HEALTH BENEFITS OF OLDER ADULTS PARTICIPATION IN CREATIVE AND PERFORMING ARTS PROGRAMS

Transcription

1 HEALTH BENEFITS OF OLDER ADULTS PARTICIPATION IN CREATIVE AND PERFORMING ARTS PROGRAMS Linda S. Noelker, MA, PhD Benjamin Rose Institute on Aging Cleveland, Ohio Presented at the Geriatric Nursing Conference, Embassy Suites, Independence, OH, June 1,

2 Presentation Objectives To explain changes in the aging brain thought to enhance creative activities in later life To review scientific research evidence regarding the range of health benefits for older adults from participation in arts programs To further understanding of ways to improve and expand the evidential base for health benefits of arts participation To review local resources for bringing arts programs to older adults. 2

3 Arts, Health and Healing Connection across cultures and time Non-pharmacological and non-medical intervention for health and healing Brings together health researchers and practitioners with the arts community Requires an evidence base to qualify for inclusion in AoA s toolkit of best practices 3

4 Contributions of Dr. Gene D. Cohen References: Cohen, G. D. (2000). The creative age: Awakening human potential in the second half of life. New York: Avon. Cohen, G. D. (2006). Research on creativity and aging: The positive impact of the arts on health and illness. Generations, 30(1), Cohen, G. D., Perlstein, S, Chapline, J., Kelly, J., Firth, K. M., & Simmens, S. (2006). Impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults. The Gerontologist, 46,

5 Dr. Cohen s Thesis Aging brain (10% loss) vs. reserve capacity Neuroscience: brain plasticity (use it or lose it) Decreased left/right sidedness with age Creativity enhancement: more integrated brain functioning 5

6 Arnold Toynbee (77) Historian Every stage of life has its own ordeals and rewards. My reward for having reached my present age is that this has given me time to carry out more than the whole of my original agenda; and an historian s work is of the kind in which time is a necessary condition for achievement. 6

7 Methods for the Review Systematic literature review in 2009 using Wolter Kluwer Health (Ageline), Sociological Abstracts and Academic Search Complete All study designs were included and only English language articles were reviewed Keywords used: creative*, health promotion, arts, program*, aging, perform*, and health *denotes the derivatives and variations of the word 7

8 Methods (continued) Inclusion criteria for articles 1. Creative activities that either exclusively targeted or included older adults 2. Activity was not a therapy or arts & crafts 3. Participatory activity, not observant 4. Documentation of at least one healthrelated benefit 8

9 Meta-Analysis Results 2,205 articles identified using search terms (publication dates 1978 through 2009) 42 were retained for review 11 met inclusion criteria and were retained (references included) No existing meta-analysis or review articles found on health benefits of professionally-led participatory arts programs for older adults 9

10 Gene Cohen s Leadership and Research Philosophic change from aging as decline and decrement to aging as potential and accomplishment 2001 Creativity and Aging Study: Multi-site longitudinal study of health benefits of professionally-led, community-based cultural programs for those 65+ Theoretically grounded (mastery and social engagement theory) Performing Arts Program: Physical, social and creative components 10

11 Cohen et al. Evaluation Research Outcome Measures Health Ratings Overall health rating; physical and emotional health problems Morale, depression and loneliness Health Behaviors Number of doctor visits Number of over-the-counter medications Number of falls Number of activities; number of weekly activities 11

12 Cohen et al., 2006 Impact of 30-week participation in a professionally-led chorale group on overall health & mental health of older adults in intervention (n=77) and comparison groups (n=64) Mostly female and Caucasian subjects Pre-test and post-test after 12 months Findings showed intervention subjects reported better overall health; used fewer over-the-counter medications; had fewer falls, fewer physician visits, higher morale and decreased loneliness scores 12

13 Cohen et al., month follow up of participants in the chorale and comparison groups (three data points) Findings showed intervention subjects had a smaller increase in use of over-thecounter and prescription drugs and reported fewer health problems 13

14 Davis, one-hour creative drama classes over 6 weeks 13 women/2 men age 67-84; all Caucasian Qualitative analysis of weekly selfreports pre- and post-participation Decrease in anxiety and one measure of hostility 14

15 Bohlmeijer et al., 2005 Reminiscence and creative expression hours for 12 sessions to reduce depression Pre- and post-test design 79 participants; mean age of 66; mostly female Significant improvement in depression and mastery 15

16 Kinney & Rentz, 2005 Comparative effectiveness of art program (Memories in the Making) compared to structured activity (e.g., word game, crafts) on emotional well-being indicators 12 older adults with dementia at two day centers 7 female/5 male; age 65-85; 5 African American and 7 Caucasian Those in the art program had higher levels of well-being on five indicators 16

17 Bugos et al., 2007 Effects of Individualized Piano Instruction (IPI) over 6 months on cognitive functioning Random assignment to IPI (16 persons) and control group (15 persons); no baseline differences; used pre- and post-tests Findings showed IPI subjects had better performance on two cognitive tests (perceptual speed and memory) 17

18 Alpert et al., 2009 Impact of jazz dance instruction on balance, cognition and mood Convenience sample of 13 women age 52-88, 12 Caucasian Self report with repeated measures design preand post-intervention for 15 weeks Findings showed improvement in balance 18

19 Noice et al., 1999 Intervention: four weeks of acting classes to assess impact on cognitive skills using pre- and post-tests 13 participants age 65-82, all healthy and well-educated Improved test scores indicate acting lessons can improve immediate and delayed recall in healthy older adults 19

20 Noice et al., 2004 Study of theatrical training on cognition and mental health using 124 subjects from a senior center in acting, visual arts, and no treatment groups Age and 96% Caucasian Acting group subjects had higher scores on recall and problem-solving and the psychological well-being measure than those in the two comparison groups 20

21 Noice et al., 2006 Tested the theatrical training for four weeks, twice a week 18 adults in a CCRC with mobility and memory impairments Findings from two pre-tests and one posttest showed improvement in word recall and problem-solving skills 21

22 Noice et al., 2009 Comparative analysis of cognitive outcomes for 122 older adults randomly assigned to theatrical training group, singing group and no-treatment group Age 68-93; mean level of education years Eight sessions, twice a week for 4 weeks Findings show those in the acting group had improvements in 4 out of 5 cognitive measures compared to those in the other two groups Both intervention groups reported higher personal growth compared to the no-treatment group 22

23 Limitations of the Studies RCTs uncommon Small, homogeneous samples Convenience sampling Short duration of the intervention Limited attention to longer term effects (sustained impact) Limited description of intervention s design (content, delivery, instructor, intensity, amount and duration of the intervention) 23

24 Conclusions Limited number of studies that met inclusion criteria Findings suggest that participatory creative and performing arts programs have a range of physical and mental health benefits for older adults 24

25 Update: New Literature Review by Keogh et al. Physical Benefits of Dancing Physical benefits of dance for healthy older adults (over 60) Study category levels: 1) RCT with over 100 participants 2) RCT with less than 100 participants 3) non-randomized comparisons 4) non-randomized with non-dancers 5) case studies/no control 18 studies identified; no level 1 studies found; 9 were level 2 25

26 Results: Keogh et al. Dancing can significantly improve muscle endurance, aerobic power, and lower body flexibility Significant improvements also relate to fall prevention: improvements in static and dynamic balance, gait performance, gait speed, and agility 26

27 Update: Literature Review by Stuckey & Nobel Art, Healing and Public Health Only over the past decade have health researchers examined how arts can: Heal emotional injuries Increase understanding of self and others Enhance self-reflection Reduce symptoms Alter behaviors and thinking patterns 27

28 Primary Art Therapy Areas Music engagement Visual arts Dance and movement (including drama) Expressive writing and poetry 28

29 Music Therapy Decrease anxiety Restore emotional balance Control over pain Reduce heart and respiratory rates Reduce serum cortisol level (coronary disease and cancer patients) 29

30 Visual Art Therapy Improved psychological well-being; decreased negative emotions and increased positive emotions Reduced depression, anxiety and stress Improved medical outcomes and healing (chronic illness, cancer, hemodialysis, and trauma patients) 30

31 Dance and Movement Therapy Improved gait, balance, ambulation Improved cognitive functioning (recall, problem solving) Improved shoulder range of motion & body image Improved self-awareness (elderly and breast cancer patients) 31

32 Expressive Writing Therapy Improvement in CD4+ lymphocyte counts Improved control over pain and depressed mood Better psychological well-being and less fatigue (HIV, chronic illness, and fibromyalgia patients) 32

33 Future Investigations Use meaningful control groups Specify intervention and outcomes precisely and standardize for cross-study comparisons Larger, more diverse samples Longer term follow-up Conduct in community settings Partner with the arts community 33

34 National Center for Creative Aging Integrate the humanities and arts into all curricular activities to ensure person-centered care Develop an interactive curriculum that builds on narrative medicine and importance of story Develop clinical experiences for the program Oversee faculty development in the humanities and arts 34

35 Resources American Society on Aging webinars on creative aging programs Museum of Modern Art (NYC) Program in Arts and Dementia for those with Alzheimer s and their Caregivers Science of Creativity and Cognitive Enhancement: learn how to keep the aging brain fit through creative engagement 35

36 Seeks to ensure quality of life for older adults across the cognitive spectrum and to transform the health and well-being of society Helps families and artists to bring music to older relatives through song composition and performance Elders and caregivers perform their songs: 36

37 Resources Timeslips Storytelling Project (training manual, DVD and story kit) for those with memory loss Elders Share the Arts: A Guide to the Living History Theater Program (integrates personal reminiscence, oral history, and art making; uses visual arts, theater arts, writing, and storytelling) 37

38 Resources Stagebridge Senior Theater: Oldest senior theater in the U.S. brings performance arts training (theater, storytelling, and music) to older adults who perform for younger generations 38

39 Some Local Resources Photocoloring (Carolina Martin, Art on Wheels) Journaling for Health (Sarah G. Sieradzki, OT, UH) Creative Card Making (Deena Baenen, MS, LSW, COTA) Drumming (Adam Kukuk, drumming) Magic of Memories (Kim Synder, Western Reserve Historical Society) 39

40 Some Local Resources Art Therapy Studio Karen Peterson Philosophy: Art making is central to healing and wellness Mission statement: Enhancing the quality of life for children and adults affected by spinal cord injury, brain trauma, stroke and multiple sclerosis through the therapeutic use of art Currently working at the VA with spinal cord injury, psych., and hospice patients at bedside, one-on-one and in small groups 40

41 Thank you! Questions or comments 41

42 References Alpert, P. T., Miller, S. K., Wallmann, H., Havey, R., Cross, C., Chevalia, T., et al. (2009). The effect of modified jazz dance on balance, cognition, and mood in older adults. Journal of the American Academy of Nurse Practitioners, 21, 2, Bohlmeijer, E., Valenkamp, M., Wsterhof, G., Smit, F., & Cuijpers, P. (2005). Creative reminiscence as an early intervention for depression: Results of a pilot project. Aging and Mental Health, 9, 4, Bugos, J. A., Perlstein, W. M., McCrae, C. S., Brophy, T. S. & Bedenbaugh, P. H. (2007). Individualized piano instruction enhances executive functioning and working memory in older adults. Aging and Mental Health, 11, 4, Castora-Binkley, M., Noelker, L., Prohaska, T., & Satariano, W. (2010). Impact of arts participation on health outcomes for older adults. Journal of Aging, Humanities and the Arts, 4, Cohen, G. D., Perlstein, S., Chapline, J., Kelly, J., Firth, K. M., & Simmens, S. (2006). The impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults. The Gerontologist, 46, 6,

43 References Cohen, G. D., Perlstein, S, Chapline, J., Kelly, J., Firth, K. M., Simmens, S. (2007). Impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults--2-year results. Journal of Aging, Humanities and the Arts, 1, 1-2, Davis, B. W. (1985). Impact of creative drama training on psychological states of older adults: An exploratory study. The Gerontologist, 25, 3, Kinney, J. M. & Rentz, C. A. (2005). Observed well-being among individuals with dementia: Memories in the Making, an art program, versus other structured activity. American Journal of Alzheimer's Disease and Other Dementias, 20, 4,

44 References Noice, H., & Noice, T. (2006). A theatrical intervention to improve cognition in intact residents of long term care facilities. Clinical Gerontologist, 29(3), Noice, H. & Noice, T. (2009). An arts intervention for older adults living in subsidized retirement homes. Neuropsychology, Development, and Cognition. Section B, Aging, Neuropsychology and Cognition, 16(1), Noice, H., Noice, T., Perrig-Chiello, P., & Perrig, W. (1999). Improving memory in older adults by instructing them in professional actors' learning strategies. Applied Cognitive Psychology, 13(4), Noice, H., Noice, T., & Staines, G. (2004). A short-term intervention to enhance cognitive and affective functioning in older adults. Journal of Aging and Health, 16(4),

45 References Newer Literature Reviews Koegh, J. W., Kilding, A., Pidgeon, P., Ashley, L. & Gillis, D. (2009). Physical benefits of dancing for healthy older adults: A review. Journal of Aging and Physical Activity, 17, Stuckey, H. L., & Nobel, J. (2010). The connection between art, healing and public health: A review of current literature. American Journal of Public Health, 100(2),