Worldwide, >55 million people are currently living with dementia, making dementia one of the leading causes of disability among older adults globally [1]. While many people living with dementia are aged ≥65 years, younger onset dementia can affect people of different ages. As well as difficulties with cognition, people living with dementia may experience a range of behavioral and psychological symptoms, such as agitation, anxiety, irritability, and depression [2]. These difficulties place considerable demands on family and other “informal” caregivers, who provide the majority of care for people with dementia living in the community [3]. Although informal caregivers frequently report that they need additional support and information [4], they are often reluctant, or lack knowledge, to fully use services [5], leaving many of them feeling burdened and experiencing depressive symptoms [6]. As a result, caregivers and people with dementia need accessible strategies to support their everyday care needs [7-10].

Music is a nonpharmacological tool that can provide numerous benefits for people with dementia [11-14]. Music therapy, where music is used as an intervention by a trained therapist, has long been shown to assist in managing symptoms of dementia, such as agitation and depression, and can support interpersonal connection between people with dementia and their caregivers [11,15-19]. While music therapy is a promising avenue for improving the lives of people with dementia and their caregivers, it may not be readily accessible for all people with dementia, particularly those who are less able to participate in activities outside of the home [20]. Caregiver training programs informed by music therapy, where caregivers are trained by music therapists in intentional uses of music, have received attention as a method of providing quality informal care [21]. While experiences informed by music therapy can strategically target specific care needs for people living with dementia, music activities not informed by therapeutic approaches can still be valuable for a range of purposes across the continuum from therapeutic to recreational experiences [11].

In the absence of a music therapist, recreational music experiences such as music listening or singing can also provide important everyday support for improving quality of life [11,22]. In the aged care setting, recreational music listening can provide people with dementia with enjoyment, relaxation, social connectedness, entertainment, and mood regulation [13,23]. Similar benefits of music use have been identified for older adults with dementia living at home, with music reducing agitation, improving cognition, and enhancing social well-being and connection [19,24]. However, much of the research on this topic has focused on identifying benefits gained from participating in organized music activities, such as community singing groups [18]. There has been less research investigating how informal caregivers use music and music technologies in everyday home-based care [25]. One exception, a study by Elliott et al [24], used a case study approach to examine the musical experiences of 3 people living with dementia and their caregivers, but it did not examine the technologies used to access music. As such, there remains a need for further research to understand the role of music in everyday dementia care as well as the role of technology in facilitating access to music for people with dementia and their caregivers.

While technology can support both therapeutic and recreational uses of music in dementia care, existing research has focused primarily on using technology to support recreational uses of music, primarily in formal care settings. Several technologies have been developed and trialed to support music listening and music-based activities for people living with dementia [26,27]. Researchers have designed and trialed technologies that aim to support music for dementia care by bringing enjoyment and social connection to people with dementia through both music and sound [28,29]; for example, Hodge et al [30] created a virtual reality environment of a concert experience, tailored for the specific interests of 1 person living with dementia.

Music-based technologies in the aged care context have been explored as a way to promote an enjoyable, active form of engagement with music that may facilitate connection and shared movement [31-33]. In another example, researchers created a musical interface that aimed to facilitate collaborative music making to foster partnership between aged care residents and professional caregivers [29]. Interactive approaches to designing for musical interaction for people living with dementia extend to mobile apps, which can facilitate collaborative music making [34]. In addition, music therapists use a range of technologies to engage their clients in communication, connection, and music making [35]. This suggests that music technologies have utility for recreational and therapeutic music experiences for people living with dementia; yet, their use by informal caregivers remains understudied. There are substantial differences between formal and informal care settings. Formal care often involves group activities, facilitated by trained caregivers. Conversely, informal care typically takes place in the private home, with family caregivers who may not have training in using specific care strategies in their care. While benefits shown in formal care settings likely apply across contexts, informal caregivers’ existing everyday care practices with mainstream technologies, without training or formal intervention, remain unclear. Furthermore, understanding everyday uses of music technologies in caregiving can help to identify what works well and where opportunities may lie for technology innovation.

In this paper, we aim to understand the role of music and music technologies in the everyday lives of people with dementia and their family caregivers. Here, we define music technologies broadly as technologies used to facilitate listening to (eg, music streaming services and CDs) or playing (eg, a piano app) music. We consider the potential of music technologies both for recreation and for managing the behavioral and psychological symptoms of dementia. Music is now often accessed through technologies such as streaming services, but there may be barriers to using these technologies in the complex environment of family-based dementia care. To create new technologies that support the use of music for people living with dementia at home, we must understand how music technologies are currently used in dementia care and what challenges these groups face in using music with current technologies.

This study used a mixed methods design with 2 phases. An initial survey with family caregivers and people with dementia aimed to investigate their use of music and technology. Survey participants were then invited to take part in a focus group study, which further discussed current practices with music and music technologies in dementia care. We aimed to understand how people with dementia and their family caregivers use music and music technologies as part of their everyday care practices. We further aimed to explore the perceived benefits of using music and music technologies, as well as the perceived challenges that caregivers and people living with dementia face in accessing music through technology.

All procedures were approved by the University of Melbourne Human Research Ethics Committee (2020-14155-13119-4). A plain language statement and consent form were shown at the beginning of the survey, and respondents had to provide consent before proceeding with the survey. Survey respondents could also indicate their interest in participating in focus groups for the main study. Participants who completed the survey were entered into a draw to win an iPad Mini. Survey respondents who were willing to participate in the focus groups were sent an electronic plain language statement and consent form indicating that they could be contacted via phone or email. Participants who provided consent were then contacted by a member of the research team who invited them to take part in web-based focus group discussions. During this contact, the researcher provided an overview of the study and an opportunity for participants to ask questions. Participants could attend the sessions alone or as a dyad (caregiver and person living with dementia attending together). All participants were offered a voucher worth Aus $30 (approximately US $23) for their time.

Survey responses were analyzed using descriptive statistics; we tabulated frequency data for responses to each question using Stata SE (version 16.1; StataCorp LLC). The audio recordings of the focus groups were transcribed by the researchers. We analyzed the transcripts using reflexive thematic analysis [39,40]. Consistent with the assumptions of thematic analysis, we adopted a constructionist approach, meaning that our interpretation considered the socially constructed meaning of participants’ experiences alongside our own interpretations [41]. The data were coded using an inductive approach. Researcher subjectivity is central to reflexive thematic analysis, which is typically led by a single coder [42]. This analysis was led by the first author, who has training in the fields of human-computer interaction and music psychology as well as experience conducting research with people living with dementia and their caregivers.

After familiarization with the transcripts, the first author generated initial codes and developed preliminary themes, which included 6 themes grouped under the category of benefits of music and technology and 5 themes grouped under the category of barriers to use. Initial themes were discussed among a subset of the authors with expertise in human-computer interaction. Initial themes were subsequently defined and named and further refined, using an iterative approach when outlining themes during the writing process. During this phase, several themes were removed, combined, or restructured based on discussions between authors and comments on draft iterations. When a full draft was complete, further discussion with the remaining authors (with expertise in music therapy), and reflection on the presentation of findings led to additional revisions. Discussions and comments led to further narrowing the focus and framing the findings around music technologies, acknowledging that music use is almost always facilitated by technology. These revisions led to the finalization of the themes presented here.

Using a mixed methods design, this study aimed to understand how people living with dementia and their family caregivers use music and music technologies in their everyday caring, as well as the challenges they experience using music technologies. In our survey, we found that the majority of participants living with dementia (9/13, 69%) and caregivers (47/63, 75%) use music often or very often in their daily lives, with music having been an important or meaningful part of their lives in the past. Consistent with prior work, participants reported using a range of methods and devices for accessing music, with high rates of use for music and video streaming services, as well as the use of more traditional music technologies such as CDs and radio [43]. Participants were interested in new ways of using music to support their care, with a willingness to try new music-based mobile apps, and considered a range of potential benefits such an app could provide. These findings, alongside previous work supporting the important role that music can play in the everyday lives of people living with dementia [24], suggest that new music technologies can be designed to complement and extend existing uses. New technology-based solutions, if designed appropriately to ensure ease of use and adding no further burden to caregivers, may provide valuable benefits for this group.

Through the focus groups, we found several perceived benefits of using music technologies, alongside the challenges that caregivers and people living with dementia face in using music and technology in these contexts. We found that people living with dementia and their caregivers use music for regulating mood, providing joy, and encouraging social connection, as well as to make caregiving easier, provide continuity, and promote reminiscence. These uses align with benefits identified in research evaluating music interventions with people living with dementia [11,23,25,28,31]; however, we additionally highlight how these benefits are demonstrated in everyday caregiving practices. We also identified barriers to using music technologies, predominantly due to participants with dementia having low self-efficacy with technology and challenges for both caregivers and people living with dementia in staying up to date with evolving technology. Here, we consider how future music technologies can be designed to capitalize on the existing uses of music technology among caregivers of people living with dementia and to empower caregivers to use music strategically and therapeutically at home [7].

People living with dementia and caregivers predominantly used music during everyday care for mood regulation, such as relaxation, to lift mood, and to provide joy. This extends prior research findings that caregivers and people living with dementia often use music for specific functions, such as relaxation or calming [23]; for example, Ingrid listened to music with her mother to manage behaviors such as late-day confusion and restlessness. In addition, participants spoke fondly of music’s ability to simply provide joy, echoing previous work where music and sound technologies have been shown to enrich the lives of people living with dementia and provide enjoyable moments at home [29]. This highlights the need for music technologies and interventions to consider the enjoyable and recreational aspects of music as well as its potential therapeutic benefits [11]. Importantly, digital technologies provide an avenue for these benefits to be translated to situations outside of the home, with Anita and Lucy suggesting that music could be a convenient and portable mood regulation tool.

The role of music and music technologies for supporting social connection, both within a care dyad and with others, was evidenced in our study and aligns with prior research [25,29,31-33]. Participating in music activities outside of the home fostered social connections for people living with dementia, as did music activities within residential aged care settings. Extending prior work, our findings show how everyday technologies were important to these interactions; for example, James discussed how mobile apps supported him and his partner in practicing their choir singing.

We found that caregivers and people living with dementia described existing relationships with music, outlining some continuity between experiences before and after the dementia diagnosis. Music technologies facilitated this continuity, enabling caregivers to encourage the use of familiar technologies, such as CDs and vinyl records, as well as personalized playlists. Music use was often associated with reminiscence, with people living with dementia reporting that they could sing along to old favorites, even if they experienced challenges with memory or other forms of verbal communication. Consistent with the idea of the “reminiscence bump,” where individuals tend to favor the music of their youth [44-46], many people living with dementia preferred older styles of music. Existing relationships with music were also connected with collections of vinyl records, CDs, and favorite radio stations, with our findings also illustrating the importance of radio for older adults during everyday care [47,48].

Finally, consistent with previous work [25,49], music technologies were important for making caregiving easier, such as accessing music to fill time or silence. We extend these findings, showing that modern music technologies, such as wireless speakers, enabled music to be played for the person living with dementia not only by the primary carer but also by others in the broader care network, such as visiting caregivers, with minimal setup. This enhanced everyday care for our participants.

While previous research has identified the uses of music in residential aged care settings [13,23] and designed tools for music listening, sound, and music activities in dementia care [27-30,33,34], there has been limited research investigating the everyday uses of music technologies in care practices by family caregivers of people living with dementia. To date, no research has clearly identified opportunities for music technologies to play a role in the therapeutic use of music at home. Building on our findings, ensuring the ease of use of music technologies is likely crucial for engaging caregivers and people living with dementia in music use, both for its therapeutic benefits and for recreational uses of music. This is especially pertinent given that the major barriers to music technology use in everyday care included difficulties with self-efficacy around technology use and challenges staying up to date with evolving technology. Previous research has established the importance of digital literacy and self-efficacy in technology use among older adults [50], indicating that this is an important consideration when designing technologies for people living with dementia. Therefore, if caregivers and people living with dementia are not confident using existing technologies to support music use, co-designing new technologies that capitalize on the everyday ways in which these groups use music technologies should be a priority.

Our findings suggest several design opportunities for future technologies. New technologies should be designed to align with how music is used to regulate mood and capitalize on the ways in which music technologies can be used as a portable emotion regulation tool. Music technologies can also be used to foster social interaction between people living with dementia and their caregivers, with videoconferencing tools and apps designed to support web-based music activities, such as choirs and dancing. In addition, in designing music technologies for people living with dementia and their caregivers, access to personally preferred music is crucial. Often, this may be from the reminiscence bump (ie, music from a person’s youth); however, music taste should not be assumed nor limited to older styles. These considerations for music selection and the affordances of personalized playlist creation highlight the benefits that streaming platforms might have over physical music collections, as long as they are easy to access for both people living with dementia and caregivers. One way this could be achieved is through playlists configured to play on a smart speaker with an easy-to-remember prompt that activates the desired playlist. Research has shown that voice interaction devices such as smart speakers (eg, Amazon Alexa and Google Home) have accessibility advantages over screen-based technologies for some users [51-54]. Music technologies can also be designed to make it easy for caregivers to play recorded music and use music in intentional ways to relieve pressure in family caregivers [6]. This could extend to co-designing new music technologies that train caregivers to use music therapeutically in their everyday care [7,55]. Focusing on such factors and ensuring that people living with dementia and their caregivers are comfortable using such technologies is a crucial first step to supporting the use of music technologies in care.

This is the first study to our knowledge that provides an in-depth understanding of how caregivers and people living with dementia use music and music technologies in their everyday caregiving practices, outside the context of a formal intervention. Understanding these everyday uses of music technologies in caregiving highlights opportunities for new technological innovation. We intend to use these findings to inform the design of future music-based technologies for this setting, capitalizing on these existing uses of music technologies. A further strength of this study was the involvement of both caregivers and people living with dementia in our survey and focus groups, recognizing the importance of understanding the perspectives of both groups.

One limitation of this study was that due to the COVID-19 pandemic at the time of recruitment, the complexity of this care setting, and the aim to recruit participants across Australia, recruitment and data collection took place entirely on the web. As such, our sample may not be representative of people living with dementia and caregivers with less technology experience. Future research may consider recruiting participants with a more diverse experience with digital technologies. Furthermore, our findings may not be generalizable outside of the Australian context.

Informal caregivers of people with dementia report that they need additional support and information [4]; yet, they are often reluctant, or lack knowledge, to fully use services [5]; in addition, many family caregivers experience high levels of stress and burden [6]. As a result, caregivers and people living with dementia need accessible, everyday strategies to draw on to support their needs, and technologically supported music use is a key avenue for future research [7,9,27]. This study draws attention to the ways in which these groups already use music technologies to support their needs, outside the context of organized activities or targeted music interventions. Caregivers and people living with dementia believe that music technologies may be a useful way to access music for regulating mood, providing joy, encouraging social connection, providing continuity, promoting reminiscence, and making caregiving easier. The technologies used to play music are diverse across users, and people living with dementia and their caregivers face barriers to using new digital music technologies, despite their acknowledged advantages over more familiar technologies. These findings will contribute to understanding how new music technologies and interventions may complement existing practices. There is a clear opportunity to design technologies to capitalize on existing music use in these groups to enable easier access to specific music activities to support people living with dementia with recreational and therapeutic music listening as well as music-based activities.