Exploration of the effectiveness and transferability of an English model of health promotion based on participation in singing groups for older adults (Silver Song Clubs) in Italy

Background
There is growing interest in the idea that arts and singing have effects on health, wellbeing and quality of life in older individuals. This study assesses the effectiveness and transferability to Italy of an English model of health promotion which promotes wellbeing and quality of life in older people through participation in singing groups (Silver Song Clubs). The model developed in the South East of England has proved to be successful. A recently completed randomized controlled trial (Coulton, et al. in press) demonstrated a significant improvement in mental health with a reduction in measured anxiety and depression for older people living independently. The current study adopted the same measures.

Method
A mixed method approach was adopted with research divided into two parts; Part A was focused on exploring the status of older people living in Rome, their interest in music and singing today and in the past and in taking part in a singing experience. It also explored how local politicians and social workers see the status of older people. Part B was focused on setting up and evaluating singing groups and gathering information from participants on their experiences of singing. The primary outcome measure was an Italian version of the York SF-12 which provides scores for physical and mental wellbeing. The Italian version of the EQ-5D-3L questionnaire was also employed.

Results
Results from Part A revealed a highly fragmented Italian family, with widespread poverty and social isolation and a need for emotional support and leisure activities among older people. In Part B, three singing groups were established in different areas of Rome with weekly sessions over a period of three months. Participants completed the standardized measures of health and wellbeing at baseline (n=62), after the singing experience (n=45) and three months later (n=41). After the singing experience, older people showed a statistically significant decrease in their levels of anxiety and depression, but this was not maintained over the three month follow up period. However, a significant improvement was found from baseline to follow up in reported performance of „usual activities‟.

Conclusions
Silver Song Clubs provide a health promotion model which was successfully transferred from England to the different cultural setting of Italy. Singing can be widely used because it is grounded in a fundamental human ability to engage with music. The present study had a number of limitations, primarily a lack of a control group and small sample size. However it provides a good foundation for the development of further research on singing and the wellbeing of older people in Italy.