples reconnect beyond the caregiver-care recipient roles, reinforcing emotional intimacy and mutual enjoyment. Finally, the choir’s design and performances align with the broader aim of community engagement. As noted by Mittelman & Papayannopoulou, (2018) and observed and described in interviews, people in the early to middle stages of dementia, along with their family members and friends, were able to not only enjoy and participate in weekly rehearsals but also contribute meaningfully through public performances that bring joy and awareness to the wider community. This visible participation helps challenge stigma and creates opportunities for community understanding, inclusion, and honoring people living with dementia and their caregivers. Implications for Practice This program evaluation offers valuable insights for organizations seeking to replicate or enhance caregiver-focused music interventions. The Gleeful Choir’s emphasis on joy, inclusivity, and meaningful engagement illustrates how structured group singing can foster emotional well-being, strengthen caregiver–care recipient bonds, and cultivate supportive communities. These outcomes suggest that similar programs can be effective when they intentionally promote low-pressure, welcoming environments and adapt to the evolving needs of dyads affected by dementia. The tools developed for this evaluation, including an observational checklist, caregiver survey, and staff interview guide, can be adapted by other community organizations to assess existing musical or arts-based programs. These tools not only help evaluate outcomes like 25 emotional relief, social connection, and participation barriers, but also support continuous improvement based on participant feedback. Furthermore, the Gleeful Choir model provides a clear example of how music can be used not just for entertainment, but as a tool for respite, relationship-building, and emotional support for dementia caregivers. Conclusion This program evaluation highlighted the joy, emotional relief, and sense of belonging that the Gleeful Choir brings to family caregivers of people living with dementia. Through group singing, participants experienced renewed connection with the person for whom they care, with peers who share their caregiving journey, and with themselves. Observational, survey, and interview data all point to the choir's effectiveness in fostering social connection, promoting emotional well-being, and offering meaningful engagement for caregivers facing the complexities of dementia care. The evaluation revealed how the choir’s joyful atmosphere, inclusive community, strong facilitation, and shared musical expression contribute to the caregiver’s well-being. These findings aligned with the program’s stated goals of creating meaningful experiences, fostering connections, supporting caregivers, and encouraging a return to couple-hood. Importantly, this program evaluation, guided by a structured measurement plan, provided not only evidence of the choir’s positive impact but also practical feedback to inform ongoing development. Findings from this program evaluation have been briefly shared with the Gleeful Choir director, Emily Christensen. In preparation for her recent interview with Alzheimer’s TODAY magazine, several positive quotes from the open-ended caregiver survey responses and the survey results were shared with her. Emily expressed appreciation for the feedback and shared that it inspired ideas for future planning, such as exploring ways to better engage and connect 26 more introverted choir members. At the conclusion of this project, a final copy of the full evaluation report will be shared with both Emily, the director, and Rosemary, the Jewish Family Service care manager, to support ongoing program development and improvement. Overall, the Gleeful Choir serves as a compelling model for how community-based music interventions can enhance the quality of life for caregivers. As the need for dementia support continues to grow, programs like this offer a ray of sunshine and joy, empowering caregivers through shared song, connection, and community. Continued support and expansion of such initiatives are essential to building inclusive, creative, and compassionate community programs for family and professional caregivers facing the long journey of caring for someone with Alzheimer’s disease or a related dementia. 27 References AARP. (2023, July 18). AARP Research Insights on Caregiving. AARP. https://www.aarp.org/pri/topics/ltss/family-caregiving/aarp-research-insights-caregiving/ Alzheimer’s Association. (2023). 2023 Alzheimer’s disease facts and figures. 19(4), 1598–1695. https://doi.org/10.1002/alz.13016 Alzheimer’s Association. (2024). Utah Alzheimer’s statistics. https://www.alz.org/getmedia/13db5064-ffa9-48ed-a98d-ed954a60b810/utah-alzheimersfacts-figures-2024.pdf Anderson, Z., & Sheets, D. (2017). Musical Connections: A Descriptive Study of CommunityBased Choirs for Persons with Dementia and their Caregivers. The Arbutus Review (TAR), 8(1), Article 1. https://doi.org/10.18357/tar81201716810 Blazek, M., Lehmann, S., & Gilbert, M. (2024). Innovative Approaches Using the Arts to Support Persons with Dementia and Caregivers. The American Journal of Geriatric Psychiatry, 32(4, Supplement), S6–S7. https://doi.org/10.1016/j.jagp.2024.01.047 Bourne, P., Camic, P. M., & Crutch, S. J. (2021). Psychosocial outcomes of dyadic arts interventions for people with a dementia and their informal caregivers: A systematic review. Health & Social Care in the Community, 29(6), 1632–1649. https://doi.org/10.1111/hsc.13267 Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa Brodaty, H., & Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11(2), 217–228. https://doi.org/10.31887/DCNS.2009.11.2/hbrodaty 28 Bufalini, J., Eslinger, P., Lehman, E., & George, D. R. (2022). Effects of a Personalized Music Intervention for Persons with Dementia and their Caregivers. Journal of Alzheimer’s Disease Reports, 6(1), 43–48. https://doi.org/10.3233/ADR-210043 Camic, P. M., Williams, C. M., & Meeten, F. (2011). Does a ‘Singing Together Group’ improve the quality of life of people with a dementia and their carers? A pilot evaluation study. Dementia, 12(2), 157–176. https://doi.org/10.1177/1471301211422761 Davidson, J. W., & Faulkner, R. (2010). Meeting in music: The role of singing to harmonise carer and cared for. Arts & Health, 2(2), 164–170. https://doi.org/10.1080/17533010903488608 Dowson, B., Schneider, J., McDermott, O., & Orrell, M. (2023). Online Singing Groups for People With Dementia: Adaptation and Resilience in the Face of the COVID-19 Pandemic. Dementia, 22(7), 1348–1371. https://doi.org/10.1177/14713012231179262 Falth, N., Brorsson, A., & Londos, E. (2022). Choral Singing Enriches Everyday Life for People With Mild to Moderate Dementia and Their Family Caregivers. Journal of Psychosocial Nursing and Mental Health Services, 60(5), 29–36. https://doi.org/10.3928/0279369520211015-01 Fredrickson, B. L. (1998). What Good Are Positive Emotions? Review of General Psychology, 2(3), 300–319. https://doi.org/10.1037/1089-2680.2.3.300 Harris, P. B., & Caporella, C. A. (2014). An Intergenerational Choir Formed to Lessen Alzheimer’s Disease Stigma in College Students and Decrease the Social Isolation of People With Alzheimer’s Disease and Their Family Members: A Pilot Study. American Journal of Alzheimer’s Disease & Other Dementias®, 29(3), 270–281. https://doi.org/10.1177/1533317513517044 29 Hiyoshi-Taniguchi, K., Becker, C. B., & Kinoshita, A. (2018). What Behavioral and Psychological Symptoms of Dementia Affect Caregiver Burnout? Clinical Gerontologist, 41(3), 249–254. https://doi.org/10.1080/07317115.2017.1398797 Lee, S., Allison, T., O’Neill, D., Punch, P., Helitzer, E., & Moss, H. (2022). Integrative review of singing and music interventions for family carers of people living with dementia. Health Promotion International, 37(Supplement_1), i49–i61. https://doi.org/10.1093/heapro/daac024 Li, H.-C., Wang, H.-H., Chou, F.-H., & Chen, K.-M. (2015). The Effect of Music Therapy on Cognitive Functioning Among Older Adults: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 16(1), 71–77. https://doi.org/10.1016/j.jamda.2014.10.004 Mabire, J.-B., Bouaziz, N., de Malherbe, A., & Charras, K. (2023). Inclusive Choir for Persons Living with Dementia: A Qualitative Study. Activities, Adaptation & Aging, 47(4), 501– 518. https://doi.org/10.1080/01924788.2022.2151801 Mittelman, M. S., & Papayannopoulou, P. M. (2018). The Unforgettables: A chorus for people with dementia with their family members and friends. International Psychogeriatrics, 30(6), 779–789. https://doi.org/10.1017/S1041610217001867 Pearlin, L., Mullan, J., Semple, S., & Skaff, M. (1990). Caregiving and the Stress Process: An Overview of Concepts and Their Measures. Gerontologist, 30(5), 583–594. https://doi.org/10.1093/geront/30.5.583 Pentikäinen, E., Pitkäniemi, A., Siponkoski, S.-T., Jansson, M., Louhivuori, J., Johnson, J. K., Paajanen, T., & Särkämö, T. (2021). Beneficial effects of choir singing on cognition and 30 well-being of older adults: Evidence from a cross-sectional study. PloS One, 16(2), e0245666. https://doi.org/10.1371/journal.pone.0245666 Raglio, A., Fonte, C., Reani, P., Varalta, V., Bellandi, D., & Smania, N. (n.d.). Active Music Therapy for Persons With Dementia and Their Family Caregivers. Retrieved June 8, 2025, from https://remix.berklee.edu/mhi-music-dementia/77 Särkämö, T., Tervaniemi, M., & Huotilainen, M. (2013). Music perception and cognition: Development, neural basis, and rehabilitative use of music. WIREs Cognitive Science, 4(4), 441–451. https://doi.org/10.1002/wcs.1237 Skingley, A., Billam, D., Clarke, D., Hodges, R., Jobson, I., Jobson, R., Moore, J., VellaBurrows, T., Vickers, P., Walker, J., & West, H. (2021). Carers Create: Carer perspectives of a creative programme for people with dementia and their carers on the relationship within the (carer and cared-for) dyad. Dementia, 20(4), 1319–1335. https://doi.org/10.1177/1471301220933121 Stuart-Röhm, K., Clark, I., & Baker, F. A. (2023). Development of a person-centered caregiver singing model for formal caregivers of people living with dementia in South Africa. Geriatric Nursing, 53, 261–269. https://doi.org/10.1016/j.gerinurse.2023.08.004 Tamplin, J., Thompson, Z., Clark, I. N., Teggelove, K., & Baker, F. A. (2024). Remini-Sing RCT: Therapeutic Choir Participation for Community-Dwelling People with Dementia and Their Primary Caregivers. Journal of Music Therapy, 61(3), 263–287. https://doi.org/10.1093/jmt/thae008 The Gleeful Choir. (2025, March 17). Jewish Family Service of Utah. https://jfsutah.org/event/the-gleeful-choir/the-gleeful-choir-2/ 31 Thompson, Z., Tamplin, J., Clark, I., & Baker, F. (2023). Therapeutic Choirs for Families Living with Dementia: A Phenomenological Study. Activities, Adaptation & Aging, 47(1), 40– 74. https://doi.org/10.1080/01924788.2022.2056682 Unadkat, S., Camic, P. M., & Vella-Burrows, T. (2017). Understanding the Experience of Group Singing for Couples Where One Partner Has a Diagnosis of Dementia. The Gerontologist, 57(3), 469–478. https://doi.org/10.1093/geront/gnv698 World Health Organization (WHO). (2021). Dementia Fact Sheet. https://www.who.int/newsroom/fact-sheets/detail/dementia Young, A. E., Cornacchio Ph.D., R., & Hamon Ph.D., R. R. (2019). Sing for the Moment: A Choral Ensemble for Persons with Dementia and Their Care Partners: Program Profile. Journal of Intergenerational Relationships, 17(1), 110–117. https://doi.org/10.1080/15350770.2019.1551644 32 Appendices Appendix A - Observation Field Notes Observation Checklist/Field Notes Project Title: The Power of Group Singing in Enhancing the Well-being of Dementia Caregivers: A Program Evaluation of the Gleeful Choir Observer Name: Date: __________ Time: __________ Location: _________________ Session Number: __________ Caregiver Identifier Engagement Level (CG-#) Notes : (NE, MI, MoI, FE) Key: Emotional Response (S, N, S, J) Engagement Level (Not Engaged, Emotional Expression (Sad, Minimally Engaged, Moderately Engaged, Neutral, Smiling, Joyful) Fully Engaged) Social Interaction (N, P, P/F, G) Social Interaction (None, With Partner, With Partner & Facilitator, With Group/All) 33 Observation in the Rehearsal Setting General Description of the Setting Physical layout: access (physical and auditory, etc.) and barriers Feeling/atmosphere: do participants feel welcome and comfortable? Facilitator enthusiasm and responsiveness (does facilitator encourage participation?) Clarity of session structure (is the session well-paced and easy to follow?) Interactions (types of interaction among participants - joking, following directions, requesting help or information, assisting with tasks, statements, behaviors, etc.) Questions (ideas for questions to ask in semi-structured staff interviews to understand an insider’s view? Things to address in the next observation, initial impressions) (Kayser-Jones format) 34 Appendix B – Survey Caregiver Survey: The Gleeful Choir Program Evaluation Instructions: Please answer the following questions based on your experience in The Gleeful Choir. Some questions are on a scale from 1 (Strongly Disagree) to 5 (Strongly Agree), and others ask for your personal thoughts in writing. Thank you so much for sharing your valuable feedback! Part I: Caregiver Well-Being (Likert Scale Questions, please circle the number that best represents your experience.) 1. Participation in the choir is enjoyable for me. 1 - Strongly Disagree / 2 - Disagree / 3 - Neutral / 4 - Agree / 5 - Strongly Agree 2. The choir setting feels inclusive and welcoming. 1 - Strongly Disagree / 2 - Disagree / 3 Neutral / 4 - Agree / 5 - Strongly Agree 3. I feel a sense of connection with other choir members. 1 – Strongly Disagree / 2 – Disagree / 3 – Neutral / 4 – Agree / 5 – Strongly Agree 4. I feel supported by the choir staff. 1 - Strongly Disagree / 2 - Disagree / 3 - Neutral / 4 - Agree / 5 - Strongly Agree 5. Participating in the choir provides me with a sense of emotional uplift or joy. 1 - Strongly Disagree / 2 - Disagree / 3 - Neutral / 4 - Agree / 5 - Strongly Agree 6. Overall, I am satisfied with my experience in the choir program. 1 - Strongly Disagree / 2 Disagree / 3 - Neutral / 4 - Agree / 5 - Strongly Agree Part II: Open-Ended Questions 7. In what ways has participating in the Gleeful Choir affected your well-being as a caregiver? 8. Are there any challenges or difficulties in program participation? 9. Do you have any suggestions for improving the choir experience for caregivers and their family members? 10. Are there any other comments you would like to share? 35 Appendix C - Semi-Structured Interview Guide – Program Staff Semi-Structured Interview – Program Staff 1. Can you describe your role in The Gleeful Choir and how you interact with caregiver participants? 2. From your perspective, what do caregivers seem to gain from participating in the choir? 3. Are there any challenges you’ve noticed that caregivers face while participating in the choir? 4. What aspects of the program seem to resonate most with caregivers? (e.g., social connection, music, emotional expression) 5. Are there any parts of the program that you believe could be improved to better support caregivers? 6. Have you received any informal feedback from caregivers? If so, what kinds of things have they shared with you? 7. Is there anything else you’d like to share about caregivers’ experiences or how the program might evolve in the future? 36