The short-term impact of music interventions on stress: Results of a multinational cluster-randomized trial using salivary cortisol and alpha-amylase assessments in care home residents with dementia

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Stress can have a negative impact on well-being and quality of life in people with dementia. Our study explored the effect of music as a potentially stress-reducing strategy in care home residents with dementia and depression of 25 care home units included in the multinational cluster-randomized controlled trial Music Interventions for Dementia and Depression in Elderly care (MIDDEL). Methods: Group music therapy consisted of singing well-known songs and reminiscence in small groups, optionally improvising on instruments and moving to music. Choir singing consisted of rehearsing well-known and new songs in larger groups of 10+ participants. During month 1, 3, and 6, saliva samples were collected 10 minutes before and 15 and 60 minutes after a session of group music therapy ( n = 55), recreational choir singing ( n = 72) or a book reading ( n = 56) in 183 care home residents, along with a stress visual analogue scale. Results: Of 1014 saliva samples collected, 671 (66%) were valid for alpha-amylase assay and 633 samples (62%) for cortisol assay. Significant pre/post session changes were found for salivary cortisol, alpha-amylase, and subjective stress within study arms, although no significant difference was found between study arms. Conclusion: Group interventions, including music therapy, can have a positive impact on stress levels in care home residents with dementia. The level or intensity of participation required from the person with dementia may play a role in the impact of music on stress. Findings indicate it is feasible to collect saliva in persons with dementia non-invasively. Future studies in this population should consider strategies to improve validity of data, such as stimulating saliva flow. ClinicalTrials.gov registration NCT03496675. • Collecting saliva samples in care home residents with dementia is feasible and acceptable. • Saliva flow may have to be stimulated to increase chances of sufficient saliva for assay. • Variation in interpretation of the concept ‘stress’ combined with multiple respondents, calls for a reliable alternative to the Visual Analogue Scale to assess subjective stress or arousal in people with dementia. • Physiological stress measured in salivary biomarkers cannot be directly compared to subjectively perceived (proxy) or experienced (participant) stress. • Group-based interventions have a stress-reducing effect, where arousal or the degree of active role of the resident can influence physiological outcomes.

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