A Qualitative Pilot Study of Adolescents’ Characteristics and Experiences Delivering a Digital, Intergenerational Music Program to Older Adults with Alzheimer’s and Dementia

Abstract

Music interventions show promise to support critical areas of decline for those living with dementia. There is a gap in identifying the skills and experiences necessary to facilitate the music activities in such an intervention. This pilot research creates an understanding of the characteristics and experiences of adolescent musicians who facilitated a digital, intergenerational music intervention. The research team conducted in-depth interviews with the adolescent participants and used descriptive phenomenological methodology.

Eight adolescent musicians participated in the study, ranging from 14 to 18 years old. For characteristics, adolescents reported prior experience in music and key social supports. For experiences, adolescents reported decreased performance anxiety and increase in human connection and understanding of Alzheimer’s disease and dementia.

There is potential for researchers to explore if adolescents who facilitate such a music intervention experience less performance anxiety as well as more empathy for those living with dementia.

Introduction

Worldwide, 55 million people are living with dementia. By 2050, that number is expected to rise to 139 million people (WHO, 2021). Alzheimer’s disease and Alzheimer’s disease-related dementias (AD+ADRD) have a devastating impact on the lives of older adults, including negatively impacting their cognitive (Hugo & Ganguli, 2014), emotional (Caselli et al., 2018), and social well-being (Kane & Cook, 2013).

Music is a non-pharmacological intervention that has demonstrated positive effects for adults with AD+ADRD, suggesting support for their cognitive function, emotional well-being, and social connection (Biasutti & Mangiacotti, 2018; Clare et al., 2019; Hall et al., 2009; Mendoza Laiz et al., 2018). Researchers of a recent systematic review (Dorris et al., 2021) reported that actively participating in music supported cognitive function for adults with AD+ADRD. As the research around music interventions gains clarity, a potent area for investigation is the music facilitators, who deliver the music content.

Evidence has shown a diversity of experience within facilitators of music interventions, including music therapists, performers, and health professionals (Dorris et al., 2021; Waters et al., 2022). Understanding who can facilitate a music intervention is crucial to translating music interventions into the community to serve the rapidly growing population of adults with AD+ADRD.

Intergenerational Programs

Intergenerational programs, activities which serve multiple generations, have been shown to promote cross-generational comfort (Belgrave & Keown, 2018) and positively influence children’s perception of older adults (Gualano et al., 2018). Additionally, researchers have shown participating in intergenerational programming has positively influenced older adults’ perceived quality of life and social connection (de Vries, 2011). Intergenerational music programs have utilized a variety of designs, ranging from pairing preschool children with adults with AD+ADRD (Newman & Ward, 1992), pairing pre-adolescents with both older adults and adults with AD+ADRD (Belgrave & Keown, 2018), and pairing college students with both older adults and those living with AD+ADRD (Ballantyne & Baker, 2013; Harris & Caporella, 2014; Wlodarczyk, 2019). A gap exists to better understand how adolescents and older adults with AD+ADRD interact.

Researchers have begun examining if the younger generation can facilitate music interventions to the older generation (Gerritzen et al., 2020). Adolescents are a promising population to explore as potential music intervention facilitators, as they may benefit from music in terms of their emotional well-being (Stewart et al., 2019), self-esteem (Mak & Fancourt, 2019), and identity (Campbell et al., 2007). There is a gap in the evidence exploring the characteristics and experiences of adolescents who deliver a music intervention to adults with AD+ADRD. It’s important to understand adolescents’ characteristics to clarify the qualities of future adolescent musicians who may be facilitators of future music interventions. Understanding experiences can help elucidate if such an intervention could have benefits for both generations, and if the experiences of the young musicians may be similar or different to benefits previously found for older adult participants. Such findings could enable future researchers to identify young participants and empower those running community programming to understand the scalability of the program to reach the growing population of adults with AD+ADRD.

Additionally, it’s imperative to understand the experiences of the adolescents in delivering such a program. This understanding would help researchers iteratively improve the program and training and elucidate potential outcomes that support adolescents in a vulnerable time in their development (Centers for Disease Control and Prevention, 2021).

Our qualitative research question, utilizing the SPIDER tool (Cooke et al., 2012), is “What are the characteristics and experiences of adolescent musicians regarding the delivery of a digital, intergenerational music-making program to adults with AD+ADRD?” Our design to answer this question was to complete in-depth interviews with the adolescent musicians about their personality characteristics (conducted prior to the study, to clarify qualities of adolescents who may be potential facilitators) and their experiences delivering the music program (conducted after the study, to explore for future outcomes). We conducted conventional content analysis. We utilized the Standards for Reporting Qualitative Research (SRQR), a 21-item checklist that defines standards for reporting on qualitative research (O’Brien et al., 2014).

Methods

Program and Theory

Project Unmute is an intergenerational music-making intervention that utilizes the learning theory of Social Constructivism (Vygotsky, 1987) to promote shared music learning, discussion, and participation between the adolescent musicians, the older adults and their caregivers, and the research team and community partner staff. Project Unmute’s activities are explicated in Figure 1; they promote interactive engagement in music between generations. Each session took place live via Zoom, and featured the following activities: 1) The adolescents performed a favorite song of the older adults live on their instrument; 2) The adolescents discussed a musical concept from the song with the older adults; 3) The adolescents facilitated an interactive activity in which both generations engaged in the music together. These activities are inclusive for a range of people living with dementia and utilize activities that do not require prior music experience.. After being developed iteratively with stakeholders (Dorris, Chang, et al., 2022; Dorris, DiCicco, et al., 2022; Dorris, Terhorst, et al., 2022), the training structure and ingredients were finalized. The training structure included training in the music intervention, information about communicating with adults with AD+ADRD, and guidance from Music Mentors with whom adolescents practiced their individual music programs. Then, adolescent musicians performed three 30-minute music programs for small groups of adults with AD+ADRD and their caregivers over Zoom. Table 1 shows the intervention’s properties.

Figure 1.

Ingredients of Project Unmute.

Table 1.

Intervention properties

Activities	Setting	Duration	Facilitator	Older adults	Support personnel
Music Appreciation Musical Concept Interaction	Zoom; live	60 minutes	2 adolescent musicians (presenting 30 minutes each)	2–8 older adults	Community partner staff and research team

Qualitative Approach and Research Paradigm

This qualitative pilot study used a descriptive phenomenological methodology (Korstjens & Moser, 2017) to explore the characteristics and perceptions of the adolescents providing the music program. This methodology was chosen to promote in-depth insights to real-world situations (Moser & Korstjens, 2017). We utilized a constructivist paradigm, recognizing that there are multiple interpretations of reality, with a goal of understanding how the adolescent musicians construct the reality of their experiences as musicians and in the training and delivery of a digital intergenerational music-making program to adults with AD+ADRD (Moser & Korstjens, 2017).

Researcher Characteristics and Reflexivity

The PI (JD) led the study at the University of Pittsburgh and has a a background as a classical musician. She has designed music programs for adults with AD+ADRD and music programs for adolescents. The PI consented the adolescent participants, conducted the interviews, and served as a Music Mentor. To discourage bias from socially desirable responses (Paulhus, 2002), she educated the adolescent musicians on their role in the research to encourage honest and constructive feedback, rather than giving feedback they may imagine she would want to hear.

Context

The study’s data collection and intervention sessions took place using the digital platform of Zoom (Zoom Video Communications, Inc.2022). In response to the COVID-19 pandemic, many community programs serving older adults switched to virtual platforms to continue providing programming in a safe manner. The research team partnered with Dementia360, a western-Pennsylvania-based community organization serving adults with AD+ADRD and their caregivers. Dementia360 provided an existing Zoom link that had been utilized by their clients to access programming throughout the pandemic. The research team supported the digital programming by offering technical training to the adolescent musicians to ensure they had the highest possible quality of performance sound and utilized the unique features of Zoom’s platform to share the musical activities.

Sampling Strategy

We used criterion sampling to ensure we captured the experiences of adolescent musicians who had the shared experience of delivering the phenomenon under study, the digital, intergenerational music-making program (Moser & Korstjens, 2018). As an exploratory pilot study, we sought to increase the potential for generalization by seeking adolescents that varied in their characteristics (age, race, gender) and individual music backgrounds (number of years of music education, number of instruments played).

The research team enrolled eight adolescent musicians, guided by the framework of typical sample sizes for phenomenological studies (Moser & Korstjens, 2018; Starks & Brown Trinidad, 2007). This sample size was also guided by the rigorous assessment offered by Guest et al., in which the research team found that six to seven interviews captured the majority of themes for thematic analysis (Guest et al., 2020).

Ethical Issues Pertaining to Human Subjects

This study received Institutional Review Board (IRB) approval from the University of Pittsburgh, 20080152. The consent process was verbal and took place in the month prior to study activities. Consent from guardians and assent from adolescent musicians was obtained. Older adult participants were consented separately.

Data Collection Methods

Data were collected through in-depth interviews to provide detailed descriptions of adolescent musicians’ characteristics and experiences (Korstjens & Moser, 2017). Interviews have been suggested as the appropriate method of data collection for a phenomenological design (Starks & Brown Trinidad, 2007) due to their ability to closely capture the individual experience. Interviews were semi-structured, to leave room for probing questions to stay close to the lived experience (Starks & Brown Trinidad, 2007). Two interviews were conducted. Figure 2 explicates the study flow. The first interview happened after the consent process and prior to the intervention training and delivery. This interview was to determine the adolescents’ characteristics, or who they perceived themselves to be prior to the intervention. The second interview was scheduled following the last intervention delivery. This interview was to determine adolescent experiences that occurred during their facilitation of the three music sessions with the older adults. We estimated that each interview would take 60 minutes; adolescents were informed of the two-hour time request for interviews during the consent process.

Figure 2.

Study design

Data Collection Instruments and Technologies

A description of the interview guide, including questions for the characteristics interview and the experiences interview, is included. This interview guide was developed iteratively during intervention development, including feedback from adolescent musicians (Dorris, Chang, et al., 2022; Dorris, DiCicco, et al., 2022). Each session was recorded on Zoom. See Appendix A.

Units of Study

The units under study were adolescent musicians’ characteristics, their potential learning, and their reflections on the training and delivery of the intervention (Starks & Brown Trinidad, 2007). Each of the eight adolescent musicians were offered two in-depth interviews, one to reflect on their characteristics and one to reflect on their experiences with the training and implementation of the digital music program.

Data Processing

The research team utilized Zoom’s transcription services and listened to each interview to clean the formatting and correct any automated errors from the transcription. The interviews yielded 83 single-spaced pages. During this process, they de-identified any recognizable information from the transcripts. Transcripts were uploaded to NVivo, a qualitative data analysis software (QSR International Pty Ltd, 2020).

Data Analysis

Because the aim was to describe a phenomenon and there was limited literature on the experience of adolescents delivering a digital, intergenerational music-making program, the research team followed a conventional content analysis approach (Hsieh & Shannon, 2005). This analytic approach helped researchers identify categories and patterns in the transcribed data (Hsieh & Shannon, 2005). Conventional content analysis aligned with the research team’s goal of developing a concept of the characteristics and experiences of adolescents when delivering a music program (Hsieh & Shannon, 2005).

The research team used an iterative process to code the interviews. They listened to the digital recordings of the interview and identified coded keywords. Then, the codes were evaluated and categorized. Themes were selected based on combining and grouping codes. The research team determined if larger categories were needed to create a hierarchy among related themes. Two researchers (JD and KR) independently coded 20% of the transcripts, (n = 6, 25 pages). They discussed the codes and themes until consensus was met. One researcher (JD) continued coding the remainder of the transcripts. Using memos, she did not note new themes, suggesting that data saturation was reached. The two researchers (JD and KR) critically examined the themes and recharacterized them to illustrate the relationships between the themes. They both agreed that no new themes emerged from the data.

Techniques to Enhance Trustworthiness

For credibility, the research team shared thematic findings from the analysis with five of the eight adolescent musicians for confirmation. For transferability, the researchers provided rich descriptions of the characteristics of the adolescent musicians and their experiences with the different aspects of the digital, intergenerational music-making program. For dependability and confirmability, the research team kept an audit trail by documenting the research steps taken from the start of the research project to the development and reporting of the findings (Starks & Brown Trinidad, 2007).

Results

The research team worked with music teachers at an independent college preparatory school in the Northeast to recruit adolescent musicians. Together, they screened 49 adolescent musicians. 14 musicians did not want to participate. Of the remaining 35 willing adolescent musicians, the music teachers worked with the research team to aid in purposeful sampling between age, race, gender, and music experiences, screening out an additional 26 students for this purpose. One adolescent completed the consent process but was removed after, as they did not meet the age requirement. Eight adolescents enrolled in the study and participated until its completion. See Table 1. Intervention sessions took place over a four-month time period. Themes and sub-themes are summarized in Table 2 & 3.

Table 2.

Demographic characteristics of the sample (n=8).

Variable	n (%)
Gender
Male	5 (62.5)
Female	3 (37.5)
Age
14	2 (25.0)
15	2 (25.0)
17	3 (37.5)
18	1 (12.5)
Race/ethnicity
White	2 (25.0)
Hispanic or Latino/White	1 (12.5)
Asian/White	1 (12.5)
Asian	2 (25.0)
Black or African American	2 (25.0)
Parents’ education
Bachelor’s	2 (25.0)
Masters	4 (50.0)
PhD or MD	2 (25.0)
English learned as first language
Yes	5 (62.5)
Yes, with another language	1 (12.5)
No	2 (25.0)
Instrument
Bass	1 (12.5)
Cello	1 (12.5)
Clarinet	1 (12.5)
French horn	1 (12.5)
Harp	1 (12.5)
Piano/Saxophone	1 (12.5)
Violin	2 (25.0)
Length of musical training
10 years or more	5 (62.5)
5–9 years	3 (37.5)

Table 3.

Themes and subthemes

Themes and subthemes
Characteristics
Relationship to music Creatives Developing responsibility and maturity Value others
Experiences
New opportunity in music Don’t have to play perfectly Learning music’s impact
Human connection Creating new awareness of Alzheimer’s and dementia
Structure led to stress-free environment

Characteristics

The research team asked adolescent musicians about their characteristics one month prior to intervention sessions beginning. The interviews ranged from nine to 24 minutes, with a mean and standard deviation of 13.13(4.91) minutes. The characteristics interviews, added together, summed 34 pages, single-spaced, in Word. Four major themes emerged:

Theme 1. Relationship to music

Adolescents described a positive relationship to music. They spoke about their ‘strong connection to music’ (101), saying “I’ve never found music gets boring” (103) and “I’ve always loved music, since a very young age.” (105) They also explored how music functions in their lives, including as a means of expression and of escape from their daily lives:

“For me the harp it’s like an escape or I always find myself, if I have like a ton of homework, I’ll put it down and walk in and play the harp and come back, it’s kind of like my own personal little thing that I have.” (108)

Theme 2. Creatives

The adolescent musicians identified with being creative, participating in creative activities, and the importance of creativity. One adolescent described doing sculpture and journaling, another adolescent enjoyed design and collage, and a third did crocheting and knitting in their free time. Multiple adolescent musicians discussed that they found being creative to be an important skill: “….in English and even math or other subjects being creative, I think, is really helpful and can really motivate you to think about things differently.” (104)

Theme 3. Developing Responsibility and Maturity

Adolescent musicians discussed having strong support systems in their lives that offered them the opportunity to grow more responsible. Most of the adolescents commented on their school’s role in supporting their growing maturity:

“With boarding school that was the biggest like, switch from being cared for to caring for yourself. I guess, when it first started, I was like skipping meals and on my phone a little bit too much. But yeah, gradually it did come more naturally but I definitely had to, like, switch a gear in my brain to be able to do that.” (107)

Adolescent musicians discussed the support from their families for introducing them to music and providing the resources to participate. One adolescent had no interest in music until their mother began playing classical music in the car and signed them up for violin. (103) Several watched their older brothers and sisters play instruments: “I’d watch through the little windows, him playing the piano, and I always wanted to try myself because if he’s doing it, I can I do it.” (108)

Theme 4. Value Others

The adolescents emphasized that they related keenly to others, particularly those who are different than them:

“If someone is different from me, then obviously I won’t have the same experiences as them, so being able to learn from those experiences and kind of take from those thoughts of other people, like, kind of allows me to grow as a person myself.” (109)

The adolescent musicians also cited that connecting with others was a motivating factor in participating in the research project:

“Well, I was really excited about, like, the prospect of using my French Horn in a different way. Because I’ve never really, like, played music, for reasons other than just, like, my own enjoyment or orchestra or something like that, so I think it’s exciting to try to see where else it could take me in the future, and now.” (102)

Experiences

Within a month after each adolescent musician completed their delivery of the intervention, they did an interview with a research team member to discuss their experiences. The interviews ranged from 10 to 48 minutes, with a mean and standard deviation of 21.75(11.81) minutes. The experiences interviews, added together, summed 49 pages, single-spaced. Three major themes, two of which had subthemes, emerged:

Theme 1. New Opportunity in Music

The adolescent musicians explained what new music opportunities the program offered them outside of their existing musical training:

“I feel like I learned a lot about what I, like, think about when I listen to music and a lot of times it’s not like, the dynamics or anything, and it’s just, like, how I feel when I hear the song. I’ve been listening to the songs that I’ve played, like, over and over again since then.” (102)

Don’t Have to Play Perfectly.

The adolescent musicians described their nerves during traditional performances and made sense of how the experience affected their perfectionism toward playing. Several adolescents cited that performing in Project Unmute helped ease their musical performance anxiety:

“…. every single time I have a recital of something like the stage fright and the anxiety, it always circles back right before I’m performing. But after my first performance, like for my second, third performance, I didn’t have any stage fright at all or wasn’t scared at all.” (103)

Learning Music’s Impact.

Adolescent musicians recounted the importance of seeing music creating an effect on their audience, recalling times that older adults moved to the music, showed excitement, and smiled: “It’s just the power of music in general. Like, the way how music can cheer people up.” (105)

Improvise.

The adolescent musicians explored improvisation while delivering the intervention. Multiple adolescents talked about their prior need to use a script during presentations or play only from sheet music. One said by their final performance they only needed an outline of four words to guide them through their discussion, and another felt comfortable improvising on the music itself. Often, these improvisations would come as they discussed the music with the older adults:

“…. a lot of the time I was just pulling, like I would play the piece itself, and then, when I actually, like, was talking through the music presentation I would just pull random pieces from the top of my head and it would be, like, yeah, I would have either, like, not have them memorized or not played it for a couple years or just learned it by ear or something like that.” (107)

Theme 2. Human Connection

Many of the adolescent musicians described the connection they felt to the adults with AD+ADRD while they performed the intervention, saying they ‘had a lot of fun hanging out with them’ (101) and ‘it definitely felt pretty comfortable, like, lots of people were involved. Like you could see that they were engaged in whatever I was saying, which was nice.’ (102)

Adolescent musicians also noted that it was during the interactive components of the intervention that they perceived the most connection:

“I guess I really enjoyed the interactions I had with them and I guess just being able to break through some of that just to really get to see them where they are. I think, like the engagement parts of the meetings, performances were really helpful with that, kind of getting them involved with the creation of music. It was mostly those parts that I thought I could really talk to them.” (104)

Creating New Awareness of Alzheimer’s and Dementia.

In addition, the adolescent musicians described how the experience broke preconceived notions or built new awareness of people living with AD+ADRD. Many mentioned having an idea that the older adults would not be responsive to them and being surprised at the level of interaction. One adolescent, whose grandfather had Alzheimer’s disease, saw the difficult effects in their family first-hand. Their experiences in the program added nuance to the experience; they noted that it was meaningful that older adults who weren’t verbally communicating would begin moving as they played their instrument. Another adolescent, whose grandmother had Alzheimer’s, said at the beginning of the project that they had limited memories of interacting with their grandmother when they were younger. After performing, they noted increased confidence in their knowledge and interactions

“I definitely feel more comfortable, just like interacting and like talking with older adults with Alzheimer’s. I feel like being able to interact with them and talk about certain things that, you know, I’m interested in, and they’re interested in, too, I thought that was super cool and super interesting.” (109)

Theme 3. Structure Led to Stress-Free Environment

The adolescent musicians discussed the effects of the structure of the program, including the training and the ability to perform the program repeatedly. In Figure 3, researchers have created a visual representation of the four main components of the intervention, including the intervention training, the dementia training, the Music Mentor sessions, and the repeated performances. Adolescent musicians attributed this combination of factors to creating a stress-free environment:

Figure 3.

Structure of Unmute training and intervention components

“…In terms of, like, the amount of hours I had to put in, it was, like, very few in a good way in terms of it wasn’t stressful and it wasn’t some added stress in my life, it was literally just like this very fun experience that I’m getting to be a part of.” (101)

Discussion

This study presents a digital, intergenerational music-making program delivered by adolescent musicians to adults with AD+ADRD. In this study, we trained the adolescent musicians in the intervention, and they performed three 30-minute music interventions for the older adults. Our findings suggest that participating in an interactive, intergenerational music program supported adolescents with their performance anxiety, enabled them to think on their feet, and fostered new understandings and connections with an older generation. Music is a safe, engaging modality that engages multiple areas of the brain at once for all ages (Alluri et al., 2012; Schlaug, 2015). Knowing that music interventions can provide emotional and cognitive benefits to older adults(Dorris et al., 2021), these findings build an understanding of what the benefits may look like for the young facilitators of these interventions.

New Opportunity in Music may Provide Mental Health Benefits to Adolescents

Adolescent musicians enumerated the new opportunities in music they experienced as a result of delivering the intervention, many of which centered on their own well-being. This study adds to the current evidence base in identifying mental health benefits for adolescents participating in an intergenerational music program. Prior intergenerational researchers have explored college students’ perceived effects of heightened performance experience (Conway & Hodgman, 2008) and positive perceptions of facilitating music sessions (Ballantyne & Baker, 2013). Our study initiates an understanding of the adolescent experience, as these musicians reported the program does not add stress to their lives and suggested it aids in performance anxiety and their ability to improvise both musically and verbally.

This clarifies three important points: 1) For the adolescents to feel at ease delivering the protocol, it is critical to continue offering the multi-pronged intervention training structure to support them. This builds on previous evidence elucidating best practices in intergenerational programming, which suggests the importance of facilitator training and structure (Baker et al., 2018; Jarrott et al., 2021). However, researchers should consider that these adolescent musicians indicated strong support systems in their school and family lives, which may provide additional confidence in delivering the program. To better understand the breadth of adolescents who can deliver the intervention without stress, future research can explore if adolescents with less support at school and home may need additional resources. 2) Adolescent musicians asserted that participating in this program reduced their musical performance anxiety. This is important, because researchers have shown that musical training can increase musical performance anxiety, which in turn has an effect on anxiety, negative emotions, and belief in self-efficacy (Jeong & Ryan, 2022). Future researchers could study the specific outcome of performance anxiety in adolescents to understand if this type of program delivery could benefit their perceptions of performance. 3) The adolescent musicians described the different ways they were able to improvise during their performances, both in terms of playing music and in verbally delivering the presentation. It is important to understand if the adolescent musicians’ ability to think on their feet may be supporting their resilience. Previous studies have shown participation in music to increase resilience in children, which can be critical in supporting long-term mental health (Nijs & Nicolaou, 2021).

Human Connection and Generational Awareness

This study is consistent with previous studies that elucidate the benefits of generational awareness on children who participate in intergenerational programming (Belgrave & Keown, 2018; de Vries, 2011; Gualano et al., 2018). This adds to the evidence in creating a unique understanding of the experiences of adolescents who have facilitated the intergenerational program. The adolescent musicians reported that they felt increased human connection and developed a new awareness of people different than them. Additionally, they described the importance of witnessing music’s impact on the older generation as they performed for them.

This suggests that future researchers could explore the outcomes of empathy and prosocial behaviors in adolescents who facilitate similar intergenerational protocols. This builds on previous research that suggests music training can increase levels of empathy (Wu & Lu, 2021). Future pilot studies may explore attitudinal change pre- and post- intervention for adolescent musicians. These adolescents did self-identify as people who ‘valued others’ in their pre-intervention interviews; those recruiting future adolescents could test if this characteristic is needed to produce a change in empathy.

There are limitations to this study. This is a small, exploratory pilot study, and the sample size (n = 8) creates limitations for generalizability. Additionally, the adolescent musicians were recruited from the same school, limiting the generalizability of the results. The research team strived to provide descriptions of the sample and recruited for diversity of age, gender, race/ethnicity, and music experience. However, future research will benefit from understanding the characteristics and experiences of a larger, more diverse sample of adolescents. Though the adolescent musicians were told about the research process, it does not necessarily eliminate bias from socially desirable responses, in which the adolescent musicians repressed their own opinions to respond in a way they thought the research team desired. We acknowledge that several of the adolescent interviews took a shorter amount of time than expected. Though some of the adolescents opted for brevity, they all answered each question fully and were given opportunities for reflection. In future studies, we will alert adolescents of a range of time to save for interviews to better reflect these data.

Conclusion

This research demonstrates that participating in delivering a digital, intergenerational music-making program may benefit adolescent musicians in multiple ways, including supporting their mental health and promoting empathy for an older generation. As mental health concerns grow for adolescents, participating in such a program may provide critical support during this vulnerable time in their development. Further, the adolescents described the importance of connecting with the older generation. With cases of AD+ADRD rapidly increasing, these young musicians may be able to provide a scalable support for the growing population of older adults living with the effects of AD+ADRD.

Contribution to the Field:

• Demonstrates the potential that facilitating an intergenerational music intervention can have positive effects on adolescents’ music skills and social well-being, informing future pilot studies.

• Provides an understanding about the promise of adolescent musicians to facilitate an intergenerational music intervention for adults living with dementia, suggesting mutual benefits and scalability of this intergenerational design.

• Describes the characteristics of the adolescent musicians, informing future research studies and community programs of the qualities of adolescents for recruitment.

Appendix A: Interview Guide

Characteristics

1. Tell me about what motivated you to participate in this music program.

   1. Will this project be applicable toward service hours you may need for school, scholarships, or another organization?
2. What drew you to music?

   1. Prompt: Did you listen to music at home at a young age, know someone who played an instrument?
3. What motivates you to be in music right now?

   1. Do you feel motivated by yourself, such as that you love to play/have particular music that you play that you feel connected to? Or are you motivated when people in your life, such as your parents or teachers, encourage you to play?
4. What do you think would make you a better musician?

   1. Do you want to get better at your instrument, understand more about music theory, know more about music history? Learn techniques like composition or improvisation?

5. Describe all the ways you have learned or been taught music

6. Describe what practicing your instrument looks like, including how often you do so

7. How would you react to something not going as planned? How would you feel?

8. How important is being creative to your overall and day-to-day life?

   1. How does creativity manifest in your life? What does that look like for you?

9. Would you describe yourself as an introvert, an extrovert, or a combination of the two?

10. What does responsibility look like in your day-to-day life?

    1. When do you have to be responsible? Does it come naturally to you?
11. How does it make you feel to engage with people who are different than you in certain ways?

    1. For example, if they were different in terms of abilities, their background, the way they live their lives?
12. How would you describe your ability to focus on different musical activities?

    1. When are you the most engaged or the most focused?
    2. Are there any things that help you focus?
    3. About how long do you stay focused –for example, 15, 20, 30, 45 minutes?

Experiences: 1) Older adults 2) Training 3) Program Implementation 4) What they learned

1. How did you feel about older adults with Alzheimer’s before the program?

2. How did you feel about older adults with Alzheimer’s after the program?

   1. How did it feel interacting with the older adults during the music program?
3. Tell me about your experience with the initial training, where you learned about the music program and its components.

   1. Did you know what to do to prepare?
   2. What worked, and what could be better?
4. Tell me about your experience with the ‘meet-and-greet’ with Dementia360.

   1. How did this help you plan your music program?
   2. What was your experience like interacting with them?
5. Tell me about working with your Music Mentor:

   1. How did interactions with your mentors influence your preparation of your guest artist program?
   2. What recommendations can you make for future teens and mentors?
6. Overall, how successful did you feel you were in delivering your guest artist program?

   1. Discuss the components of the guest artist program. How did it feel preparing and performing each of these?
   2. What went well, and what didn’t?
   3. Are there any parts of the music program that should be changed for the future?

7. What did you learn after participating in this program?

8. Tell me about if this program built on existing skills or helped you learn new skills

9. In what ways was this process similar to ways you have engaged and perceived music in the past?

   1. In what ways was this process different to ways you have engaged and perceived music in the past?
10. Do you feel like this program was a good fit for you?

    1. Why?
    2. (If applicable): Why would you continue?
    3. (If applicable): What would you change?
    4. What did you like and dislike about the program?

11. Would you be willing to continue this type of program in the future, yes or no?