Strengths, limitations and future directions
This research had several methodological strengths. Drop-out
and lost on follow-up rates were zero, with 100% of the
subjects in both groups providing data during two months.
Despite this strength, the research also had limitations that
affected its outcome. First, the sample was depended on the
researcher’s social network via snowballing sampling technique.
This could have created bias in the selection of the
sample, even though the sample was randomised after being
selected. Second, blinding of the participant to the intervention
was not possible as the participants were aware that they
were listening to music, and Hawthorne effect could not be
avoided, even though the researcher remained a distance
away from the participants during the intervention. Third,
length between the interventions was one week apart, and
thus, confounding variables could have set in during the week
and cause a change in the outcome variables. For example,
this study did not control the number of times the participant
can listen to music at home other than the intervention
session. They were only encouraged to listen to music at
home after the intervention session, but it was not made
compulsory. Therefore, the participant may listen to more
music on a particular week, which may result in a significant
difference from the baseline. Fourth, although results shown
that listening to music may act as an effective intervention to
allay depression levels in a group of older people, because of
small sample sizes, we could consider it as a preliminary
Table 2 Comparison of GDS-15 by groups again at eight weeks
Depression
Non-music (n = 26) Music (n = 24)
Mean (SD) Mean (SD) F (p-value)
GDS-15
Week 1 4Æ23 (2Æ89) 4Æ17 (3Æ14) 1Æ10 (0Æ427)
Week 2 3Æ96 (2Æ66) 3Æ63 (2Æ95) 0Æ22 (0Æ639)
Week 3 3Æ77 (3Æ37) 2Æ96 (2Æ39) 1Æ60 (0Æ213)
Week 4 4Æ31 (3Æ12) 1Æ88 (2Æ29) 8Æ57 (0Æ005**)
Week 5 4Æ04 (3Æ45) 1Æ92 (2Æ32) 3Æ02 (0Æ089)
Week 6 4Æ15 (3Æ74) 1Æ46 (1Æ79) 6Æ96 (0Æ012*)
Week 7 4Æ00 (3Æ29) 1Æ46 (1Æ84) 7Æ65 (0Æ008**)
Week 8 4Æ15 (3Æ53) 1Æ38 (1Æ84) 8Æ51 (0Æ006**)
Between-group
effect, F
(p-value)
6Æ31 (0Æ016*)§
Within-time
effect, F
(p-value)
1Æ00 (0Æ418)§
Interaction
effect, F
(p-value)
4Æ01 (0Æ001**)§
GDS-15, Geriatric Depression Scale.
Significant at *p < 0Æ05, **p < 0Æ01.
ANCOVA adjusted by age, gender, religious belief and habit.
ANCOVA at week 2 to week 8 adjusted by week 1 (baseline), age,
gender, habit, religious belief.
§
Repeated measures ANCOVA adjusted by week 1 (baseline), gender,
religious belief and habit.
0
12345678
1
2
3
4
5
Depression scores
Week
Non-music
Music
Figure 2 Comparison of depression between groups.
Original article Older adults listening to music
2011 Blackwell Publishing Ltd
Journal of Clinical Nursing, 21, 776–783 781
study and further study should proceed by recruiting more
subjects. Last but not the least, to be aware of the emotional
side effects that may occur in some of the older people after
listening to music, having a psychologist work with the
research nurse to handle this issue is suggested for future
studies.
Relevance to clinical practice
From this randomised controlled study, it is shown that
listening to music may act as an effective intervention to
reduce depression levels for a group of older adults.
Accumulative effects were confirmed on this two months
design; however, because of small sample sizes, we would
consider it as a pilot study. In practice, health-care
professionals can encourage older people to listen to music
as a self-care therapy that could enable them to reduce their
depression levels and develop a healing process in their daily
lives.
Acknowledgements
This study was funded by the Cross-Faculty Research Grant
of the National University of Singapore (CFG09P30).
Contributions
Study design: MFC, HO, NVT; data collection and analysis:
ZYW, MFC and manuscript preparation: MFC, ZYW, HO,
NVT.
Conflict of interest
The author(s) declare that they have no conflict of interests.