“Sculpture by Ron Mueck – Two Women 2005” by flickr user Lance

Title: Participatory Arts for Older Adults: A Review of Benefits and Challenges

Author(s): Tony Noice, Helga Noice, and Arthur F. Kramer

Publisher: The Gerontologist, 54(5)

Year: 2013

URL: http://gerontologist.oxfordjournals.org/content/early/2013/12/10/geront.gnt138.full.pdf+html

Topics: Arts participation, older adults, creative aging, quality of life, health benefits, cognition

Methods: Literature review

What it says: This article reviews literature on the health benefits of active arts participation among older adults ages 60 and older in good general health. Arts activities include dance, expressive writing, music (singing and instrumental), theater, and visual arts. The review included a combination of 31 experimental and correlational studies conducted between 1985 and 2013. The following were excluded: case studies; studies with small sample sizes (n < 8); reports in non-peer-reviewed journals; articles not written in English; and studies focusing on arts therapies to treat those with illness, trauma, or other life challenges.

Overall, the studies demonstrate positive cognitive, affective, and quality-of-life outcomes. The review categorizes findings based on art forms

• A number of dance studies using quasi-experimental designs demonstrated cognitive and physiological improvements (e.g., increased attentional control). Dancers also scored higher on self-assessments of general health and subjective wellbeing compared to control groups. One of the studies suggests that cognitive benefits might be attributed to dance’s aesthetic qualities, rather than aerobic exercise, as no significant improvement in cardiorespiratory fitness among study groups (dancers and non-dancers alike) was observed.
• Studies related to expressive writing include evidence of improved processing, speed, attention, verbal learning, and memory, although this may be moderated by participants’ educational level and interest in writing. One study revealed psychological benefits, indicated by improvements of scores on a standard depression scale. The authors note that studies involving expressing writing were the only ones where a professional artist was not involved. This is a notable distinction because it may 1) point to why effects were likely moderated by participants’ level of educational attainment, or existing interest in writing, and 2) shed light on the value of formal arts instruction, which is likelier to draw sustained engagement (and produce substantive effects) than one-off attendance at events or other modes of passive engagement in the arts.
• Music-related studies produced a wide variety of results. For singing, there were self-reported decreases in doctor visits, falls, and use of over-the-counter medicine, decreases on a standard depression/anxiety scale, as well as improvements in overall health and involvement in activities and statistically significant improvements in emotional wellbeing, quality of life, and knowledge of singing;increases in self confidence were marginally significant. As for playing a musical instrument, results include: decreased levels of anxiety and depression, increases in the human growth hormone (associated with higher energy and improved memory and sex function), significant improvements in cognitive processes, and perceived favorable effects on health, and to a lesser extent, on social relationships and personal development. In some cases, positive outcomes did not persist over the longer term following music participation,unless, instrumentalists had trained or practiced over an extended period of their lives.
• Theater studies produced positive evidence, mostly related to increases in memory, comprehension, creativity, problem-solving, and personal growth. A study on improvisational drama yielded positive changes in anxiety, and another demonstrated improvements in wellbeing and physical measures, but not psychological health.
• Lastly, visual arts studies using qualitative methods revealed increases in social engagement, sense of empowerment, psychological health, skills development, ability to set new challenges, and identity preservation. One study using a randomized controlled trial yielded positive outcomes measures for anxiety, affect, and self-esteem.

The authors acknowledge the limitations of the research: the total number of studies reviewed is relatively small; a variety of instruments were used to measure change; and not all experiments were well controlled. To improve consistency across future research, they propose standardizing measures, vocabulary, and behavioral outcomes to assess effectiveness of interventions across art forms. They also recommend consistent use of pre/post design, and including control groups, where appropriate, as well as pursuing more meaningful sample sizes, more diverse populations, and longitudinal studies that measure effects over a long period of time.

What I think about it: The review offers a useful overview of health benefits associated with older adults’ arts participation. Some of the claims that were summarized had no indication of statistical significance, which may be a result of authors’ attempt to succinctly summarize findings from studies that used a wide variety of research designs. Nonetheless, the summary chart prepared by the authors is useful in showing the breadth of methods, sample sizes, and outcome measures used across arts interventions among older adults.

What it all means: Noice, Noice, and Kramer’s review was published the same year that NEA released The Arts and Aging: Building the Science, a report summarizing findings from its public workshop exploring research gaps and opportunities for understanding the relationship between the arts and health and wellbeing among older adults. A preliminary version of this review was prepared as a paper for the workshop, so this is a useful, evidence-based supplement to the mostly anecdotal findings in the NEA’s summary. The two combined – in addition to the NEA’s 2011 white paper on the arts and human development, which has a chapter on arts, health and wellbeing among older adults – show that there is growing momentum in the field of creative aging. The health focus and population specificity of this field offers a unique opportunity to lay the groundwork for developing more rigorous research designs for arts inventions broadly. In doing so, researchers can begin to identify the specific benefits of aesthetic engagement. In addition, researchers and advocates can use this evidence to gain support not only from public arts agencies, but also from non-arts agencies serving aging populations.

• Singing improves mental health and subjective wellbeing (i.e., perceived quality of life)
• Taking dance classes bolsters cognition and motor skills, and even lessens the likelihood of developing dementia later in life
• Playing a musical instrument has myriad positive effects, including dementia risk reduction
• Visual arts practice generates increases in social engagement, psychological health and self-esteem

Just how the arts benefit society is one of the most studied topics in arts research, to the extent that multiple literature reviews, most notably the RAND Corporation’s decade-old landmark Gifts of the Muse, have sought to compile our collective knowledge on the subject. In recent years, several important initiatives and publications have added to this evidence base, including the final report earlier this year from the UK-based Arts and Humanities Research Council’s Cultural Value Project and National Endowment for the Arts’s 2011 literature review on the arts and human development. Over the past few months, Createquity has been reviewing these and other publications with an eye toward creating a continually-updated catalogue of demonstrated impacts for arts activities. What are all of the ways in which the arts contribute to or detract from wellbeing, and how strong is the evidence supporting each of those claims?

Our review of the literature addressing these questions yielded a surprising result: the most compelling evidence of the value of the arts revolves around improving the lives of older adults. Better understanding the relationship between the arts and aging may help to identify areas for improvement in future research into wellbeing, as well as opportunities for investing in the quality of life of older individuals.

Painter — photo by Flickr user M-n-M

The global population is aging in unprecedented numbers and living longer than ever. Between 1980 and 2010, a period marking most of millennials’ present lifetimes, the number of U.S. centenarians increased by nearly two-thirds! Longer lifespans bring immediate implications for many and eventual implications for us all, if we’re lucky. While extending the so-called golden years can be a blessing, challenges include deteriorating health, social isolation, loss of loved ones, and life transitions.

Fortunately, research shows that arts-related interventions can help (in some cases, more so than traditional Western medicine). In particular, there is substantial causal evidence that participatory arts activities help to maintain the health and quality of life of older adults. These benefits, detailed below, include improvements in cognitive and tactile abilities, subjective wellbeing, and dementia risk reduction (although the effects on managing dementia are less clear).

Jamming and Grooving Towards Better Health

The literature on the effects of participatory arts engagement within aging populations is significant not only for the breadth of demonstrated benefits to older adults, but also the relatively high quality of evidence supporting these claims.

Most of the literature we encountered involved making music, although a number were focused on dance. Music and movement activities (playing instruments, singing, dancing) have been shown to improve mental and physical health among older adults. In a randomized controlled trial of 212 British adults over the age of 60, those who participated in weekly singing groups over three months were found to have had improved mental health (decreased anxiety and depression) compared to those who didn’t. These health effects were mostly sustained over a period of at least three months after the weekly singing ended. By contrast, the positive effects of instrument playing do not always persist over the longer term following participation, unless participants have trained or practiced over an extended period of their lives. This might explain why lifelong engagement with music, particularly playing an instrument, is correlated with improved memory among older adults ─ and why some older musicians, like Herbie Hancock at a solid 76, still perform with as much gusto now as they did in their prime. Despite a smaller sample size, another randomized controlled trial of 35 adults aged 60 and over suggested health benefits of dance for older adults. Those who took weekly dance classes over a six-month period showed improved cognition and attention, posture and balance, and hand/motor skills like steadiness and aim in comparison to the control group.

Other research points to the role of the arts in improving overall quality of life for older adults more generally, such as attitudes toward social life. For example, an evaluation of a different, yearlong weekly singing program for adults aged 60 and over revealed marked improvements in emotional wellbeing, especially for those who had been widowed. A mixed-methods study of the effects of painting lessons among older adults in the same age range documented similar improvements in both mental health and social wellbeing. After having participated in these professionally conducted lessons, participants noted increases in social engagement, their sense of belonging, and self awareness and understanding. Likewise, a randomized controlled trial of 50 older adults who participated in 12 visual art sessions over a month showed improvements in self-esteem and anxiety reduction. No wonder your grandmother was always in a good mood after watercoloring class, treating you to ice cream when you picked her up!

Doses of Art to Stay Lucid?

Every 66 seconds, an American develops Alzheimer’s disease. It is the sixth leading cause of death in the United States, and kills more people than breast cancer and prostate cancer combined. As the population ages, millions will be affected: the number of Americans with the disease will double between 2015 and 2050. With soaring diagnoses come soaring costs ─ financial, emotional, and social ─ for patients and their caregivers. Establishment of accessible and cost-effective methods of delaying Alzheimer’s disease and other dementia-related illnesses is crucial.

A 21-year longitudinal study of 469 older adults aged 75 and over published in 2003 found that playing an instrument, reading, and playing board games were strongly associated with lower incidence of dementia. In fact, those who scored in the highest third on the study’s cognitive-activity scale had a 63 percent lower risk of dementia than those in the lowest third. Dancing was the only physical activity to show similar effects.

Arts engagement also seems to benefit older adults who already have dementia, providing improved communication, cognitive function, self-esteem and social participation. TimeSlips, a creative storytelling program for people with dementia, appears to promote engagement, alertness and social interaction among participating adults, as well as improved attitudes among caregivers towards their patients. On the other hand, a 2013 report from the National Endowment for the Arts cites a review of 24 studies that presents a more mixed picture of the evidence, with music interventions leading to both positive and negative outcomes for individuals in severe stages of dementia-related illness. It’s also important to note that methodological challenges abound in this area of research, including confounding external factors related to social context, interrelated variables, and inconsistent outcome measures, all of which makes drawing firm conclusions difficult.

In fact, a separate literature review by Tony Noice et al. notes similar shortcomings in a broader set of research on participatory arts for older adults. As a general rule, research on the benefits of the arts lags behind the level of rigor frequently encountered in the broader universe of scientific research. So while the evidence described above is quite strong by arts research standards, it nevertheless has limitations. Other opportunities for improvement, according to Noice et al., include introducing more standardized assessment of interventions across art forms and measuring effects over a longer period of time. Though the work to date has been promising, until studies on the effectiveness of arts interventions for older adults more consistently meet rigorous standards, their ability to shape perception of the value of such programs will remain limited.

Music has powers — photo by Flickr user Jinx McCombs

As mentioned earlier, we discovered this wealth of literature on arts and aging as part of a larger inquiry into the benefits of the arts in general. That inquiry, in turn, extends a longer-term initiative on Createquity’s part to reconcile the benefits of arts and culture with broader theories of wellbeing (or quality of life), such as the capability approach. Our next article will explore some of the other areas of benefit that have been claimed for arts participation, along with an assessment of the evidence backing up those claims.

In the meantime, rest assured knowing the older people in your life who participate in the arts are not just pursuing a silly pastime. For some, it might just be the key to a worry-free life or a still-taut mind ─ all the more reason to encourage them to channel their inner Aretha, Baryshnikov, or Picasso.