Chapter 1


By Bruce DARLING, Head Investigator

   Kyushu University of Health and Welfare


This research project on the Quality of Life in Elderly Facilities and the Role of the Arts investigates the role of the arts in our aging societies to see how the arts can be used to improve the quality of life for our elderly. Note that our use of the term art should be taken in its broadest sensenot only objects in museums but extending to beautiful and useful objects we use everyday.  Perhaps this sounds familiar.  In “The Aims of Art” (1886) William Morris explained his views of the nature and role of art in society:

“I must ask you to extend the word art beyond those matters which are consciously works of art, to take in not only painting and sculpture and architecture, but the shapes and colours of all household goods, nay, even the arrangement of the fields for tillage and pasture, the management of towns and of our highways….in a word, to extend it to the aspect of all the externals of our life.”[1] 


We began by making several overseas visits to various types of organizations that are promoting the arts among the elderly, as well as to numerous different living situations for the elderly where the arts are playing an important role. While most of our visits and interviews has been in the United States, others have been in several countries in Europe and in Australia; in Japan as well we visited various people, places, organizations. We wanted to investigate specifically how the arts were being integrated in programs for the elderly. Who was planning these programs? What kind of programs were there? Were they proving to be beneficial and if so was this being recognized by administrators and funding sources?


 In our interviews, those directly involved in this advocacy of the arts expressed again and again their certainty that the arts can make a most effective and beneficial contribution for enhancing the QOL of the elderly. They have seen for themselves the healthful role the arts can play. Indeed, the introduction of the arts in the health and care sectors has become a growing worldwide movement. While we found that many people working with the elderly are aware of this, many care workers as well as the general populace know little about it. This lack of awareness is found world-wide, including in Japan.  Certainly, then, the possibilities for an ever increasing role of the arts among the elderly exists.  


The chapters that follow are an attempt to place the problem in context, to show the wide ranging scope of what is being done, to suggest possibilities from successful projects for trial in Japan, and to point out how the validity of art programs for the elderly is being documented. One objective of this research is to disseminate knowledge about the role of arts, to lend a hand of support to those already hard at work at this endeavor, and at the same time to encourage others to participate in this important effort. The broad range of discussions that follow reflect our holistic approach to the introduction of the arts into health and care.


We should also note that what began as an objective study about QOL, the elderly and the arts has become much more. For me, like so many others I have met on the project, improving the quality of life of our older people through the arts has become a mission that has only begun with this ongoing project.  I initially began the project because the arts had always been an important part of my own life and so naturally thought they could also be beneficial to the lives of the elderly. I did not realize just how important they could be. I learned a great deal pursuing this subject, but I feel as though I have only just begun.


One of the first things I realized upon getting into this research project was that restricting its scope to what we commonly consider elderly facilities as such was much too narrow. In fact, this was all but impossible.  Health and welfare facilities do not exist in a vacuum. They are very much a part of their time, place, culture.  Thus, we must give consideration to the physical, natural and social settings a particular facility is a part of. We might term this kind of consideration as an “ecological approach to health and care environments.” This terminology was suggested to me by the title of William M. Mace’s discussion of James Gibson’s ecological approach to visual perception, “James J. Gibson’s Strategy for Perceiving: Ask Not What’s Inside Your Head, but What Your Head’s Inside of.” [2] 


Second, in order to contribute beneficially to the lives of our elderly we must understand who the elderly really are; the true image of aging must be widely conveyed to society as a whole.  We must get rid of defining terms like bed-ridden, burdensome, parasite, non-contributor, sickly, useless, costly, handicapped--these are some of the negative hackneyed expressions used to define our older citizens.  Today’s older generation is more healthy, wealthy and better educated than earlier generations. And these older people are demanding more for their autumnal years. They have untold experience, knowledge and, yes, wisdom that they want to share with the younger generations. They want to remain engaged. They want to be useful. Many want to continue working in some capacity, many want to return to school to learn new things, many want to travel. They all want rich full lives for as long as possible. In sum, today’s older generation is concerned with quality of life. Among other things, this means paying attention to one’s psychological well-being as well as physical health, and hence of striving to maintain both. Emphasis must be placed not on decrepitude but wellness.


Third, the effort to introduce the arts and humanities into health and care is today a growing energetic world-wide movement with a tremendous range of activities.  For example, in the Nordic countries, England, United States and notably Japan organizations promoting the arts in healthcare and among the elderly have been established in just the last few years.  The broad scope of the innovative programs being implemented reflects the wide variety that is the art world and the creativity of those promoting these programs—painting, sculpture. ceramics, book making, poetry and stories, quilting, origami, flower arranging, gardening, music, dance, theatre.  Designers and architects are concerned with creating environments that support the life-giving impetus of these programs.  Also, the people involved in this new field are from all backgrounds –some with professional training in the fields of health and care, others from completely different backgrounds –dance, academic, architecture, business-- but all also with personal experiences.[3]


Fourth, the movement is growing but more rapid diffusion is inhibited by various barriers -- most generally, lack of education in the arts; more specifically, lack of appreciation and lack of knowledge about the possibilities of art.  Health and care workers often display a limited awareness of successful programs; government officials and funding committees likewise demonstrate a lack of appreciation and lack of knowledge about the possibilities of art. Moreover, nearly all those involved in this movement speak of the need for solid scientifically-based quantitative and especially  qualitative research supporting the health and economic benefits of such programs.  Indeed, with respect to qualitative research in the healthcare field a reevaluation of narrative is being undertaken.  People overseeing the financial purse strings must acknowledge the validity of such qualitative approaches.


          Fifth, the Japanese health and welfare net (a reflection of the humanitarianism of the society) lies somewhere between those of Europe and the United States. For me this suggests that even if Japan can not match the government funding (drawn from high taxes) for the art programs being implemented in the welfare states of northern Europe nor copy the some of innovative approaches to the arts and elderly being tried out in expensive retirement communities in the United States, Japan can certainly pay attention to the possibilities these art programs offer and implement aspects that are appropriate to the Japanese situation. Indeed, here in Japan many dedicated people are already working toward this end—but knowledge and recognition of these innovative programs and their beneficial outcomes remains limited. Local government officials and healthcare workers must become more knowledgeable about the possibilities of such art programs. They must keep up to date on the latest research supporting the benefits of such programs.  If so, public resources will begin to be allocated with more enthusiasm. The public must demand this.


Members of the research team have also contributed specific studies into several important aspects regarding the role of the arts in increasing the quality of life of the elderly.  Takesuke Muteki 無敵剛介discusses the importance of narrative in oriental medical practice.  He throws light on an issue that demands further discussion.  Acknowledgement of the validity of narrative analysis with regard medicine and the social sciences seems to me to be to be crucial to the broader acceptance of the role of the arts in health and care.  Indeed, it would seem to lie at the center of patient-centered care.


In her European survey, Masuyo Tokita 常田益代introduces elder facilities in Germany, Sweden and Holland where the arts are playing an important role. In these European nations, we find increasing attention is being paid to the beneficial role that art and culture play in health and care.  The citizens of these nations appear to expect the quality of life that is associated with such interventions. We should note that in Europe, what I have been calling “art” is often termed “culture.”


Based on his survey in the United States, Steven Snyder considers the issue of the relative non-use of art therapies in rural regions as compared with its wider use in metropolitan areas. He calls for increasing utilization of the arts in the care for the elderly.


           Midori Yasukawa 安川緑 discusses the role of gardens and the use of horticultural therapy in social welfare facilities based on her surveys in Australia and the United States. Today we see an increasing appreciation for the role nature plays in health and healing.


The appendices introduce to two remarkable approaches to elder health and care, the Humanitas Foundation based in Holland and Eden Alternative based in United States.  Hans Becker, CEO of Humanitas, gave permission to include his introduction to Humanitas philosophy and the exemplary “apartments for life.” Yukiko Hattori provides a Japanese translation. Emi Kiyota contributes two discussions, one in English and the other in Japanese, about William Thomas and Judy Meyers-Thomas’s  Eden Alternative approach to elderly “human habitats” with their children, pets, and plants. Though these two organizations in some respects take diametrically opposed approaches, the elderly resident-centered philosophies that lie at the core of both have elements that may well contribute to improving the quality of life of the elderly in Japan.


Finally, I would like to express my appreciation to the many people active in the field who have contributed to this project by sharing their knowledge and experiences with us. Many, but not all, of their names appear in the following discussions. Indeed, their dedication and enthusiasm, their sense of mission, provide for me the strongest validation for the importance of the arts in healthcare movement. Thank you all.


[1] Quoted from Norah C. Gillow, “William Morris: Art, Work and Socialism;” in William Morris (An Exhibition catalog for an exhibition held at the Isetan Museum of Art, Tokyo from 1-28 March 1989 and Daimaru Museum, Osaka Umeda from 19 April –1 May 1989), p. 26. Here is the Japanese translation:


(William Morris, in “The Aims of Art” (1886)Ibid.,  p. 20.

[2] William M. Mace, “James J. Gibson’s Strategy for Perceiving: Ask Not What’s Inside Your Head, but What Your Head’s Inside of.” In Perceiving, Acting, and Knowing: Toward an Ecological Psychology, Robert Shaw & John Bransford, editors. pp. 43-65.  Hilldale, New Jersey: Lawrence Erlbaum Associates, Publishers, 1977.

[3] See also the following two reports in Japanese :

ダーリング・ブルース, 高齢者福祉施設の「生活の質」と芸術」『九州保健福祉大学 大学研究紀要』 No。1  2000年 3月。 1116頁。