The growth of the older population in the UK is substantial and the social care and health needs of older people represent a considerable cost to health and social care services . There is clear scientific evidence of the importance for 'successful aging' of maintaining an active lifestyle-physically, mentally and socially  and considerable attention has been given to the need to promote the health of older people, to help them maintain active and independent lives in the community and delay the need for residential care . There is also a need to address mental health problems among the elderly and wider issues associated with social isolation and exclusion.
It is widely understood that the NHS cannot alone address the diverse needs of older people, but has to work in partnership with other statutory bodies and voluntary agencies in the development of services and models of intervention to assist people in living independently and maintaining health and wellbeing [4–7].
In recent years there has been growing interest in the potential value of the arts in addressing significant social issues [8, 9]. The social utility of the arts has been promoted by the national Arts Councils, and both DCMS and DH have supported research to explore the contribution of the arts in the field of mental health. The Department of Health established a Review of Arts and Health Working Group which reported in 2007. This led to the Department of Health and Arts Council England publishing A Prospectus for Arts and Health (2007), which provides an overview of the current Arts and Health field in the UK, and offers recommendations for future developments. Coinciding with publication of the Prospectus, Arts Council England published its own strategic framework on Arts, Health and Wellbeing .Under the Labour Government the Home Office recognised the value of the arts in work with offenders, and the Treasury funded several projects on arts and community health under the Invest to Save Budget framework (see for example Manchester Metropolitan 'Invest to Save Arts in Health Project' http://www.miriad.mmu.ac.uk/investtosave/.
There is growing recognition of the value of arts activities in improving the lives of older people [13–16], and particularly the value of live music and musical participation for older people , including those affected by Alzheimer's and other forms of dementia [18, 19]. These studies are useful in highlighting some of the standardized measures which may be employed in studies of arts and health. They do, however, address very disparate interventions within a single study, making cause-effect conclusions problematical. Further, many studies use subjects as their own controls, rather than incorporating a control or comparison group, which would further enhance scientific rigour.
We have recently completed a systematic review of all available non-clinical research studies concerned with the possible benefits of active engagement in singing. A systematic search of the published literature identified 56 reports giving attention to singing and its benefits. Of these reports, 18 were excluded from consideration as being of limited interest. The remaining 36 sources are extremely diverse with respect to the research problem addressed, the participants involved, research design and methods of data gathering and analysis. These papers have been carefully scrutinised but limited synthesis is possible.
Only two studies out of these 36 attempted to assess the wellbeing/health benefits of participation in group singing using standardised measures of health [20, 21]. Both studies were concerned with older people. In each study, a positivistic research model was adopted in which pre and post assessments were made of participants in intervention and control groups, with statistical comparison of means between the groups.
Houston et al  (UK) assessed the impact of four hour-long sessions of singing over four weeks with 31 residents in three care homes using GHQ-28 and HADS. A non-intervention group of 30 residents in three further care homes were also assessed (mean age 84 years). The authors claim that the intervention group showed significant improvements in measured anxiety and depression over the four weeks compared with the non-intervention group.
Cohen et al.  (USA) assessed the impact of weekly participation in a community choir on 90 people aged 65 and older. The study ran over a period of two years, and a range of measures of physical health, health service utilisation, mental health and social activity were employed at pre-test and follow up after one and then two years. A matched non-intervention comparison group (N = 76) were also assessed. The authors claim to find a range of positive effects from participation in the singing group, including higher rating of physical health, fewer doctor visits, fewer falls and better mental health.
Both studies have limitations and both methodological and analytical weaknesses, which raise doubts about the validity of their conclusions. Neither study justified sample sizes in terms of study power. In neither study is there evidence of randomization to intervention or control group, or any formal assessment of cost effectiveness of the intervention.
A central focus of the current proposal is the evaluation of an innovative initiative - the Silver Song Club Project - which provides opportunities for older people to come together on a regular basis to make music and sing, with the support of professional musicians and volunteers drawn from established choral societies and singing groups. Currently, over 40 Silver Song Clubs are in operation across the South East of England, managed by a third sector organization, Sing For Your Life Ltd. (SFYL).
A qualitative and process-oriented formative evaluation has been completed , providing information on how the project is run, the experiences of facilitators, volunteers, participants and carers and perceived benefits gained. Data were collected on six of the clubs through observation of sessions, focus groups with volunteers and interviews with club facilitators and participants, venue managers and SFYL directors and facilitators. Older participants have reported positive health benefits across psychological, cognitive, social and physiological domains, supporting previous research findings. There is now a need to develop a more controlled and objective assessment of the benefits for older people of participation in Silver Song Club activities.
Aims of the study
To assess the effectiveness for older people of active engagement in community music activities on measures of physical and mental health.
To evaluate the cost-effectiveness for older people of active engagement in community singing.