Using psychological and physiological measures in arts-based activities in a community sample of people with a dementia and their caregivers: a feasibility and pilot study

Introduction: Nearly all community-based dementia care studies employ either qualitative methods or use a combination of self-report questionnaire within mixed-methods research designs. Physiological measures, however, are rarely used in community-based studies with this population yet could provide valuable biological information for specific activities across the course of the dementias.

Method: The study employed a within-subjects design to assess the feasibility of obtaining physiological measures (salivary cortisol and Heart Rate Variability (HRV)) alongside subjective measures of wellbeing and stress using Visual Analogue Scales (VAS) during two community-based activiti of choral singing and art viewing, respectively, for People With Dementia (PWD) in the early to middle stages of impairment and their caregivers.

Results: As anticipated, pre-post subjective wellbeing measures were relatively easy to complete by PWD and caregivers with no substantive difficulties observed or reported; significant increases in composite wellbeing, happiness and optimism were found. Continuous measurement of physiological data of HRV through a sensor-based device (Empatica® E4) was also found to be neither non-intrusive to participants nor disruptive to the interventions. Preliminary indications showed, for example, HRV significantly increased for PWD during choral singing, which may be associated
with an increase in wellbeing. Measuring stress hormones through pre-post saliva samples, however, encountered several difficulties.

Conclusions: The findings provide support for the feasibility of using non-intrusive sensor-based physiological measures alongside subjective measures for this population. Subjective measures may also give more confidence in interpreting directionality of physiological measures. A full pilot study is warranted to further investigate interactions of physiological and psychological variables in choral singing and viewing art activities but it is uncertain whether measuring stress hormones through saliva collection is feasible for this population and raised doubts about their use in a large scale trial. Holding particular promise is the use of sensor-based technology across different stages of dementia as well as across different activities.

Funded in part by Wellcome Trust and the National Health Service