Arts for ageing well: a propensity score matching analysis of the effects of arts engagements on holistic well-being among older Asian adults above 50 years of age

Slow art plus: developing and piloting a single session art gallery-based intervention for mental health promotion via a mixed method waitlist randomized control trial

Introduction

The current study builds on the expertise of National Gallery Singapore and Nanyang Technological University Singapore (NTU) in developing and piloting an enhanced version of the Slow Art program, namely "Slow Art Plus" for mental health promotion.

Methods

A single-site, open-label, waitlist Randomized Control Trial (RCT) design comprising of a treatment group and waitlist control group was adopted (ClinicalTrials.gov ID: NCT05803226). Participants (N = 196) completed three online questionnaires at three timepoints: baseline [T1], immediately post-intervention/s baseline [T2], post-intervention follow-up/immediately post-intervention [T3]. Qualitative focus groups were conducted to evaluate program acceptability.

Results

A mixed model ANOVA was performed to understand intervention effectiveness between the immediate intervention group and waitlist control group. The analyses revealed a significant interaction effect where intervention group participants reported an improvement in spiritual well-being (p = 0.001), describing their thoughts and experiences (p = 0.02), and nonreacting to inner experiences (p = 0.01) immediately after Slow Art Plus as compared to the control group. Additionally, one-way repeated measure ANOVAs were conducted for the intervention group to evaluate maintenance effects of the intervention. The analyses indicated significant improvements in perceived stress (p < 0.001), mindfulness (p < 0.001) as well as multiple mindfulness subscales, active engagement with the world (p = 0.003), and self-compassion (p = 0.02) 1 day after the completion of Slow Art Plus. Results from framework analysis of focus group data revealed a total of two themes (1: Experiences of Slow Art Plus, 2: Insights to Effective Implementation) and six subthemes (1a: Peaceful relaxation, 1b: Self-Compassion, 1c: Widened Perspective, 2a: Valuable Components, 2b: Execution Requisites, 2c: Suggested Enhancements), providing valuable insights to the overall experience and implementation of the intervention.

Discussion

Slow Art Plus represents a unique approach, offering a standardized, multimodal, single-session program that integrates mindfulness and self-compassion practices, as well as reflective and creative expressions with Southeast Asian art. It demonstrates potential in meeting the mental health needs of a wide range of individuals and could be readily incorporated into social prescribing initiatives for diverse populations.

Spiritual care for older people living in the community: A scoping review

BACKGROUND

The population of older people should be supported to enjoy optimal quality of life. Health professionals should consider a range of interventions that support the older population to maintain their quality of life. One such interventional approach involves spiritual care.

OBJECTIVE

To explore what is known about spiritual care approaches for older people living in the community.

METHODS

Scoping review informed by Joanna Briggs Institute guidelines. Eight electronic databases were searched: CINAHL, Ageline, PubMed, ProQuest Nursing & Allied Health, PsycINFO, Scopus, Garuda, and Neliti. The review included quantitative and qualitative primary peer-reviewed research studies focusing on spiritual care interventions for older people living in the community published between 2011 and 2021 in English or Bahasa Indonesia. The search was uploaded into an electronic citation manager and imported into Covidence for screening.

RESULTS

A total of 29 studies were included in the review. While the studies were conducted in five continents, most were reported from the Asian continent. Five key issues based on the outcome of interventions were found namely psychological, physical, spiritual, multidisciplinary approach, and social connection.

CONCLUSION

This scoping review identifies spiritual interventions conducted across many countries have been implemented for older people living in the community. Although there are review limitations and further research is needed, these spiritual interventions, both faith-based and non-faith-based, are identified as useful to support the well-being of older people.

The little intervention that could: creative aging implies healthy aging among Canadian seniors

OBJECTIVES

Through a process of 'creative ageing', there is increased interest in how active participation in the arts can help promote health and well-being among seniors. However, few studies have quantitatively examined the benefits of a foray into artistic expression, and even fewer employ rigorous identification strategies. Addressing this knowledge gap, we use a series of quantitative techniques (ordinary least squares and quantile regression) to analyze the impact of an arts-based intervention targeting the elderly.

METHODS

Recruited from Saint John, New Brunswick (a city of about 125,000 people in Eastern Canada), 130 seniors were randomly assigned to the programme, with the remaining 122 serving as the control. This intervention consisted of weekly 2-h art sessions (i.e. drawing, painting, collage, clay-work, performance, sculpting, and mixed media), taking place from January 2020 until April 2021.

RESULTS

Relative to the control group, the intervention tended to reduce participant loneliness and depression, and improve their mental health. Outcomes were more evident toward the latter part of the programme, were increasing in attendance, and most efficacious among those with initially low levels of well-being.

CONCLUSION

These findings imply that creative ageing promotes healthy ageing, which is especially noteworthy given COVID-19 likely attenuated our results.

A qualitative examination on the implementation of participatory "A"rt-based activity on "Health" of older community-dwellers: what worked for the Singapore A-Health Intervention?

Introduction

Art and museum-based interventions are gaining increasing recognition for their potential as low-risk activities for older adults, offering numerous physical, cognitive, and emotional benefits. However, there remains a dearth of knowledge regarding the science of implementation as well as the factors and processes that contribute to their effectiveness from the perspectives of intervention participants.

Methods

The current research draws on the qualitative evaluation data obtained from a larger mixed-method randomized control trial that evaluated a standardized Participatory "A"rt-Based Activity On "Health" of Older Community-Dwellers-the Singapore A-Health Intervention. Adopting a participatory action research approach, the primary objective is to critically examine the lived experiences and health impact of the Singapore A-Health Intervention with a secondary objective to uncover strategies for optimized implementation outcomes. All 56 participants who completed the intervention filled out a program evaluation survey and a nested sample of 30 participants completed a series of acceptability focus groups.

Results

Descriptive analyses of the program evaluation survey data revealed that 96.2% of participants were satisfied with the overall experience of the Singapore A-Health intervention (M = 9.00, SD = 1.76), reported that the intervention positively impacted their quality of life (M = 8.90, SD = 1.43), and social wellbeing (M = 8.92, SD = 1.43). Thematic analysis with a grounded theory approach on the qualitative focus group data revealed three interrelated themes detailing how the Singapore A-Health Intervention contributed to positive health and wellbeing outcomes (1. A-Health Experience, 2. Wellbeing Outcomes, 3. Enabling Factors) and nine subthemes (1a. Intellectual Stimulation, 1b. Positive Stress, 1c. Peer Interaction, 2a. Interpersonal Bonds, 2b. Personal Growth, 2c. Mindful Living, 3a. Integrated Support, 3b. Session Design, 3c. Mode of Engagement).

Discussion

This investigation provides important insights to the Singapore A-Health intervention's effectiveness for enhancing wellbeing among older adults, as well as the factors that enable successful program implementation. These findings offer a culturally unique perspective on the benefits of art and museum interventions, while underscoring the imperative need for strong partnership and collaborations among community stakeholders in supporting the health and wellbeing of ageing populations.

Receptive and participatory arts engagement and subsequent healthy aging: Evidence from the Health and Retirement Study

RATIONALE

Arts engagement is associated with prolonged longevity, but it remains unclear whether it is also associated with increases in the portion of people's lives for which they remain healthy. We investigated whether receptive and participatory arts engagement were associated with healthy aging two and four years later.

METHOD

We included 1269 older adults from the Health and Retirement Study (HRS), a longitudinal study of individuals aged 50 and above in the United States. Participants who completed the HRS 2014 Culture and the Arts Module and who were alive in 2016 and 2018 were eligible. We measured the number of participatory arts activities engaged in (e.g., crafts, dancing) and frequency of receptive arts engagement (e.g., going to a gallery or performance) in the past year. Healthy aging was a binary outcome, conceptualized as no major chronic diseases, no cognitive impairment, good physical functioning, and good mental health.

RESULTS

In logistic regression models, doing receptive arts once a month or more was associated with higher odds of healthy aging four years later compared to never engaging (odds ratio [OR] = 1.80, 95% CI = 1.10, 2.96). However, this evidence was attenuated after adjusting for demographic and socioeconomic covariates (adjusted OR = 1.44, 95% CI = 0.84, 2.46). The number of participatory arts activities engaged in was not associated with healthy aging two or four years later. In sensitivity analyses, there was some evidence that receptive engagement was associated specifically with higher odds of good physical functioning four years later.

CONCLUSIONS

The lack of consistent associations between receptive and participatory arts engagement and healthy aging was unexpected given previous evidence for links between arts engagement and each of the four domains of healthy aging. Our findings highlight key methodological issues that should be explored in further research with larger nationally representative samples, longer follow-ups, and more detailed measures of arts engagement.

Art engagement and psychological well-being among community-dwelling older adults in Japan: an observational cross-sectional study

OBJECTIVES

Art engagement, which includes individual art activities and museum and gallery visits, potentially contributes to improving psychological well-being. However, there is insufficient evidence of its effects on the older population, and few reports are from Asia, including Japan. This study examined the association between art engagement and psychological well-being among older adults in Japan.

STUDY DESIGN

An observational cross-sectional study design was used.

METHODS

Community-dwelling older adults aged ≥60 years were recruited from the visitors to public facilities (including community centres, sports centres and cultural centres) in Aichi, Japan, in 2022, and completed questionnaires. The psychological well-being assessment included five domains according to Seligman's PERMA framework: Positive emotion, Engagement, Relationship, Meaning and Accomplishment. Regarding art engagement, the frequencies of active art engagement (e.g. activities by individuals and participation in groups, such as music and painting) and receptive art engagement (e.g. visiting museums, galleries and the theatres) were assessed.

RESULTS

A total of 522 participants were included in the analysis (mean age = 74.1 years; 78.0% females). Results from the multivariable linear regression analysis, which adjusted for demographic and socio-economic factors, revealed that higher frequencies of active art engagement were significantly associated with higher scores in all five PERMA domain scores. Higher frequencies of receptive art engagement were significantly associated with higher levels of Positive emotion, Engagement and Meaning domain scores, but were only marginally associated with the Accomplishment domain and were not associated with the Relationships domain.

CONCLUSIONS

This study indicates that art engagement has the potential to enhance psychological well-being among older adults. National and local government strategies to increase accessibility to art and cultural activities for older adults are recommended.

The role of arts engagement in reducing cognitive decline and improving quality of life in healthy older people: a systematic review

In recent years, arts engagement has been proposed as a non-pharmacological approach to reduce cognitive decline and increase well-being and quality of life in specific populations such as the elderly or patients with severe disease. The aim of this systematic review was to assess the effects of receptive or active arts engagement on reducing cognitive decline and improving quality of life and well-being in healthy populations, with a particular focus on the role of arts engagement in the long term. A comprehensive search strategy was conducted across four databases from February to March 2023. Ten studies with a total of 7,874 participants were incorporated in accordance with the PRISMA guidelines. Active and receptive arts engagement was found to be an effective approach to reduce cognitive decline and improve well-being and quality of life in healthy populations. The role of the positive effects of arts engagement could be determined by the combination of several factors such as exposure to cultural activities and the group effect. There is limited evidence of the protective effects of active arts engagement over a long period of time. Given the increasing demand for preventive programmes to reduce the negative effects of population ageing, more research on arts engagement should be conducted to identify its mechanisms and long-term effects.

Productive arts engagement at the Tokyo Fuji Art Museum and its health effects on the older Japanese population: results of a randomized controlled trial

Background

This randomized controlled trial aims to compare changes in mental and physical health in older Japanese community-dwellers who participated in a productive art-based activity at the Tokyo Fuji Art Museum (intervention group) and in their counterparts, who did not participate in the intervention (control group).

Methods

A total of 73 older community-dwellers living in Tokyo participated in a single-blind RCT in two parallel groups (intervention group versus control group). The intervention was 2 h of productive art-based activities per week. The weekly sessions were carried out at the Tokyo Fuji Art Museum over a 12-week period. The control group did not participate in any productive art-based activity over the study period. Well-being, quality of life and frailty were assessed before the first, and after the last, art-based activity. These outcomes were assessed with the same schedule in both groups.

Results

The intervention group saw a significant improvement in their quality of life (p < 0.044) and mixed results on their physical health (i.e., decreased frailty status) when compared to the control group. The comparison of changes in frailty scores between M0 and M3 showed improvement in the intervention group (p = 0.014), but when adjusted for baseline characteristics by linear regressions, revealed only a trend (p = 0.070). No conclusive effect was shown with well-being.

Interpretation

This RCT showed mixed health effects of productive art engagement in older Japanese community-dwellers in Tokyo. Benefits were reported for quality of life and mixed effects were observed for frailty, while no significant effect was found for well-being.Clinical Trial Registration: Ethic committee of Shobi University, Tokyo (Japan), ref. A-2021-1; Clinical Trial Number NCT03679715.

"Take a walk in someone else's shoes": the role of participatory arts for health research development and training

Participatory arts are increasingly recognised as a valuable and accessible mechanism for giving a voice to the experiences of individuals' health and healthcare. In recent years, there has been a move towards embedding participatory arts-based models into public engagement processes. Here, we contribute to the existing literature on the use of participatory arts-based approaches and their role in health research and healthcare practise, focusing on two interlinked approaches, the creation of personas and storytelling. We draw on two recent projects which have utilised these approaches to inform subsequent healthcare research and as a professional training tool to improve patient experience in a healthcare setting. We add to emerging literature to outline the benefits of these approaches in supporting research and training in healthcare settings, with a focus towards the co-produced foundations of these approaches. We demonstrate how such approaches can be utilised to capture different forms of voices, experiences and perspectives to help inform healthcare research and training, rooted in the lived experience of individuals who are directly involved in the creative process of developing personas via storytelling. These approaches challenge the listener to "walk in someone else's shoes", using their own homes and lives as a theatrical set in which to envisage someone else's story, involving the listener in the creative process through (re)imagining the stories and experiences of the characters. Greater use of immersive, co-produced participatory art-based approaches should be used in PPIE to inform research and training in healthcare settings as a means of centring those with lived experience through co-production. Involving those with lived experience, particularly from groups who are traditionally excluded from research, via a process which is based on co-creation and co-production, reorientates the researcher-participant dynamic to fully centre those involved in the research at the heart of the tools used to guide health and healthcare research. In this way, it may also aid in trust and relationship building between institutions and communities in a way which is focused around positive, creative methods to aid health research and healthcare processes. Such approaches may help to break down barriers between academic institutions, healthcare sites and communities.

Associations between participation in community arts groups and aspects of wellbeing in older adults in the United States: a propensity score matching analysis

Objectives: There is a social gradient in both arts engagement and wellbeing that may have led to an overestimation of the impact of arts engagement on wellbeing. We tested whether participation in community arts groups was associated with wellbeing after removing confounding by demographic, socioeconomic, and health-related factors.Methods: Using propensity score matching, we analyzed data from 12,055 older adults in the Health and Retirement Study. We measured community arts groups participation and concurrent life satisfaction (evaluative wellbeing), positive and negative affect (experienced wellbeing), and purpose in life, constraints on personal control, and mastery (eudaimonic wellbeing).Results: After matching, arts group participation was associated with higher positive affect (average treatment effect on the treated [ATT] = 0.18, 95% CI = 0.12-0.24), life satisfaction (ATT = 0.09, 95% CI = 0.04-0.15), purpose in life (ATT = 0.07, 95% CI = 0.02-0.13), and mastery (ATT = 0.07, 95% CI = 0.01-0.14) than not participating. Participation was not associated with negative affect or constraints on personal control. In sensitivity analyses, these associations were maintained four years later.Conclusion: Arts group participation was associated with the positive elements of evaluative, experienced, and eudaimonic wellbeing. Facilitating participation in community arts groups could help to promote healthy aging, enabling a growing segment of the population to lead more fulfilling and satisfying lives.

Bayesian Spatial Modeling of Diabetes and Hypertension: Results from the South Africa General Household Survey

Determining spatial links between disease risk and socio-demographic characteristics is vital in disease management and policymaking. However, data are subject to complexities caused by heterogeneity across host classes and space epidemic processes. This study aims to implement a spatially varying coefficient (SVC) model to account for non-stationarity in the effect of covariates. Using the South Africa general household survey, we study the provincial variation of people living with diabetes and hypertension risk through the SVC model. The people living with diabetes and hypertension risk are modeled using a logistic model that includes spatially unstructured and spatially structured random effects. Spatial smoothness priors for the spatially structured component are employed in modeling, namely, a Gaussian Markov random field (GMRF), a second-order random walk (RW2), and a conditional autoregressive (CAR) model. The SVC model is used to relax the stationarity assumption in which non-linear effects of age are captured through the RW2 and allow the mean effect to vary spatially using a CAR model. Results highlight a non-linear relationship between age and people living with diabetes and hypertension. The SVC models outperform the stationary models. The results suggest significant provincial differences, and the maps provided can guide policymakers in carefully exploiting the available resources for more cost-effective interventions.

Older adults' participation in artistic activities: a scoping review

This scoping review analyses existing literature on older adults' participation in artistic activities. It identifies gaps in this research topic and suggests new directions for research. We followed the five-step process defined by Arksey and O'Malley (2005) and extended by Levac et al. (2010). Four electronic databases were searched, and 129 peer-reviewed articles were included in the scoping review. Research into older adults' participation in artistic activities has grown in the last ten years. However, empirical papers tend to focus on the outcomes of older people's participation in artistic activities, in particular the benefits. Most papers centred on facilitators to examine the antecedents of this type of participation among people in late life. Research about experiences, potentially negative consequences or barriers to older adults' participation in artistic activities have been largely overlooked. We identified several gaps in the literature, which we classified as: related to the artistic activities that were considered; the potential costs and barriers for older adults' participation in artistic activities; older adults' voices and their diversity; the life course perspective; and a contextual view of research on the topic. These gaps suggest challenges that future research on older adults' participation in artistic activities should consider.

Connecting the Dots: The State of Arts and Health in Singapore

Background: This article examines the state of the field of arts and health in Singapore and identifies the drivers that have shaped its development to date, adding new insights from Asia to the growing international literature in this area. Methods: Various methods, including an online survey and in-depth focus groups were used. Results: We find that the field in Singapore is rapidly growing, with a proliferation of activities across the arts and culture, healthcare, and social care sectors in recent decades fostered by various policy developments, increased funding and new peer-to-peer networking. Nevertheless, several issues persist, including inconsistent understanding and conceptualisation of the field as a whole across multiple stakeholders, limited research capacity and training platforms, and lack of professional recognition. Conclusions: We provide recommendations for further action, including developing arts and health literacy and research capacity, investing in efforts to bridge education and practice, and focusing on formalising and elevating professional standards.

A Randomized Waitlist-Controlled Trial of an Intergenerational Arts and Heritage-Based Intervention in Singapore: Project ARTISAN

Loneliness has become a global major public health concern, with detrimental effects to the young and old. ARTISAN (Aspiration and Resilience Through Intergenerational Storytelling and Art-based Narratives) is a 5-week, 15-h participatory art and group-based intervention that focuses on resilience building and loneliness alleviation among the young and old through a structured multimodal framework held at a museum space. Developed with a Participatory Action Research (PAR) approach, this intervention is evaluated using an open-label waitlist randomized controlled trial design (RCT) comprised of community-dwelling youth and older adults randomized into an intervention group (n = 35) or a waitlist-control group (n = 33). Participants were assessed on standardized self-reported psychometric measures including loneliness, resilience, quality of life, social support, life satisfaction and national identity at three time points. Qualitative data generated during each intervention session as well as acceptability focus groups were recorded and transcribed. Linear mixed modeling analyses revealed that participants in the intervention group experienced improvements in life satisfaction compared to participants in the waitlist-control group (95% CI: 0.22 to 0.77, p < 0.001, Cohen's d = 0.53) immediately after the completion of ARTISAN. Subgroup analyses for youth participants indicated improvements in quality of life (95% CI: 0.16 to 0.52, p < 0.001, d = 1.31) and national identity (95% CI: 0.18 to 0.80, p = 0.002, d = 0.43) in comparison to the waitlist-control group. At 5-weeks follow-up, the intervention group participants continued to experience high levels of life satisfaction (95% CI: 0.04 to 0.42, p = 0.017, d = 0.47), enhancements in resilience (95% CI: 0.07 to 0.55, p = 0.011, d = 0.46), as well as a significant reduction in loneliness (95% CI: −0.34 to −0.08, p = 0.001, d = 0.61) compared to baseline, reflecting the effectiveness and positive residual effects of the ARTISAN intervention. Similarly, the qualitative findings provided support for the intervention and additional insights to the quantitative findings. This holistic intervention framework that integrates stories, arts and heritage for bridging and empowering lives fills a critical gap in knowledge and practice between the arts, health and citizenship, paving the way for further research in creating a more caring and inclusive society with the arts.

Clinical Trials Registration:www.ClinicalTrials.gov, identifier: NCT03048708.

Arts-based interventions to improve cognition in older persons with mild cognitive impairment: A systematic review of randomized controlled trials

OBJECTIVES

As the global burden of dementia rises, the search for preventive measures such as interventions for mild cognitive impairment (MCI) remains a research priority. While arts-based interventions have demonstrated some success in improving cognitive functioning among older adults and those with dementia, its effectiveness for older persons with MCI remains unexplored. We conducted a systematic review to examine the effects of arts-based interventions on cognition in older persons with MCI.

METHOD

The following databases were searched in November 2019: PubMed, EMBASE, PsycINFO, and CINAHL Plus, supplemented by Google Scholar and ALOIS. Study inclusion criteria were older persons aged ≥ 60 with MCI; arts-based interventions such as dance, drama, music, or visual arts; and randomized controlled trial with cognitive outcome. Database search, study selection, and data extraction were conducted independently by 2 reviewers.

RESULTS

Eleven randomized controlled trials examining 13 interventions (817 participants) were identified, of which 4 involved visual arts, 4 dance/movement, 3 music, and 2 storytelling. Significant improvement on at least one cognitive outcome was reported in 10 of the 13 interventions. These included improvements in global cognition (6/7 interventions), learning and memory (5/9), complex attention (4/10), executive functioning (2/6), language (2/3), and perceptual-motor function (1/4).

CONCLUSION

This review found that arts-based interventions can potentially improve various aspects of cognitive functioning in older persons with MCI, although our confidence was dampened by methodological limitations such as the moderate-to-high risk of bias present in studies and heterogeneity in the way MCI was defined. Recommendations for future research are discussed.